The overall prevalence of diarrhoeal disease was 20.9% amongst children below the age of 5 years. Factors such as caregiver’s age, region (east & West), age of child, child’s sex having a radio were found to be significant factors associated with diarrhoea disease. The results of this study were consistent with existing literature that has assessed the prevalence of diarrhoeal illness in Uganda among children. As an example, Omona et al. (2020), Ocamanono (2018), Adeokun and Yaya (2020) and Nambuusi et al. (2020) reported the prevalence of diarrhoeal illness among children to be in a range of 20–34%, where factors such gender, mother’s age and age of child were found to be factors that could either escalate or decrease the occurrence of diarrhoeal illness (8–11). Caregivers that were younger were associated with high odds of diarrhoea as compared to older caregivers. Similar findings were found the study conducted by Omona et al (2020) and George et al (2014). This is due to the fact that older caregivers typically have more expertise caring for children than their younger counterparts, which lowers the prevalence of childhood diarrhoea (12, 13).
Male children are more exposed due to possible malnutrition, thus resulting in diarrhoea as compared to female children (14). Similar findings were observed in research done by Paul (2020) in India and Sarker et al. (2016) in Bangladesh, who report that male children are more likely to experience a high prevalence of diarrhoeal illness (15, 16). Hygiene and sanitation among male children were reported to be generally poor, since there caretakers often do not take them for showers, compared to female (15, 16). Children who come from the Central and Western region had a 35% and 18% reduced risk of suffering from childhood diarrhoeal illness (aOR;0.65; 95% CI:0.56–0.75 & aOR;072; 95%CI:0.65–0.81, respectively). Also, children who were two years older had a 40% reduced risk of suffering from diarrhoeal illness (aOR;0.60; 95% CI:0.49–0.75), compared to those who are 4 years old. A study done by Ssenyonga et al. (2017) in Uganda shows that the Eastern and Northern regions have the highest prevalence of diarrhoeal disease in the country, compared to the Central region (17). This can be explained as that the Northern and Eastern regions have been plagued with rebel insurgencies, which have hindered these regions to progress in terms of establishing and advancing the healthcare systems (18).
In 2015, the WASH interventions were implemented successfully in the Central and Western regions due to the positive collaboration of the community and available partnerships that facilitated in reaching out to the various communities (19).
Also, children who were over the age of two had a 40% reduced risk of suffering from diarrhoeal illness (aOR:0.60: 95% CI:0.49–0.75). In relation to the child’s age, the study findings contradict other published research, because it is expected that as a child grows older, he/she is less likely to experience diarrhoeal disease. Since younger children spend most of their time crawling on the floor and putting their unwashed fingers in the mouth at any time, which makes it easier for them to ingest contaminating agents (20). Education is key in combating childhood diarrhoeal disease. In the study, 13.7% had no formal education and the majority (62.6%) attained primary education level in the study. Even though this was not a significant variable in the study, lower educated people were more likely to be unaware of appropriate hygiene and sanitation measures thus, resulting into increased childhood diarrhoeal illness status (16).
In the assessment of the relationship between environmental factors and childhood diarrhoeal illness, only source of water such as using a well, visitation of health facilities and having received vitamin A dose, were significant factors associated with diarrhoeal illness. In the study, caregivers who used wells as a source of water had reduced odds of their children suffering from diarrhoeal illness, compared to those who use piped water (aOR;0.85; 95% CI:0.73–1.00). The findings of the study were consistent with a study done by Ssenyonga et al. (2017) in Uganda, and by Tumwine et al. (2002) in Mali (17, 21). In Uganda, it is traditional practise that all water collected from the well should be either boiled or treated before using it in the house. At the time of the study, only 15.4% of the caregivers used piped water as source of water with the majority using protected wells. Unprotected wells are strongly linked with diarrhoeal illness due to most of the water being contaminated already with the bacteria or parasites that are responsible for diarrhoeal infection. However, most countries have started treating all their water reservoirs through natural purification, photolysis and chemical water treatments (22).
In this study, caregivers who reported that their children had diarrhoeal illness reported having visited health facilities (21.9%) and that the children that had received a dose of vitamin A (29.5%). In regression analysis, caregivers who visited health care facilities and those whose children received a dose of vitamin A were more likely to report their children to experience diarrhoeal illness. With regard to the vitamin A dosage, most children have only one dose, which may escalate the susceptibility to infectious diseases in children, which can result in diarrhoeal diseases(23) Also, the children that are sick attend the clinic where they will most likely get the vitamin a dose, thus this may not be a direct link to diarrhoea but rather receiving a vitamin A dose, is related to visiting a health facility. Child stool disposal was not found to be significant for the study, nonetheless, improper disposal could lead to increased diarrhoeal illness among children (24).Latrine availability and toilet sharing were other factors that are not significant in the study. However, toilets are very crucial structures in a house to prevent people from randomly defecating anywhere, which can result in the contamination of food and water when faeces are not properly cleared in the environment (25).
The study presents vital findings that add to the existing literature on the prevalence and risk factors of childhood diarrhoeal illness in Uganda with relation to the prevalence and risk factors of diarrhoeal illness. These findings indicate that additional prevention strategies to reduce the observed prevalence in Uganda may be necessary. Therefore, health practitioners’ engagement with the communities to improve education and training on risk factors of diarrhoeal illness and providing them with services that can eradicate the disease may be needed. Although the study shows that education level was not a significant predictor in reducing or increasing childhood diarrhoeal illness, it is still advisable that the country increase awareness of diarrhoeal disease through encouraging caregivers to practise good hygiene. Other interventions designed should include creation of posters & charts that can be placed in every home as a reminder to diarrhoeal issues and prevention.
It is therefore recommended that future studies use mixed methods approach such as conducting a community interviews to aid in better understanding knowledge and perception of the community on risk factors of childhood diarrhoeal illness. Moreover, future research should also seek to establish the extent to which diarrhoeal disease is intentionally or accidentally acquired by children from different backgrounds, thus, such information will assist in developing target interventions.