BACKGROUND: The prevalence of acute respiratory infection (ARI) among children under five years of age varies across geographic regions, yet previous studies have not sufficiently addressed this variation in Ethiopia. Therefore, this study aimed to examine the geographic variation of ARI in Ethiopia using spatial analysis.

METHODS: A total of 10,417 children under five years were included in this study. Data analysis was conducted using STATA-17, ArcGIS 10.8, and SaTScan 9.6. Variables with a p-value <0.25 in the bi-variable analysis were included in the final model, and p-values <0.05 were considered statistically significant. Ordinary least squares (OLS) and geographically weighted regression (GWR) were employed to explore the spatial relationships between the outcome and determinant variables. The model with the lowest corrected Akaike Information Criterion (AICc) value was considered the best-fit model.

RESULTS: The prevalence of ARI among children under five in Ethiopia was 12.29% (95% CI = 11.68–12.94%). Most hotspot areas were located in Tigray, central Oromia, eastern SNNPR, and southern Amhara. In spatial analysis, significant predictors of hotspot areas included a higher proportion of rural women, children with diarrhea, Muslims, women with no education, low media exposure, and the poorest households. In the multilevel analysis, secondary maternal education, child age 48–59 months, recent diarrhea, and residence in Afar, Amhara, Benishangul, and SNNP were significantly associated with ARI.

CONCLUSION: There is notable spatial variation in the prevalence of ARI in Ethiopia. Factors such as child age, recent diarrhea, maternal education, and region were significantly associated with this spatial variation. The government of Ethiopia should re-evaluate current ARI prevention strategies and implement geographically targeted interventions to reduce the burden of ARI.

KEYWORDS: Geographically weighted regression, acute respiratory infection, multilevel analysis, EDHS, Ethiopia