Socio-demographic, environmental and behavioural characteristics of the study participants
The study included 8,041 under-five children. Out of these 3938 (49.0%) were females, 891 (11.1%) were less than 6 months and 3265 (40.6%) were age greater than 35 months [Table 1]. The majority of the children 5459 (67.9%) were currently breastfeeding at the time of the survey. Around 4774 (59.4%) of the children were from households with six or more family members. Regarding mothers, 5801 (72.1%) had no formal education and 7659 (95.2%) were married.
Table 1: Socio-demographic characteristics related to under-five children and their bivariate analysis with the occurrence of diarrhoea in rural Ethiopia
Variables
|
|
Had diarrhoea recently
|
-test
|
|
Counts (%)
|
No (%)
|
Yes (%)
|
P-value
|
|
Current age of mother (year)
15-24
25-34
35-49
|
1972(24.5)
4080 (50.7)
1989(24.7)
|
1724 (87.4)
3610 (88.5)
1803(90.6)
|
248 (12.6)
470(11.5)
186(9.4)
|
0.004
|
|
Sex of child
Male
Female
|
4103(51.0)
3938(49.0)
|
3613(88.1)
3524(89.5)
|
490(11.9)
414(10.5)
|
0.042
|
|
Current age of child
<6 month
6-11
12-23
24-35
>35 month
|
891(11.1)
801(10.0)
1517(18.9)
1567(19.5)
3265(40.6)
|
816(91.6)
650(81.1)
1243(81.9)
1378(87.9)
3050(93.4)
|
75(8.4)
151(18.9)
274(18.1)
189(12.1)
215(6.6)
|
0.000
|
|
Education of mother
No formal education
Primary
Secondary
Higher
|
5801(72.1)
1912(23.8)
270(3.4)
58(0.7)
|
5182(89.3)
1667(87.2)
235(87.0)
53(91.4)
|
619(10.7)
245(12.8)
35(13.0)
5(8.6)
|
0.050
|
|
Region
Tigray
Afar
Amhara
Oromia
Somali
Benishangul
SNNP
Gambela
Harari
Dire Dawa
|
820(10.2)
879(10.9)
838(10.4)
1414(17.6)
1106(13.8)
765(9.5)
1104(13.7)
491(6.1)
364(4.5)
260(3.2)
|
726(88.5)
787(89.5)
725(86.5)
1250(88.4)
1032(93.3)
692(90.5)
946(85.7)
431(87.8)
320(87.9))
228(87.7)
|
94(11.5)
92(10.5)
113(13.5)
164(11.6)
74(6.7)
73(9.5)
158(14.3)
60(12.2)
44(12.1)
32(12.3)
|
0.000
|
|
Number of under 5 children in a household
2 or less
3 and above
|
6342(78.9)
1699(21.1)
|
5589(88.1)
1548(91.1)
|
753(11.9)
151(8.9)
|
0.001
|
|
Wealth index of the household
Poor
Middle
Rich
|
5194(64.6)
1332(16.6)
1515(18.8)
|
4649(89.5)
1167(87.6)
1321(87.2)
|
545(10.5)
165(12.4)
194(12.8)
|
0.015
|
|
Birth order number
1st order
2nd
3rd
4th
5th and above
|
1362(16.9)
1224(15.2)
1152(14.3)
1062(13.2)
3241(40.3)
|
1195(87.7)
1103(90.1)
1011(87.8)
935(88.0)
2893(89.3)
|
167(12.3)
121(9.9)
141(12.2)
127(12.0)
348(10.7)
|
0.185
|
|
Religion
Orthodox
Catholic
Protestant
Muslin
Traditional/other
|
2108(26.20)
46(0.6)
1492(18.6)
4232(52.6)
163(2.0)
|
1859(88.2)
40(87.0)
1291(86.5)
3801(89.8)
146(89.6)
|
249(11.8)
6(13.0)
201(13.5)
431(10.2)
17(10.4)
|
0.011
|
|
Mother’s current work status
Not working
Working
|
6046(75.2)
1995(24.8)
|
5390(89.1)
1747(87.6)
|
656(10.9)
248(12.4)
|
0.053
|
|
Mother’s marital status
Married/Living with partner
Widowed/separated/never in union
|
7659(95.2)
382(4.8)
|
6805(88.8)
332(86.9)
|
854(11.2)
50(13.1)
|
0.242
|
|
Number of household members
5 and fewer
6 and above
|
3267(40.6)
4774(59.4)
|
2872(87.9)
4265(89.3)
|
395(12.1)
509(10.7)
|
0.046
|
|
Child lives with whom
Mother
Other caregiver
|
7904(98.30)
137(1.70)
|
7010(88.7)
127(92.7)
|
894(11. 3)
10(7.3)
|
0.141
|
|
Currently breastfeeding
No
Yes
|
2582(32.1)
5459(67.9)
|
2333(90.4)
4804(88.0)
|
249(9.6)
655(12.0)
|
0.002
|
|
= Chi-square
Concerning the environmental and behavioural characteristics of the households, 3713 (46.7%) of mothers/caregivers have used unimproved source of drinking water [Table 2]. There were 3262 (41.0%) unimproved toilet facility and 4103 (51.6%) no toilet facility in the household. Furthermore, around 3171 (61.0%) of the mothers/caregivers were not properly discarding the youngest child's stools.
Table 2: Environmental and behavioural characteristics related to under-five children and their bivariate analysis with the occurrence of diarrhoea in rural Ethiopia
Variables
|
|
Had Diarrhoea recently
|
-test
|
Counts (%)
|
No (%)
|
Yes (%)
|
P-value
|
Source of drinking water
Improved water
Unimproved
|
4241(53.3)
3713(46.7)
|
3763(88.7)
3305(89.0)
|
478(11.3)
408(11.0)
|
0.689
|
Type of toilet facility
Improved toilet facility
Unimproved toilet facility
No Facility/bush/field
|
589(7.4)
3262(41.0)
4103(51.6)
|
530(90.0)
2863(87.8)
3675(89.6)
|
59(10.0)
399(12.2)
428(10.4)
|
0.034
|
Toilet facilities shared with other household
No
Yes
|
2986(77.5)
865(22.5)
|
2648(88.7)
745(86.1)
|
338(11.3)
120(13.9)
|
0.041
|
Disposal of youngest child's stools
Proper disposal
Improper disposal
|
2013(38.8)
3171(61.2)
|
1754(87.1)
2816(88.8)
|
259(12.9)
355(11.2)
|
0.070
|
Main floor material
Natural floor
Rudimentary floor
Finished floor
|
7413(93.2)
72(0.9)
469(5.9)
|
6594(89.0)
63(87.5)
411(87.6)
|
819(11.0)
9(12.5)
58(12.4)
|
0.634
|
= Chi-square
Prevalence of Diarrhoea
The overall prevalence of diarrhoea among under-five children was 11.2% (95% CI: 10.5%-11.9%) in rural Ethiopia. The result displayed in Table 1 and Table 2 showed that the occurrence of diarrhoea was highest among children age 6-11 months (18.9%) and 12-23 months (18.1%). The highest prevalence of diarrhoea was also observed on children live in southern Nations Nationalities and People’s region (SNNPR) (14.3%), whose household shared toilet facility with other households (13.9%), protestant followers’ children (13.5%) and widowed/separated mothers’ children (13.1%). Table 1 and Table 2 also show that there are other socio-demographic, environmental and behavioural characteristics of the children that the occurrence of diarrhoea was above the overall average (11.2%).
Associated risk factors of Diarrhoea
In bivariate analysis, the chi-square test results [Tables 1 and Table 2] and the estimated crude odds ratios [Table 3] showed that there were a significant association between occurrence of diarrhoea and mother's current age, sex of a child, current age of a child, 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 analysis, the Hosmer-Lemeshow goodness-of-fit test result (P-value = 0.763) showed that the final multivariable binary logistic regression model was a good fit to the data. In the final model, the overall effects of the socio-demographic, environmental and behavioural risk factors on the occurrence of under-five diarrhoea were assessed.
The result showed that current age of child [6-11 months (AOR: 3.5; 95% CI: 2.58-4.87), 12-23 months (AOR: 3.1; 95% CI: 2.33-4.04) and 24-35 months (AOR: 1.7; 95% CI: 1.26-2.34) as compared to >35 months], sex of child [male (AOR: 1.3; 95% CI: 1.05-1.58)], region [Afar (AOR: 1.92; 95% CI: 1.01-3.64), Somali (AOR: 0.42; 95% CI: (0.217-0.80) and Gambela (AOR: 2.12; 95% CI: 1.18- 3.81) as compared to Tigray region], birth order [4th (AOR: 1.81; 95% CI: 1.17-2.79), 5th and above (AOR: 1.85; 95% CI: 1.22-2.81) as compared to 1st order], toilet facilities shared with other households (AOR: 1.4; 95% CI: 1.09-1.77) and mother’s current age 35-49 years in a household with three or more under-five children (AOR: 4.7; 95% CI: 1.64-13.45) as compared to those maternal age of 15-24 years in a household with less than or equal to two under-five children were statistically significant associated risk factors of diarrhoeal occurrence among under five children at 5% level of significance [Table 3].
Table 3: Multivariable binary logistic regression analysis of the effects of socio-demographic and environmental associated risk factors of occurrence of diarrhoea among under-five children in rural Ethiopia.
Variables
|
COR(95% CI)
|
AOR(95% CI)
|
P-value for AOR
|
Current age of mother [15-24]
25-34
35-49
|
---
0.90(0.77, 1.07)
0.72(0.59, 0.88)**
|
---
0.66(0.47, 0.93
0.36(0.23, 0.58)
|
-
0.016
0.000
|
Sex of child (Female)
Male
|
---
1.15(1.00, 1.33)*
|
---
1.29(1.05, 1.58)
|
-
0.013
|
Current age of child [>35 month]
<6 month
6-11
12-23
24-35
|
---
1.30(0.99, 1.71)
3.30(2.63, 4.13)**
3.13(2.59, 3.78)**
1.95(1.58, 2.39)**
|
---
1.34(0.91, 1.99)
3.54(2.58, 4.87)
3.07(2.33, 4.04)
1.72(1.26, 2.34)
|
-
0.140
0.000
0.000
0.001
|
Region [Tigray]
Afar
Amhara
Oromia
Somali
Benishangul
SNNP
Gambela
Harari
Dire Dawa
|
----
0.90(0.67, 1.22)
1.20(0.90, 1.61)
1.01(0.77, 1.33)
0.55(0.40, 0.76)**
0.81(0.59, 1.12)
1.290(.98, 1.69)
1.07(.76, 1.52)
1.06(.72, 1.55)
1.08(.71, 1.66)
|
---
1.91(1.01, 3.64)
1.51(0.93, 2.46)
1.24(0.80, 1.91)
0.42(0.22, 0.80)
0.95(0.60, 1.52)
1.39(.90, 2.15)
2.12(1.18, 3.81)
0.89(0.49, 1.62)
0.72(0.31, 1.65)
|
-
0.047
0.095
0.338
0.009
0.844
0.134
0.012
0.698
0.440
|
Birth order number [1st order]
2nd
3rd
4th
5th and above
|
---
0.78(0.61, 1.01)
0.99(0.79, 1.27)
0.97(0.76, 1.24)
0.86(0.71, 1.05)
|
---
0.91(0.62, 1.34)
1.48(0.98, 2.22)
1.81(1.17, 2.79)
1.85(1.22, 2.81)
|
-
0.647
0.059
0.007
0.004
|
Toilet facilities shared with other households [No]
Yes
|
---
1.26(1.01, 1.58)*
|
---
1.39(1.09, 1.77)
|
-
0.008
|
No. of under 5 children*Age of mother [(2 or less)*(15-24)]
NoChildU5( ) by ageM(25-34)
NoChildU5( ) by ageM(35-49)
|
|
---
2.46(0.96, 6.30)
4.70(1.64, 13.45)
|
-
0.060
0.004
|
The reference categories are those indicated in square brackets
*Statistically significant variables at p < 0.05; **statistically significant variables at p < 0.01