Country characteristics and acute diarrhea in children from developing nations: a multilevel study

Abstract

BackgroundEach year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries.MethodsThis study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank.ResultsThe prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117–1.663) and country’s low income (OR = 1.488; 95 % CI 1.024–2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother’s lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900–0.944), age of the child (OR = 0.978; 95 % CI 0.978–0.979), immunization status (OR = 0.821; 95 % CI 0.799–0.843), normal birthweight (OR = 0.879; 95 % CI 0.834–0.926), maternal age (OR = 0.987; 95 % CI 0.985–0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283–1.564), working status of the mother (OR = 1.136; 95 % CI 1.106–1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753–0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923–0.975), and household wealth (OR = 0.948; 95 % CI 0.921–0.977).ConclusionsInequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the country.

Risk Factors for Undernutrition and Diarrhea Prevalence in an Urban Slum in Indonesia: Focus on Water, Sanitation, and Hygiene

“…In a multilevel study in developing countries, including Indonesia, high wealth was reported as a preventive factor for diarrhea in children under 5 years. 29 This present study showed that children from middle-income households had lower risk of diarrhea prevalence than children from lowincome households (Table 5). Generally, children under 5 years old are more likely to suffer from infectious disease than those of other ages; however, this study revealed that diarrhea prevalence was higher in children older than 5 years (14.8%) than in those under 5 years (11.4%).…”

Non-specific effects of childhood vaccines on acute childhood morbidity among HIV-exposed children in sub-Saharan Africa: a multilevel analysis

“…19 A multinational study on acute diarrhoea in developing countries among both immunised and non-immunised children shows that country inequalities, maternal illiteracy and unemployment were greatly associated with diarrhoea. 20 Female children, normal birthweight, older children, complete immunisation coverage, advanced maternal age, planned pregnancy, good sanitation and rich household were associated with reduction in episodes of diarrhoea. 20 Furthermore, the findings from the multinational studies.- 18,20 involved children that were both immunised and unimmunised.…”

“…20 Female children, normal birthweight, older children, complete immunisation coverage, advanced maternal age, planned pregnancy, good sanitation and rich household were associated with reduction in episodes of diarrhoea. 20 Furthermore, the findings from the multinational studies.- 18,20 involved children that were both immunised and unimmunised. The study participants were both HIV-exposed and non-exposed children.…”

Socioeconomic factors associated with dysentery in children under-five years from developing countries

“…In a recent study, we evaluated the relationship between some characteristics of developing countries and the occurrence of diarrheal disease. We concluded that residents of nations with higher inequality and lower incomes have greater probabilities of having diarrhea, especially when there is a lack of household wealth and mother’s education [9].…”

“…Other factors that showed strong positive association with diarrhea were female sex of the child, younger age of the child, incomplete immunization status, birth weight, lack of education of the mother and an unemployed mother [9].…”