3.1 Descriptive statistics analysis
Table 1 presents the characteristics of children under five years of age included in this study. A total of 19,561 children were included, with 7,289 (37.3%) experiencing childhood diarrhea. Out of the study sample, 51.5% were male and 48.5% female. The distribution of children according to age was 0-5 months (9.8%), 6-11 months (10.5%), 12-23 months (20.1%), 24-35 months (21.1%), 36-47 months (20.5%) and 48-59 months (20.5). Maternal education levels varied; a majority (40.4%) of mothers or caregivers had no formal education, less than 5% had attained a higher education level, while the remainder had received varying degrees of formal schooling. In a rural-urban split, a rural domicile was observed for approximately three-quarters (72.4%) of the sampled children below five years old. With regard to the wealth status of households, the distribution ranged from as minimum as 17.2% for richest category to as maximum as 23.7% for poorest category. In addition, 79.2% of the households had been drinking water from an improved source and 60% of the households used an improved sanitation system.
Table 1 Socio-demographic and households characteristics of the study sample
Variables
|
Frequency
|
Percentage
|
Child age (months)
|
0-5
|
1909
|
9.8
|
6-11
|
2061
|
10.5
|
12-23
|
3927
|
20.1
|
24-35
|
4119
|
21.1
|
36-47
|
4013
|
20.5
|
48-59
|
3532
|
18
|
Gender
|
Male
|
10073
|
51.5
|
Female
|
9488
|
48.5
|
Mother’s education
|
No formal education
|
7909
|
40.4
|
Primary education
|
5002
|
25.6
|
Lower secondary education
|
2394
|
12.2
|
Upper secondary education
|
3360
|
17.2
|
Higher education
|
896
|
4.6
|
Household Wealth
|
Poorest
|
4630
|
23.7
|
Poor
|
4000
|
20.4
|
Middle
|
3750
|
19.2
|
Rich
|
3817
|
19.5
|
Richest
|
3364
|
17.2
|
Place of residence
|
Urban
|
5389
|
27.6
|
Rural
|
14172
|
72.4
|
Source of drinking water
|
|
|
Unimproved
|
4064
|
20.8
|
Improved
|
15497
|
79.2
|
Sanitation
|
|
|
Unimproved
|
7821
|
40.0%
|
Improved
|
11738
|
60.0%
|
3.2 Prevalence of childhood diarrhea
Table 2 demonstrates the prevalence of childhood diarrhea stratified by socio-demographic determinants in children under five years of age. A statistically significant disparity in the prevalence was recorded between rural and urban dwellings, with rural areas exhibiting a higher proportion (39.3% compared to 32.6% in urban locales; ). Moreover, a significant differences was observed between maternal education levels and the prevalence of diarrhea in children The analysis also revealed that the highest prevalence of childhood diarrhea was within the poorest households (44.7%), with marked differences when contrasted with other households wealth situations. Age-specific prevalence indicated a higher occurrence in children aged 6–11 months (47.4%) and 12–23 months (48.7%). Gender-based analysis showed no significant variation in the prevalence of childhood diarrhea, with male children presenting a prevalence rate of 38.7%, while females had a rate of 36.1%. The prevalence of diarrhea in those who drink from unimproved water sources was 43.2%. Additionally, households lacking in improved sanitation facilities reported a higher occurrence of childhood diarrhea (43.1%) compared to those with access to better sanitation. Figure 1 depicts the distribution of diarrhea prevalence among children below five years across Yemeni governorates. The figure indicates that AlMahwit Governorate exhibits the highest prevalence rate at 57.1%. This is closely followed by AlJawf Governorate, with a prevalence of 56.9%. In contrast, Socotra Governorate demonstrates the lowest prevalence, with a rate of 4.7%.
Table 2 Prevalence of childhood diarrhea by socio-demographic and households characteristics
Characteristic
|
Prevalence
|
|
Child age (months)
|
|
0-5
|
33.4
|
|
6-11
|
47.4
|
|
12-23
|
48.7
|
|
24-35
|
36.7
|
|
36-47
|
32.0
|
|
48-59
|
28.2
|
|
Gender
|
|
Male
|
38.7
|
|
Female
|
36.1
|
|
Mother’s education
|
|
No formal education
|
38.5
|
|
Primary education
|
38.6
|
|
Lower secondary education
|
36.5
|
|
Upper secondary education
|
36.0
|
|
Higher education
|
29.6
|
|
Household Wealth
|
|
Poorest
|
44.7
|
|
Poor
|
43.0
|
|
Middle
|
37.3
|
|
Rich
|
34.9
|
|
Richest
|
23.7
|
|
Place of residence
|
|
Urban
|
32.6
|
|
Rural
|
39.3
|
|
Source of drinking water
|
|
|
Unimproved
|
43.2
|
|
Improved
|
35.9
|
|
Sanitation
|
|
|
Unimproved
|
43.1%
|
|
Improved
|
33.7%
|
|
3.3 Multivariable analysis
Table 3 reports the results of the logistic regression analysis, which encompass both unadjusted odds ratios obtained from a logistic regression with one predictor (Model I) and adjusted odds ratios obtained from multivariable logistic regression (Model II). The unadjusted logistic regression results demonstrates an inverse association between children age and the incidence of childhood diarrheal episodes. Specifically, children in the 12–23 month age category (UOR: 2.42; 95% CI: 2.199, 2.667) exhibited a higher odd of childhood diarrhea, compared to their older counterpart aged 48-59 months. This trend was similarly observed in children aged 6–11 months (UOR: 2.30; 95% CI: 2.055, 2.578). An increase in odds of childhood diarrhea by more than 20% was also noted among children aged 24-35 months (UOR: 1.48; 95% CI: 1.341 to 1.629), 0-5 months (UOR: 1.28; 95% CI: 1.134 to 1.443) and 36-47 months (UOR: 1.20; 95% CI: 1.088 to 1.327). Gender disparities emerged from the analysis as well; male children faced a statistically significant increase of 12% in diarrheal odds (UOR: 1.12; 95% CI: 1.053, 1.183) compared to female children. The educational level of mothers or primary caregivers has been statistically related to childhood diarrhea. Specifically, a mother's or caregiver's limited education correlates with a 49% increased likelihood of diarrhea in children (UOR: 1.49; 95% CI: 1.280, 1.730), relative to their counterparts whose mothers/caregivers possess higher levels of education. Additionally, the socioeconomic standing of a household, as measured by wealth status, demonstrates a significant association with the prevalence of childhood diarrhea. Children from households classified within the lowest two wealth quintiles, poorest (UOR: 2.61; 95% CI: 2.360, 2.875) and poor (UOR: 2.42; 95% CI: 2.190, 2.682), exhibit higher odds of diarrhea compared to those from households in the richest wealth quintile. In contrast, children residing in households categorized within the middle and upper-middle wealth brackets show increased odds of suffering from diarrheal diseases by 92% (UOR: 1.92; 95% CI: 1.726-2.124) and 73% (UOR: 1.73; 95% CI: 1.557-1.917), respectively, when compared to children from the wealthiest families. The study also illuminates geographical disparities, evidencing a reduction childhood diarrhea risk among urban-dwelling children by approximately 25% (UOR: 0.75; 95% CI: 0.699-0.798) when compared to their rural counterparts. An increase in the risk of childhood diarrhea was also observed in households with unimproved drinking water sources by 36% (UOR: 1.36; 95% CI: 1.265, 1.456), compared to those with improved drinking water sources. Regarding sanitation, the results showed a 49% increase in the odd of childhood diarrhea in households with unimproved sanitation (UOR: 1.49; 95% CI: 1.405, 1.581).
Upon adjusting for socio-demographic characteristics, the results presented in Table 3 suggest a higher odd of childhood diarrhea among children aged 12–23 months (AOR: 2.497; 95% CI: 2.263, 2.755) and 6–11 months (AOR: 2.4; 95% CI: 2.136, 2.695), relative to their counterpart aged 48-59 months. In furtherance, there is a marked incensement in diarrhea risk by approximately 21–51% among children aged 24-35 months (AOR: 1.497; 95% CI: 1.356, 1.652), those ranging from birth to 5 months (AOR: 1.257; 95% CI: 1.112, 1.420), and those between 36-47 months (AOR: 1.210; 95% CI: 1.094, 1.338). In terms of gender differences, male children have a higher odd (AOR: 1.142; 95% CI: 1.076, 1.212) of experiencing pediatric diarrhea than female children. Regarding maternal educational attainment, the children of mothers with varying levels of education, from no formal education to upper secondary education, exhibited odds ratios close to unity as compared to children born to mothers with higher educational levels (No formal education AOR:0.951; 95%CI: 0.808, 1.119, primary education AOR: 1.060; 95%CI: 0.900, 1.248, lower secondary education AOR: 1.112; 95%CI: 0.936, 1.322, upper secondary education AOR: 1.092; 95%CI: 0.925, 1.289), demonstrating no significant association between diarrhea and maternal/caregiver educational level. Furthermore, children born to households classified as poorest and poor encountered increased odds of childhood diarrhea by factors of nearly four (AOR: 3.562; 95%CI: 3.074–4.128) and three (AOR: 3.341; 95% CI: 2.914–3.831), respectively, relative to peers from the richest households. Additionally, significant association between childhood diarrhea and geographic area was noted, with children residing in urban environments exhibiting a one-and-a-half-fold greater likelihood of suffering from childhood diarrhea (AOR: 1.508; 95% CI: 1.363–1.669) compared with their rural counterparts. The study found no statistically significant association between source of drinking water and childhood diarrhea, when comparing unimproved sources (AOR: 0.983; 95% CI: 0.905–1.069). The results further revealed that households relying on unimproved sanitation facilities, such as non-flushing toilets or open latrines, experienced a 21% (AOR: 1.205; 95%CI: 1.121–1.295) increase in the likelihood of childhood diarrhea compared to those with access to improved sanitation systems.
Table 3 Factors associated with childhood diarrhea in Yemeni children under the age of five
Characteristic
|
Unadjusted OR
|
95%
|
Adjusted OR
|
95%
|
Child age (months)
|
0-5
|
1.279*
|
1.134
|
1.443
|
1.257*
|
1.112
|
1.420
|
6-11
|
2.302*
|
2.055
|
2.578
|
2.400*
|
2.136
|
2.695
|
12-23
|
2.422*
|
2.199
|
2.667
|
2.497*
|
2.263
|
2.755
|
24-35
|
1.478*
|
1.341
|
1.629
|
1.497*
|
1.356
|
1.652
|
36-47
|
1.201*
|
1.088
|
1.327
|
1.210*
|
1.094
|
1.338
|
48-59
|
1.00
|
|
|
1.00
|
|
|
Gender
|
Male
|
1.116*
|
1.053
|
1.183
|
1.142*
|
1.076
|
1.212
|
Female
|
1.00
|
|
|
1.00
|
|
|
Mother’s education
|
No formal education
|
1.489*
|
1.280
|
1.730
|
0.951
|
0.808
|
1.119
|
Primary education
|
1.497*
|
1.283
|
1.748
|
1.060
|
0.900
|
1.248
|
Lower secondary education
|
1.370*
|
1.160
|
1.617
|
1.112
|
0.936
|
1.322
|
Upper secondary education
|
1.340*
|
1.142
|
1.573
|
1.092
|
0.925
|
1.289
|
Higher education
|
1.00
|
|
|
1.00
|
|
|
Household Wealth
|
Poorest
|
2.605*
|
2.360
|
2.875
|
3.562*
|
3.074
|
4.128
|
Poor
|
2.423*
|
2.190
|
2.682
|
3.341*
|
2.914
|
3.831
|
Middle
|
1.915*
|
1.726
|
2.124
|
2.534*
|
2.219
|
2.893
|
Rich
|
1.728*
|
1.557
|
1.917
|
1.921*
|
1.722
|
2.142
|
Richest
|
1.00
|
|
|
1.00
|
|
|
Place of residence
|
Urban
|
0.747*
|
0.699
|
0.798
|
1.508*
|
1.363
|
1.669
|
Rural
|
1.00
|
|
|
1.00
|
|
|
Source of drinking water
|
|
|
|
|
|
|
Unimproved
|
1.357*
|
1.265
|
1.456
|
0.983
|
0.905
|
1.069
|
Improved
|
1.00
|
|
|
1.00
|
|
|
Sanitation
|
|
|
|
|
|
|
Unimproved
|
1.491*
|
1.405
|
1.581
|
1.205*
|
1.121
|
1.295
|
Improved
|
1.00
|
|
|
1.00
|
|
|
* = Significant at -value < 0.05; 1.00 = Reference category