Factors associated with diarrheal diseases among children under five years of age in mjini Unguja, Zanzibar, 2024

Abstract

ABSTRACT Background: Diarrhea, characterized by passing three or more loose stools daily, is a major cause of child deaths, especially in developing countries, due to inadequate sanitation and unsafe water. WHO and UNICEF report that about 525,000 children under five years die each year from diarrheal diseases, often worsened by malnutrition and weak immune systems. Preventive strategies include better sanitation, access to clean water, and good hygiene practices. In Zanzibar, despite health interventions, diarrhea continues to be a leading cause of child illness and death, particularly during the rainy season. Objective: To determine the factors associated with diarrhea among children below five years of age in Mjini Unguja, in May 2024 Methods: A cross-sectional household survey was conducted in 2024. Caregivers of children aged 6 to 59 months were selected using a multistage cluster sampling technique. Data was collected using a structured questionnaire focusing on demographics, household characteristics, hygiene practices, and health behaviors. Ethical considerations were maintained. Modified Poisson regression was fitted in the final statistical model. Results: A total of 561 children with their caregivers were included. Most of the children were male (53.6%) and the majority of the caregivers were mothers (85.4%). Overall, 16.7% of the children experienced diarrhea within two weeks (95% CI 13.8%-20.1%). Improper disposal of feces increased the risk of diarrhea by 89% [Adjusted Prevalence Ratio (APR)= 1.89, (95% CI: 1.23-2.59)]. Those children cared for by the grandmother [APR= 0.37,(95% CI: 0.54-0.98)], children whose guardians performed moderate hand hygiene [APR= 0.22, (95% CI: 0.14-0.35)] and those who performed good hand hygiene [APR= 0.19, (95% CI: 0.09-0.37)] had less risk of developing diarrhea. Conclusion and recommendations: Childhood diarrhea is a major health concern in Zanzibar. The occurrence of diarrhea is associated with improper waste disposal and poor hygienic practices. To combat this problem, the government should emphasize educating parents and guardians on good hygiene practices, and sanitation.