Diarrhea as a Disease of Poverty Among Under-Five Children in Sub-Saharan Africa: A Cross-Sectional Study.

The objective of this study was to assess the prevalence of diarrhea among under-five children in low-middle-income countries and identify the sociodemographic factors associated with it. Data of 36 countries in sub-Saharan Africa from demographic and Health Surveys (2006-2018) comprising 251 341 mother-child (singleton) dyads were analyzed to estimate the prevalence and various modifiable and non-modifiable risk factors of diarrhea. Occurrence of diarrhea during the last 2 weeks was the outcome variable which was measured by mothers' observation of the condition. The overall prevalence of having diarrhea during last 2 weeks was 18.44% (19.12% among boys and 17.75% among girls). Boys had higher percentage of having diarrhea than girls in all countries except in Libya. The risk ratios of having diarrhea decreased progressively with higher wealth quintiles; the risks of were respectively 7% [RR = 0.93, 95% CI = 0.91; 0.97], 11% [RR = 0.89, 95% CI = 0.86; 0.92] and 18% [RR = 0.82, 95% CI = 0.78; 0.85] lower for households in the middle, richer and richest households. Rural residency was associated with lower risks [RR = 0.95, 95% CI = 0.93; 0.98] and not having access to improved water [RR = 1.05, 95% CI = 1.03; 1.08] and toilet facilities [RR = 0.04, 95% CI = 1.01; 1.07] were associated with higher risks of diarrhea. Regarding children's characteristics, higher age groups, birth order were associated with higher risks and female sex with lower risks. Children with mothers in the higher age groups and with above secondary level education had lower risks, and primary education had higher risks of diarrhea. Meta-analysis of 36 countries revealed a significantly negative association between wealth quintile and diarrhea (Odds ratio = 0.72, 95% CI = 0.69; 0.74). Findings indicate the presence of a significant wealth gradient in the burden of diarrheal diseases among under-five children in sub-Saharan Africa, and underscores the need for paying special attention to the marginalized communities when designing intervention programs.