Regional disparities and predictors of childhood diarrhea in Ethiopia: a multilevel logistic regression analysis.

introductionDiarrheal disease is a significant public health concern, especially among children under the age of five. Its burden is particularly high in low-income countries, including Ethiopia. However, there is a lack of recent, nationally representative studies that adequately identify individual and community-level factors to inform effective interventions. Hence, this study aimed to fill this gap.

methodsThis study utilized data from the national representative Health Equity Survey, conducted in all regional states and two city administrations of Ethiopia. A total of 8,747 mothers with children under five were selected using a two-stage stratified cluster sampling. Data were collected through face-to-face interviews. Descriptive statistics were computed, and mixed- effect multilevel logistic regression identified factors associated with diarrheal disease. Significance was set at p-value of < 0.05, with results reported as AORs and 95% CI. Four models were fitted, and the best-fit model was selected based on the lowest value of Deviance Information Criterion (DIC), Akaike's Information Criterion (AIC), and Bayesian Information Criterion (BIC).

resultsThe prevalence of diarrheal disease among children under five years old was 7.8% and varied across different regions of the country, ranging from 21% (Afar region) to 1.9% (Southwest region). In the multilevel logistic regression analysis, children aged 6-12 months (AOR = 4.5; 95% CI: 2.86, 6.97), children aged over 12 months (AOR = 3.5; 95% CI: 2.31, 5.45), no formal maternal education (AOR = 1.8; 95% CI: 0.99, 3.13), unimproved water sources (AOR = 1.6; 95% CI: 1.07, 2.52), and unimproved sanitation facilities (AOR = 1.7; 95% CI: 1.34, 2.09) had higher odds of developing diarrheal disease, while mothers aged 30 years and older (AOR = 0.8; 95% CI: 0.59, 1.02), living at altitude of 2501-3500 m and 3501-5500 m (AOR: 0.6, 95%CI: 0.43-0.77) and (AOR: 0.5, 95%CI: 0.42-0.60), had lower odds of diarrheal disease.

conclusionThe prevalence of diarrheal disease among children under five in Ethiopia remains high with regional variations. Contributing factors include younger age particularly aged < 12 months, maternal lack of formal education, limited access to improved water sources and sanitation facilities. To effectively decrease this burden, targeted public health strategies are needed focusing on interventions that will address educational disparities and expanding access to clean water and adequate sanitation.