{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:59:58Z","timestamp":1789520398180,"version":"build-2803163510"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The global public health problem of diarrhea is most prevalent in developing countries including Ethiopia, especially among children under two years of age. Limited information on the determinants of diarrhea among children aged 0\u201323\u2009months hinders the design and prioritization\u00a0of intervention strategies to address childhood diarrhea in Dessie City, northeastern Ethiopia. Therefore, this study was designed to assess the determinants of diarrhea in order to identify priority interventions for its control.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A community-based matched case-control study was conducted among children aged 0\u201323\u2009months during January\u2013February 2018. Cases defined as children with acute diarrhea, and controls defined as\u00a0children without acute diarrhea, were matched by child\u2019s age (months) and place of residence (residing in the same <jats:italic>kebele,<\/jats:italic> the lowest local\u00a0administrative unit, each of which has a population of approximately 5000) during the two weeks prior to data collection. Data were collected from mothers\/caregivers of the 119 cases and 238 matched controls using a pre-tested structured questionnaire and an observational checklist. Data were analyzed using conditional logistic regression model with 95% confidence interval (CI); variables with <jats:italic>p\u2009&lt;<\/jats:italic>\u00a00.05 from multivariable analysis were considered as significantly associated with acute diarrhea among children aged 0\u201323\u2009months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Age of mothers\/caregivers (<jats:underline>&gt;<\/jats:underline>\u200935\u2009years of\u00a0age) (adjusted matched odds ratio [adjusted mOR]\u2009=\u20092.00; 95% CI: 1.37\u20135.8); divorced\/widowed marital status (adjusted mOR\u2009=\u20091.40; 95% CI: 1.26\u20133.3); lack of exclusive breastfeeding (adjusted mOR\u2009=\u20092.12; 95% CI: 1.15\u20133.70); presence of feces within\/around latrines (adjusted mOR\u2009=\u20091.37; 95% CI: 1.21\u20133.50); lack of handwashing facility near latrine (adjusted mOR\u2009=\u20091.50; 95% CI: 1.30\u20135.30); presence of domestic sewage discharge within and\/or outside the compound (adjusted mOR\u2009=\u20093.29; 95% CI: 1.85\u20137.50) and practice of handwashing at fewer than three of the five critical daily times (adjusted mOR\u2009=\u20094.50; 95% CI: 2.54\u20139.50) were significantly associated with acute diarrhea among children aged under two years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>To reduce acute diarrheal disease among children under two, priority should be given to interventions that focus on\u00a0improving exclusive breastfeeding practices, regular cleaning of latrines, advocating for availability of handwashing facility within\/around latrines, use of proper domestic sewage discharge methods and improving handwashing practice at the five critical times each day. Strengthening communication that promotes hygiene and behavioural change may also raise awareness among mothers\/caregivers and empower them to enhance handwashing practices at critical times.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-021-02592-5","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T07:03:09Z","timestamp":1617174189000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Priorities for intervention to prevent diarrhea among children aged 0\u201323\u2009months in northeastern Ethiopia: a matched case-control study"],"prefix":"10.1186","volume":"21","author":[{"given":"Alemwork","family":"Baye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metadel","family":"Adane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadesse","family":"Sisay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu Shimels","family":"Hailemeskel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"2592_CR1","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1136\/archdischild-2011-301621","volume":"98","author":"A Unger","year":"2013","unstructured":"Unger A. Children\u2019s health in slum settings. Arch Dis Child. 2013;98:799\u2013805.","journal-title":"Arch Dis Child"},{"issue":"9832","key":"2592_CR2","doi-asserted-by":"publisher","first-page":"2151","DOI":"10.1016\/S0140-6736(12)60560-1","volume":"379","author":"L Liu","year":"2012","unstructured":"Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151\u201361.","journal-title":"Lancet"},{"issue":"5","key":"2592_CR3","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1038\/ajg.2016.126","volume":"111","author":"MS Riddle","year":"2016","unstructured":"Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602\u201322.","journal-title":"Am J Gastroenterol"},{"key":"2592_CR4","unstructured":"Gerald TK, Olivier F, Alok B. et al. Diarrheal diseases. Disease control priorities in developing countries | Gerald T. Keusch, Olivier Fontaine, Alok Bhargava, and others.\u00a02007;371\u201387."},{"key":"2592_CR5","unstructured":"Christina MS, Blanca O. Diarrheal diseases\u00a0 FACG. 2007."},{"issue":"9875","key":"2592_CR6","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/S0140-6736(13)60222-6","volume":"381","author":"CLF Walker","year":"2013","unstructured":"Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381(9875):1405\u201316.","journal-title":"Lancet"},{"key":"2592_CR7","volume-title":"Inheriting a sustainable world? Atlas on children\u2019s health and the environment","author":"WHO","year":"2017","unstructured":"WHO. Inheriting a sustainable world? Atlas on children\u2019s health and the environment. Geneva: World Health Organization; 2017."},{"issue":"4","key":"2592_CR8","doi-asserted-by":"publisher","first-page":"420","DOI":"10.4269\/ajtmh.2004.71.420","volume":"71","author":"S Luby","year":"2004","unstructured":"Luby S, Agboatwalla M, Hoekstra R, Rahbar M, Billhimer W, Keswick B. Delayed effectiveness of home-based interventions in reducing childhood diarrhea, Karachi, Pakistan. 2004;71(4):420\u201327. Am J Trop Med Hyg. 2004;71(4):420\u20137.","journal-title":"Am J Trop Med Hyg."},{"issue":"5","key":"2592_CR9","doi-asserted-by":"publisher","first-page":"926","DOI":"10.4269\/ajtmh.2005.73.926","volume":"73","author":"J Lule","year":"2005","unstructured":"Lule J, Mermin J. E J, Malambo S, downing R, ransom R, et al. effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg. 2005;73(5):926\u201333.","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"2592_CR10","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.4269\/ajtmh.14-0057","volume":"91","author":"CM George","year":"2014","unstructured":"George CM, Perin J, De Calani KJN, Norman WR, Perry H, Davis TP Jr, et al. Risk factors for diarrhea in children under five years of age residing in peri-urban communities in Cochabamba, Bolivia. Am J Trop Med Hyg. 2014;91(6):1190\u20136.","journal-title":"Am J Trop Med Hyg"},{"key":"2592_CR11","doi-asserted-by":"crossref","unstructured":"Mulatya DM, Ochieng C. Disease burden and risk factors of diarrhoea in children under five years: evidence from Kenya's demographic health survey 2014. Int J Infect Dis. 2020;93:359\u201366","DOI":"10.1016\/j.ijid.2020.02.003"},{"issue":"1","key":"2592_CR12","doi-asserted-by":"publisher","first-page":"30166","DOI":"10.3402\/gha.v9.30166","volume":"9","author":"AR Bado","year":"2016","unstructured":"Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990\u20132013): assessing the neighborhood inequalities. Glob Health Action. 2016;9(1):30166.","journal-title":"Glob Health Action"},{"key":"2592_CR13","unstructured":"CSA, ICF-International. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Calverton, Maryland, USA: Central Statistical Agency [Ethiopia] and ORC Macro2016."},{"issue":"6","key":"2592_CR14","doi-asserted-by":"publisher","first-page":"e0199684","DOI":"10.1371\/journal.pone.0199684","volume":"13","author":"A Alebel","year":"2018","unstructured":"Alebel A, Tesema C, Temesgen B, Gebrie A, Petrucka P, Kibret GD. Prevalence and determinants of diarrhea among under-five children in Ethiopia: a systematic review and meta-analysis. PLoS One. 2018;13(6):e0199684.","journal-title":"PLoS One"},{"issue":"8","key":"2592_CR15","doi-asserted-by":"publisher","first-page":"e0182783","DOI":"10.1371\/journal.pone.0182783","volume":"12","author":"M Adane","year":"2017","unstructured":"Adane M, Mengistie B, Kloos H, Medhin G, Mulat W. Sanitation facilities, hygienic conditions, and prevalence of acute diarrhea among under-five children in slums of Addis Ababa, Ethiopia: baseline survey of a longitudinal study. PLoS One. 2017;12(8):e0182783.","journal-title":"PLoS One"},{"issue":"7","key":"2592_CR16","doi-asserted-by":"publisher","first-page":"e0181516","DOI":"10.1371\/journal.pone.0181516","volume":"12","author":"M Adane","year":"2017","unstructured":"Adane M, Mengistie B, Medhin G, Kloos H, Mulat W. Piped water supply interruptions and acute diarrhea among under-five children in Addis Ababa slums, Ethiopia: a matched case-control study. PLoS One. 2017;12(7):e0181516.","journal-title":"PLoS One"},{"issue":"1","key":"2592_CR17","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1186\/s12879-019-4030-3","volume":"19","author":"AB Dagnew","year":"2019","unstructured":"Dagnew AB, Tewabe T, Miskir Y, Eshetu T, Kefelegn W, Zerihun K, et al. Prevalence of diarrhea and associated factors among under-five children in Bahir Dar city, Northwest Ethiopia, 2016: a cross-sectional study. BMC Infect Dis. 2019;19(1):417.","journal-title":"BMC Infect Dis"},{"key":"2592_CR18","volume-title":"Health Sector Transformation Plan (HSTP) 2015\/16\u20132019\/20, The Federal Democratic Republic of Ethiopia Ministry of Health. Addis Ababa","author":"MOH","year":"2015","unstructured":"MOH. Health Sector Transformation Plan (HSTP) 2015\/16\u20132019\/20, The Federal Democratic Republic of Ethiopia Ministry of Health. Addis Ababa. 2015."},{"key":"2592_CR19","volume-title":"The Sustainable Development Goals Report 2016. United Nations, New York","author":"UN","year":"2016","unstructured":"UN. The Sustainable Development Goals Report 2016. United Nations, New York 2016."},{"key":"2592_CR20","doi-asserted-by":"crossref","first-page":"2333794X1668090","DOI":"10.1177\/2333794X16680901","volume":"3","author":"AR Sarker","year":"2016","unstructured":"Sarker AR, Sultana M, Mahumud RA, Sheikh N, Van Der Meer R, Morton A. Prevalence and health care\u2013seeking behavior for childhood diarrheal disease in Bangladesh. Glob Pediatr Health. 2016;3:2333794X16680901.","journal-title":"Glob Pediatr Health"},{"issue":"9888","key":"2592_CR21","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/S0140-6736(13)60844-2","volume":"382","author":"KL Kotloff","year":"2013","unstructured":"Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, S P, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): A prospective, case-control study. Lancet. 2013;382(9888):209\u201322.","journal-title":"Lancet"},{"key":"2592_CR22","unstructured":"CSA. Population Projection of Ethiopia for All Regions At Wereda Level from 2014\u20132017 Central Statistical Agency 2017."},{"key":"2592_CR23","volume-title":"The treatment of diarrhea. A manual for physicians and other senior health workers. Department of Child and Adolescent Health and Development","author":"WHO","year":"2005","unstructured":"WHO. The treatment of diarrhea. A manual for physicians and other senior health workers. Department of Child and Adolescent Health and Development. Geneva: World Health Organization; 2005."},{"key":"2592_CR24","doi-asserted-by":"crossref","unstructured":"Farthing M, Salam M, Lindberg G, Dite P, Khalit I, Lindo S, et al. World Gastroenterology Organization Global Guidelines. Acute diarrhea in adults and children: a global perspective. World Gastroenterology Organization; 2012. p. 1\u201324.","DOI":"10.1097\/MCG.0b013e31826df662"},{"key":"2592_CR25","first-page":"144","volume-title":"Case-control studies: design, conduct, analysis","author":"J Schlesselman","year":"1982","unstructured":"Schlesselman J, Stolley P. Case-control studies: design, conduct, analysis. Oxford: Oxford University Press; 1982. p. 144\u201370."},{"issue":"1","key":"2592_CR26","doi-asserted-by":"publisher","first-page":"e0004283","DOI":"10.1371\/journal.pntd.0004283","volume":"10","author":"S Breurec","year":"2016","unstructured":"Breurec S, Vanel N, Bata P, Chartier L, Farra A, Favennec L, et al. Etiology and epidemiology of diarrhea in hospitalized children from low income country: a matched case -control study in Central African Republic. PLoS Negl Trop Dis. 2016;10(1):e0004283.","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"2592_CR27","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1007\/s10900-017-0437-1","volume":"43","author":"M Adane","year":"2018","unstructured":"Adane M, Mengistie B, Mulat W, Medhin G, Kloos H. The most important recommended times of hand washing with soap and water in preventing the occurrence of acute diarrhea among children under five years of age in slums of Addis Ababa, Ethiopia. J Community Health. 2018;43(2):400\u20135.","journal-title":"J Community Health"},{"key":"2592_CR28","volume-title":"Core Questions on Drinking Water and Sanitation for Household Surveys. JMP Publication of the World Health Organizations and United Nations Children Fund. Switzerland","author":"WHO, UNICEF","year":"2006","unstructured":"WHO, UNICEF. Core Questions on Drinking Water and Sanitation for Household Surveys. JMP Publication of the World Health Organizations and United Nations Children Fund. Switzerland. Geneva: WHO; 2006."},{"key":"2592_CR29","doi-asserted-by":"crossref","unstructured":"Kasee LF, Merrom OS, Hassa HY. Assessment of the prevalence of diarrheal disease under-five children Serbo town, Jimma zone south West Ethiopia. Clin Mother Child Health. 2018;15(1).1000280.","DOI":"10.4172\/2090-7214.1000281"},{"key":"2592_CR30","doi-asserted-by":"crossref","unstructured":"Diouf K, Tabatabai P, Rudolph J, Marx M. Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level. Glob Health Action. 2014;7:24895.","DOI":"10.3402\/gha.v7.24895"},{"issue":"1","key":"2592_CR31","first-page":"31","volume":"26","author":"N Rohmawati","year":"2012","unstructured":"Rohmawati N, Panza A, Lertmaharit S. Factors associated with diarrhea among children under five years of age in Banten Province, Indonesia. J Health Res. 2012;26(1):31\u20134.","journal-title":"J Health Res"},{"issue":"10","key":"2592_CR32","doi-asserted-by":"publisher","first-page":"233","DOI":"10.4236\/ojpm.2016.610022","volume":"6","author":"A Hashi","year":"2016","unstructured":"Hashi A, Kumie A, Gasana J. Prevalence of diarrhoea and associated factors among under-five children in Jigjiga District, Somali region, Eastern Ethiopia. Open J Prev Med. 2016;6(10):233\u201346.","journal-title":"Open J Prev Med"},{"issue":"4","key":"2592_CR33","first-page":"193","volume":"3","author":"AA Kolahi","year":"2008","unstructured":"Kolahi AA, NABAVI M, Sohrabi MR. Epidemiology of acute diarrheal diseases among children under 5 years of age in Tehran, Iran. Iran J Clin Infect Dis. 2008;3(4):193\u20138.","journal-title":"Iran J Clin Infect Dis"},{"issue":"1","key":"2592_CR34","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13006-017-0115-z","volume":"12","author":"Z Gizaw","year":"2017","unstructured":"Gizaw Z, Woldu W, Bitew BD. Child feeding practices and diarrheal disease among children less than two years of age of the nomadic people in Hadaleala District, Afar region, Northeast Ethiopia. Int Breastfeed J. 2017;12(1):24.","journal-title":"Int Breastfeed J"},{"key":"2592_CR35","doi-asserted-by":"crossref","unstructured":"Asfaha KF, Tesfamichael FA, Fisseha GK, Misgina KH, Weldu MG, Welehaweria NB, et al. Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a community based unmatched case\u2013control study. BMC Pediatr. 2018;18:120.","DOI":"10.1186\/s12887-018-1098-7"},{"key":"2592_CR36","doi-asserted-by":"publisher","unstructured":"Getachew A, Guadu T, Tadie A, Gizaw Z, Gebrehiwot M, Cherkos DH, et al. Diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar zone, Northwest Ethiopia. Int J Pediatr. 2018;2018.\u00a0https:\/\/doi.org\/10.1155\/2018\/6031594.\u00a0","DOI":"10.1155\/2018\/6031594"},{"issue":"2","key":"2592_CR37","doi-asserted-by":"publisher","first-page":"e0171792","DOI":"10.1371\/journal.pone.0171792","volume":"12","author":"FA Ogbo","year":"2017","unstructured":"Ogbo FA, Agho K, Ogeleka P, Woolfenden S, Page A, Eastwood J, et al. Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality. PLoS One. 2017;12(2):e0171792.","journal-title":"PLoS One"},{"key":"2592_CR38","doi-asserted-by":"crossref","unstructured":"Bizuneh H, Getnet F, Meressa B, Tegene Y, Worku G. Factors associated with diarrheal morbidity among under-five children in Jigjiga town, Somali Regional State, eastern Ethiopia: a cross-sectional study. BMC pediatrics. 2017;17:182.","DOI":"10.1186\/s12887-017-0934-5"},{"key":"2592_CR39","volume-title":"End preventable deaths: Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea.: World Health Organization\/The United Nations Children\u2019s Fund (UNICEF)","author":"WHO","year":"2013","unstructured":"WHO. End preventable deaths: Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea.: World Health Organization\/The United Nations Children\u2019s Fund (UNICEF) 2013."},{"key":"2592_CR40","first-page":"1","volume":"4","author":"DT Asnakew","year":"2017","unstructured":"Asnakew DT, Teklu MG, Woreta SA. Prevalence of diarrhea among under-five children in health extension model households in Bahir Dar Zuria district, North-Western Ethiopia. Edorium J Public Health. 2017;4:1\u20139.","journal-title":"Edorium J Public Health"},{"issue":"6","key":"2592_CR41","doi-asserted-by":"publisher","first-page":"581","DOI":"10.4314\/ejhs.v26i6.12","volume":"26","author":"W Regassa","year":"2016","unstructured":"Regassa W, Lemma S. Assessment of diarrheal disease prevalence and associated risk factors in children of 6-59 months old at Adama District rural Kebeles, eastern Ethiopia, January\/2015. Ethiop J Health Dev. 2016;26(6):581\u20138.","journal-title":"Ethiop J Health Dev"},{"key":"2592_CR42","volume-title":"World Medical Associations Declaration of Helsinki. Ethical principles for medical research involving human subjects, 6th revision. Helsinki, Finland","author":"WMA","year":"2008","unstructured":"WMA. World Medical Associations Declaration of Helsinki. Ethical principles for medical research involving human subjects, 6th revision. Helsinki, Finland. 2008."}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-021-02592-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12887-021-02592-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-021-02592-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T19:04:33Z","timestamp":1617217473000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-021-02592-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,31]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2592"],"URL":"https:\/\/doi.org\/10.1186\/s12887-021-02592-5","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,31]]},"assertion":[{"value":"22 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"An ethical approval letter was obtained from the Institutional Ethical Review Committee of the College of Medicine and Health Science of Wollo University. That committee approved both the protocol and the consent forms. A cooperation letter was obtained from Wollo University, which in turn helped to get permission to conduct the study from Dessie City Health Bureau, and the respective <i>kebele<\/i> administrators and health offices. Written, informed consent was obtained from the mothers\/caregivers of case and control children. Mothers\/caregivers were assured that their information would not be used for purposes other than scientific research and that their\u00a0participation was voluntary.The ethical principles of the Declaration of Helsinki were upheld in this study [] in that mothers\/caregivers of the case children were given oral rehydration salt for acute diarrheal treatment and advised to visit the public health facility for further treatment if there was no recovery within two days. All study participants were assured that their information was confidential. Confidentiality was assured by collecting the data anonymously and coding the names of the mothers\/caregivers.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"155"}}