Prevalence and Its Associated Factors to Diarrhea Among Under Five Children in Ethiopia

: Diarrhea is defined as having three or more loose, or liquid stools per day. Ethiopia is one of the developing sub-Saharan African countries sharing the high burden of diarrhea mortality. The risk of a child dying before becoming the age of under-five children was highest in Ethiopia as well as in the world. The aim of the study was to assess the prevalence and factors associated with diarrhea among children of age of under-five in Ethiopia. This study used data from the 2016 Ethiopia demography and health survey. The prevalence of diarrhea among under-five children was 825 children out of 5,335 in Ethiopia. Based on the chi-square test; region, currently pregnant mothers, child lives with whom and source of drinking water were significantly associated with the prevalence of diarrhea among the ages of under-five children. Binary logistic regression was applied and analyzed using Stata version 14. Region, child living with whom and source of water are the significant factor of the prevalence of diarrhea under five children. A child taking protected water, and a child living with his or her family is highly appreciated for reducing the prevalence of diarrhea among the ages of under-five children. In addition, planning for better access to health facilities for each region.


Introduction
Diarrhea is defined as having three or more loose, or liquid stools per day [1]. Diarrhea disease is the cause of the death of under-five children, every year globally killing around 760, 000 children and more than 90% results from contaminated food and water sources in the world [2,3] and children under the age of five has been high risk living in low and middleincome countries [4]. The risk of a child dying before becoming the age of under-five children was highest in the World health organization African Region (90 per 1000 live births), which is approximately seven times higher than that in the World health organization European Region (12 per 1000 live births) [5]. Of the estimated total of 10.6 million deaths among children younger than five years of age worldwide, 42% occurred in the African region due to diarrhea and others diseases [6,7].
Ethiopia is one of the developing sub-Saharan African countries sharing the high burden of diarrhea mortality. The incidence of illnesses contributing to avoidable death's diarrhea is higher in Ethiopia compared to other Sub Saharan African countries partly due to living conditions, high incidence of illness, lack of safe drinking water, sanitation, and hygiene; as well as poorer overall health and nutritional status [2,8,9].
Twelve percent of children under five had diarrhea two weeks before the survey. More than four out of 10 children under five (44%) who had diarrhea sought treatment. The diarrhea rate is still high, it continues to be a burden to Ethiopia population and diarrhea is the main problem not only the age of under-five children but also for all populations [10]. Therefore, the study aims were to assess the prevalence and risk factors of diarrhea among under-five children in Ethiopia.

Source of Data
This study used data from the 2016 Ethiopia demography and health survey.

Variables
The dependent variable is diarrhea disease status or occurrence of diarrhea among the ages of under-five children and explanatory variables are region, types of place of residence, source of drinking water, ages of households, currently pregnant of mothers, a child lives with whom, types of toilet facility.

Binary Logistic Regression Model
Binary logistic regression is used for this study when the dependent variables are dichotomous [11]. The error terms are not normally distributed [12]. The logistic regression model is given as: Maximum likelihood estimator is used to estimate the parameter of the model [13] and Hosmer-Lemeshow test also available for model adequacy test.

Results
The prevalence of diarrhea among under-five children was 825 children out of 5,335 in Ethiopia. Based on the chisquare test; region, currently pregnant mothers, child lives with whom and source of drinking water were significantly associated with the prevalence of diarrhea among the ages of under-five children (Table 1). According to Hosmer-Lemeshow goodness-of-fit test statistic (p value=0.055) is greater than 0.05, we conclude that the model is adequate.
Based on table 2, the expected value of the occurrence of diarrhea among under-five children from Amhara, Oromia, and Southern nations, nationalities, and people's region were 0.47, 0.77 and 0.72 times lower than the occurrence of diarrhea among the ages of under-five children in Tigray, respectively.
When we look at the source of drinking water, the odds of the occurrence of diarrhea among under-five children was 0.78 times lower than children taking protected water as compared to unprotected water. Table 2 shows that the odds of the prevalence of diarrhea among the ages of under-five children from a child's lives with others were 5.95 times higher than the occurrence of diarrhea for the child lives with the respondents (his or her family).

Discussion
This study identified the risk factors associated with diarrhea among under-five children in the study area using the 2016 Ethiopia demography and health survey. This study indicated that the prevalence of diarrhea was observed in the Tigray region, 7.8%% followed by Southern nations, nationalities, and people's region, Amhara and Oromia regions, 2.9%, 2.8%, and 1.8%, respectively. The odds of the occurrence of diarrhea among the ages of under-five children from Amhara, Oromia, and Southern nations, nationalities, and people's regions were less than as comparing to the Tigray region. This is inconsistent with findings from other studies [5,14].
Another predictor variable of diarrhea found in this study was the source of drinking water. The present study found that the odds of diarrhea diseases of children for taking protected water were lower than unprotected (unsafe) water. This study is consistent with in Ethiopia [5,15,16]. Another study in sub-Saharan African [17], Indonesia [18] and Malaysia [19] also stated that the prevalence of diarrhea among the ages of under-five children for taking unprotected water is higher than drinking protected water.
According to the results of this study, it was found that the odds of prevalence of diarrhea in child lives with others were higher than that of children live his or her families. This may be due to misconception, and the negative attitude of the caregivers toward the causes of diarrhea. A study conducted in Ethiopia found that children living with others were more likely to the prevalence of diarrhea as compared to children living with the respondents [20]. Another study in Kenya [21] and Nigeria [22] also found that children living with others were at a high risk for the prevalence of diarrhea.

Conclusion
This study used data from the 2016 Ethiopia demography and health survey. Region, child lives with whom and source of drinking water were statistically significant factors for the prevalence of diarrhea under the age of under-five children. A child taking protected water, and a child living with his or her family is highly appreciated for reducing the prevalence of diarrhea among the ages of under-five children. In addition, planning for better access to health facilities for each region.

Ethics Approval and Consent to Participate
Ethical clearance for the 2016 EDHS was provided by the Ethiopian Health and Nutrition Research Institute Review Board, the National Research Ethics Review Committee at the Ministry of Science and Technology, the Institutional Review Board of ICF International, and the communicable disease control. Additionally, written consent for participation was obtained from each respondent. However, the dataset of the 2016 EDHS is not available as a public domain survey dataset. The authors requested access to the data from demographic, health survey program team and access was granted to use the data for this research. document.