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

Abstract

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.

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

“…The present study also showed that children to mothers who currently work had higher odds of diarrhea compared to mothers who do not work currently. This finding is in line with other studies in Ethiopia and some sub-Saharan countries [ 13 , 14 , 17 ]. This could be because mothers who currently work might not have enough time to care their children since they spend most of their time at work to increase family income while mothers who do not work currently usually have time to care their children and can minimize the exposure of their children from contaminated objects.…”

“…Inadequate quantities and quality of drinking water and lack of sanitation facilities cause the death of millions of the world’s poorest people through diarrheal diseases each year [ 9 , 10 ]. Furthermore, studies revealed that age of child [ 11 – 15 ], maternal education [ 11 , 12 , 16 ], lack of awareness of mothers/caregivers [ 17 , 18 ], lower socio-economic status [ 12 ], distance and source of drinking water [ 11 , 19 , 20 ], latrine and hand washing facilities [ 21 , 22 ], breast feeding [ 21 , 23 ], place of residence [ 14 , 22 , 24 ], disposal of children’s stool [ 24 – 26 ], family size [ 17 , 27 ], number of under-five children in the household [ 13 , 18 ], maternal age [ 19 , 20 ] and maternal employment status [ 13 , 17 , 19 , 28 ] as the determinant factors of diarrhea among under-five children.…”

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

“…The study further reported measles vaccination was associated with reducing diarrhea in vaccinated children by 22% in the Democratic Republic of Congo, 21% in Nigeria, 19% in Pakistan, and 12% in India. 50 The link between measles vaccination status and associated diarrheal morbidity reduction was in line with previously conducted studies in different corners of the globe, in India, 56 Zimbabwe, 57 and Brazil. 58 Moreover, in the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) agenda which is initiated by WHO and UNICEF, measles vaccination has been introduced as a preventive measure to end preventable child deaths from pneumonia and diarrhea by 2025.…”

“…16 And was also consistent with previously conducted studies in Ethiopia. 41 , 42 , 49 - 51 The other possible reason for this could be attributed to the fact that at this age children crawling and walking on the ground may have an increased probability of exposure to pathogenic microorganisms from the environment. This pattern was consistent within many low-income countries.…”

A Multilevel Analysis of Factors Associated with Childhood Diarrhea in Ethiopia

“…For example, 2 studies by Messelu et al 20 and Nigatu et al 21 were survey-specific, while the others focused on geographical disparities of childhood diarrhea. 22 , 23 …”