Descriptive Results of Socio-demographic, Environmental and behavioural characteristics
The study included 8,041 under-five children and their mothers or caregivers. Out of these 49% were females, 11.1% of children were less than 6 months old and 40.6% of them were age greater than 35 months. The majority of the children (67.9%) were currently breastfeeding at the time of the survey, very few children (1.7%) were lives with someone else. Regarding mothers/caregivers, 5,801(72.1%) had no formal education, 95.2% were married, 50.7% mothers were between 25-34 years old, 24.7% were 35 years old and above. Around 60% of the households had 6 and above family members [Table 1].
Out of the total 8,041 households, 46.7% have used unimproved source of drinking water, 61.2% of mothers/caregivers were not properly removed youngest child's stools, there were 41% unimproved sanitation (toilet facility) and 51.6% no toilet facility in the household [Table 2].
Table 1: Socio-demographic characteristics of respondents among under-five children and their bivariate analysis with Prevalence of Diarrhea in Rural Ethiopia
Variables
|
Had Diarrhea recently
|
Total (%)
|
-test
|
No (%)
|
Yes (%)
|
P-value
|
Current Age of respondent (year)
15-24
25-34
35-49
|
1724 (21.4)
3610 (44.9)
1803(22.4)
|
248 (3.1)
470(5.8)
186(2.3)
|
1972(24.5)
4080 (50.7)
1989(24.7)
|
0.040
|
Sex of child
Male
Female
|
3613(44.9)
3524(43.8)
|
490(6.1)
414(5.1)
|
4103(51.0)
3938(49.0)
|
0.042
|
Current Age of child
<6 month
6-11
12-23
24-35
>35 month
|
816(10.1)
650(8.1)
1243(15.5)
1378(17.1)
3050(37.9)
|
75(.9)
151(1.9)
274(3.4)
189(2.4)
215(2.7)
|
891(11.1)
801(10.0)
1517(18.9)
1567(19.5)
3265(40.6)
|
0.000
|
Education of Mother/caregiver
No formal education
Primary
Secondary
higher
|
5182(64.40)
1667(20.70)
235(2.90)
53(0.70)
|
619(7.70)
245(3.00)
35(0.40)
5(0.10)
|
5801(72.10)
1912(23.80)
270(3.40)
58(0.70)
|
0.005
|
Region
Tigray
Afar
Amhara
Oromia
Somali
Benishangul
SNNPR
Gambela
Harari
Dire Dawa
|
726(9.00)
787(9.80)
725(9.00)
1250(15.50)
1032(12.80)
692(8.6)
946(11.80)
431(5.40)
320(4.00))
228(2.80)
|
94(1.20)
92(1.10)
113(1.40)
164(2.00)
74(0.90)
73(0.90)
158(2.00))
60(0.70)
44(0.50)
32(0.40)
|
820(10.20)
879(10.90)
838(10.40)
1414(17.60)
1106(13.80)
765(9.50)
1104(13.70)
491(6.10)
364(4.50)
260(3.20)
|
0.000
|
Number of under 5 children in h.h.
2 or less
3 and above
|
5589(69.50)
1548(19.30)
|
753(9.40))
151(1.90)
|
6342(78.90)
1699(21.10)
|
0.001
|
Wealth index of the household
Poor
Middle
Rich
|
4649(57.80)
1167(14.50)
1321(16.40)
|
545(6.80)
165(2.10)
194(2.40)
|
5194(64.60)
1332(16.60)
1515(18.80)
|
0.015
|
Birth order number
1st order
2nd
3rd
4th
5th and above
|
1195(14.90)
1103(13.70)
1011(12.60)
935(11.60)
2893(36.00)
|
167(2.10)
121(1.50)
141(1.80)
127(1.60)
348(4.30)
|
1362(16.90)
1224(15.20)
1152(14.30)
1062(13.20)
3241(40.30)
|
0.185
|
Religion of the respondent
Orthodox
Catholic
Protestant
Muslin
Traditional/other
|
1859(23.10)
40(0.50)
1291(16.10)
3801(47.30)
146(1.80)
|
249(3.10)
6(0.10)
201(2.50)
431(5.40)
17(0.20)
|
2108(26.20)
46(0.60)
1492(18.60)
4232(52.60)
163(2.00)
|
0.011
|
Respondent’s Current work status
Not working
Working
|
5390(67.00)
1747(21.70)
|
656(8.20)
248(3.10)
|
6046(75.20)
1995(24.80)
|
0.053
|
Respondent’s Marital status
Married/Living with partner
Widowed/separated/never in union
|
6805(84.60)
332(4.10)
|
854(10.60)
50(0.60)
|
7659(95.20)
382(4.80)
|
0.242
|
Number of household members
5 and fewer
6 and above
|
2872(35.70)
4265(53.00)
|
395(4.90)
509(6.30)
|
3267(40.60)
4774(59.40)
|
0.046
|
Child lives with whom
Respondent
Someone else/Lives elsewher
|
7010(87.20)
127(1.60)
|
894(11.10)
10(0.10)
|
7904(98.30)
137(1.70)
|
0.141
|
Currently breastfeeding
No
Yes
|
2333(29.00)
4804(59.70)
|
249(3.10)
655(8.10)
|
2582(32.10)
5459(67.90)
|
0.002
|
X 2= Chi-square
Table 2: Environmental and Behavioral characteristics of respondents among under-five children and their bivariate analysis with Prevalence of Diarrhea in the selected regions of Ethiopia
Variables
|
Had Diarrhea recently
|
Total (%)
|
-test
|
No (%)
|
Yes (%)
|
P-value
|
Source of drinking water
improved water
unimproved
|
3763(47.30)
3305(41.60)
|
478(6.00)
408(5.10)
|
4241(53.30)
3713(46.70)
|
0.689
|
Type of toilet facility
improved sanitation
unimproved sanitation
No Facility/bush/field
|
530(6.70)
2863(36.00)
3675(46.20)
|
59(0.70)
399(5.00)
428(5.40)
|
589(7.40)
3262(41.00)
4103(51.60)
|
0.034
|
Toilet facilities shared with other h.h.
No
Yes
|
2648(68.80)
745(19.30)
|
338(8.80)
120(3.10)
|
2986(77.50)
865(22.50)
|
0.041
|
Disposal of youngest child's stools
proper disposal
improper disposal
|
1754(33.80)
2816(54.30)
|
259(5.00)
355(6.80)
|
2013(38.80)
3171(61.20)
|
0.07
|
Main floor material
Natural floor
Rudimentary floor
Finished floor
|
6594(82.90)
63(0.80)
411(5.20)
|
819(10.30)
9(0.10)
58(0.70)
|
7413(93.20)
72(0.90)
469(5.90)
|
0.634
|
X 2 = Chi-square
Magnitude of under-five Diarrhea
The overall prevalence of diarrhea among under-five children two weeks before the survey was 11.2% in rural Ethiopia. Result displayed in Tables 1 and 2 showed that the prevalence of diarrhea was the highest among children lives with respondents (11.1%), who used unimproved sanitation (10.4%), and lived in natural floor material (10.3%). The highest magnitude of diarrhea was also observed on child’s still breastfeeding (8.1%), non-educated mothers (7.7%), current age of mother’s/caregivers 25-34 years (5.8%) and child’s age 12-23 months (3.4%).
Results of Bivariate and Multivariable Logistic Regression Analysis
In Bivariate analysis, the chi-square test result in Tables 1 and 2 and the estimated crude odds ratios in Table 3 showed that there were a significant association between prevalence of diarrhea and variables respondent's current age, sex of child, current age of child, education of mother/caregiver, region, number of under-five children, wealth index of the household, religion, Number of household members, current breastfeeding status, Type of toilet facility and toilet facilities shared with other households at 5% level of significance.
In multivariable binary logistic regression, the overall effect of the socio-demographic, environmental and behavioural risk factors on the prevalence of under-five diarrhea was assessed. The result showed that mother’s current age, current age of child, sex of child, region, birth order, toilet facilities shared with other households and number of under-five children interacted with mother’s current age were statistically significant risk factors of diarrheal occurrence among under five children at 5% level of significance [Table 3]. The Hosmer-Lemeshow goodness-of-fit test result (Chi-square statistic value = 4.953, df =8, Sig. =0.763) showed that the final model was a good model to fit the data. For selected variables in the final model, the estimated crude odds ratio (COR), adjusted odds ratio (AOR) and their 95% confidence interval are included in Table 3.
Table 3: Multivariable binary logistic regression analysis of the effects of socio-demographic and environmental risk factors of prevalence of diarrhea among under-five children in Rural Ethiopia (the final reduced model)
Variables
|
Had Diarrhea recently
|
COR(95% CI)
|
AOR(95% CI)
|
No (%)
|
Yes (%)
|
Current Age of respondent (35-49)
15-24
25-34
|
1724 (21.4)
3610 (44.9)
1803(22.4)
|
248 (3.1)
470(5.8)
186(2.3)
|
---
.905(.768, 1.067)
.717(.586, .877)**
|
---
.659(.469, .926)*
.364(.230, .577)**
|
Sex of child (Female)
Male
|
3524(43.8)
3613(44.9)
|
414(5.1)
490(6.1)
|
---
1.154(1.005, 1.326)*
|
---
1.291(1.054, 1.581)*
|
Current Age of child (>35 month)
<6 month
6-11
12-23
24-35
|
3050(37.9)
816(10.1)
650(8.1)
1243(15.5)
1378(17.1)
|
215(2.7)
75(.9)
151(1.9)
274(3.4)
189(2.4)
|
---
1.304(.991, 1.715)
3.296(2.63, 4.13)**
3.127(2.59, 3.78)**
1.946(1.58, 2.39)**
|
---
1.343(.908, 1.988)
3.545(2.580, 4.872)**
3.071(2.334, 4.041)**
1.717(1.262, 2.336)**
|
Region (Tigray)
Afar
Amhara
Oromia
Somali
Benishangul
SNNPR
Gambela
Harari
Dire Dawa
|
726(9.00)
787(9.80)
725(9.00)
1250(15.50)
1032(12.80)
692(8.6)
946(11.80)
431(5.40)
320(4.00))
228(2.80)
|
94(1.20)
92(1.10)
113(1.40)
164(2.00)
74(0.90)
73(0.90)
158(2.00))
60(0.70)
44(0.50)
32(0.40)
|
----
.903(.666, 1.224)
1.204(.899, 1.613)
1.013(.774, 1.327)
.554(.403, .762)**
.815(.590, 1.125)
1.290(.982, 1.695)
1.075(.761, 1.518)
1.062(.725, 1.555)
1.084(.707, 1.663)
|
---
1.915(1.008, 3.640)*
1.512(.931, 2.456)
1.237(.800, 1.913)
.417(.217, .802)**
.954(.597, 1.525)
1.393(.904, 2.146)
2.117(1.177, 3.809)*
.888(.486, 1.621)
.721(.314, 1.655)
|
Birth order number (1st order)
2nd
3rd
4th
5th and above
|
1195(14.90)
1103(13.70)
1011(12.60)
935(11.60)
2893(36.00)
|
167(2.10)
121(1.50)
141(1.80)
127(1.60)
348(4.30)
|
---
.785(.613, 1.006)
.998(.786, 1.268)
.972(.760, 1.243)
.861(.707, 1.048)
|
---
.915(.627, 1.337)
1.478(.985, 2.218)
1.811(1.175, 2.792)**
1.853(1.220, 2.814)**
|
Toilet facilities shared with other household (No)
Yes
|
2648(68.80)
745(19.30)
|
338(8.80)
120(3.10)
|
---
1.262(1.009, 1.578)*
|
---
1.387(1.088, 1.768)*
|
No. of under 5 children*Age of Mother ((2 or less)*(15-24))
NoChildU5( ) by ageM(25-34)
NoChildU5( ) by ageM(35-49)
|
|
|
|
---
2.463(.963, 6.298)
4.702(1.64, 13.45)**
|
Constant
|
|
|
|
0.059**
|
The reference categories are those indicated in brackets
*Statistically significant variables at p < 0.05; **statistically significant variables at p < 0.01
COR= crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval