Background: Acute respiratory infections (ARIs) generally describe a group of infections caused by a range of organisms whose site of action includes the nostrils, through the pharynx to the alveoli. ARIs are reportedly key contributing factors to childhood morbidities and deaths, with a higher impact on children less than the age of five years. This paper aimed at exploring the prevalence of ARIs and their contextual determinants among children less than 60 months of age in the rural settings of the Gambia. Method: The Gambia Demographic and Health Survey (GDHS) in 2019-20 was used for this study. Data were obtained from 1364 rural women aged 15-49 with children less than 60 months through a stratified two-stage cluster sampling approach. Percentages and chi-square tests were used and variables with p-value <0.15 were included in the model. A multivariable logistic regression model was used to assess the predictors of acute respiratory infection at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs). All the study data were analyzed using Stata version 17. Results: The weighted prevalence of ARIs among children under 60 months of age in the rural Gambia was 37.1% with 95% CI (34.5% -39.6%). The magnitude of ARI was higher among children 25-60 months age group (38.6%), male children (38.9%) unvaccinated children (42.9%), and those whose fathers and mothers were not working at 60.5% and 38.7%, respectively. In the adjusted model, children whose mother had primary education [aOR=0.65, 95% CI= 0.46-0.91], currently non-breastfed children [aOR=1.40, 95% CI= 1.09-1.79] and those whose father were not working [aOR=2.65, 95% CI= 1.47-4.17] were found to be associated with ARIs among children less than 60 months in The Gambia. Conclusion: The prevalence of ARI was moderately high across children under 5 years of age in rural Gambia, low mother's educational levels, and unemployed fathers. The program must consider improvements in the quality of care provided to children in both primary, secondary and tertiary healthcare levels in rural settings. Partner support and adapting community-based supporting systems on child health strategies should be strengthened especially in rural settings.

Schistosomiasis is endemic in both the central and upper river region of The Gambia. Two mass drug administrations of praziquantel did not stop the transmission of these infections. Most of the World Health Organization recommended approach to controlling schistosomiasis through Mass Drug Administration has not significantly reduced transmission. The best approach could be multifaceted which will be designed to explore in the context of implementation research approach in addressing this infection at one of the hot spots in the Gambia to enhance the attainment of the schistosomiasis elimination road map of 2030. The target population will be farmers engaged in rice growing in river sites and swampy areas, as well as fishermen. Most of whom are women who do their laundry around farmland water bodies or freshwater river sites. The data collected will be analyzed and interpreted to provide better understanding in the context of knowledge, attitudes and, practices of these nomadic communities regarding the risk factors involved with schistosomiasis transmission, control and prevention. Developed materials and awareness messages on the prevention and control of schistosomiasis will therefore be use for community engagement activities to increase awareness on the disease, improve health seeking behaviors and increase treatment uptake. Thus, this community-led intervention could help to reduce the prevalence of schistosomiasis in Upper and Lower Falladou Districts.