Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990-2013): assessing the neighborhood inequalities

Prevalence and risk factors associated with under-five years children diarrhea in Malawi: Application of survey logistic regression

Background

Diarrhea is a leading cause of illness and mortality among children under five, posing a significant public health challenge in Malawi. The current study assesses the prevalence and risk factors linked to diarrhea among under-five children in Malawi.

Method

The researcher used the Malawi Multiple Indicator Cluster Survey (MICS) 2019-20 as the dataset for this study. Due to the complex sampling design, survey logistic regression was used to accomplish the study objectives. The sample size was 15569 children who were aged under five.

Results

The study found that the prevalence of diarrhea was 24.9%, with a higher percentage observed among children aged 12-23 months (38.5%) compared to other age groups. Additionally, children from the southern region had a higher prevalence of diarrhea at 27% compared to those from the northern region at 19.3%. Children from the poorest households also had a higher prevalence of diarrhea at 28.9% compared to those from the richest households at 22.6%. Furthermore, children with fever had a higher prevalence of diarrhea at 33.3% compared to those who did not have fever at 19.4%.

Conclusion

The current study concluded that the prevalence of diarrhea was higher among children aged 12-23 months. Subsequently, policymakers should apply policies to reduce this high prevalence among this age group of children. In addition, the government needs special consideration in diarrhea control for children from the southern region because of the high prevalence of the disease compared to the other regions in Malawi. My study can help policymakers understand the scope and nature of the problem, which can notify the development of policies and programs intended to decrease the prevalence of risk factors and enhance child health outcomes.

Prevalence and predictors of diarrhea among children under five in Ghana

BACKGROUND

Globally, childhood diarrhea is a major public health concern. Despite numerous interventions that have been put in place to reduce its incidence over the years, childhood diarrhea remains a problem and is the fourth leading cause of child mortality in Ghana. This study examined the predictors of diarrhea among children under the age of five in Ghana.

METHODS

Data from the 2014 Ghana Demographic and Health survey, a cross-sectional survey, was used for the purpose of this study. A total of 2,547 children under the age of five were included in this study. Logistic regression analysis was performed to establish the factors associated with childhood diarrhea and ascertain explanatory variables.

RESULTS

The prevalence of diarrhea was 11.7%. Male children (13.4%) and those living in rural areas (12%), particularly in the Brong Ahafo region (17%) recorded the highest prevalence of diarrhea. Children aged 6 to 35 months of age, maternal age and education, sex of children and region of residence were the predictors of diarrhea among children under the age of five years in this study.

CONCLUSION

To lessen the prevalence of diarrhea among children under five in Ghana, existing interventions must be evaluated in the context of the predictors identified. Based on observations deduced from this study, the Ministry of Health, Ghana Health Service and other health regulatory agencies should intensify monitoring and awareness in the various regions, particularly in the transition and savannah zones on the causes, risk factors, and methods of preventing diarrhea in children under five. Various stakeholders including government and non-governmental organizations should take into account the predictors of diarrhea identified in the design of interventions to effectively reduce morbidity and mortality associated with childhood diarrhea.

The impact of anthropogenic climate change on pediatric viral diseases

The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.

Exploring the Association between Ambient Temperature and Daily Hospital Admissions for Diarrhea in Mopani District, Limpopo Province, South Africa

Diarrhea contributes significantly to global morbidity and mortality. There is evidence that diarrhea prevalence is associated with ambient temperature. This study aimed to determine if there was an association between ambient temperature and diarrhea at a rural site in South Africa. Daily diarrheal hospital admissions (2007 to 2016) at two large district hospitals in Mopani district, Limpopo province were compared to average daily temperature and apparent temperature (Tapp, 'real-feel' temperature that combined temperature, relative humidity, and wind speed). Linear regression and threshold regression, age-stratified to participants ≤5 years and >5 years old, considered changes in daily admissions by unit °C increase in Tapp. Daily ranges in ambient temperature and Tapp were 2-42 °C and -5-34 °C, respectively. For every 1 °C increase in average daily temperature, there was a 6% increase in hospital admissions for diarrhea for individuals of all ages (95% CI: 0.04-0.08; p < 0.001) and a 4% increase in admissions for individuals older than 5 years (95% CI: 0.02-0.05; p < 0.001). A positive linear relationship between average daily Tapp and all daily diarrheal admissions for children ≤5 years old was not statistically significant (95% CI: -0.00-0.03; p = 0.107). Diarrhea is common in children ≤5 years old, however, is more likely triggered by factors other than temperature/Tapp, while it is likely associated with increased temperature in individuals >5 years old. We are limited by lack of data on confounders and effect modifiers, thus, our findings are exploratory. To fully quantify how temperature affects hospital admission counts for diarrhea, future studies should include socio-economic-demographic factors as well as WASH-related data such as personal hygiene practices and access to clean water.

The magnitude of oral rehydration salt utilization in diarrhea hot spot regions of Ethiopia and its associated factors among under-five children: A multilevel analysis based on Bayesian approach

Background

Diarrhea leads the children to severe dehydration or death as a result of the loss of water and electrolytes (namely, potassium, chloride, sodium, and bicarbonate). To compensate for the losses, ORS is given to children who experienced diarrhea.

Objective

To estimate the magnitude of ORS utilization in diarrhea hotspot regions of Ethiopia and to assess its associated factors among under-five children.

Methods

To conduct this study, we used the 2016 Ethiopian demographic and health survey data. A total of 1,079 weighted sample children were selected. Each sample was selected randomly. Then, to identify factors associated with ORS utilization in diarrhea hotspot regions of Ethiopia, a multilevel analysis based on the Bayesian approach was applied. Finally, the credible interval of AOR that does not include 1 was considered statistically significant.

Results

The magnitude of ORS utilization for children in diarrhea hotspot regions of Ethiopia was 28%. Being urban resident (AOR = 1.92; 95% CrI: 1.13-3.3), woman household head (AOR = 2.11; 95% CrI: 1.3-3.9), having higher educational level (AOR = 1.52; 95% CrI: 1.04-2.22), member of health insurance (AOR = 1.73; 95% CrI: 1.14-2.43), and being exposed for media (AOR = 1.43; 95% CrI: 1.18-2.5) increases ORS utilization for diarrhea management.

Conclusion

Residence, educational level, health insurance, and media exposure were the factors of ORS utilization. So, to increase the practice of ORS utilization for diarrhea management in Ethiopia, the Ministry of Health and the Government of Ethiopia should consider those factors when they design diarrhea prevention and control strategies.

Availability of Drinking Water Source and the Prevalence of Diarrhea among Nigerian Households

Diarrhea is highly prevalent in Nigeria and accounts for 16% of deaths among Nigerian children. The WHO classifies water source into two categories: improved and unimproved. This study aimed to examine the association between type of water source and the prevalence of diarrhea among members of a nationally representative sample of Nigerian households while controlling for key sociodemographic and household factors. This study used cross-sectional data from 22,571 households participating in the 2018 Water, Sanitation and Hygiene-National Outcome Routine Mapping survey. Data collectors visited and interviewed household members across all 36 states in the country. Logistic regression was used to assess associations between water source type and the odds of a family member reporting diarrhea, after controlling for financial status, availability of soap/detergent for handwashing, availability of a refrigerator in the home, toilet type, and urban/rural status. After controlling for explanatory variables in the adjusted model, having an unimproved water source was associated with greater odds of diarrhea among a family member (odds ratio, 1.59; 95% CI, 1.44-1.77). Not having a refrigerator and not having soap/detergent for handwashing were also associated with greater odds of diarrhea. In summary, this study found an association between water-source type and diarrhea prevalence among Nigerian households. This study is in line with prior studies in Nigeria and elsewhere, and the results call for greater commitment and action by stakeholders to improve water sources and, ultimately, reduce the prevalence of diarrhea in Nigeria.

Individual and community-level factors associated with under-five diarrhea in Bangladesh: Evidence from Demographic and Health Survey 2014

Background

Diarrheal disease is among the leading causes of morbidity and mortality among children younger than age 5 years in Bangladesh.

Objective

The objective of this study is to assess the prevalence of diarrhea among children younger than age 5 years and its associated risk factors.

Methods

Data were sourced from the Bangladesh Demographic and Health Survey, a nationally representative study conducted in 2014. We used multilevel logistic regression models to identify factors associated with diarrheal disease.

Results

Children aged 6 to11 months (odds ratio = 2.26; 95% CI, 1.50–3.42), and 12 to 23 months (odds ratio = 2.31; 95% CI, 1.62–3.31) were more likely to have diarrhea than older children. Other significant risk factors for diarrheal infection included households without access to drinking water (odds ratio = 1.39; 95% CI, 1.03–1.88) and mothers lacking mass media access (odds ratio = 1.32; 55% CI, 1.01–1.73).

Conclusions

Childhood diarrhea in Bangladesh was associated with individual- and community-level factors. The finding of this study suggests that diarrhea prevention programs in the country can effectively be delivered by targeting young children through expanding community-based education and increasing access to health information through mass media.

Bacterial Removal Efficiency of Moringa stenopetala and Cadaba farinosa From Surface Water: Laboratory-Based Cross-Sectional Study

BACKGROUND

Consumption of polluted surface waters are leading to waterborne diseases, especially in developing countries, which results in the deaths of millions of people annually around the world. Ethiopia, like the rest of developing countries, suffers a lot of water-associated health problems. Chemical disinfectants are in use to disinfect water with some drawbacks like expensiveness, unavailability, and detrimental effect on human health. Researchers are on the search for non-expensive and locally available methods, and natural plants are the ones in the study. Thus, this study is designed to test Escherichia coli (E. coli) removal efficiency of Moringa stenopetala (M. stenopetala) and Cadaba farinosa (C. farinosa) from surface water.

METHODS

A cross-sectional study was conducted from June to July 2021. A 14 L water sample was collected from Lake Hawassa. A 30, 60, and 100 mg weights of the leaf and seed powder dosages of M. stenopetala and C. farinosa at contaminant settling times of 30, 60, and 90 minutes were used. Each 1-L water sample was treated with each of the dosages. E. coli count, temperature, pH and turbidity were measured using standard methods for water and wastewater analysis. Statistical package for social sciences (SPSS) version.23 was used for analysis. Treatment differences between plant parts and association between variables were also tested.

RESULT

The result indicated that raw water samples having 18 initial E. coli colonies per 100 mL of water showed zero E. coli colonies per 100 mL of water after treatment with 30 mg dosage of M. stenopetala seed, 30 mg dosage of C. farinosa seed, and 60 mg dosage of M. stenopetala leaf after 90 minutes of settling time, but C. farinosa leaf was unable to reduce E. coli colonies to 0 per 100 mL of water. M. stenopetala leaf showed the highest turbidity reduction of 83.3% at 60 mg dosage. A pH of 7.30 and 8.50 and a temperature of 20°C to 23.5°C were recorded. There was a significant difference in E. coli removal between C. farinosa seed and leaf. Turbidity was identified as a factor that positively affects E. coli removal during M. stenopetala seed and leaf. Dosage and settling time were also identified as predictors of E. coli removal.

CONCLUSION

M. stenopetala and C. farinosa have antimicrobial properties against E. coli, but only M. stenopetala showed E. coli, turbidity, and pH values within the recommended World Health Organization standards. So, we suggest M. stenopetala as a promising natural disinfectant that needs attention from organizations working on the water.

Sense and Manner of WASH and Their Coalition With Disease and Nutritional Status of Under-five Children in Rural Bangladesh: A Cross-Sectional Study

This study aimed to assess the knowledge and practice of caregivers and their relationship to the disease and nutritional status of children under 5 years of age in rural areas of Sylhet, Bangladesh. A total of 110 households with at least a child aged 6 to 59 months were selected by simple random method from 10 rural communities of three Upazila of Sylhet from September 2019 to February 2020. Descriptive statistics were used to assess the "Water Access, Sanitation, and Hygiene" (WASH) knowledge and practice, and multivariate chi-square analyses were performed to assess associations among diseases and nutritional status with WASH following a structured questionnaire. The study found a significant association between WASH with childhood disease and nutritional status, and 65% of children were found to be in a diseased state and 35% of children were found in a no exposure of disease state within the last 6 months. The findings sketched that mother with poor WASH knowledge and practice was at greater risk for disease outbreaks, disease frequency, and duration. The highest incidence of diarrhea was 17% in children aged 12 to 23 months. A significant effect of WASH was also found in children's nutritional status, which was reflected in the ratio of stunted, underweight, and wasted children. Integrated convergent work focusing on providing clean water within the household, stopping open defecation, promoting handwashing, behavior change, and poverty alleviation is needed to improve the situation. Health, nutrition, and livelihood programs should be uninterrupted, and mothers or caregivers should be encouraged to participate in these programs.

The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia

Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.

The impact of Ethiopian community-based health extension program on diarrheal diseases among under-five children and factors associated with diarrheal diseases in the rural community of Kalu district, Northeast Ethiopia: a cross-sectional study

Background

The health extension program is a community-based health care delivery program with eighteen defined packages. The main aim of the health extension program is to help to reduce child mortality. So, the aim of this study is to assess the impact of a health extension program on diarrheal disease under-five children in the rural community of Kalu district, Northeast Ethiopia, 2021.

Methods

A community-based cross-sectional study design was conducted from March to April/2021. A Multi-stage sampling technique was used to get a total sample size of 556 (182 model households and 374 non-model households) with a response rate of 92.22%. Binary logistic regression analysis was done, and P-value < 0.05 was considered statistically significant. Propensity score matching analysis was used to determine the contribution of health extension program “model households” on diarrhea diseases among under-five children. The average treatment effect on the treated was calculated to compare the means of outcomes across model and non-model households.

Results

Health extension program (HEP) model household contributed a 17.7% (t = -5.02) decrease in children’s diarrheal diseases among under-five children compared with HEP non-model households. Mothers from non-model households were 2.19 times more likely to develop under-five children diarrheal diseases AOR (Adjusted Odds Ratio): 2.19, 95% CI: 1.34–3.57 than mothers from model households. Households who got no frequent home visits were 3.28 times more likely to develop under-five diarrheal diseases AOR (Adjusted Odds Ratio): 3.28, 95% CI: 1.40–7.68.

Conclusion

When the health extension program is implemented fully (model household), the prevalence of under-five diarrheal disease in the rural community could decrease. The need to develop supportive strategies for the sustainability of model households and encouraging households to be model households is very important.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07565-7.

Patterns, Outcomes and Predictors of Pediatric Medical Admissions at Gadarif Hospital in Eastern Sudan

BACKGROUND

The reduction of childhood mortality is a reliable indicator of a national health system's progress and improvement. Sudan's population is still suffering from communicable diseases, with a considerably higher mortality rate among children. Efforts are therefore needed to reduce mortality and achieve the Millennium Development Goals and Sustainable Development Goals. This study was conducted to determine the morbidity, mortality and outcomes of children admitted to Gadarif Hospital in eastern Sudan.

METHOD

A retrospective study was conducted by reviewing the medical files of pediatric patients who were admitted to Gadarif Hospital between March 1, 2019 and March 31, 2020.

RESULT

A total of 740 medical files were reviewed. Most, 453 (61.2%) of the admissions were males. The median (interquartile range) age was 3.0 (8.0) years and 433 (58.8%) of the admissions were under 5 years of age. The median (interquartile range) of the length of hospital stay was 9.0 (12.0) days. Visceral leishmaniasis, malnutrition, severe malaria, sickle cell disease, acute watery diarrhea, severe anemia (regardless of its cause), septicemia and acute respiratory infection were the most common causes of admission. The mortality rate was 5.7%, and it was significantly higher in females than males [24/287 (8.4%) vs. 18/453 (4.0%), P = 0.01] and in children under 5 years [36/433 (8.3%) vs. 6/307 (2.0%), P < 0.001]. Malnutrition, visceral leishmaniasis, septicemia and meningitis/encephalitis were the main diseases causing death in the study population. The case fatality rate was not significantly different in malnutrition than in visceral leishmaniasis [9/93 (9.7%) vs. 7/178 (3.9%), P = 0.05].

CONCLUSION

The main causes of morbidity and mortality for children admitted to Gadarif Pediatric Hospital were communicable diseases. The mortality rate was 5.7%. Females and children under 5 years were the most vulnerable groups for fatality.

Diarrhea and associated factors among under five children in sub-Saharan Africa: Evidence from demographic and health surveys of 34 sub-Saharan countries

Introduction

Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa.

Methods

The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model.

Result

The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts.

Conclusion

This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.

Exploring the socio-economic determinants of educational inequalities in diarrhoea among under-five children in low- and middle-income countries: a Fairlie decomposition analysis

BACKGROUND

What explains the underlying causes of educational inequalities in diarrhoea among under-five children in low- and middle-income countries (LMIC) is poorly exploited, operationalized, studied and understood. This paper aims to assess the magnitude of educational-related inequalities in the development of diarrhoea and decompose risk factors that contribute to these inequalities among under-five children (U5C) in LMIC.

METHODS

Secondary data of 796,150 U5C from 63,378 neighbourhoods in 57 LMIC was pooled from the Demographic and Health Surveys (DHS) conducted between 2010 and 2019. The main determinate variable in this decomposition study was mothers' literacy levels. Descriptive and inferential statistics comprising of bivariable analysis and binary logistic multivariable Fairlie decomposition techniques were employed at p = 0.05.

RESULTS

Of the 57 countries, we found a statistically significant pro-illiterate odds ratio in 6 countries, 14 showed pro-literate inequality while the remaining 37 countries had no statistically significant educational-related inequality. The countries with pro-illiterate inequalities are Burundi (OR = 1.11; 95% CI: 1.01-1.21), Cameroon (OR = 1.84; 95% CI: 1.66-2.05), Egypt (OR = 1.26; 95% CI: 1.12-1.43), Ghana (OR = 1.24; 95% CI: 1.06-1.47), Nigeria (OR = 1.80; 95% CI: 1.68-1.93), and Togo (OR = 1.21; 95% CI: 1.06-1.38). Although there are variations in factors that contribute to pro-illiterate inequality across the 6 countries, the overall largest contributors to the inequality are household wealth status, maternal age, neighbourhood SES, birth order, toilet type, birth interval and place of residence. The widest pro-illiterate risk difference (RD) was in Cameroon (118.44/1000) while the pro-literate risk difference was widest in Albania (- 61.90/1000).

CONCLUSIONS

The study identified educational inequalities in the prevalence of diarrhoea in children with wide variations in magnitude and contributions of the risk factors to pro-illiterate inequalities. This suggests that diarrhoea prevention strategies is a must in the pro-illiterate inequality countries and should be extended to educated mothers as well, especially in the pro-educated countries. There is a need for further studies to examine the contributions of structural and compositional factors associated with pro-educated inequalities in the prevalence of diarrhoea among U5C in LMIC.

Prevalence and Determinants of Diarrheal Diseases among Under-Five Children in Horo Guduru Wollega Zone, Oromia Region, Western Ethiopia: A Community-Based Cross-Sectional Study

Background

Diarrheal diseases are the leading cause of preventable death, especially among under-five children in developing countries, including Ethiopia. Although efforts have been made to reduce the morbidity and mortality resulting from diarrheal diseases, there is scarce information on the progress of the interventions against the burdens. Therefore, this study aimed to assess the prevalence of diarrhea and its associated factors in under-five children in Horo Guduru Wollega Zone, Oromia Region, Western Ethiopia.

Methods

A community-based cross-sectional study was conducted. Of 12,316 households, 620 households that had under-five children were selected by simple random sampling technique from randomly selected kebeles. Before data collection, a pretest of the structured questionnaires was done on nonselected kebeles. Binary logistic regression was used to assess the association of the diarrheal diseases with independent variables. Finally, the odds ratio along with a 95% confidence interval was used to report the significant association between the outcome variable and its associated factors. A P value of ≤0.05 was considered statistically significant.

Results

The prevalence of diarrhea among under-five children was 149 (24%) (95% CI: 20.8, 27.3). Diarrhea was significantly associated with poor knowledge of mothers/caretakers on diarrhea prevention methods (AOR: 2.05, 95% CI (1.14, 3.69), being in the age group of 6-11(AOR = 1.546 (1.68, 3.52), and 12-23 months (AOR = 1.485 (1.84, 2.63)), families with poor wealth index (AOR: 2.41, 95% CI (1.29, 4.51)), children who were not vaccinated against measles (AOR: 4.73, 95% CI (2.43, 9.20)), unsafe child feces disposal (AOR = 3.75; 95% CI (1.91, 7.39)), inappropriate liquid waste disposal (AOR = 3.73 (1.94, 7.42)), and having two or more siblings (AOR: 3.11, 95% CI (1.81, 5.35)). Conclusion and Remarks. The prevalence of diarrhea among under-five children was high. There was a statistically significant association between diarrhea and age of the child (6-11 and 12-23), poor knowledge of mothers/caretakers on diarrhea prevention methods, families with poor wealth index, being unvaccinated against measles, improper liquid waste disposal, unsafe child feces disposal, and having at least two siblings. The findings have a significant policy inference for childhood diarrheal disease prevention programs. Therefore, educating mothers/caregivers on diarrheal disease prevention methods, child spacing, regular hand washing practice after disposing child feces, safely disposing liquid waste, and vaccinating all eligible children against measles should be a priority area of intervention for diarrheal disease prevention. Moreover, since these associated factors are preventable, the government needs to strengthen the health extension workers program implementations to reduce childhood diarrhea.

Determinants of Childhood Diarrhea in Households with Improved Water, Sanitation, and Hygiene (WASH) in Ethiopia: Evidence from a Repeated Cross-Sectional Study

BACKGROUND

Determinants of childhood diarrhea in households with improved WASH (ie, households with improved drinking water sources, improved sanitation facilities, and those who practiced safe child stool disposal) are limited. This study aimed to identify the determinants of diarrhea among under-five children exclusively in households with improved Water, Sanitation, and Hygiene (WASH).

METHODS

A repeated cross-sectional study design was followed, and data from the Demographic and Health Survey (DHS) conducted between 2005 and 2016 in Ethiopia was used. A total of 1,975 child-mother pairs (257 children with diarrhea and 1718 children without diarrhea) in households with improved WASH were included in this study. Hierarchical conditional logistic regression models were used. Adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI) were estimated to determine the strength of association.

RESULTS

Children aged 13 to 24 months (Adjusted Odds Ratio [AOR] = 2.70, 95%CI: 1.69-4.32), children who did not receive the measles vaccine (AOR = 2.33, 95%CI: 1.60-3.39), and those residing in the agrarian region (AOR = 1.66, 95%CI: 1.10-2.49) were significantly more likely to develop diarrheal morbidity. The size of the child at birth was also found to be significantly associated with diarrheal morbidity.

CONCLUSION

In this study, child factors (age of the child, vaccinated for measles, and the size of a child at birth), and household-related factors (contextual region) had a significant effect on the risk of childhood diarrheal morbidity in households with improved WASH in Ethiopia.

Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

Several studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

A Multilevel Analysis of Factors Associated with Childhood Diarrhea in Ethiopia

BACKGROUND

Childhood diarrhea is the major contributor to the deaths of children under the age of 5 years in Ethiopia, but evidence at the national level to identify the contributing factors associated with diarrhea by considering the clustering effects is limited. Hence, this study aimed to identify factors associated with childhood diarrhea at the individual and community levels.

METHODS

A secondary data analysis was conducted using the 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 23 321 children with their mothers were included in this study, and multilevel logistic regression models were applied for the data analysis.

RESULTS

The odds of diarrhea among female children were 13% lower (AOR = 0.87; 95% CI: 0.79-0.94) compared with male children. The odds of diarrhea among children aged between 13 and 24 months were 31% higher than (AOR = 1.31; 95% CI: 1.17-1.47) their younger counter parts. Children aged ⩾25 months (AOR = 0.50; 95% CI: 0.45-0.56), those whose mothers were unemployed (AOR = 0.79; 95% CI: 0.73-0.87), and children live in households between 2 and 3 under-5 children (AOR = 0.87; 95% CI: 0.79-0.96) were associated with lower odds of experiencing diarrhea. The odds of diarrhea among children whose mother had no formal education were 49% higher than (AOR = 1.49; 95% CI: 1.08-2.07) their counterparts. Besides, children residing in city administrations (AOR = 0.69; 95% CI: 0.58-0.82) had lower odds of experiencing diarrhea than children living in agrarian regions.

CONCLUSIONS

At the individual level (sex and age of the child, mother's employment status, and educational level, and the number of under-5 children) and the community-level (contextual region) were found to be significant factors associated with childhood diarrhea in Ethiopia.

Priorities for intervention to prevent diarrhea among children aged 0-23 months in northeastern Ethiopia: a matched case-control study

BACKGROUND

The global public health problem of diarrhea is most prevalent in developing countries including Ethiopia, especially among children under two years of age. Limited information on the determinants of diarrhea among children aged 0-23 months hinders the design and prioritization of intervention strategies to address childhood diarrhea in Dessie City, northeastern Ethiopia. Therefore, this study was designed to assess the determinants of diarrhea in order to identify priority interventions for its control.

METHODS

A community-based matched case-control study was conducted among children aged 0-23 months during January-February 2018. Cases defined as children with acute diarrhea, and controls defined as children without acute diarrhea, were matched by child's age (months) and place of residence (residing in the same kebele, the lowest local administrative unit, each of which has a population of approximately 5000) during the two weeks prior to data collection. Data were collected from mothers/caregivers of the 119 cases and 238 matched controls using a pre-tested structured questionnaire and an observational checklist. Data were analyzed using conditional logistic regression model with 95% confidence interval (CI); variables with p < 0.05 from multivariable analysis were considered as significantly associated with acute diarrhea among children aged 0-23 months.

RESULTS

Age of mothers/caregivers (> 35 years of age) (adjusted matched odds ratio [adjusted mOR] = 2.00; 95% CI: 1.37-5.8); divorced/widowed marital status (adjusted mOR = 1.40; 95% CI: 1.26-3.3); lack of exclusive breastfeeding (adjusted mOR = 2.12; 95% CI: 1.15-3.70); presence of feces within/around latrines (adjusted mOR = 1.37; 95% CI: 1.21-3.50); lack of handwashing facility near latrine (adjusted mOR = 1.50; 95% CI: 1.30-5.30); presence of domestic sewage discharge within and/or outside the compound (adjusted mOR = 3.29; 95% CI: 1.85-7.50) and practice of handwashing at fewer than three of the five critical daily times (adjusted mOR = 4.50; 95% CI: 2.54-9.50) were significantly associated with acute diarrhea among children aged under two years.

CONCLUSION

To reduce acute diarrheal disease among children under two, priority should be given to interventions that focus on improving exclusive breastfeeding practices, regular cleaning of latrines, advocating for availability of handwashing facility within/around latrines, use of proper domestic sewage discharge methods and improving handwashing practice at the five critical times each day. Strengthening communication that promotes hygiene and behavioural change may also raise awareness among mothers/caregivers and empower them to enhance handwashing practices at critical times.

Association between Sociodemographic Factors and Diarrhea in Children Under 5 Years in Rwanda

Diarrheal disease is the second leading cause of mortality and morbidity in children under 5 years old worldwide, and is the most common cause of malnutrition in sub-Saharan Africa. In Rwanda, diarrhea is the third leading cause of death in children under 5 years old. This study examined the association between sociodemographic factors and diarrhea in children under 5 years using the data of 7,474 households in the 2014-2015 Rwanda Demographic and Health Survey. Overall prevalence of diarrhea in this study was 12.7% in children. An increased risk for diarrhea was found for children aged 12-23 months (odds ratio (OR)=4.514), those with a low economic status (OR=1.64), those from the Western province (OR=1.439), those with poorly-educated mothers (OR=5.163), and those with families engaged in agricultural activities (OR=1.624). In conclusion, sociodemographic factors significantly affect the risk of developing diarrhea in children under 5 years in Rwanda. Designing and implementing health education promoting awareness of early interventions and rotavirus vaccination are essential to reduce diarrheal diseases for the Rwandan community.

Trends and determinants of diarrhea among under-five children in Ethiopia: cross-sectional study: multivariate decomposition and multilevel analysis based on Bayesian approach evidenced by EDHS 2000-2016 data

Background

Despite significant progress in the reduction of under-five child deaths over the last decades in Ethiopia, still diarrhea remains the second cause of morbidity and mortality among under five children next to pneumonia.

Objective

To show trends and determinants of diarrhea among under five children in Ethiopia based on the four Ethiopian Demographic and health surveys data (2000–2016).

Methods

A total of 10,753 in 2000, 10,039 in 2005, 10,946 in 2011 and 10,337 in 2016 under five age children were involved in this study. Multivariate decomposition and multilevel analysis based on Bayesian approach was performed.

Results

Ninety seven percent of the change in diarrhea prevalence over time was attributable to difference in behavior. Being twin (AOR = 1.3; 95% CrI 1.1–1.5), big weight (AOR = 1.63; 95% CrI 1.62–2.02), not vaccinated for rotavirus (AOR = 1.44; 95% CrI 1.12–1.9) and for measles (AOR = 1.2; 95% CrI 1.1–1.33), poor wealth status (AOR 2.6; 95% CrI 1.7–4.06), having more than three under-five children (AOR 1.3; 95% CrI 1.1–1.61), member of health insurance (AOR 2.2; 95% CrI 1.3–3.8) and long distance from the health facility (AOR 2.7; 95% CrI 2.2–3.5) were more likely to experience diarrhea.

Conclusion

The prevalence of diarrhea was significantly declined over the last sixteen years and the decline was due to difference in behavior between the surveys. Being twin, weight of child at birth, vaccinated for measles and rotavirus, number of under-five children, wealth status, distance to health facility, health insurance and child waste disposal method were significantly associated with diarrhea among under five children in Ethiopia. Therefore Ethiopian government should focus on the strengthening and scaling up of behavioral change packages of the community regarding to keeping hygiene and sanitation of the community and their environment, vaccinating their children, accessing health care services to prevent diarrheal disease.

Oral rehydration solution coverage in under 5 children with diarrhea: a tri-country, subnational, cross-sectional comparative analysis of two demographic health surveys cycles

Background

More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals.

Methods

The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007–2010 (1st Period), and 2013–2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage.

Results

Crude ORS coverage increased from 21.0% (95% CI: 17.4–24.9) in 1st Period to 40.5% (36.5–44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1–65.3) to 64.7% (61.8–67.5) in Zambia; and decreased from 72.3% (68.4–75.9) to 64.6% (60.9–68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from − 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from − 16.5% in the Northern Province to − 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66–5.86) for Zimbabwe, 2.83 (2.35–3.40) for Zambia, and, 0.71(0.59–0.87) for Malawi.

Conclusion

ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09811-1.

Diarrheal morbidity and predisposing factors among children under 5 years of age in rural East Ethiopia

BACKGROUND

Diarrheal diseases remain a leading cause of preventable death among children under-five in low- and middle-income countries (LMICs). In Ethiopia, diarrhea is the major contributor to deaths for children under the age of 5 years. In order to develop prevention strategies for the alleviation of childhood diarrhea, it is necessary to identify the important predisposing factors. These predisposing factors have been observed to vary by location across Eastern Ethiopia. Moreover, the evidence on prevalence and determinants of diarrhea among children under 5 years of age in Dire Dawa and its suburbs is very limited and those available have been erratic. The objective of this study was to determine the prevalence and predisposing factors of diarrhea among children under the age of 5 years in rural Dire Dawa, East Ethiopia.

METHODS

A community-based cross-sectional study was conducted in rural Dire Dawa City Administration in May 2018. Multistage sampling technique was employed to recruit 1180 under-five children from the rural population of Dire Dawa City Administration. Data on socio-demographic, environmental, and child hygiene-related factors were collected by trained data collectors using a structured questionnaire. Logistic regression was used to identify independent risk factors for childhood diarrhea.

RESULTS

The 2-week prevalence of diarrhea among the under-five children was 23% (95% CI 20.8-25.7%). Maternal diarrhea (AOR = 2.22, 95% CI 1.10-4.47), handwashing after contact with child feces (AOR = 6.27, 95% CI 2.01-19.55), use of a dipper to draw water from containers (AOR = 2.88, 95% CI 1.41-5.89), and presence of a refuse disposal facility (AOR = 2.47, 95% CI 1.09-5.60) were the significant predisposing factors of diarrhea.

CONCLUSION

Our study identified a high burden of childhood diarrheal disease in rural Dire Dawa City Administration in Eastern Ethiopia. The identified risk factors were maternal diarrhea, handwashing after contact with child feces, use of a dipper to draw water from containers, and presence of refuse disposal facility. To minimize the risk of diarrhea, health education programs focusing on good hygiene practice and sanitation as well as early treatment are recommended.

Geographical disparities and determinants of childhood diarrheal illness in Ethiopia: further analysis of 2016 Ethiopian Demographic and Health Survey

Background

Childhood diarrheal illness is the second leading cause of child mortality in sub-Saharan Africa, including Ethiopia. Epidemiology of diarrhea has long-term implications with respect to medical, social, and economic consequences. Studies hypothesize that there have been regional differences, and this study aimed to examine the spatial variations and identify the determinants of childhood diarrhea in Ethiopia.

Methods

Data from the 2016 Demographic and Health Survey of Ethiopia (EDHS), which included 10,337 aged under 5 years were analyzed. The survey was conducted using a two-stage stratified sampling design. The study attempted to detect and test the clustering of diarrhea cases using global Moran’s I and LISA. Descriptive statistics followed by mixed-effect logistic regressions were used to identify factors related to the prevalence of diarrhea.

Results

Overall, 11.87% of the children experienced childhood diarrheal illness. The study showed that the risk was high in the southern and central parts and low in the eastern and western regions of the country. Children aged 6–12 (AOR = 2.66, [95% CI 2.01, 3.52]), 12–23 (AOR = 2.45, [95% CI 1.89, 3.17]), and 24–35 (AOR = 1.53, [95% CI 1.17, 2.01]) months were more likely to suffer from childhood diarrhea than those aged less than 6 months. Children in Tigray (AOR = 1.69 [95% CI 1.01, 2.83]), Amhara (AOR = 1.80, [95% CI 1.06, 3.06]), SNNPR (AOR = 2.04, [95% CI 1.22, 3.42]), and Gambella (AOR = 2.05, [95% CI 1.22, 3.42]) were at higher risk than those in Addis Ababa. The odds of getting diarrhea decreased by 24% among households with ≥ 3 under-five children compared to those with only one under-five child (AOR = 0.76 [95% CI 0.61, 0.94]). The odds of getting diarrheal illness for the children of employed mothers increased by 19% compared to those children of non-employed mothers (AOR = 1.19 [95% CI 1.03, 1.38]).

Conclusions

Childhood diarrheal disease is prevalent among under-five children, particularly in the regions of SNNP, Gambella, Oromia, and Benishangul Gumuz, while the regions are generally making progress in reducing childhood illness. Capacity building programs with the best experience sharing and better home environments can be effective in reducing the incidence of childhood diarrhea in Ethiopia.

Spatiotemporal and hotspot detection of U5-children diarrhea in resource-limited areas of Ethiopia

Under-five children (U5-children) diarrhea is a significant public health threat, where the World Health Organisation (WHO) reported it as the second leading cause of children's death worldwide. Nearly 1.7 billion cases occur annually with varied temporal and spatial factors. Identification of the spatiotemporal pattern and hotspot areas of U5-children diarrhea can assist targeted intervention and provide an early warning for more effective response measures. This study aimed at examining spatiotemporal variability along with the detection of hotspot areas for U5-children diarrhea in the Bench Maji Zone of southwestern Ethiopia, where resources are limited and cultural heterogeneity is highest. Retrospective longitudinal data of ten years of diarrhea records from January 2008 to December 2017 were used to identify hotspot areas. The incidence rate per 1,000 per year among children was calculated along with seasonal patterns of cases. The spatiotemporal analysis was made using SaTScan version 9.4, while spatial autocorrelations and hotspot identification were generated using ArcGIS 10.5 software. A total of 90,716 U5-children diarrhea cases were reported with an annual incidence rate of 36.1 per 1,000 U5-children, indicating a relative risk (RR) of 1.6 and a log-likelihood ratio (LLR) of 1,347.32 (p < 0.001). The highest incidence of diarrhea illness was recorded during the dry season and showed incidence rate increment from October to February. The risky clusters (RR > 1) were in the districts of Bero, Maji, Surma, Minit Shasha, Guraferda, Mizan Aman Town, and Sheko with annual cases of 127.93, 68.5, 65.12, 55.03, 55.67, 54.14 and 44.97 per 1,000, respectively. The lowest annual cases reported were in the four districts of Shay Bench, South Bench, North Bench, and Minit Goldiya, where RR was less than a unit. Six most likely clusters (Bero, Minit Shasha, Surma, Guraferda, South Bench, and Maji) and one lower RR area (North Bench) were hotspot districts. The U5-children's diarrhea in the study area showed an overall increasing trend during the dry seasons with non-random distribution over space and time. The data recorded during ten years and analyzed with the proper statistical tools helped to identify the hotspot areas with risky seasons where diarrhea could increase.

Co-occurrence of Campylobacter Species in Children From Eastern Ethiopia, and Their Association With Environmental Enteric Dysfunction, Diarrhea, and Host Microbiome

High Campylobacter prevalence during early childhood has been associated with stunting and environmental enteric dysfunction (EED), especially in low resource settings. This study assessed the prevalence, diversity, abundance, and co-occurrence of Campylobacter spp. in stools from children in a rural area of eastern Ethiopia and their association with microbiome, diarrhea, and EED in children. Stool samples (n = 100) were collected from randomly selected children (age range: 360-498 days) in five kebeles in Haramaya District, Ethiopia. Diarrhea, compromised gut permeability, and gut inflammation were observed in 48, 45, and 57% of children, respectively. Campylobacter prevalence and species diversity were assessed using PCR and meta-total RNA sequencing (MeTRS). The prevalence of Campylobacter spp. in the children's stools was 50% (41-60%) by PCR and 88% (80-93.6%) by MeTRS (P < 0.01). Further, seven Campylobacter species (Campylobacter jejuni, Campylobacter upsaliensis, Campylobacter hyointestinalis, Campylobacter coli, Campylobacter sp. RM6137, uncultured Campylobacter sp., and Campylobacter sp. RM12175) were detected by MeTRS in at least 40% of children stools in high abundance (>1.76-log read per million per positive stool sample). Four clusters of Campylobacter species (5-12 species per cluster) co-occurred in the stool samples, suggesting that Campylobacter colonization of children may have occurred through multiple reservoirs or from a reservoir in which several Campylobacter species may co-inhabit. No associations between Campylobacter spp., EED, and diarrhea were detected in this cross-sectional study; however, characteristic microbiome profiles were identified based on the prevalence of Campylobacter spp., EED severity, and diarrhea. Forty-seven bacterial species were correlated with Campylobacter, and 13 of them also correlated with gut permeability, gut inflammation and/or EED severity. Forty-nine species not correlated with Campylobacter were correlated with gut permeability, gut inflammation, EED severity and/or diarrhea. This study demonstrated that (1) in addition to C. jejuni and C. coli, multiple non-thermophilic Campylobacter spp. (i.e., Campylobacter hyointestinalis, Campylobacter fetus, and Campylobacter concisus) were frequently detected in the children's stools and (2) the Campylobacter, gut permeability, gut inflammation, EED severity, and diarrhea were associated with characteristic microbiome composition. Additional spatial and longitudinal studies are needed to identify environmental reservoirs and sources of infection of children with disparate Campylobacter species and to better define their associations with EED in low-income countries.

Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis

INTRODUCTION

Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever.

MATERIALS AND METHODS

A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity.

RESULTS

The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage.

CONCLUSIONS

High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Reduction of hospitalizations with diarrhea among children aged 0-5 years in Nouakchott, Mauritania, following the introduction of rotavirus vaccine

INTRODUCTION

Rotavirus vaccine was introduced in Mauritania in December 2014. We investigated hospitalizations with diarrhea during pre and post-vaccination periods among children aged 0-5 years in Nouakchott, the capital of Mauritania.

METHODS

We conducted a retrospective review of hospital admission registries from November 1st 2012 through October 31th 2017 at all referral hospitals in Nouakchott. We described admissions of children aged 0-5 years by diagnosis, data of admission, age and sex, and compared the proportion of all childhood hospitalizations with diarrhea before and after rotavirus vaccine introduction.

RESULTS

In total, 6552 (19%) of all 34,329 hospitalizations in 0-5 year-olds had diarrhea. Of these, 3523/16,952 (20.7%) were recorded during the pre-vaccine period, 1373/6897 (19.9%) during the transition period (November 2014-October 2015), and 1656/10,480 (15.8%) during the post-vaccination period. The proportion of all childhood hospitalizations with diarrhea during the pre-vaccine period was 22.6% among males and 18.7% among females. Approximately one third (32.3%) of hospitalizations with diarrhea occurred in children aged 6-11 months. During the post-vaccination period, the proportion of hospitalizations with diarrhea declined by 24%, and the highest reduction (74%) was observed in children aged 2 to 5 years (P < 0.001).

CONCLUSIONS

The proportion of childhood hospitalizations with diarrhea in Nouakchott was reduced by about one fourth after introduction of rotavirus vaccination in Mauritania, indicating a major impact for public health for children in the capital city.

Risk factors for acute childhood diarrhea: A cross-sectional study comparing refugee camps and host communities in Gambella Region, Ethiopia

BACKGROUND

Diarrhea is one of the most common causes of child morbidity and mortality in refugee camps, aggravated by inadequate water, sanitation and hygiene services, and malnutrition, particularly in developing countries.

METHODOLOGY

A comparative cross-sectional study was conducted to assess acute diarrhea and associated risk factors among under-five children in refugee and host communities in Gambella Region, Ethiopia. Descriptive statistics were used, and bivariate and multivariate logistic regressions were performed to identify variables associated with diarrhea.

RESULTS

A total of 1667 under-five children was included in this study, and prevalence of diarrhea differed between the refugee (38%) and host (33%) communities [OR = 1.37, 95% CI 1.04, 1.8]. Refugee camp households using uncovered water containers, consuming low quantities of water, and lacking hand washing setups were more likely to report children with diarrhea. Within host communities, households were more likely to report acute childhood diarrhea if they consumed surface water or did not have a latrine.

CONCLUSION

The two-week prevalence of diarrhea was significantly higher among children in the refugee camps than those in the host communities. Therefore, further collaboration between government and non-government organizations is required to identify persisting factors of diarrhea transmission in various communities in the region.

District level estimates and mapping of prevalence of diarrhoea among under-five children in Bangladesh by combining survey and census data

The demand for district level statistics has increased tremendously in Bangladesh due to existence of decentralised approach to governance and service provision. The Bangladesh Demographic Health Surveys (BDHS) provide a wide range of invaluable data at the national and divisional level but they cannot be used directly to produce reliable district-level estimates due to insufficient sample sizes. The small area estimation (SAE) technique overcomes the sample size challenges and can produce reliable estimates at the district level. This paper uses SAE approach to generate model-based district-level estimates of diarrhoea prevalence among under-5 children in Bangladesh by linking data from the 2014 BDHS and the 2011 Population Census. The diagnostics measures show that the model-based estimates are precise and representative when compared to the direct survey estimates. Spatial distribution of the precise estimates of diarrhoea prevalence reveals significant inequality at district-level (ranged 1.1–13.4%) with particular emphasis in the coastal and north-eastern districts. Findings of the study might be useful for designing effective policies, interventions and strengthening local-level governance.

Epidemiological investigation and management of bloody diarrhea among children in India

BACKGROUND

The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context.

METHODS

We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years.

FINDINGS

The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics.

CONCLUSION

The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Prevalence and Factors Associated with Diarrhoea among Children between 6 and 59 Months of Age in Mwanza City Tanzania

BACKGROUND

Childhood diarrhoea is a global public health problem especially in unplanned settlements of low- and middle-income countries. Different studies have associated household settlement and childhood diarrhoea, but the prevalence and risk factors associated with childhood diarrhoea at the community level are not clearly known.

METHOD

A community-based cross-sectional study was performed to determine the prevalence and risk factors associated with diarrhoea in among 480 children between 6 and 59 months of age in Mwanza city from June to August 2016. Risk factors associated with childhood diarrhoea in Mwanza city were determined using univariate, bivariate and multivariate analysis.

RESULTS

The study showed a prevalence of diarrhoea of 20.4% and an association between type of settlement and childhood diarrhoea (p < 0.001) in a chi-square analysis. During bivariate analysis, and logistic regression, after controlling for other factors, unplanned settlement was significantly associated with childhood diarrhoea (odds ratio=3.475, p < 0.001 and AOR=3.469, p < 0.001). Other factors associated with childhood diarrhoea were behaviour of mother washing hands before preparing food (AOR = 0, 193, p < 0.001), mother washing hands after changing child's napkins (AOR = 0.544, p < 0.036) and the behaviour of the child washing hands after toilet (AOR = 0.447, p < 0.006).

CONCLUSION

Risk factors associated with childhood diarrhoea in Mwanza city are unplanned settlement and behaviour of mother and child washing hands during critical time; hence, continuous community health promotion insisting on washing hands with soap and water during critically time is the best method for fighting childhood diarrhoea in Mwanza city.

Trends for Diarrhea Morbidity in the Jasikan District of Ghana: Estimates from District Level Diarrhea Surveillance Data, 2012-2016

About 22% of childhood deaths in developing countries are attributable to diarrhea. In poor resource settings, diarrhea morbidities are correlated with poverty and socio-contextual factors. Diarrhea rates in Ghana are reported to be high, with cases estimated at 113,786 among children under-five years in 2011. This study analyzed the trends of diarrhea morbidity outcomes in the Jasikan District of Ghana. A retrospective analysis of records on diarrhea data for a five years' period (January 2012 to December 2016) was undertaken. There was a total of 17740 diarrhea case reports extracted from District Health Information Management System (DHIMS) II database in an Excel format which was then exported to Stata version 14 for data cleaning, verification, and analysis. Excel version 2016 was used to plot the actual observed cases by years to assess trends and seasonality. There was a period incidence rate of 272.02 per 1000 persons with a decreasing annual growth rate of 1.85%. Declines for diarrhea generally occurred from November to December and increased from January upwards, evidence that most cases of diarrhea in this study were reported in the harmattan season. High incidence of diarrhea was found to be common among under-five children and among females. Decreasing trend of diarrhea incidence which was identified in this research within the five years' period understudied shows that, by the year 2020, there will be a sharp decline in the incidence rate of diarrhea reported cases in Jasikan District, given improvements in the external environmental conditions in the district, all things being equal.

Spatial, temporal, and spatiotemporal analysis of under-five diarrhea in Southern Ethiopia

Background

Despite improvements in prevention efforts, childhood diarrhea remains a public health concern. However, there may be substantial variation influenced by place, time, and season. Description of diarrheal clusters in time and space and understanding seasonal patterns can improve surveillance and management. The present study investigated the spatial and seasonal distribution and purely spatial, purely temporal, and space-time clusters of childhood diarrhea in Southern Ethiopia.

Methods

The study was a retrospective analysis of data from the Health Management Information System (HMIS) under-five diarrheal morbidity reports from July 2011 to June 2017 in Sidama Zone. Annual diarrhea incidence at district level was calculated. Incidence rate calculation and seasonal trend analysis were performed. The Kulldorff SaTScan software with a discrete Poisson model was used to identify statistically significant special, temporal, and space-time diarrhea clusters. ArcGIS 10.1 was used to plot the maps.

Results

A total of 202,406 under-five diarrheal cases with an annual case of 5822 per 100,000 under-five population were reported. An increasing trend of diarrhea incidence was observed over the 6 years with seasonal variation picking between February and May. The highest incidence rate (135.8/1000) was observed in the year 2016/17 in Boricha district. One statistically significant most likely spatial cluster (Boricha district) and six secondary clusters (Malga, Hulla, Aleta Wondo, Shebedino, Loka Abaya, Dale, and Wondogenet) were identified. One statistically significant temporal cluster (LLR = 2109.93, p < 0.001) during December 2013 to May 2015 was observed in all districts. Statistically significant spatiotemporal primary hotspot was observed in December 2012 to January 2015 in Malga district with a likelihood ratio of 1214.67 and a relative risk of 2.03. First, second, third, and fourth secondary hotspots occurred from January 2012 to May 2012 in Loka Abaya, December 2011 in Bursa, from March to April 2014 in Gorchie, and March 2012 in Wonsho districts.

Conclusion

Childhood diarrhea was not distributed randomly over space and time and showed an overall increasing trend of seasonal variation peaking between February and May. The health department and other stakeholders at various levels need to plan targeted interventional activities at hotspot seasons and areas to reduce morbidity and mortality.