Prevalence and associated factors of diarrhea among under-five children in Debre Berhan town, Ethiopia 2018: a cross sectional study

Diarrheal disease is a major public health problem worldwide. Globally, 525,000 children under-5 years die due to diarrhea every year, roughly 2195 every day [1]. This represents 8% of all deaths and is the second leading cause of death among children under-5 years old [2]. Annually, 1.7 billion diarrhea episodes occurred among children under-5 years worldwide [3]. The majority of morbidity and mortality occurred in south Asia and sub-Saharan African countries, which 88% were attributable to unsafe water, inadequate sanitation, and insufficient hygiene [4].

Despite global diarrheal deaths among children of under 5 years decreasing by 60% between 2000 and 2017. Ethiopian morbidity reports and community-based studies indicate that diarrheal diseases accounted for 20% of childhood death and 22% of childhood diarrheal disease in 2000 [3, 5, 6].

Studies in Ethiopia also showed that low maternal education, poor sanitation, contaminated water source, duration of breast feeding, failure to wash hands, absence of rotavirus vaccination, failure to dispose of feces hygienically, age of child and adequate food hygiene were significant predictors of diarrheal disease occurrence in children under-5 years [7‐13].

However, information related to diarrheal disease in children under-five in Debre Berhan is limited. Therefore, the aim of this research was to assess the prevalence of diarrheal disease and associated factors in children under-5 years old in Debre Berhan town, Ethiopia. The findings will contribute to improving the lives of children under-5 years. In addition, the information can be used to develop effective educational program to improve child health overall. Similarly, this research will inform policy makers and program initiators on acceptable services.

This study was conducted to assess the prevalence and associated factors of diarrhea among children under-five in Debre Berhan town, Ethiopia. The Ethiopian Demographic and Health Surveys of 2016, showed that diarrheal disease was the leading cause of illness among children under-5 years.

The result of this study showed that prevalence of diarrhea among children under-five was 16.4% (95%CI: 12.7–20.0). This finding was congruent with the study done in Dale District, Sidama zone, Southern Ethiopia, 13.9% [11], Yaya Gulele district, Ethiopia 13.5% [15], Serbo town, Southwest, Ethiopia, 14.9% [16], Bahr Dar city, 14.5% [17], and Farta Wereda, Northwest Ethiopia, 16.7% [7]. However, result of this study was lower than the study conducted in Sena’a, Yemen, 29.07% [18], Senegal, 26% [19], Cameroon, 26.1% [20], Sheka zone, southwest Ethiopia, 21.8% [12], Jig-Jiga city, Eastern Ethiopia, 27.3% [21], Bahir Dar Zuria district, Northwest Ethiopia, 20% [22], North Gondar zone, 21.1% [10] and Harena Buluk district, Southeast Ethiopia, 28.4% [23]. In contrast, it was higher than the study conducted in Wolayta Sodo town, Southern Ethiopia, 11.0% [24]. This difference may be due to seasonal trends in diarrhea disease or differences in year and age of the study participants as well as the differences in the study design and data collection.

Children aged between 7 and 11 months were at high risk of developing diarrhea compared with children aged was less than 7 months. This result was in line with the results of the study conducted in Farta Wereda, Northwest Ethiopia [7]. The increased risk might be due to the decline/loss in maternal antibodies and at this age child start complementary feeding that might increase their exposure to contaminated foods and water. In addition, crawling begins at this age further increasing potential exposure to fecally contaminated environments.

This study found that diarrhea was more common among second-born children compared with first-born children (AOR: 3.9, 95%CI: 1.7–8.5). Similarly, a cross-sectional study conducted in Jig-Jiga district, Somali region, Ethiopia showed that fourth-born children and above were more affected by diarrhea compared with first borne [21]. This may be due to quality of care and attention from parents decreases as mothers become incapable of caring for children [25].

According rotavirus vaccination were 10.3 times more likely to have diarrhea compared with children who received rotavirus vaccination (AOR: 10.3, 95%CI: 1.2–91.2). The result suggests that a major contributor to the diarrheal burden in children less than 5 years in the town is in fact rotavirus. This result was in agreement with study done in Farta Woreda, Northwest Ethiopia [7].

In this study, the following limitations were noted. The major limitation of the study was the limited time period over which the study was conducted, that may create over or under reporting of diarrhea since diarrheal diseases have some seasonal variations.

The 2 week prevalence of diarrhea among children under-5 years in Debre Berhan town was 16.4%. Childhood diarrheal disease was significantly associated with the age of children, birth order and hand feeding practice of mother. So, education program on the importance of vaccination against rotavirus, increase breast feeding frequency with complementary food after 6 months and the critical points of hand washing are recommended.