Acute respiratory infections (ARI) are the leading causes of neonatal and child mortality. Despite several national efforts to reduce the incidence of mortality among children, India is one of the largest contributors to under-five mortality in the world. In this study, we examined the effects of indoor pollution on ARI among under-five children in India. A cross-sectional study was carried using nationally representative data from the 2015–2016 National Family Health Survey (NFHS-4). This study is based on 247,743 living children under the age of five years. Bivariate and multivariate analyses were performed to assess the impact of indoor air pollution on children's ARI. Almost two-thirds of households (65.2%) used biomass fuels for cooking, 54.9% of households had a separate kitchen, and 47.2% of households had a smoker. About 2.7% of children suffered from ARI in the past two weeks preceding the survey. The use of biomass fuels (OR [odds ratio]: 1.10, 95% CI: 1.01–1.20), households having no separate kitchen (OR: 1.22, 95% CI: 1.14–1.30), and smoking behavior of household members (OR: 1.06, 95% CI: 1.00–1.12) were associated with greater risk of ARI among under-five children even after adjusting for age of child, sex of child, birth order, maternal age, maternal education, caste, religion, wealth quintile, any HH members suffer from tuberculosis (TB), and household crowding. Furthermore, the results revealed that the combined effects of biomass fuels and households without separate kitchen increased the likelihood of children's ARI by 36% (Adjusted OR: 1.35, 95% CI: 1.21–1.51). The findings of this study suggest policy interventions to reduce the exposure of indoor air pollution, particularly among the impoverished groups. The government should ensure cleaner fuels for cooking, such as LPG and electricity, to minimize the risk of respiratory diseases among children.

Background: Globally, diarrhoea is the second leading cause of death in children under five and a major public health problem. Despite several health care initiatives taken by the government, a large proportion of children still experience diarrhoeal diseases which cause high childhood death in India. This study aims to examine the socio-demographic and environmental factors associated with diarrhoea in children under five in India. Methods: A cross-sectional study was designed using secondary data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015–16. A total of 247,743 living children below 5 years of age were included in the analysis. Bivariate and multivariate logistic regression models were carried out to assess the factors associated with childhood diarrhoeal disease. Results: In India, about 9% of under-five children experience diarrhoeal disease in the past 2 weeks preceding the survey. Children living in rural areas (Adjusted odds ratio [aOR]: 1.05; 95% CI: 1.01, 1.09), children belonged to scheduled tribe (aOR: 0.83; 95% CI: 0.79, 0.89) and other castes (aOR: 0.92; 95% CI: 0.88, 0.97), Muslim children (aOR: 1.18; 95% CI: 1.13, 1.24), and children resided in the central (aOR: 1.61; 95% CI: 1.52, 1.70) and west (aOR: 1.08; 95% CI: 1.01, 1.15) regions were significantly associated with higher likelihood of diarrhoea in the past 2 weeks. Concerning environmental factors, child stool disposal (aOR: 1.06; 95% CI: 0.98, 1.09), floor materials (aOR: 1.08; 95% CI: 1.03, 1.12) and roof materials (aOR: 1.08; 95% CI: 1.04, 1.13) of the household were found to be significant predictors of childhood diarrhoea occurrence. Conclusions: Diarrhoeal disease is common among children who lived in rural areas, scheduled castes, Muslims, and children from poor families. Regarding environmental factors, stool disposal practices in the household, dirt floor, and thatch roof materials of the household unit are risk factors for diarrhoeal disease. Targeted approach should be initiated to mitigate the problem of the poor health status of children by providing adequate health care. The policy-makers and stakeholders should address adverse environmental conditions by the provision of latrine and improved housing facilities.