Climate Variability and Acute Respiratory Infections in Children: A Retrospective Study from Eastern Democratic Republic of CongoAcute respiratory infections (ARIs) constitute 15-20% of under-five mortality in sub-Saharan Africa, with climate change amplifying transmission in tropical regions. Bukavu, Eastern DRC, faces unique vulnerabilities due to Lake Kivu's microclimate, deforestation, and El Niño-Southern Oscillation (ENSO) effects. This study investigates climate-ARIs associations using local hospital data from 2018-2023.We conducted a retrospective analysis of 1,250 pediatric records (ages 0-59 months) from Université Catholique de Bukavu teaching hospital. Monthly ARI cases (upper/lower respiratory infections, pneumonia) were correlated with meteorological data from Bukavu weather station: temperature (°C), rainfall (mm), relative humidity (%), and wind speed (km/h). ENSO indices were integrated from NOAA datasets. Poisson regression models calculated incidence rate ratios (IRRs) with 95% confidence intervals, adjusting for age, sex, nutritional status, vaccination coverage, and urban/rural residence.Results demonstrated significant climate-ARIs linkages. High-rainfall months (>200mm) increased ARI incidence by 28% (IRR 1.28, 95% CI 1.12-1.46, p<0.01). Humidity >80% correlated with 35% higher severe pneumonia rates (IRR 1.35, 95% CI 1.18-1.54, p<0.001), particularly in children <24 months. Temperature fluctuations >5°C/month amplified risks in urban slums (IRR 1.42, 95% CI 1.21-1.67). ENSO warm phases (El Niño) showed 22% elevated ARIs (IRR 1.22, 95% CI 1.08-1.38).These findings align with global patterns while highlighting Lake Kivu's humidity-rainfall amplification. Limitations include retrospective design and absence of air quality metrics (PM2.5, NO2).Public health implications demand integrated strategies: 1) Climate-informed surveillance systems; 2) Community early warning via SMS/mobile apps; 3) Climate-resilient health infrastructure; 4) Vaccination campaigns timed to rainy seasons. Policy recommendations target DRC Ministry of Health for tropical climate-health integration.This research establishes baseline evidence for climate-sensitive respiratory disease management in Central Africa, informing adaptation strategies amid accelerating climate change.