Childhood diarrhea in high and low hotspot districts of Amhara Region, northwest Ethiopia: a multilevel modeling

Abstract

BackgroundChildhood diarrhea is one of the major public health problems in Ethiopia. Multiple factors at different levels contribute to the occurrence of childhood diarrhea. The objective of the study was to identify the factors affecting childhood diarrhea at individual and community level.MethodsA cross-sectional study design was employed from February to March 2015 in high and low hotspot districts of Awi and West and East Gojjam zones in Amhara Region, northwest Ethiopia. Districts with high and low hotspots with childhood diarrhea were identified using SaTScan spatial statistical analysis. A total of 2495 households from ten (five high and five low hotspot) randomly selected districts were included in the study. A semi-structured questionnaire was used to collect data. Data were entered and cleaned in Epi Info 3.5.2 version and analyzed using Stata version 12. A multilevel logistic regression was used to identify factors associated with childhood diarrhea.ResultsThe prevalence of childhood diarrhea was 13.5 % and did not show significant variation between high [14.3 % (95 % CI 12.3–16.2 %)] and low [12.7 % (95 % CI 10.9–14.6 %)] hotspot districts. Individual- and community-level factors accounted for 35 % of childhood diarrhea variation across the communities in the full model. Age of children (6–35 months), complementary feeding initiation below 6 months, inadequate hand washing practices, limited knowledge of mothers on diarrhea, lowest wealth status of households, and longer time interval to visit households by health extension workers were factors for increasing the odds of childhood diarrhea at the individual level. At the community level, lack of improved water supply and sanitation and unvaccinated children with measles and rotavirus vaccine were the factors associated with childhood diarrhea.ConclusionsIn this study, childhood diarrhea occurrences remained high. Both individual- and community-level factors determined the occurrence of diarrhea. Interventions should consider both individual- and community-level factors to reduce the occurrence of childhood diarrhea.Electronic supplementary materialThe online version of this article (doi:10.1186/s41043-016-0052-2) contains supplementary material, which is available to authorized users.

Environmental factors affecting childhood diarrheal disease among under-five children in Jamma District, South Wello zone, northeast Ethiopia

“…The finding of this study showed that children aged 6 to 23 months were at high risk of developing diarrhea than children two years old. This finding is in agreement with other studies conducted in Arbaminch and Benishangul Gumuz, and districts of the Amhara region (7,15,19). Children above the age of 6 months are at the age where they are introduced to foods other than breast milk, this may expose their undeveloped immunity to infectious agents causing diarrhea.…”

“…This study found a significant association between diarrheal disease and lack of latrine which is supported by another study conducted in Derashe town (21), northwest Ethiopia (7) and Ghana (22).…”

Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia

“…Moreover, using water collected from unprotected (unimproved) sources for cooking/washing or for other domestic purposes was also a risk factor for childhood diarrhea in this study. This study finding is similar to studies done in northwest Ethiopia, Tamale Metropolitan Area of Ghana, South African Villages and Nigeria [32,[38][39][40].…”

Trends and Determinants of Diarrhea Among Under-Five Children in Ethiopia: Cross-Sectional Study Design: Multivariate Decomposition and Multilevel Analysis Based on Bayesian Approach Evidenced by EDHS 2000-2016 Data.

“…The study revealed that children who were not vaccinated for rotavirus and measles were more risk to experience diarrhea as compared to those children who were vaccinated. This finding was in agreement with the previous study conducted in Ethiopia, 45 . Measles is a highly contagious disease which disrupts the epithelial cells and suppresses the immune system leading to infection in various organ systems and protein losing enteropathy 46 .…”