Study design and setting
A community based cross sectional study was conducted from March to April 2017 in Halaba- special woreda, Southern, Ethiopia. Halaba-special woreda is located in the South west 315 km from Addis Ababa (the capital city of Ethiopia) and 89 km from Hawassa(capital city of SNNP regional state) in the Sothern direction.
Single population proportion formula was used to determine the sample size for the first objective using Open Epi version 7 and considering the following assumptions: 95% confidence level (1.96), Margin of error (0.05), expected prevalence of children with diarrhea from similar study conducted in Arbaminch district 19.6%(25) ,we had been consider 5% margin of error for P = 19.6%,design effect of 2 and adding 10% of the none respondent’s. The final sample size was 530
Multi-stage sampling procedures were used; first by selecting 16 kebeles (more than 20%) from the total seventy nine (79) kebeles using lottery method. From a total of 2582 households with under- 5 children in the selected kebeles were registered from family folders. Households were allocated to each Keble based on proportional to size, then systematic sampling (every kth households), (k was determined by, study population (2582 hh)/sample size (530) = 5), from households with under- five children was identify and register sequentially using family folders in the kebeles were include for the study. In case, where there were more than one under-five children in the same household, only one child was selected by lottery method to take information on child’s health characteristics. Similarly in case, where there was more than one mothers/ care givers of under-five children in the same households, only one mothers/care givers was select by lottery methods.
Data Collection Tool And Procedure
Data was collected using WHO/ UNICEF and EDHS standard questionnaire(4). The questionnaire was written in English, translated into Amharic (local language), and then translated back into English to assure its consistency. The respondents were primarily mothers of eligible children-under five years of age, but in the absence of the mother, the next primary caregiver was interviewed. Pretest was done in 5% the respondents in another kebele of Halaba special district of Southern Ethiopia. The result of the pretest was used to correct some unclear ideas and statements. Five data collectors who were clinical nurses & two supervisors (Health Officers and BSC nurses) were trained for two days. House-to-house visit and interview of mothers/ care takers of under-five children was performed. The data collection was supervised by the supervisors and the principal investigator at the center. Their role was to daily check the consistency, clarity and completeness of the collected questionnaires. Incomplete and inconsistent data’s were identified and necessary corrections were made during the data collection time.
Outcome (Dependent) Variable
Two weeks prevalence of diarrhea
Explanatory (independent) Variable
Demographic & Socioeconomic status: income, place of residence, household size, maternal age, age of the child, maternal education, ethnicity, number of children, occupation, marital status, religion, etc.
Environmental & sanitation: type of water source, distance to the water source, amount of daily water consumption, availability of latrine, number of rooms, livestock in house, refuse disposal, etc.
Behavioral factors: method of water drawing and storage, feeding practices, action for diarrhea, duration of breast-feeding, time of introducing supplementary feeding, Vaccination status etc.
Data management and analysis
The data was entered using Epi data software and analyzed using SPSS version 20. The data was checked before entering in to the software and cleaning before analysis. We were conducting Bivariate and Multivariate analysis to see the possible associated factors with diarrhea, with 95% CI. Variables with p- value less than or equal to 0.25 during Bivariate analysis were enter into multivariate logistic regression models to control the effect of confounders. We reported the results as adjusted odds ratio (AOR) and 95% confidence intervals.
Ethical approval was obtained from Institutional Review Board of Hawassa University, college of medicine and health science. Permission was also obtained from concerned body of Halaba special district health office. Consent was obtained from the mothers/caretakers of the children after clear explanation about the aim of the study. Confidentiality and privacy was maintained during data collection, analysis and reporting in which the information obtains from the respondents was not share with anyone other than the data collectors and principal investigators. Children with diarrhea during the data collection process were given ORS and health education relates to diarrhea by the data collectors and advised their family to taken them the nearby health institutions for better management.