Acute respiratory infection and associated factors among young children presenting to hospital in Sierra Leone

Objectives Acute respiratory infections (ARIs) are a leading cause of infant morbidity and mortality worldwide, with a substantial burden in Sierra Leone. Although maternal, infant, and environmental factors influence ARI susceptibility, their role in disease severity remains unclear. Methods We conducted prospective surveillance of children aged <24 months admitted to Kenema Government Hospital from October 2020 to October 2021. Eligible children were enrolled within 48 hours of admission and had at least one acute respiratory symptom. Nose and throat swabs were collected and tested using multiplex reverse-transcription PCR. Statistical analyses were performed in R. Results Among 502 enrolled children, 376 (74.9%) had ≥1 viral pathogen detected by PCR. Younger age was associated with viral detection (P = .009). Global chronic malnutrition was less common among virus-positive than virus-negative children (36.5% vs 48.0%, P =.030). Infants aged 0–6 months and those breastfed for shorter durations experienced more severe disease. Each additional month of breastfeeding reduced the odds of a higher ARI severity score by 6% (OR 0.94, P = .004). Conclusion Viral ARIs are a major health challenge among young children in Sierra Leone. Breastfeeding duration and nutritional status were important modifiable risk factors associated with disease severity, highlighting opportunities for interventions.