{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T03:10:12Z","timestamp":1785208212246,"version":"3.55.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nWorldwide, diarrhea is the second most common cause of death and morbidity among under -five years\u2019 children. In sub-saran Africa, access to water, sanitation, and hygiene are very scanty and the burden of diarrhea diseases is countless relative to the rest of the world. Prior studies conducted in East Africa vary in design, sample size, and other data collection tools. Through those studies, it is hard to make regional comparisons. Combining datasets that are studied on similar people and having common variable identified enhances statistical power due to the large sample size, advance the ability to compare outcomes, and create the opportunity to develop new indicators. Hence, this study aimed to assess the prevalence and associated factors of diarrhea among under five years\u2019 children using the most recent national representative Demographic and Health Surveys from 12 East African countries. The information generated from this pooled datasets will give good insight into the sub-regional prevalence of diarrhea.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThis study utilized secondary data from 12 East African countries\u2019 most recent demographic health survey. Variables were extracted and appended together to assess the pooled prevalence of diarrhea and associated factors. A total of 90,263 under-five years of age children were encompassed in this study. STATA version was used to cross-tabulate and fit the models. To account for the hierarchical nature of the demographic health survey, multilevel logistic regression was calibrated. BIC, AIC, deviance, and LLR were used as Model comparison parameters. Variables with a p-value of <0.2 were considered for multivariable analysis. Adjusted odds ratio with 95% CI and p-value <0.05 were used to declare statistical significances of factors.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe pooled prevalence of diarrhea in under five years children was 14.28% [95%CI; 14.06%, 14.51%]. Being child whose mother age is 15\u201324 years [AOR = 1.41, 95% CI; 1.33, 1.49], 25\u201334 years[AOR = 1.17, 95%CI; 1.10, 1.23], being 7\u201312 months child [AOR = 3.10, 95%CI; 2.86, 3.35], being 12\u201324 months child [AOR = 2.56, 95%CI; 2.38, 3.75], being 25\u201359 months child [AOR = 0.88, 95%CI; 0.82, 0.95], being child from poor household [AOR = 1.16, 95%CI; 1.09, 1.23], delayed breast feeding initiation (initiated after an hour of birth) [AOR = 1.15, 95%CI; 1.10, 1.20], and being a child from community with low educational status [AOR = 1.10, 95%CI; 1.03, 1.18] were factors associated with diarrheal diseases.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe pooled prevalence of diarrhea among under five years of children in East African countries is high. Maternal age, child\u2019s age, wealth status of the household, the timing of breast feeding initiation, sex of the child, community level of educational status, working status of the mother, and the number of under five children were factors that were associated with diarrheal diseases. Scaling up of maternal and child health services by government and other concerned bodies should consider those economically marginalized communities. Additionally, awareness should be created for those uneducated mothers concerning the nature of childhood diarrhea.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0264559","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T17:45:17Z","timestamp":1649958317000},"page":"e0264559","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":45,"title":["Pooled prevalence and associated factors of diarrhea among under-five years children in East Africa: A multilevel logistic regression analysis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9076-5159","authenticated-orcid":true,"given":"Abiyu Abadi","family":"Tareke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermias Bekele","family":"Enyew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bayley Adane","family":"Takele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"issue":"5","key":"pone.0264559.ref001","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.vaccine.2010.11.065","article-title":"Diarrhea: case definition and guidelines for collection, analysis, and presentation of immunization safety data","volume":"29","author":"J Gidudu","year":"2011","journal-title":"Vaccine"},{"key":"pone.0264559.ref002","unstructured":"world health organization. diarrheal disease fact sheets 2017 [updated 2017; cited 2021 jun,8]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diarrhoeal-disease."},{"issue":"9","key":"pone.0264559.ref003","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S1473-3099(17)30276-1","article-title":"Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015","volume":"17","author":"C Troeger","year":"2017","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0264559.ref004","unstructured":"GBD. global burden of diseases visual hub. 2019."},{"issue":"1","key":"pone.0264559.ref005","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jobb.2021.03.004","article-title":"Water sanitation and hygiene in Sub-Saharan Africa: Coverage, risks of diarrheal diseases, and urbanization","volume":"3","author":"A Zerbo","year":"2021","journal-title":"Journal of Biosafety and Biosecurity"},{"issue":"6","key":"pone.0264559.ref006","doi-asserted-by":"crossref","first-page":"e0199684","DOI":"10.1371\/journal.pone.0199684","article-title":"Prevalence and determinants of diarrhea among under-five children in Ethiopia: a systematic review and meta-analysis.","volume":"13","author":"A Alebel","year":"2018","journal-title":"PloS one."},{"issue":"7","key":"pone.0264559.ref007","doi-asserted-by":"crossref","first-page":"400","DOI":"10.4066\/AMJ.2011.723","article-title":"Determinants of diarrhoea and acute respiratory infection among under-fives in Uganda","volume":"4","author":"E. Bbaale","year":"2011","journal-title":"The Australasian medical journal"},{"key":"pone.0264559.ref008","volume-title":"Factors contributing to diarrheal diseases among children less than five years in Nyarugenge District","author":"N. Jean","year":"2017"},{"issue":"2","key":"pone.0264559.ref009","doi-asserted-by":"crossref","DOI":"10.35500\/jghs.2019.1.e45","article-title":"Risk factors of diarrhea of children under five in Malawi: based on Malawi Demographic and Health Survey 2015\u20132016","volume":"1","author":"J Moon","year":"2019","journal-title":"Journal of Global Health Science"},{"issue":"1","key":"pone.0264559.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13643-020-01511-6","article-title":"Open defecation-free slippage and its associated factors in Ethiopia: a systematic review.","volume":"9","author":"TA Abebe","year":"2020","journal-title":"Systematic reviews."},{"key":"pone.0264559.ref011","volume-title":"Kenya Environmental Sanitation and Hygiene Policy 2016\u20132030.","author":"RoKMo Health","year":"2016"},{"key":"pone.0264559.ref012","author":"M Ntaro","year":"2021","journal-title":"Contextual and Psychological Factors Influencing Open Defecation Free Status: An Exploratory Qualitative Study in Rural South Western Uganda"},{"issue":"6","key":"pone.0264559.ref013","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.ijheh.2017.03.015","article-title":"Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia","volume":"220","author":"C Morgan","year":"2017","journal-title":"International journal of hygiene and environmental health"},{"issue":"1","key":"pone.0264559.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7579-2","article-title":"Prevalence of diarrheal diseases and associated factors among under-five children in Dale District, Sidama zone, Southern Ethiopia: a cross-sectional study.","volume":"19","author":"B Melese","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0264559.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12887-021-02546-x","article-title":"Factors associated with diarrhoea and acute respiratory infection in children under-5 years old in Ghana: an analysis of a national cross-sectional survey","volume":"21","author":"PA Apanga","year":"2021","journal-title":"BMC pediatrics"},{"issue":"2","key":"pone.0264559.ref016","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4314\/gjds.v16i2.8","article-title":"Maternal and child level factors associated with childhood (0\u201323 months) diarrhoea in Ghana: a pooled analysis of national representative datasets.","volume":"16","author":"AM Tampah-Naah","year":"2019","journal-title":"Ghana Journal of Development Studies"},{"issue":"1","key":"pone.0264559.ref017","first-page":"8","article-title":"Risk factors of diarrheal disease among children in the east African countries of Burundi, Rwanda and Tanzania.","volume":"6","author":"BJ OConnell","year":"2017","journal-title":"Global J Med Public Health"},{"issue":"1","key":"pone.0264559.ref018","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3347\/kjp.2021.59.1.61","article-title":"Association between Sociodemographic Factors and Diarrhea in Children Under 5 Years in Rwanda","volume":"59","author":"U Claudine","year":"2021","journal-title":"The Korean Journal of Parasitology"},{"issue":"1","key":"pone.0264559.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-017-4107-0","article-title":"Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya.","volume":"17","author":"Y Kawakatsu","year":"2017","journal-title":"BMC Public Health"},{"issue":"Supplement_1","key":"pone.0264559.ref020","doi-asserted-by":"crossref","first-page":"nzz034","DOI":"10.1093\/cdn\/nzz034.P10-013-19","article-title":"Water, Sanitation, and Hygiene (WASH) Indicators and Their Association with Child Linear Growth: A Multi-Country DHS Analysis in East Africa (P10-013-19).","volume":"3","author":"H Rakotomanana","year":"2019","journal-title":"Current developments in nutrition."},{"key":"pone.0264559.ref021","author":"T Croft","year":"2020","journal-title":"Guide to DHS Statistics: DHS-7 (version 2)."},{"issue":"2","key":"pone.0264559.ref022","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1136\/jech-2015-206693","article-title":"Individual schooling and women\u2019s community-level media exposure: a multilevel analysis of normative influences associated with women\u2019s justification of wife beating in Bangladesh.","volume":"71","author":"KH Krause","year":"2017","journal-title":"J Epidemiol Community Health"},{"key":"pone.0264559.ref023","volume-title":"Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals","author":"Organization WH","year":"2009"},{"key":"pone.0264559.ref024","unstructured":"federal minister of health. HMIS INDICATOR REFERENCE GUIDE2017."},{"issue":"4","key":"pone.0264559.ref025","doi-asserted-by":"crossref","first-page":"152","DOI":"10.32677\/IJCH.2015.v02.i04.004","article-title":"Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis.","volume":"2","author":"E Ganguly","year":"2015","journal-title":"Indian journal of child health"},{"issue":"5","key":"pone.0264559.ref026","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1093\/tropej\/46.5.282","article-title":"risk factors of diarrheal diseases among under-five children in rural Upper Egypt","volume":"46","author":"Yassin K. Morbidity","year":"2000","journal-title":"Journal of tropical pediatrics"},{"issue":"1","key":"pone.0264559.ref027","first-page":"15","article-title":"Childhood diarrheal morbidity in the Accra Metropolitan Area, Ghana: socio-economic, environmental and behavioral risk determinants.","volume":"7","author":"KO Boadi","year":"2005","journal-title":"Journal of Health & Population in Developing Countries."},{"issue":"2","key":"pone.0264559.ref028","first-page":"126","article-title":"Prevalence of diarrhoeal disease, its seasonal and age variation in under-fives in Kashmir, India.","volume":"2","author":"SF Ahmed","year":"2008","journal-title":"International Journal of Health Sciences"},{"issue":"1","key":"pone.0264559.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-019-4445-x","article-title":"Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia.","volume":"19","author":"GY Workie","year":"2019","journal-title":"BMC infectious diseases."},{"key":"pone.0264559.ref030","article-title":"Prevalence of diarrhea and associated risk factors in children under five years of age in Northern Nigeria: a secondary data analysis of Nigeria demographic and health survey 2013.","author":"H. Hussein","year":"2017","journal-title":"Unpublished Degree Project, Uppsala Universitet."},{"issue":"5","key":"pone.0264559.ref031","first-page":"847","article-title":"Mothers\u2019 knowledge, attitude and practice regarding diarrhea and its management in Morang Nepal: an interventional study","volume":"11","author":"M Ansari","year":"2012","journal-title":"Tropical Journal of Pharmaceutical Research"},{"issue":"4","key":"pone.0264559.ref032","first-page":"762","article-title":"Epidemiology of diarrhoeal diseases among children under age 5 years in Dakahlia, Egypt.","volume":"11","author":"A El Gilany","year":"2005","journal-title":"EMHJ-Eastern Mediterranean Health Journal"},{"issue":"1","key":"pone.0264559.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13006-017-0115-z","article-title":"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.","volume":"12","author":"Z Gizaw","year":"2017","journal-title":"International breastfeeding journal"},{"issue":"3","key":"pone.0264559.ref034","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/BF02725583","article-title":"Prevalence and correlates of diarrhea","volume":"70","author":"SM Shah","year":"2003","journal-title":"The Indian Journal of Pediatrics"},{"issue":"1","key":"pone.0264559.ref035","first-page":"490","article-title":"Socio-economic determinants of diarrhoea morbidity in Pakistan.","volume":"2","author":"A Arif","year":"2012","journal-title":"Academic Research International"},{"issue":"1","key":"pone.0264559.ref036","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/ajcn\/39.1.87","article-title":"Malnutrition is a determining factor in diarrheal duration, but not incidence, among young children in a longitudinal study in rural Bangladesh","volume":"39","author":"RE Black","year":"1984","journal-title":"The American journal of clinical nutrition"},{"issue":"1","key":"pone.0264559.ref037","doi-asserted-by":"crossref","first-page":"328S","DOI":"10.1093\/jn\/133.1.328S","article-title":"Diarrhea and malnutrition","volume":"133","author":"KH Brown","year":"2003","journal-title":"The Journal of nutrition"},{"issue":"1","key":"pone.0264559.ref038","first-page":"1","article-title":"Country characteristics and acute diarrhea in children from developing nations: a multilevel study.","volume":"15","author":"\u00c1M Pinz\u00f3n-Rond\u00f3n","year":"2015","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0264559.ref039","first-page":"1","article-title":"Diarrhea incidence in low-and middle-income countries in 1990 and 2010: a systematic review.","volume":"12","author":"CLF Walker","year":"2012","journal-title":"BMC public health."},{"key":"pone.0264559.ref040","author":"Organization WH","year":"2019","journal-title":"World health statistics 2019: monitoring health for the SDGs, sustainable development goals."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264559","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T17:46:14Z","timestamp":1649958374000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264559"}},"subtitle":[],"editor":[{"given":"Khin","family":"Thet Wai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,14]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264559","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,14]]}}}