Publication:

Factors associated with diarrheal disease among children under 5 years of age in a level 5 hospital in central Kenya

Background Diarrheal disease remains a major cause of morbidity and preventable mortality among children under five years globally. The 2022 Kenya demographic health survey reported that 14% of children under five had diarrhea in the two weeks preceding the survey, with higher prevalence among children aged 6-23 months.

Methods A hospital-based cross sectional unmatched case control design. The dependent variable was diarrheal disease status (yes/no). Independent variables included age group, sex, caregiver education, water source, sanitation, handwashing with soap, exclusive breastfeeding for six months, rotavirus vaccination status, and nutritional status. Bivariable and multivariable logistic regression were used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P value of <0.05 was considered significant.

Results 150 cases and 150 controls were recruited. Cases were generally younger than controls, with a lower mean age in months (24.3±14.6 vs 27.2±16.5). Independent predictors for diarrhoea in the multivariate regression model were: Age 12-23 months: aOR 2.60, p=0.034, Unimproved water source: aOR 1.97, p=0.039, Unimproved sanitation: aOR 1.93, p=0.044, No handwashing with soap: aOR 2.21, p=0.009, Undernutrition: aOR 2.18, p=0.034 and larger household size: aOR 2.63 per additional household member, p<0.001.

Conclusions Unsafe water, poor sanitation, inadequate hand hygiene, suboptimal infant feeding, and incomplete rotavirus immunization were major risk factors. Integrating child survival programs that combines clinical management with preventive WASH and immunization strategies is necessary to alleviate the burden of diarrheal disease in this setup.