Prevalence of diarrhea and associated factors among under-five children in Bahir Dar city, Northwest Ethiopia, 2016: a cross-sectional study

Diarrhea is thepassage of three or more watery or loose stools per day, and when the mother considered as increased stool frequency or liquidity [1]. The acute diarrhea causes high loss of water and salts from a body which results in either severe dehydration and death within a short period of time or predisposes children to malnutrition and makes them more susceptible to other infections [2].

Globally, around 1.3 million people were died due to diarrhea and of the total deaths about 0.54 million were children’s of under-five years of age. Majority of the mortality were occurred in developing countries [3]. Diarrhea is the second most cause of mortality and morbidity of under-five childhood illnesses in sub-Saharans Africa countries. In these countries, only 40% of people living in urban setting were accessing improved sanitations [3] and 72% of the people in Ethiopia were living without improved sanitation facilities [4].

Diarrhea is a highly prevalent disease in Ethiopia. In fact, it is the second leading cause of deaths [2, 3]. A previous 2 week survey showed that prevalence of diarrhea among children under 5 years old was 13% [3].

Different studies in Ethiopia showed that, socioeconomic status, monthly income, number of under-five children, methods of complementary feeding, types of water storage equipment, mother’s poor hand washing practices, lack of hand washing facilities, duration of breastfeeding and improper waste disposal practices were significant factors for diarrhea occurrences [5‐9].

Identifying the contributing factors of diarrhea is very important for the effective implementation of child health programs and prioritizations. There is a considerable variation in prevalence and determinant factors for diarrhea occurrence in Ethiopia. Despite the interventions and innovations undertaken regarding childhood diarrhea, the burden of the disease is high in the current study area. Therefore, this study was conducted to assess the magnitude and associated factors of diarrhea among under 5 years old children in Bahir Dar city, North West, Ethiopia.

The two weeks prevalence of childhood diarrhea among under-five years-old in this study was 14.5%. This finding is higher than studies done in East Gojjam zone, 6.5% [11] and EDHS 2016 report, 12% [12]. However, the current result is lower than west Gojjam zone, 18% [10], Egypt, 19.5% [13], Ghana, 19.2% [14], Eastern Ethiopia, 22.5% [8], Iraq, 21.3% [15], India 25.2% [16] Burundi, 32.6% [17], Arba-Minch rural community, 31% [18], and Benshangul gumz, 22.1% [19]. This may be due to; the current study setting consider only urban dwellers; differences in socio-demographic characteristics, environmental factors (climate and geographical differences) and behavioral factors (availability of water, presence and usage of latrine, availability of hand washing facilities, ways of waste disposal and food storage mechanisms in the study area compared to other studies.

Children living in households without hand washing facilities were 3.9 times more likely to develop childhood diarrhea compared to households with hand washing facilities. This finding is in line with studies done in Ghana [14], Benshangul Gumz [19] and East Gojjam [11]. This may be due to the fact that using improved latrine and presence of a hand washing facility decreases the contamination of foods and water by pathogenic organisms. Similarly, in the current study, children whose mother used only water to wash their hand were six times more likely to develop childhood diarrhea than children whose mother used water with soap to wash their hand. This finding is in line with studies done in south-west Ethiopia [20], Jijjiga [21] and Bangladesh [22]. This might be due to soap has antimicrobial agent, and it is effective to prevent diarrhea and occurrence of other hygiene related diseases. Proper hand washing can eliminate microorganisms.

Mothers feeding practices is a vital indicator for a child health. In this study, diarrhea was significantly associated with breastfeeding practices, non exclusive breastfed children were 2.3 times more likely to develop diarrhea than exclusive breastfed children during the first 6 months of their life. This finding is consistent with systematic review studies done in globe [23] and United States [24]. Which could be due to breast milk has its own polysaccharide immunoglobine A that prevents gastroenteritis by coating thegastrointestinal tract. In addition to this, breast milk is natural, safe, appropriate, cheapest and free of contamination from microbes [25]. Therefore, encouraging exclusive breastfeeding for the first 6 months of life is very important to reduce child morbidities and mortalitiesy. On the other hand, the current finding also showed that children who did not use separate feeding material were 5.7 times more likely to develop diarrhea than their counterparts which is in line with studies done in Debre Birhan [26] and Nigeria [27]. The possible reason might be, the materials that were used in common with other family member might be contaminated. Beyound this, caregivers may neglect cleaning of feeding materials that they used for serving food to their child.

Considering the current study area is urban setting, the prevalence of childhood diarrhea was high. Lack of hand washing facilities, lack of separatly feeding materials for children, not breastfeed exclusively and hand washing practice were predictors of occurrence of diarrhea. Thus, improving handwashing facilities and practices, serving the food to the child with a separate materials and encourage optimal breastfeeding were recommended.