Public Health and Epidemiology: Open Access
Determinants of Diarrheal Morbidity among Under-Five Children in Negelle-Arsi District, Oromia Regional State, Ethiopia
Abstract
Walelign Fetahei
Background: Integrated water, sanitation, and hygiene (WASH) interventions are essential for improving public health and reducing the burden of preventable diseases in rural communities. To address these challenges, governments and development partners work together to expand access to safe water, improved sanitation facilities, and appropriate hygiene practices. This study examines the factors associated with diarrhea morbidity among children under five years of age, while also assessing water supply and accessibility, sanitation conditions, and hygiene practices in rural communities.
Methods: The cross-sectional data were collected in May 2025 from six kebele administrations (KAs), consisting of three intervention areas and three non-intervention areas, using a structured household questionnaire. A total of 396 households with under five children participated in the study, with an equal split between the intervention and control groups. Descriptive analysis was applied to compare differences between the groups in water access and supply, as well as sanitation and hygiene conditions. In addition, logistic regression analysis was conducted to identify the determinants of diarrhea morbidity among children under five years of age.
Results: The findings show clear improvements among intervention households compared with controls. Average household water consumption was higher in the intervention group (20.60 liters per person per day) than in the control group (10.08 liters), and the time required to fetch water was substantially lower (13.85 minutes vs. 55.84 minutes). All intervention households used protected water sources compared with 76.8% of controls, while reliable water access was reported by 90.4% and 60.6%, respectively. Sanitation conditions were also better among intervention households, with higher latrine access (95.0% vs. 78.3%), greater open defecation-free status (76.8% vs. 48.0%), and improved availability of handwashing facilities with soap and water (81.8% vs. 32.8%). Handwashing knowledge and practices were consistently higher in the intervention group, including knowledge of critical times (77.3% vs. 45.0%) and improved hygiene behaviors across all key practices. Consequently, under-five diarrhea prevalence was much lower in intervention households (2.5%) compared with controls (34.9%). The logistic regression analysis further showed that participation in the WASH intervention was strongly associated with reduced childhood diarrhea (AOR = 0.053), while caregiver diarrhea (AOR = 3,589.75), lack of latrine access (AOR = 0.043), improper latrine use (AOR = 6.386), longer distance to roads (AOR = 1.0165), and lower wealth status were all important predictors of increased diarrhea risk.
Conclusion: Overall, the study highlights that integrated WASH interventions, combined with efforts to improve household hygiene behaviors, sanitation utilization, infrastructure access, and socioeconomic conditions, can play a critical role in reducing the burden of childhood diarrhea and improving child health outcomes in rural communities.