Breastfeeding can offer protection against childhood diarrhoea . Human milk glycans contain oligosaccharides in their natural and conjugated forms, constitute a natural immunological mechanism that accounts for the manner in which human milk offers a protective effect for breastfed infants against diarrhoea . These glycans found in human milk function as soluble receptors against pathogens from adhering to their target receptors on the mucosal surface of the children’s gastrointestinal tracts . Also, optimum breastfeeding tends to prevent infants from consuming other fluids and foods that may be unwholesome. By so doing, infants’ immune systems are fortified adequately to counteract any infections that may lead to diarrhoea .
Studies in sub-Saharan Africa have documented the protective effect breastfeeding has on the occurrence of diarrhoea among children [16, 17]. Findings from this study indicated that exclusive breastfeeding had a protective effect on the occurrence of childhood diarrhoea. Thus, children who were not breastfeeding, predominant breastfeeding, and partial breastfeeding were at a much higher risk of contracting diarrhoea than those who were exclusively breastfed. The protective effect of breastfeeding was still evident after controlling for other potential factors. This suggests that breastfeeding could minimize episodes of childhood diarrhoea, other factors over-shadow this effect. Probably, mothers or caregivers do not comply with breastfeeding recommendations or with basic hygienic processes in feeding children thereby creating a conducive environment for diarrhoea causing pathogens. In other instances, although children may be breastfeeding adequately, diarrhoea may occur especially when the foods are contaminated or not well prepared.
Moreover, the environment in which breastfeeding children live could predispose them to some morbidity; either in an urban area or in a rural setting. Place of residence, as an indirect factor, was found to be significantly associated with diarrhoea in this study. Children in rural areas were much burdened with the occurrence of diarrhoea. For instance, the consumption of contaminated foods, drinking of unimproved water, poor handling of water, poor socioeconomic status, lack of proper sanitation and poor hygiene are some factors deemed to individually or collectively overshadow the protective effect of breastfeeding, therefore, contributing to higher prevalence of diarrhoea in rural environments . Although diarrhoea cases are common in urban areas especially in urban slums, children in rural areas are more disadvantaged . Most rural areas in the country are noted for unfavourable health and environmental conditions and are also associated with cultural beliefs that may act as agents for the frequent occurrence of childhood diarrhoea [20, 21].
A birth interval of a mother is critical to determining the health outcomes of her children. A finding showed that the preceding birth interval of a mother was significantly associated with reported episodes of diarrhoea among children. As documented by Fotso, Cleland, Mberu, Mutua and Elungata  in Kenya, shorter preceding birth interval tends to lessen the time required for a mother to adequately feed younger children and that could lead to diarrhoeal morbidity and mortality. Children whose mothers had a preceding birth interval of 24 months or more were more likely to have episodes of diarrhoea. This is intriguing since such breastfeeding mothers are deemed to have ample time to cater to their children. On the contrary, children with a previous birth interval of less than 18 months had a higher risk of dying from certain causes of death, including sepsis and diarrhoea than children with a previous birth interval of 24–35 months . For this reason, education programmes on birth spacing tailored into activities of nurses at the various community-based planning and services compounds should be beneficial to the health of children to all mothers despite their preceding birth interval.
It has been asserted that infants who are partially breastfed have higher odds of experiencing diarrhoea compared to those exclusively breastfed . Even at instances where children are optimal breastfed and given unwholesome water, they would be at risk of diarrhoeal infections. It was found that the source of drinking water used by breastfeeding mothers contributed to childhood diarrhoea. Unimproved sources of water that are mostly contaminated account for a high proclivity of exposing children to diarrhoeal diseases. Elsewhere, studies have found that the use of an unimproved source of drinking water is associated with diarrhoea among infants and young children [25, 26]. Continuously educating mothers on the fact that breastmilk contains 80 per cent and exclusively breastfed children do not need to drink water would be imperative to curtailing diarrhoea cases. It would also be necessary for household visitations to be made by community nurses to educated mothers practising sub-optimal breastfeeding to use improved sources of water or carefully treat unimproved water sources before using them to prepare complementary foods for their children.
Children with mothers who used unimproved toilet facilities had higher odds of experiencing diarrhoea. This implies that in the midst of optimal breastfeeding, children would still have higher chances of experiencing diarrhoea if their households use unimproved toilet facilities. The usage of unimproved toilet facilities could expose mothers to getting in contact with diarrhoeal pathogens. At instances where mothers do not practice adequate personal hygiene, they can transmit these pathogens to their children in the process of breastfeeding, handling or preparing complementary foods. Even the manner in which the stools of children are disposed of in unimproved toilets equally predisposal pathway to childhood diarrhoeal episodes.
The main strength of this study is that it used a large nationally representative data set to analyze breastfeeding practices and childhood diarrhoea in the country. This was done using various variables at the individual, community, health, and environmental levels. Notwithstanding these strengths, limitations embedded in this study include the inability of it to assign any causality to its findings. Also, there is likely to be a recall bias since mothers reported diarrhoea cases within the last two weeks preceding the surveys. In addition, the prevalence of diarrhoea may vary seasonally and data for this study were collected between September and December, hence, interpretation of results should be linked to this time period. To present or minimize the limitations outlined, it would be prodent, in future, to conduct longitudinal cohort studies on breastfeeding practices and childhood diarrhoea among children less than two years.