Page 79 - GHES-2-2

Global Health Econ Sustain Prevalence and risk factors of childhood diarrhea

altitudes (χ : 232.960; p: 0.000) and regional divisions Comparatively, the areas with low child diarrhea prevalence
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(χ : 938.676; p: 0.000). Most of the childhood diarrheal were marked as cold spots. Regions in red indicate higher
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cases were identified within the altitudinal range between risks of childhood diarrhea, encompassing major districts
100 and 499 m (6.7%) and found in the eastern (10.1%) in West Bengal, Bihar, Jharkhand, Orissa, Rajasthan,
and western (10.0%) parts of rural India. Maharashtra, Gujrat, Andhra Pradesh, and Karnataka.

The spatial autocorrelation analysis indicates that Conversely, blue-colored areas constitute districts with low
the district-wise distribution pattern of child diarrhea child diarrhea prevalence, coverings states such as Punjab,
prevalence in India is neither random nor dispersed, as Arunachal Pradesh, Manipur, Nagaland, Mizoram,
evidenced by a Global Moran’s I value of 0.19 (p < 0.001). Tripura, Kerala, and Tamil Nadu.
This analysis suggests a clustered pattern of child diarrhea The results of logistic regression (Table 3) indicate
prevalence in Indian districts based on the NFHS-5 that in rural India, children nourished by mothers
database. Moreover, the extracted z-score value (28.43) also aged 15 – 24 years were 44% more likely (adjusted odds
indicates that there is <1% likelihood that this clustered ratio [AOR]: 1.44; p < 0.05; 95% confidence interval
pattern could be the result of random chance. [CI]: 1.34 – 1.55) to suffer from diarrheal diseases compared
to children with mothers aged 35 – 49 years, taken as the
3.3. Spatial distribution of diarrhea diseases in India reference category. Similarly, children in rural areas whose
Figure 2 depicts the spatial distribution of diarrhea disease mothers had no formal education (AOR: 1.16; p < 0.05;
occurrences within the last 2 weeks before or at the 95% CI: 1.06 – 1.30) or had only completed primary
time of sample collection for both NFHS-4 (2015 – 16) education (AOR: 1.11; p < 0.05; 95% CI: 1.05 – 1.17) were
and NFHS-5 (2019 – 21). According to the NFHS-4 16% and 11% more likely to develop diarrheal disease,
(2015 – 16) database, 32 districts reported high child respectively, compared to children with mothers who had
diarrhea prevalence, including regions such as Kishtar and completed secondary education or higher. In addition, the
Ramban in Jammu and Kashmir; Sahibzada in Punjab; and odds of childhood diarrheal disease were 2.35 times higher
Uttarkashi, Chamoli, Dehradun, Pithoragarh, Bageshwar, (AOR: 2.35; p < 0.05; 95% CI: 2.22 – 2.49) among rural
and Hardwar in Uttarakhand. Similarly, high prevalence Indian children aged 0 – 1 year compared to those aged
was observed in Northwest Delhi; Bareilly, Pilbhit, Aligarh, 4 – 5 years. The odds of diarrheal disease increased by 7%
Bahraich, Sitapur, Kushinagar, Kannaouj, Gorakhpur, among the children who belonged to the fifth or higher
Saharanpur, Meerut, and Rampur in Uttar Pradesh; birth order (AOR: 1.07; p < 0.05; 95% CI: 0.99 – 1.09). The
Gopalganj in Bihar; South Garo hills in Meghalaya; Palamu likelihood of childhood diarrheal disease was 16% and
in Jharkhand; Kendujhar and Baleswar in Orissa; and 23% lower among children who had average (AOR: 0.84;
Umaria in Madhya Pradesh. Conversely, low prevalence was p < 0.05; 95% CI: 0.77 – 0.91) and smaller than average
reported in most districts of Sikkim, Arunachal Pradesh, (AOR: 0.77; p < 0.05; 95% CI: 0.72 – 0.83) physical growth
Nagaland, Mizoram, Meghalaya, Assam, West Bengal, as compared to the children who possessed larger size than
Chhattisgarh, Gujrat, Kerala, and Telangana. In contrast, average physical growth. Children from rural households
according to NFHS-5 (2019 – 21), 11 out of 707 districts with more than six family members had 8% lower odds
of India reported high child diarrhea prevalence exceeding (AOR: 0.92; p < 0.05; 95% CI: 0.87 – 0.96) of developing
17.5%, covering the states of Bihar (Paschim Champaran, diarrheal disease compared to those from households with
Sitamarhi, Supaul, and Madhubani), Maharashtra (Nasik, fewer than five family members. Moreover, in rural India,
Jalna, and Parbhani), Orissa (Mayurbhanj and Baleshwar), children from households without electricity (AOR: 1.15;
and Chhattisgarh (Bastar). Similarly, 87 districts illustrate p < 0.05; 95% CI: 1.05 – 1.25), belonged to SC (AOR: 1.12;
that childhood diarrhea prevalence varies between 10.8% p < 0.05; 95% CI: 1.02 – 1.23) and scheduled tribe (ST)
and 17.5%. In addition, 168 districts reported childhood (AOR: 1.09; p < 0.05; 95% CI: 0.98 – 1.20) categories, were
diarrhea prevalence ranging from 6.8% to 10.8%, and 304 more likely to suffer from diarrheal disease.
districts reported diarrhea prevalence among children Estimation also revealed that the probability of childhood
ranging from 3.4 – 6.8%. The rest of the 138 districts diarrheal disease was 59% higher among the poorest
exhibited a low child diarrhea prevalence (<3.4%), covering (AOR: 1.59; p < 0.05; 95% CI: 1.45 – 1.74); 47% among
most of the districts of Jammu and Kashmir, Himachal the poorer (AOR: 1.47; p < 0.05; 95% CI: 1.34 – 1.61); 36%
Pradesh, Punjab, Haryana, Uttar Pradesh, Arunachal among the middle (AOR: 1.36; p < 0.05; 95% CI: 1.23 – 1.49);
Pradesh, Nagaland, Manipur, Mizoram, Assam, Kerala, and 26% among the richer (AOR: 1.26; p < 0.05; 95%
and Tamil Nadu. CI: 1.14 – 1.39) wealth backgrounds. In addition, there
The hot spot analysis illustrates contiguous areas with was a higher likelihood of childhood diarrhea among
high child diarrhea prevalence, indicated as hot spot areas. households with unimproved toilet facilities (AOR: 1.22;

Volume 2 Issue 2 (2024) 7 https://doi.org/10.36922/ghes.2048