Risk factors of diarrhea of children under five in Malawi: based on Malawi Demographic and Health Survey 2015–2016

Abstract

Background: Diarrhea of children under 5 in Malawi, a high-burden country for diarrhea, accounted for 7% of under-5 mortality in 2017. Preceding studies have revealed the association between diarrhea of under-fives and characteristics of children and households including water, sanitation and hygiene (WASH). There has been limited household-level analysis regarding diarrhea in Malawi, thus the aim of our study is to identify risk factors of diarrheal disease among children under 5 in Malawi. Methods: Data set for this study were drawn from the Malawi Demographic and Health Survey conducted in 2015-2016 and 14,872 children were selected as study samples. Independent variables included social-demographic characteristics, household living conditions and WASH environment. Variables that had a P-value lower than 0.05 in the simple logistic analysis were included in multiple logistic regression model. Results: Approximately 20% of children had diarrhea within 2 weeks. In multiple model, demographic characteristics of sex and age of child, size of child at birth, region, mother's age and working status were associated with the risk of diarrhea. Regarding WASH environment, 30 minutes or longer to get water (adjusted odds ratio [AOR], 1.184; 95% confidence interval [CI], 1.045-1.342), unimproved toilet facilities (AOR, 1.185; 95% CI, 1.088-1.291), toilet facilities located in yard/plot (AOR, 1.344; 95% CI, 1.056-1.711) and elsewhere (AOR, 1.375; 95% CI, 1.048-1.805), and lack of handwashing facility with water and soap (AOR, 1.180; 95% CI, 1.010-1.379) increased the odds of diarrhea. Conclusion: The findings of this study showed that socio-demographic characteristics and poor conditions of WASH increased the diarrheal risk of young children. The location of toilet facility implies that proximity is important, but it is necessary to determine the location according to local circumstances. Our study suggests that WASH infrastructure and behavior change strategies need to prioritize Malawi's vulnerable groups.

Association between Rainy Season and Diarrhea in 13- to 24-Month-Old Toddlers

“…4 Some studies found that boys are more likely to get diarrhea than girls as they do more environmental activities. 4,13 This is contradictory to what was found in this study. This study supports studies by Yusuf 14 and Anyorikeya 6 that also found more female diarrhea patients than males.…”

“…Diarrheal disease is most prevalent in children under the age of two, notably between the age of 12 and 23 months according to Moon et al. 13 Diarrhea case is particularly high between the age of 12 and 23 months because the maternal antibodies have started declining since birth. However, the immune system starts developing after the age of two from repeated environmental exposures.…”

Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People’s Democratic Republic: A Cross-Sectional Study

“…A cross-sectional study involving 347 households in rural Bangladesh showed that children U5 whose family members washed their hands with soap after defecation were significantly less likely to experience a diarrhea episode in the 48 h preceding the survey compared to children whose family members washed their hands with water only [ 26 ]. A cross-sectional study in Malawi, which used Demographic and Health Survey data, showed that the lack of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 [ 27 ]. In contrast, the main finding of the present study is not consistent with the findings of a study conducted in Saravan province of the Lao PDR.…”

“…The scoring factor of the asset was 0.301 for television, 0.357 for refrigerator, 0.334 for fan, 0.225 for water pump, 0.206 for air conditioner, 0.313 for washing machine, 0.191 for CD/DVD player/home theatre, 0.327 for iron, 0.347 for rice cooker/steam cooker, 0.246 for watch, 0.211 for bicycle, 0.196 for motorcycle/scooter, 0.005 for animal-drawn cart, 0.258 for car/truck/van, 0.044 for boat with a motor, and 0.060 for Tak Tak. Area In the LSIS II, area was divided into three categories: “urban,” “rural with road,” and “rural without road.” In the present study, “rural with road” and “rural without road” were combined into one category, titled “rural,” according to similar studies [ 27 ]. In the LSIS II, the definition of urban/rural followed the Lao Statistics Bureau’s village register in 2015: a village was classified as urban if it met at least three out of the following five conditions: (a) the village is situated in a district or provincial center, (b) more than 70% of the total households in the village use electricity, (c) more than 70% of the total households in the village use piped water, (d) the village is accessible by road throughout year, and (e) the village has a permanent market that is operating daily [ 41 ].…”

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

“…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.…”