The findings of this study revealed that the two-week prevalence of diarrhea in under-five children was 24.9% with 95% CI: (20.4, 29.7%). In the factor analysis of this study, the children’s age group, family size, hand wash practice, cooked food retention time, and household income were found statistically significant predictors of childhood diarrheal disease.
In this study, almost a quarter of under-five-children experienced the toll of diarrheal disease (24.9%). This finding is lower than the findings in rural Burundi (32.6%)(17), Hodan district Mogadishu-Somalia (47.9%) (3) and in Arba Minch, Ethiopia (30.5%)(18). This finding is in line with findings from Eastern Ethiopia (22.5%)(15), Bahir Dar Zuria district (20%)(19), rural areas of North Gondar Zone(22.1%)(16), Senegal (26%)(20) and Afar region, (26.1%)(21). However, This find is higher than the findings in Serobo town Jimma (12%)(22), Wolaita Sodo (11%)(23) and the 2016 EDHS national report (12%)(16),Tanzania (6.1%)(24), Northern Nigeria, (12.7%) (9). These differences might be due to the variation in the socio-demographic characteristics, study setting, environmental factors, study period, behavioral characteristics of the study households. This showed that the occurance of diarrheal disease was varied among children in different study areas.
In factor analysis outcome, the present study revealed that young children were more exposed to the burden of diarrheal disease. The odds of childhood diarrhea were higher than in children whose age is less than two years when compared with two years and above age groups. This could be due to multiple reasons such as the young children started crawling and walking which increases environmental exposure for infectious agents, children’s transition period from exclusive breastfeeding to complementary food supplementation that may be contaminated, and less development of immune systems that may easily be affected by diarrheal diseases. This finding is supported with the findings from the study was done in different parts of Ethiopia such as Kersa district, Afar, Benishangul Gumuz, and Sidama zone (15, 21, 25-27).
As shown in this study, the burden of diarrheal disease was about 3.5 times higher among children with lower family incomes than their high-income counterparts. This might be related to the inability to access water, sanitation, and hygiene technologies and to cover direct medical costs as well as it might be a bottleneck to fulfill the necessary dietary components to their children as a result they might become malnourished and increase the risk of acquiring the diarrheal disease. Our study finding is consistent with the findings in India, Bangladesh, Senegal, Nigeria, Rwanda, and Eretria (21, 28-32).
The finding of the current study revealed that lower family size was a protective factor for the burden of childhood diarrhea. This is the fact that high family size might be positively associated with under-five diarrheal disease in which as the number of siblings increases mothers/caretakers are exposed to high burden responsibility in different household activities. As a result, this might be diverted the mother’s attention of care to their children and this may create an abandoned opportunity for children to expose unhygienic environments. This study finding is consistent with findings of other similar studies in Kersa district, Sengale, Wolitta Soddo Town, and Eritrea (15, 20, 23, 28).
The current finding was also obtained a statistically significant association of diarrheal disease with poor hand hygiene practices of child guardians at a critical time. The occurrence of childhood diarrhea was increased by eightfold due to poor hand-washing practices after latrine visits, during child meal preparation, and after refuse handling. The possible explanation might be the high microbial load may be exposed to various health threats as contamination of hands by various types of pathogens. This finding was in line with studies in India, Somalia, Ethiopia in which children’s whose mothers/caretakers are failed to practice good hand-washing at critical times were at higher risk of diarrhea as compared with children’s whose mothers/caretakers who are practicing good hand washing abilities (3, 18, 33).
The outcome of this study was also indicated that odds of diarrheal disease were strongly associated with the time elapsed for the prepared food given to children. The odds of diarrhea among children who feed cooked foods immediately were lower when compared with children who feed cooked foods that are waiting for an undefined period of time. This might be due to some strains of pathogenic agents having the capacity to survive and reproduce in prepared foods through time which leads to diarrheal diseases. In addition, the prepared child food may be exposed to recontamination when stored for a long time. Studies done in Afar and Dessie Ethiopia showed that long storage of cooked food-related problems was strongly associated with under-five diarrheal disease (34, 35).
It is very difficult to establish a causal relationship due to the inherent nature of cross-sectional study design. Recall and/or social desirability biases may be introduced in interview-based data collection. The self-report of mothers/caretakers may cause under or over-estimation of diarrheal disease outcomes.