Abstract
BACKGROUND: Diarrhea, defined as three or more loose stool per day, is a major cause of child mortality. Exploring its prevalence, and influencing factors is crucial for public health decision and targeted interventions. This study aimed to investigate these aspects using 2021 Madagascar demographic health survey data. METHOD: This study employed a cross-sectional design, analyzing data from a total of 8,740 weighted under-five children. The dependent variable was the occurrence of diarrhea, which was measured based on caregiver-reported incidents within the previous two weeks prior to the survey. To identify factors associated with diarrhea, a multilevel logistic regression model was utilized, allowing for the examination of both individual and contextual factors. Statistical significance was determined at a p-value of less than 0.05. RESULTS: The analysis identified several significant factors associated with diarrhea in children under five. Children aged 7-12 months had a significantly higher risk of diarrhea (OR = 2.699, 95% CI: 2.028-3.591, p < 0.001) compared to those aged 0-6 months, while those aged 13-24 months were also at increased risk (OR = 2.079, 95% CI: 1.579-2.737, p < 0.001). Children using improved water sources had a lower likelihood of diarrhea (OR = 0.742, 95% CI: 0.583-0.944, p = 0.015). Female children were less likely to experience diarrhea compared to males (OR = 0.823, 95% CI: 0.708-0.956, p = 0.011). Mothers aged 25-34 years (OR = 0.741, 95% CI: 0.626-0.878, p = 0.001) and 35-49 years (OR = 0.628, 95% CI: 0.502-0.787, p = 0.03) had lower odds of their children having diarrhea compared to younger mothers (15-24 years). Primary maternal education was associated with a lower risk of diarrhea (OR = 0.77, 95% CI: 0.622-0.958, p = 0.019). Children from poorer (OR = 0.744, 95% CI: 0.591-0.937, p = 0.012) and middle-income households (OR = 0.732, 95% CI: 0.564-0.949, p = 0.019) had lower odds of diarrhea compared to those from the poorest households. Media exposure was significantly associated with higher odds of diarrhea (OR = 1.462, 95% CI: 1.208-1.769, p < 0.001). CONCLUSION: Maternal age over 25 years, child age between 7 months to 2 years, and media access are risk factors for diarrhea. In contrast, medium or low wealth levels, the mother's educational status, the child's sex, and the source of drinking water seem to be protective factors. Public health interventions should prioritize improving access to clean water and sanitation facilities, along with promoting handwashing with soap. Educational campaigns targeted towards mothers, especially those with lower education levels, can significantly improve hygiene practices, safe water handling, and early symptom recognition of diarrhea.