Behavioral and environmental determinants of acute diarrhea among under-five children from public health facilities of Siyadebirena Wayu district, north Shoa zone, Amhara regional state, Ethiopia: Unmatched case-control study

Background Acute diarrhea is a major public health problem in the world. Next to pneumonia, it is the leading cause of death in children under five years old. Globally, even though childhood diarrhea disease kills millions, the interaction of socio-demographic, behavioral, and environmental factors of acute diarrhea in children aged 6–59 months is not investigated yet in the current study area. Objective To determine behavioral and environmental predictors of acute diarrhea among under-five children from public health facilities of Siyadebirena Wayu district, North Shoa, Amhara Regional State, Ethiopia, 2019. Methods A facility-based unmatched case-control study was conducted from March 12, 2019, to May 12, 2019. A total of 315 under-five children were included in the study (105 cases and 210 controls). A systematic random sampling technique was used to select study participants. Data were collected by a structured questionnaire and analyzed by using SPSS. To analyze the data, bivariable and multivariable logistic regression analysis was used. Results The study showed that average family monthly income of 12–23 USD (AOR = 6. 22; 95% CI: 1.30, 29.64), hand washing practice of mothers/ care givers with water only (AOR = 3.75; 95% CI: 1.16, 12.13), improper disposal of infant feces (AOR = 11.01; 95% CI: 3.37, 35.96), not treating drinking water at home (AOR = 9.36; 95% CI: 2.73, 32.08), children consuming left-over food stored at room temperature (AOR = 5.52; 95% CI: 1.60, 19.03) and poor knowledge of the respondents about the risk factors for diarrhea were the determinants that significantly associated with acute childhood diarrhea. Conclusion The potential predictors of childhood diarrhea morbidity were improper hand-washing practice, not treating drinking water at home, unsafe disposal of children’s feces, children consuming left-over food stored at room temperature, and having poor knowledge about the major risk factors for diarrhea. Thus, awareness of the community on hygiene and sanitation focusing on proper handling of human excreta, safe water handling, proper hand washing practice, and proper management of leftover food should be enhanced to prevent children from acute diarrhea diseases.

Association between Attitude towards Wife Beating and Childhood Diarrhea: A Demographic and Health Survey-Based Study in 25 Sub-Saharan African Countries

Background. Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children. Methods. We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI). Results. The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54–0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women’s age (35–39 years-aOR = 0.48, 95% CI; 0.31–0.74, 40–44 years-aOR = 0.57, 95% CI; 0.35–0.93, 45–49 years-aOR = 0.35, 95% CI; 0.16–0.79) was negatively associated with childhood diarrhea, while husband’s education (primary school-aOR = 1.36, 95% CI; 1.05–1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09–1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14–2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44–8.83) were positively associated with diarrhea among under-five children. Conclusions. The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea.

Does attitude towards wife beating determine infant feeding practices during diarrheal illness in sub-Saharan Africa?

Background Inappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment—measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA. Methods We analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17–3.48). Conclusion The findings suggest that women’s disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.

The association of socio-demographic and environmental factors on childhood diarrhea in Cambodia

Background: Diarrhea diseases remain the leading cause of death among children under-five in lower and lower-middle-income countries. This study was conducted to investigate the factors related to diarrhea among children aged 12 to 35 months in Cambodia. Methods: We analyzed cross-sectional data from the Cambodia Demographic and Health Survey 2014 using a combination of household and children’s datasets. A generalized linear mixed model was used to analyze the determinant factors of diarrhea. Results: The survey included 2,828 children aged 12 to 35 months. The prevalence of diarrhea in the last 2 weeks was 16.44% (95% CI: 14.72%-18.31%). Factors significantly associated with childhood diarrhea were: maternal unemployment (AOR = 1.43; 95% CI: 1.14-1.78); the child being male (AOR = 1.25; 95%CI: 1.02-1.53); the presence of unimproved toilet facilities (AOR = 1.17; 95%CI: 1.05-1.31); and unhygienic disposal of children’s stools (AOR = 1.32; 95%CI: 1.06-1.64) when controlling for other covariates. Both maternal age (one year older; AOR = 0.85; 95%CI: 0.78– 0.93) and child age (one month older; AOR = 0.86; 95%CI: 0.78-0.94) had significant negative associations with the occurrence of childhood diarrhea. Conclusion: Childhood diarrhea remains a public health concern in Cambodia. Intervention programs should focus on reducing diarrheal diseases by constructing improved toilet facilities and promoting behavior to improve hygiene, specifically targeting younger mothers.

A Multilevel Analysis Factors Associated With Diarrhea Among Under-five Children in Ethiopia Using 2016 EDHS Data: Individual and Community Level Factors.

Background: Despite numerous attempts, diarrhea remains one of the leading causes of death among children under the age of five around the world. Globally, diarrhea is the second prominent cause of death in children next to pneumonia. Every year, there are 1.7 billion children who develop diarrhea and at least 525,000 die from diarrhea. In low- and middle-income countries such as Ethiopia, diarrhea still remains one of the health problems due to its high morbidity and mortality. This study was conducted identify factors associated with diarrhea at community (cluster) level and individual level.Objectives: To assess individual and community level factors of childhood (0–59months) diarrhea in Ethiopia by using the 2016 Ethiopian Demography and Health surveys (EDHS) data, 2020. Methods: A cross-sectional secondary analysis of data pooled from 2016 Ethiopian Demographic and Health Surveys (EDHS) data was used. The analysis was done using Stata version 14.2. A multilevel logistic regression model was used to identify independent predictors of childhood diarrhea. Odds ratio with 95% CI was used in identifying the association between dependent and independent predictors Result: The prevalence of diarrhea in Ethiopia based on EDHS 2016 was 11.78%.The odds of diarrhea among children reside in rural area were 1.84 times more likely to develop diarrhea (AOR=1.82; 95% CI: 1.52-2.16) as compared to urban dwellers. Those children aged between 13 and 24 months were 2.2 times more likely to have diarrhea than (AOR=2.2, 2.15-2.98) their older counter parts (48-59 months). The measure of variation was also assessed by using ICC, MOR, and DIC with the result of 10.08, 1.56 and 316.18 respectively.Conclusion: Our findings identified that childhood diarrhea was affected by not only individual level factors but also community-level factors. At the individual level (age of the women, number of under five children in the households, age of the child, number of family members, maternal education, and the number of under-5 children) and the community-level, place of residence were significant factors associated with childhood diarrhea in Ethiopia.