A Multilevel Analysis of Factors Associated with Childhood Diarrhea in Ethiopia

Spatiotemporal variation of under-5 children diarrhea incidence and associated meteorological factors in central Gondar zone, Northwest Ethiopia. A retrospective time series study

Under-5 children's diarrhea is a significant public health threat, and the World Health Organization (WHO) reported that it is the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 children's diarrhea incidence rates. Therefore, this study was conducted to assess the spatiotemporal variation under-5 diarrhea incidence and associated meteorological factors in the Central Gondar Zone. The data for under-5 diarrhea were obtained from Central Gondar Zone Health Department diarrhea reports from January 2013 to December 2022. Climatic variables were obtained from the West Amhara Meteorological Agency. Every district was covered and given a geocode. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots. The Poisson model, which applies the Kulldorff methods and SaTScan™9.6, was used to analyze the purely temporal, spatial, and space-time clusters. Spearman correlation and bivariate and multivariable negative binomial regressions were used to analyze the relationships between under-5 diarrhea cases and climatic factors. This study revealed spatial variation in the incidence of under-5 diarrhea, where Dembia, Gondar Zuria, and Chilga districts and Gondar Zuria, East Dembia, and Lay Armacho districts were high-rate spatial clusters between 2013 and 2018 and between 2019 and 2022, respectively. A temporal scan statistic identified 2014-2016 and 2020-2021 as risk periods across all districts. Spatiotemporal scan statistics revealed high-rate clusters in Dembia, Gondar Zuria, Chilga, Wegera, Alefa, Lay Armacho, and West Belesa between 2013 and 2018, and Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. This study also revealed positive correlations between the number of individuals with under-5 diarrhea and the average monthly temperature at 0 and 2 lag months, with values of 1.0209 (1.0034-1.0387) and 1.0202 (1.0022-1.0385), respectively. In addition, there was a negative correlation between the number of under-5 diarrhea events and the average monthly rainfall at 0 and 2 lag months, with values of 0.999 (0.9985-0.9996) and 0.9992 (0.9987-0.9997), respectively. In conclusion, there has been spatiotemporal variability in the incidence of diarrhea in children under-5 years of age in the Central Gondar Zone. The mean monthly temperature and rainfall were positively and negatively related to the incidence of diarrhea in children under-5 years of age. Season-specific intervention strategies should be developed to reduce under-5 morbidity and mortality.

Menstrual hygiene practice and associated factors among adolescent primary school females in Dale Woreda, Sidama, Ethiopia: a cross sectional study

Background

Despite poor menstrual hygiene practices exposing adolescent females to reproductive health problems, it has not been adequately studied in low-income countries. Due to a lack of proper information, the majority of teenage girls enter puberty without having prepared themselves. The aim of this study was to assess menstrual hygiene practice and associated factors among adolescent female students.

Methods

An institution-based cross-sectional study design was employed from March 10 to April 20, 2022. A random sample of 608 adolescent female students was included in the study. A multistage sampling was applied to employee study participants. Data were collected using a structured questionnaire administered through an interview technique. A logistic regression model was used to analyze the data using version 26 SPSS statistical software. Descriptive statistics were used to summarize the data. An adjusted odds ratio with a 95% confidence interval and a corresponding p-value <0.05 was used to measure the strength of association.

Result

The prevalence of poor menstrual hygiene practices among adolescent girls was 28.4%. Poor knowledge of adolescent girls [AOR = 2.64, 95% CI: 1.74, 4.02], mothers' educational level [AOR = 0.86, 95% CI: 0.79, 0.94], fathers' occupation of private employers and daily laborers [AOR = 3.1, 95% CI: 1.46, 6.69] and [AOR = 1.98, 95% CI: 1.03, 3.8], and having hand washing facilities [AOR = 0.51, 95% CI: 0.34, 0.77] were significantly associated with poor menstrual hygiene management practices among adolescent schoolgirls.

Conclusion

In this study, we determined the level of poor menstrual hygiene practice. We identified factors significantly associated with menstrual hygiene practices. Interventions should focus on creating awareness among adolescent girls, providing menstrual hygiene management facilities, and improving the educational and occupational levels of parents.

Prevalence of Diarrhea Disease and Associated Factors Among Children Under 5 Years in Geshiyaro Project Implementation Sites in Ethiopia: A Cross-Sectional Study

Background

Globally, infectious diseases such as pneumonia, diarrhea, and malaria are the leading causes of death for children under 5. Diarrheal disease is a significant public health concern and causes the death of approximately 525,000 children under the age of 5 every year. In Ethiopia, studies revealed that the prevalence of diarrhea among children under 5 years is alarming. However, there has been a shortage of studies regarding the predictors of diarrheal disease in Geshiyaro project implementation sites in Ethiopia. Therefore, this study aimed to fill this gap.

Methods

A community-based cross-sectional study was conducted from June to July 2023. A total of 2937 participants were enrolled in this investigation. Descriptive and multivariate logistic regression analysis was performed using STATA version 16.

Results

The 2-week prevalence of diarrhea among children under 5 years was 11.8%. The following factors were significantly associated (p < 0.05) with the occurrence of childhood diarrhea: sex of the child (AOR: 1.6; 95% CI, 1.17-2.19), child age in a month (AOR: 0.5; 95% CI, 0.26-0.94), drinking water service (AOR: 2.6; 95% CI, 1.33-5.25), knowledge on diarrhea prevention (AOR: 1.4; 95% CI, 1.05-1.98), open defecation practice (AOR: 1.9; 95% CI, 1.33-2.74), and rotavirus vaccination (AOR: 1.8; 95% CI, 1.20-2.56).

Conclusions

This study identified several factors contributing to diarrhea. Besides, it also studied and showed a larger number of children who were not receiving basic vaccines. Therefore, the government and partner organizations should implement effective interventions to increase vaccine coverage and reduce diarrhea.

Prevalence of diarrhea and its associated factors among children under five years in Awi Zone, Northwest Ethiopia

BACKGROUND

Globally, diarrhea continues to be the leading cause of morbidity and mortality for children under five, with an annual rate of 149 million cases of illness and 760,000 deaths. This study aimed to assess prevalence and contributing factors of diarrhea among children under-five years in Awi Zone, Northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted on 1387 participants from February to June 2023. A multistage sampling method was conducted. Structured and pretested questionnaires were used to collect the data. Data were entered in to Epi data and exported to STATA for analysis. A multivariable logistic regression was performed to determine factors associated with diarrhea with p-value < 0.05.

RESULTS

The prevalence of diarrheal disease among children under five was 17.16%. Child's age 12 to 23 months [AOR = 16.642; 95% CI: (3.119, 88.805)], protected drinking water [AOR: 0.629; 95% CI: (0.840, 0.928)], health insurance [AOR = 0.571;95% CI: (0.386, 0.844)], institutional delivery [AOR = 0.426, 95% CI: (0.256, 0.707)], water shortage [AOR = 1.570, 95% CI: (1.083, 2.277)], and vaccinated for measles [AOR = 0.124, 95% CI: (0.065, 0.236)] were associated with diarrhea.

CONCLUSION

Age of children, source of drinking water, health insurance, place of delivery, family size, water shortage, liquid waste disposal, and measles vaccination were significantly associated with diarrhea among under five children. Interventions targeting improvements in drinking water sources, health insurance coverage, sanitation practices, and vaccination rates are crucial for mitigating the impact of diarrheal disease among children under five years in Awi Zone.

Under five children diarrhea prevalence and associated factors in slum areas of Gondar City Northwest Ethiopia: a community based cross-sectional study

Slum areas in Ethiopia have high poverty status. In addition, they possess poor water and sanitation accesses such as unsafe drinking water, a lower number of sanitation facilities and poor hygienic conditions. These scenarios are important in the occurrence of diarrhea among under five children's. However, there are many studies conducted on diarrhea among under five children in Ethiopia, unfortunately, the majority usually didn't give enough coverage for the burden of diarrhea among under five children in slum areas. This study aimed to determine the prevalence of diarrhea and associated factors among under five children in slum areas of Gondar City. This community-based cross-sectional study was conducted in slum areas of Gondar City among under five children from March 28 to April 28, 2023. A multi-stage sampling technique was used to collect a sample of 836 through interview-administered methods using a structured data collection tool. The collected data was manually checked for completeness, coded, and entered into EPI Info version 7.1.5.2 software. It was then exported to Stata version 14.1 software for descriptive analysis, as well as bivariable and multivariable binary logistic regression analyses, to identify factors associated with diarrhea among under five children. The prevalence of diarrhea among under five children at 95% confidence interval was 24.64% (CI 21.71-27.56). Mothers/caretakers age < 25 years (AOR = 1.88, 95% CI 1.16-3.06), mothers/caretakers age between 28 and 31 years (AOR = 1.82, 95% CI 1.08-3.05), mothers/caretakers who had no formal education (AOR = 3.18, 95% CI 1.86-5.41), mothers/caretakers who had primary education (AOR = 1.67, 95% CI 1.09-2.57), income level between 4877 and 5643 Ethiopian Birr (AOR = 1.81, 95% CI 1.04-3.15), family size greater than five (AOR = 1.54, 95% CI 1.00-2.36), flies around the house (AOR = 2.27, 95% CI 1.38-3.73), playground not clean (AOR = 2.70, 95% CI 1.62-4.50), breastfed for ≥ 1 year (AOR = 0.63, 95% CI 0.41-0.97), mothers/caretakers who did not wash their hands before food preparation and eating (AOR = 2.31, 95% CI 1.39-3.58), mothers/caretakers who did not wash their hands after visiting latrine (AOR = 1.60, 95% CI 1.07-2.38) were significantly associated factors with diarrhea among under five children in slum areas of Gondar City. The study indicates that the prevalence of diarrhea was higher among under five children in slum areas of Gondar City. The Gondar City Administration Education Bureau should give great emphasis on improving mother's and caretaker's education. In addition, the Gondar City Administration Health Bureau should educate mothers and caretakers about breastfeeding, sanitation, and hygiene in the slum areas of Gondar City.

Detection of spatial, temporal and spatiotemporal distribution of diarrhea incidence among under-five children in Central Gondar zone, Northwest Ethiopia: a time-series study (2019-2022)

Under-five children's diarrhea is a significant public health threat and the World Health Organization (WHO) reported it as the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 diarrhea incidence. This study was therefore, conducted among all districts in the Central Gondar zone to assess the spatial, temporal, and spatiotemporal variation in diarrhea incidence among under-five children in the Central Gondar zone. The data for children under 5 years of age with diarrhea was obtained from Central Gondar Zone Health Department diarrhea reports from January 2019 to December 2022. All districts were included and geo-coded. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots and cold spots. The Poisson model was generated by applying the Kulldorff method in SaTScan™9.6 to analyse the the purely temporal, spatial, and space-time clusters. The study revealed spatial variation of under-5 diarrhea where Gondar City, Gondar Zuria, East Dembia, and Lay Armacho districts were the high-rate spatial clusters during the study period. A year search window for temporal scan statistic identified 01 January 2020-30 December 2021 as risk periods across all districts. Spatiotemporal scan statistics detected high-rate clusters at Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. In conclusion, there has been a spatial, temporal, and spatiotemporal variability of under-5 children's diarrhea in the Central Gondar Zone. Interventional and preventive strategies should be developed and given priority to the areas that has been detected as a hotspot in this study to reduce the mortality and morbidity of under 5 children.

Spatio-temporal distributions and determinants of diarrhea among under-five children in Ethiopia

Objective

The purpose of this study was to evaluate the spatio-temporal pattern of Ethiopia's childhood diarrheal disease and identify its contributing factors.

Methods

We conducted analyses on secondary data from four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. Moran's I was used to determine spatial dependence and spatial models were used to evaluate variables associated with diarrhea in under-five children at the zonal level.

Results

Childhood diarrhea showed spatial clustering in Ethiopia (Moran's I; p < 0.05). The spatial regression model revealed significant factors at the zonal level: children born at home (e θ = 1.355, 95% CI: 1.052-1.544, p < 0.001), low birth weight (e θ = 1.18, 95% CI: 1.017-1.691, p < 0.05), and unimproved source of water (e θ = 0.8568, 95% CI: 0.671-1.086, p < 0.01).

Conclusion

The prevalence of diarrhea among under-five children varied over time by zone, with the Assosa, Hundene, and Dire Diwa zones having the highest rates. Home births and low birth weight contributed to the prevalence of childhood diarrhea. In high-risk zones of Ethiopia, reducing childhood diarrhea requires integrated child health interventions and raising awareness about the potential hazards associated with unimproved water sources.

Contextual factors associated with diarrhea among under-five children in the Gambia: a multi-level analysis of population-based data

BACKGROUND

Diarrhea poses a significant threat to the lives of children in The Gambia, accounting for approximately 9% of all deaths among children under the age of five. Addressing and reducing child mortality from diarrhea diseases is crucial for achieving the Sustainable Development Goal (SDG) 3, specifically target 3.2, which aims to eliminate preventable deaths in newborns and children under the age of five by 2030. Thus, this research aims to assess the prevalence and contextual factors associated with diarrhea among under-five children in The Gambia.

METHODS

This research employed secondary data from the 2019/20 Gambia Demographic Health Survey (GDHS). The study initially involved 8,362 women aged between 15 and 49 years. Of these, 6,929 women with children under five were included in this analysis. Data were analyzed using STATA with cross-tabulation and model fitting. Multilevel logistic regression was applied to accommodate the hierarchical structure of the demographic health survey data. The model comparison parameters were BIC, AIC, deviance, and LLR. Variables with a p-value less than 0.05 were selected for multivariable analysis. The statistical significance of the factors was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a p-value of less than 0.05.

RESULTS

The prevalence of diarrhea in under-five children was 53.2% in males and 46.8% in females. In the final model, Kerewan (aOR = 0.58; 95% CI = 0.33-0.98) and Basse (aOR = 0.59; 95% CI = 0.35-0.98) have significantly lower odds of childhood diarrhea compared to Banjul, female children show slightly lower, yet significant, odds of diarrhea compared to males (aOR = 0.96; 95% CI = 0.86-0.98), deliveries at government health centers are associated with higher odds of childhood diarrhea compared to home births (aOR = 1.24; 95% CI = 1.01-1.52). Mothers with post-secondary education had significantly lower odds of having children with diarrhea than those without any education (aOR = 0.50; 95% CI = 0.26-0.99) after controlling for confounders.

CONCLUSION

The study findings indicate that several factors significantly impact the risk of childhood diarrhea in The Gambia. These factors include region of residence, sex of the child, place of delivery, and education level of the mother. The study suggests that existing interventions aimed at improving child health outcomes in the country should take into consideration these influential factors. Addressing these modifiable factors can enhance the effectiveness of interventions and promote better health outcomes for children in Gambia.

Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data

Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.

A multilevel analysis of the predictors of diarrhea among children under 5 years of age in Eswatini

Diarrhea remains a public health challenge and persistently affect children under 5 years of age, primarily in developing countries. The aim of the study was to investigate the effects of individual, household and community level factors on child diarrhea. Using combined data 2010 and 2014 Eswatini Multiple Indicator Cluster surveys, data for 4,363 under five children was analysed. Univariable, bivariable and multivariable multilevel logistic regression models were used for data analysis. We found that the prevalence of diarrhea was 16.2%, (95% confidence interval (CI): 15.3-18.1). Higher odds of diarrhea were observed among children aged 6-11 months (AOR: 2.67, 95% CI: 1.93, 3.71) and 12-23 months (AOR=2.12, 95% CI: 1.56, 2.87) compared to those aged less than 6 months. However, lower odds of diarrhea were observed among children aged 36-47 months (AOR=0.68, 95% CI: 0.48, 0.97) and 48-59 months (AOR=0.39, 95% CI: 0.26, 0.58), compared to children aged less than 6 months. Children born to mothers aged 35-39 years had lower odds of having diarrhea, (AOR=0.48, 95%CI: 0.30, 0.79) compared to those born to mothers aged 15-19 years. Higher odds of having diarrhea were observed among children from communities with a low proportion of households with improved toilet facility (AOR=1.29, 95% CI: 1.01, 1.66) compared to those from communities with a high proportion of households with improved toilet facility. We found that individual- and community-level factors were associated with child diarrhea in Eswatini. Programmes and policies that aim to mitigate child morbidity due to diarrhea should pay attention to the individual and community factors.

Associations of WHO/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia: a cross-sectional study

OBJECTIVE

To determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia.

DESIGN

A community-based cross-sectional study.

SETTING

Bishoftu town, Ethiopia, January-February 2022.

PARTICIPANTS

A total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected.

OUTCOME

The response variable was diarrhoeal disease among children under 5 years.

RESULTS

The 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother's age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child's age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease.

CONCLUSION

In this study, diarrhoea among children is a significant health issue. Child's age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.

Determinants, inequalities, and spatial patterns of diarrhea in the Peruvian under-five population: findings from nationally representative survey data

Objective

To determine the associated factors, decompose the socioeconomic inequalities, and analyze the spatial distribution of childhood diarrhea in Peru.

Methods

A cross-sectional analytical study was conducted using data from the National Demographic and Family Health Survey 2021. The dependent variable was the presence of diarrhea in the last two weeks. Three types of analysis were performed: (i) to evaluate the associated factors, generalized linear models of the Poisson family with logarithmic link were applied and prevalence ratios with their 95% confidence intervals were reported; (ii) for the analysis of inequalities, a decomposition of the Erreygers concentration index was performed using a generalized linear model; and (ii) a spatial autocorrelation analysis, hot spot analysis and cluster and outlier analysis were performed.

Results

A total of 18,871 children under 5 years of age were included. The prevalence of diarrhea in this population was 10.0%. Determinants such as being aged 0-23 months, being male, belonging to the poorest, poorer and rich wealth index, and residing in the Highlands and Jungle increased the probability of presenting diarrhea. In the decomposition analysis, diarrhea had a pro-poor orientation, with the greatest contributors were age 0-23 months, belonging to the poorest and poorer wealth indexes, and residing in the Highlands and Jungle. Spatial analysis showed that the highest concentrations and occurrence of this event were observed in departments of the Highlands and Jungle.

Conclusion

Government institutions seeking to reduce the numbers and burden of childhood diarrhea should focus their strategies on promoting hygiene measures and improving access to water and sanitation services, especially in poor populations living in the Peruvian Highlands and Jungle.

Factors associated with diarrhea in children under 12 years of age referred to Ostad Motahari hospital of Jahrom in 2020

Background and Objective

Despite the relatively high prevalence of diarrhea among children, clinical features and factors associated with the incidence of diarrhea in children have not been yet studied in Jahrom. Therefore, this study aimed to determine the factors associated with diarrhea in children under 12 years of age referred to Ostad Motahari Hospital of Jahrom, Iran, in 2020.

Materials and Methods

The present study was a descriptive cross-sectional study, in which 385 children under 12 years of age with diarrhea complaints were selected using the census sampling method. The checklist used to collect data included patient-related factors, maternal factors, family factors, type of diarrhea, and stool test.

Results

There was a significant relationship between the availability of proper hand-washing facilities, the use of water purifier, a history of antibiotic use, and the incidence season with a possible factor of diarrhea, type of diarrhea, the frequency of diarrhea per day, and pus cell outcome (P < 0.0001). However, no statistically significant relationship was observed between the availability of safe drinking water, travel history of patients, and consumption of raw or undercooked foods with a possible factor of diarrhea and OB/OP results (P < 0.05).

Conclusion

Recognizing environmental risk factors to inform parents about preventing diarrhea in children can be an effective strategy to avoid imposing a heavy financial burden on the health system.

Prevalence of overweight/obesity and associated factors among under-five children in Ethiopia: A multilevel analysis of nationally representative sample

Background

Childhood overweight and obesity are emerging public health challenges of the twety-first century. There was a 24% increase in the number of overweight children under the age of 5 years in low-income countries. Despite the significant risk of childhood overweight/obesity for non-communicable diseases, premature death, disability, and reproductive disorders in their adult life, little attention has been given. Therefore, we aimed to assess the prevalence of overweight/obesity and associated factors among under-five children.

Methods

This study was conducted using data from a nationally representative sample of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). The Mini EDHS was a community-based cross-sectional study that covered all the administrative regions of Ethiopia. The data collection was conducted between March 21, 2019 and June 28, 2019. Both descriptive and analytic findings were produced. The overweight/obesity was measured by the weight-for-height (WFH) index, more than two standard deviations (+2 SD) above the median of the reference population based on the BMI Z-score. To identify significantly asso.

Results

A total of 5,164 under-five children were included in this study cited factors of overweight/obesity, a multilevel binary logistic regression model was fitted to account for the hierarchical nature of the data. Adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI) was reported to show the strength of association and statistical significance. The overall prevalence of overweight/obesity was 2.14% (95% CI: 1.74-2.53). The odds of overweight/obesity was higher among children aged <6 months (aOR = 5.19; 95% CI: 2.98-9.04), 6-24 months (aOR = 1.97; 95% CI: 1.18-3.29), delivered by cesarean section (aOR = 1.75; 95% CI: 1.84-3.65), living in Addis Ababa city (aOR = 2.16; 95% CI: 1.59-7.81), Oromia region (aOR = 1.93; 95% CI: 1.71-5.24), having mothers with the age 40-49 years (aOR = 3.91; 95% CI: 1.90-16.92), uses traditional contraceptive methods (aOR = 2.63; 95% CI: 1.66-10.47) and households headed by male (aOR = 1.71; 95% CI: 1.84-3.48).

Conclusion

This study showed that the prevalence of overweight/obesity among under-five was low in Ethiopia. There were several factors that affect childhood overweight/obesity including child age, maternal age, mode of delivery, sex of head of household, contraception use, and geography of residence. Therefore, strategies to reduce childhood overweight and obesity should consider an identified multitude of contributing factors.

Water, Sanitation, and Hygiene Service Ladders and Childhood Diarrhea in Haramaya Demographic and Health Surveillance Site, Eastern Ethiopia

BACKGROUND

The WHO/UNICEF Joint Monitoring Program (JMP) service ladders are worldwide indicators for monitoring drinking water, sanitation, and hygiene elements of the sustainable development goal targets. However, evidence on how the prevalence of childhood diarrhea looks across the service ladders is limited. This study aimed to assess the relationship between WASH service ladders and the prevalence of childhood diarrhea in Haramaya Demographic and Health Surveillance site, Eastern Ethiopia.

METHODS

A cross-sectional study using a structured questionnaire, observational checklist, and water quality analysis was conducted on 535 households with children under 5 years of age. Poisson regression with a robust error variance estimator was used to investigate the relationship between dependent and independent variables.

RESULTS

The prevalence of diarrhea among under-five children in the surveillance site was 24.8% (95% CI: 22.3-27.6). The regression model revealed that water and sanitation service ladders were associated with childhood diarrhea. Childhood diarrhea was found to be 73% (APR = 0.27; 95% CI: 0.12-0.57) less common in families with a basic water service ladder than in households with a surface water service ladder. In addition, children in households with basic sanitation services had 83% (APR = 0.17; 95% CI: 0.05-0.56) lower diarrhea prevalence than children in households where open defecation was practiced.

CONCLUSION

The present study found that childhood diarrhea differed considerably among WASH service levels and continues to be a serious health problem at the surveillance site. This study also shows that much work is needed to improve WASH services.