DIARRHEA AMONG UNDER-FIVE YEAR CHILDREN AND ITS ASSOCIATION WITH WATER, SANITATION AND HYGIENE SERVICE LADDER IN HARAMAYA DEMOGRAPHIC AND HEALTH SURVEILLANCE SITE, EASTERN ETHIOPIA

Abstract

Background: Childhood diarrhea is a serious public health challenge and one of the leading causes of death globally. The association of the disease with water, sanitation and hygiene has been aknolweged in various study findings. However, a significant number of populations in developing countries are still struggling to get adequate water supply, sanitation and hygiene services. Recently, the joint monitoring program of World Health Organization and United Nations International Children‟s Emergency Fund categorize water, sanitation and hygiene services into ladders for measuring the service level. In Ethiopia, although there are reports in this regard, its association with childhood diarrhea is lmited. Objectives: The objective of the study was to assess prevalence of diarrhea among children of under-five years and its association with water, sanitation and hygiene service ladder in Haramaya Woreda, Demographic and Health Surveillance Site, Eastern Ethiopia, from March 10 to 17, 2020 Methods and Materials: A community based cross-sectional study design was conducted among a 535 households with under-five children in Haramaya Woreda, Demographic and Health Surveillance site, Eastern Ethiopia. A pretested structured questionnaire was used to collect the data. A total of 600 water samples, from 535 households and 65 water sources, were collected and analyzed using a membrane filtration technique to assess the existence of indicator bacteria (Thermotolerant bacteria). Poisson regression with robust error variance estimator was performed to assess the association of diarrhea with water, sanitation and hygiene service ladders after controlling other varibales. The level of statistical significance was considered at a p-value less than 0.05 Result: The prevalence of diarrhea among children under-five years of age in the surveillance site was 24.86%. The water, saniation and hygiene service ladder assessment shows that none of the households had a safely managed water and sanitation service ladders and basic hygiene service ladders. Fourth-five of the households had a limited drinking water service, about three-fifth practiced open defecation, and more than nine-tenth did not have a hand washing facility at all. The prevalence of diarrhea was high among households with a limited (APR=2.63; 95% CI: 1.50-4.61) and unimproved (APR=2.82; 95% CI: 1.61-4.94) drinking water service ladder compared to those with a basic service ladder. The prevalence was also high among households xi with unimproved sanitation service ladder (APR= 4.52; 95% CI: 1.47-13.85) compared to those with basic service ladder, and those who did not use a soap to wash hands after visiting toilet (APR=1.46; 95% CI: 1.04- 2.90). Conclusion: The find shows that childhood diarrhea in the study area was high. A significant number of households had limited and unimproved sanitation services, and practiced open defication. Therfore, improving drinking water supply, sanitation and hygiene service ladders is needed to reduce the diarrheal problem.