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Global Health Econ Sustain Prevalence and risk factors of childhood diarrhea

and middle-income countries, where a lack of sanitation maternal age (Hussein, 2017; Moon et al., 2019), maternal
facilities, inadequacy of hygiene and safe drinking water, education level (Nasir et al., 2020; Melese et al., 2019;
cleaning, cooking, and impoverished housing conditions Escobar et al., 2015), child’s age (Atnafu et al., 2020; Bado
are widespread (Chopra et al., 2010; Mosisa et al., 2021). et al., 2016; Colombara et al., 2016), birth order (Sinmegn
Globally, diarrheal disease ranks as the second leading Mihrete et al., 2014; Egbewale et al., 2022), and child size
cause of death among children under five, accounting for (Agmas & Asmare, 2022). Likewise, household factors such
nearly 9% of all deaths within this age group (WHO, 2020; as household size, access to electricity, caste/tribe, religious
Tesfaye et al., 2020). Despite the global success in dwindling affiliation, and household wealth status are also associated
childhood diarrheal disease and reducing related deaths with childhood diarrhea occurrences (Agegnehu et
over the past two decades, approximately1.8 billion cases al., 2019; Didcock & Polnay, 2001; Asfaha et al., 2018;
are recorded annually, with children under the age of Lakshminarayanan, & Jayalakshmy, 2015; Bedowski et
five accounting for 80% of these cases (Bakir et al., 2017; al., 2018). Furthermore, environmental factors, including
Hodge et al., 2016). Alarmingly, a significant proportion of insufficient quantity and quality of drinking water, lack of
these deaths occurs among children under 2 years of age proper toilet facilities, and substandard dwelling conditions
(Paul, 2020). significantly contribute to diarrheal deaths, particularly
among the rural poor worldwide (Zedie & Kassa, 2018;
In developing countries like India, children under
the age of five typically experience approximately three Getachew et al., 2018; Workie et al., 2019). One notable
observation was that the prevalence of childhood diarrhea
episodes of diarrheal disease per year. Moreover, the
mortality rate due to childhood diarrhea is 10 times also varies significantly across the regional divisions of
greater in developing countries than in developed India (Kamath et al., 2018; Srivastava et al., 2022).
countries (Ghosh et al., 2021; Behera & Mishra, 2022). Childhood diarrhea among children under the age of
According to the latest report from the National Family five has emerged as a significant health concern in India,
and Health Survey (NFHS), the prevalence of childhood especially in rural areas. In spite of various interventions,
diarrhea has increased from 9% in 2015 to 9.2% in 2021 in policies, programs, and schemes by the Government of
India (NFHS 4 & 5). India to prevent and control diarrhea-related morbidity
and mortality among this age group, the situation
Childhood diarrhea deleteriously affects a child’s
physical growth as well as cognitive development (Niehaus remains alarming in many parts of the country. While
previous studies have suggested that childhood diarrhea
et al., 2022). Children suffering from diarrhea generally in developing countries significantly differs with different
face various problems, such as loss of appetite, electrolyte risk factors, most of the studies are region-specific, and
imbalances, and heightened susceptibility to other studies related to recognizing the risk factors of this disease
infectious diseases. Moreover, diarrhea is significantly are comparatively fewer in India than in other developing
associated with an increased risk of children’s malnutrition countries. The NFHS report 2019 – 2021 revealed that
(UNICEF & WHO, 2005; 2017). On average, approximately the occurrences of diarrheal disease among children
90% of diarrheal diseases are observed in South-Asian under the age of five are relatively high in rural India as
countries and sub-Saharan countries (Troeger et al., 2018). compared to urban areas. The prevalence of childhood
Although India has made substantial strides in minimizing diarrhea among the under-five in urban areas is 6.2%,
child mortality over the past 20 years, the prevalence of whereas it is relatively high in rural parts of India, at
this disease still remains high. The Government of India 7.7%. Despite this significant disparity, there is a scarcity
has already taken several initiatives to alleviate the burden of studies focusing on recognizing the risk factors for
of childhood diarrheal disease. Programs such as the diarrheal disease, specifically in rural India. While a few
Integrated Child Development Scheme and the National state-level studies exist, national-level studies addressing
Diarrheal Disease Control Program, alongside various these issues, especially in rural areas, remain limited
policies aimed at improving child health and nutrition, (Saha et al., 2022). Therefore, this study aims to identify
were launched to reduce the occurrences of diarrhea- the most significant factors (maternal-and child-related,
related morbidity and mortality among children under the household, and environmental factors) contributing to the
age of five (Dev et al., 2022; Khan & Chhabra, 2021). occurrence of diarrheal disease among under-five children
Various environmental, maternal, child-related, and using nationally representative sample survey data in rural
household-related determinants are responsible for the India. Besides, this study also aims to visualize the spatial
frequent incidence of diarrhea among children under the prevalence of diarrheal disease among under-five children
age of five in rural India (Badowski et al., 2011). Maternal across the districts of India through the identification of
and child-related factors play a crucial role, including diarrheal hot-spot and cold-spot regions.

Volume 2 Issue 2 (2024) 2 https://doi.org/10.36922/ghes.2048