Diarrhea prevalence: Table 1 shows the prevalence of diarrhea among children under five years old in Myanmar, categorized by age and gender. In a total of 1207 underfive children, 86 (7.13%) experienced diarrhea within two weeks of data collection. According to age group, the highest prevalence of diarrhea was found in 36- to 47-month-old (8.63%) children, followed by children aged 6 to 11 months (7.66%), 24 to 35 months (6.69%), 12 to 23 months (6.23%), and 48 to 59 months (6.15%). In terms of diarrhea prevalence by gender, 7.58 percent of girls and 6.72 percent of boys had diarrhea.
Table 1
Diarrhea prevalence among children under five years old in Myanmar
Diarrhea status | Total | Yes | 95% CI |
Number | % | |
Child’s Gender | | | | |
Female | 567 | 43 | 7.58 | 5.67 to 10.08 |
Male | 640 | 43 | 6.72 | 5.02 to 8.94 |
Age of children | | | | |
6 months to 11 months | 222 | 17 | 7.66 | 4.81 to 11.99 |
12 to 23 months | 257 | 16 | 6.23 | 3.84 to 9.93 |
24 to 35 months | 229 | 16 | 6.69 | 4.32 to 11.12 |
36 to 47 months | 255 | 22 | 8.63 | 5.74 to 12.77 |
48 to 59 months | 244 | 15 | 6.15 | 3.73 to 9.96 |
Total | 1207 | 86 | 7.13 | 5.80 to 8.72 |
Baseline characteristics: Table 2 shows the baseline characteristics of the respondents. The majority of children (78.62%) came from rural areas. This study comprised children from hilly regions, coastal locations, and plain zones. Most of the children (84.76%) were living in cement or wooden floor houses. A total of 37.37% of the total families had fewer than four family members. In this study, 46.98% were girls, and 53.02% were boys. A total of 79.29 percent of families with underfive children had fewer than three children. A total of 3.35 percent of total children were born before 37 weeks of labor. One-third of children had not taken the oral vitamin A supplement. Deworming medications were used by 59.15% of all children. Exclusive breast milk was used by 76.22 percent of the total children. A total of 43.58 percent of women were under the age of 30, 46.31 percent were between the ages of 30 and 40, and 10.11 percent were over the age of 40. The majority (35.29%) of underfive children’s mothers completed middle school. The major occupation of mothers (34.13%) was manual labor, and the average family income was 77.55 USD.
Regarding water, sanitation, and hygiene (WASH) status, 11.10 percent and 19.30 percent of households used unimproved and surface water without any treatment, respectively. A total of 8.29 percent and 7.21 percent of respondents were at the unimproved and open defecation sanitation service levels, respectively. A total of 87.66% were at the basic hygiene level, and 4.06% were at the limited hygiene level. A total of 8.29 percent did not have a dedicated handwashing facility at their home. A total of 18.89 percent of all households needed more than 15 minutes to collect water.
A total of 18.31 percent of households with children under five shared toilet facilities with others. The vast majority (91.80%) had a toilet in their home or compound. A total of 59.57 percent of those polled had a toilet with a secure containment structure. A total of 15.08 percent of households disposed of child excreta improperly. A total of 30.74 percent and 55.92 percent of households with underfive children disposed of the garbage and domestic wastewater improperly.
In terms of handwashing practices, a fixed-position handwashing facility was used by 70.75 percent of families, while a movable kind was used by 20.96 percent. Water was available in 90.47 percent of households, while soap was available in 87.90 percent of households. One of seven underfive-year-old children's mothers washed their hands in seven steps. One-third of all mothers cleansed their hands in fewer than four steps. A total of 44.32 percent of fathers cleansed their hands in fewer than four steps. Almost 30% of the children cleansed their hands in 4–7 steps.
The majority of the respondents (91.80%) had 17 to 24 food safety scores. A total of 8.04% of children still eat breastmilk as their main food after 6 months of age. A total of 19.30 percent of children avoided some kinds of food since birth. Regarding mothers’ health literacy level, 17.98 percent had inadequate sanitation health literacy, 27.01 percent had inadequate hygiene health literacy, and 17.48 percent had inadequate diarrhea health literacy.
Table 2
Baseline characteristics of respondents
Characteristics | Total (n = 1207) |
Number | Percentage (%) |
Residencial location | | |
Ward (Municipal area) | 258 | 21.38 |
Village (Rural area) | 949 | 78.62 |
Geolocation | | |
Hilly | 418 | 34.63 |
Coastal | 423 | 35.05 |
Plain | 366 | 30.32 |
House floor type | | |
Cement or wooden | 1023 | 84.76 |
Bamboo or Not have floor | 184 | 15.24 |
Family size | | |
< 4 members | 451 | 37.37 |
≥ 4 members | 756 | 62.63 |
Child’s Gender | | |
Female | 567 | 46.98 |
Male | 640 | 53.02 |
Children parity | | |
Have less than 3 children | 957 | 79.29 |
Have 3 or more children | 250 | 20.71 |
Labor type | | |
Preterm labor | 44 | 3.65% |
Full term labor | 1163 | 96.35 |
Oral vitamin A supplement | | |
Not taken | 435 | 36.04 |
Taken | 772 | 63.96 |
Deworming medicine | | |
Not taken | 493 | 40.85 |
Taken | 714 | 59.15 |
Breast feeding | | |
Not exclusive breast feeding | 287 | 23.78 |
Exclusive breast feeding | 920 | 76.22 |
Age of mother at data collection time | | |
Less than 30 years | 526 | 43.58 |
Between 30 to 40 years | 559 | 46.31 |
Equal or more than 40 years | 122 | 10.11 |
Education level of mother | | |
University graduate | 122 | 10.11 |
High school | 272 | 22.54 |
Middle school | 426 | 35.29 |
Primary school | 313 | 25.93 |
Can read and write | 46 | 3.81 |
Illiterate | 28 | 2.32 |
Education level of father | | |
University graduate | 96 | 7.95 |
High school | 288 | 23.86 |
Middle school | 428 | 35.46 |
Primary school | 315 | 26.10 |
Can read and write | 75 | 6.21 |
Illiterate | 5 | 0.41 |
Occupation of mother | | |
Government staff | 54 | 4.47 |
Private employee | 27 | 2.24 |
Dependent | 278 | 23.03 |
Manual labor | 412 | 34.13 |
Own business | 328 | 27.17 |
Farmer | 7 | 0.58 |
Other | 101 | 8.37 |
Government staff | 54 | 4.47 |
Private employee | 27 | 2.24 |
Dependent | 278 | 23.03 |
Monthly income in USD | | |
Less than 100 | 670 | 55.51 |
Equal or more than 100 | 537 | 44.49 |
Water services level | | |
At least basic | 826 | 68.43 |
Limited | 14 | 1.16 |
Unimproved | 134 | 11.10 |
Surface water | 233 | 19.30 |
Sanitation services level | | |
Safely managed | 719 | 59.57 |
Basic | 80 | 6.63 |
Limited | 221 | 18.31 |
Unimproved | 100 | 8.29 |
Open defecation | 87 | 7.21 |
Hygiene services level | | |
Basic | 1058 | 87.66 |
Limited | 49 | 4.06 |
No handwashing facility | 100 | 8.29 |
Water collection time | | |
Less than 15 minutes | 677 | 56.09 |
From 1 to 15 minutes | 302 | 25.02 |
More than 15 minutes | 228 | 18.89 |
Share use of toilet with others | | |
No | 986 | 81.69 |
Yes | 221 | 18.31 |
Toilet location | | |
In house/compound | 1108 | 91.80 |
Elsewhere | 99 | 8.20 |
Safe containment of toilet | | |
Not safely contained | 80 | 6.63 |
Safely contained | 719 | 59.57 |
Limited/unimproved/open defecation | 408 | 33.80 |
Child excreta disposal | | |
Proper excreta disposal | 1025 | 84.92 |
Unproper excreta disposal | 182 | 15.08 |
Garbage disposal | | |
Proper garbage disposal | 836 | 69.26 |
Unproper garbage disposal | 371 | 30.74 |
Domestic wastewater disposal | | |
Proper domestic wastewater disposal | 532 | 44.08 |
Unproper domestic wastewater disposal | 675 | 55.92 |
Handwashing facility type | | |
Fixed facility | 854 | 70.75 |
Mobile facility | 253 | 20.96 |
No handwashing place | 100 | 8.29 |
Availability of water at handwashing facility | | |
Yes | 1092 | 90.47 |
Not have water and facility | 115 | 9.53 |
Availability of soap at handwashing facility | | |
Yes | 1061 | 87.90 |
Not have water and facility | 146 | 12.10 |
Handwashing with 7 steps by mother | | |
Yes | 177 | 14.66 |
No | 1030 | 85.34 |
Mother’s handwashing steps | | |
4–7 steps | 783 | 64.87 |
Less than 4 steps | 424 | 35.13 |
Father’s handwashing steps | | |
4–7 steps | 672 | 55.68 |
Less than 4 steps | 535 | 44.32 |
Child’s handwashing steps | | |
4–7 steps | 357 | 29.58 |
Less than 4 steps | 850 | 70.42 |
Food safety score | | |
< 17 scores | 99 | 8.20 |
17 to 24 scores | 1108 | 91.80 |
Mean (SD) | 19.67 | (± 2.18) |
Median (Min:Max) | 20 | (12 : 24) |
Main type food | | |
Rice or others | 1,110 | 91.96 |
Breastmilk | 97 | 8.04 |
Avoiding on some kinds of food | | |
Not avoiding, eat any | 974 | 80.70 |
Yes avoiding on some kinds of food | 233 | 19.30 |
Mother’s health literacy level on sanitation promotion | | |
Inadequate level | 217 | 17.98 |
Problematic level | 263 | 21.79 |
Adequate level | 641 | 53.11 |
Excellent level | 86 | 7.13 |
Mother’s health literacy level on Hygiene promotion | | |
Inadequate level | 326 | 27.01 |
Problematic level | 283 | 23.45 |
Adequate level | 526 | 43.58 |
Excellent level | 72 | 5.97 |
Mother’s health literacy level on Diarrhea prevention | | |
Inadequate level | 233 | 17.48 |
Problematic level | 278 | 24.69 |
Adequate level | 634 | 51.78 |
Excellent level | 72 | 6.05 |
After bivariate analysis, urban/rural residency, geolocation, house floor type, parity, birthweight, vitamin A supplement, deworming, exclusive breast feeding, mother’s education, father’s education, mother’s occupation, family income, water collection time, water shortage, water supply services level, sharing use of toilet facility, toilet facility location, child feces disposal, toilet containment, sanitation services level, handwashing facility type, availability of water at handwashing facility, availability of soap at handwashing facility, solid waste disposal, waste water disposal, handwashing systematically by mother, handwashing systematically of father, handwashing systematically of child, food security score, main food, food avoidance, sanitation health literacy, hygiene health literacy and diarrhea health literacy were added to final analysis model as p values less than 0.25.
Table 3
Factors associated with diarrhea among children under five years old in Myanmar
Variable | Total (No.) | Diarrhea (%) | COR | AOR | 95% CI | p value |
Hygiene services level | | | | |
Basic | 1058 | 4.91 | 1 | 1 | | |
Limited | 49 | 22.45 | 5.60 | 2.85 | 1.31 to 6.21 | 0.01 |
No facility | 100 | 23.00 | 5.78 | 2.63 | 1.42 to 4.89 | < 0.01 |
Father’s handwashing steps | | | | | | |
4–7 steps | 672 | 3.72 | 1 | 1 | | |
Less than 4 steps | 535 | 11.40 | 3.33 | 2.20 | 1.29 to 3.74 | < 0.01 |
Water collection time | | | | | | |
Less than 15 minutes | 979 | 25.41 | 1 | 1 | | |
More than minutes | 228 | 14.47 | 2.96 | 1.77 | 1.06 to 2.97 | 0.03 |
Share use of toilet with others | | | | | | |
No | 986 | 6.19 | 1 | 1 | | |
Yes | 221 | 11.31 | 1.93 | 2.00 | 1.15 to 3.48 | 0.01 |
Mother’s health literacy level on Hygiene promotion | | | | |
Adequate and excellent | 598 | 3.01 | 1 | 1 | | |
Inadequate and problematic | 609 | 11.17 | 4.05 | 2.20 | 1.24 to 3.90 | 0.01 |
House floor type | | | | |
Cement or wooden | 1023 | 5.28 | 1 | 1 | | |
Bamboo or not have floor | 184 | 17.39 | 3.78 | 2.31 | 1.38 to 3.89 | < 0.01 |
Parity | | | | |
1–2 children | 597 | 5.75 | 1 | 1 | | |
3 and more children | 250 | 12.40 | 2.32 | 1.68 | 1.01 to 2.79 | 0.05 |
Main food | | | | | | |
Rice and others | 1110 | 6.13 | 1 | 1 | | |
Breastmilk | 97 | 18.56 | 3.49 | 2.07 | 1.09 to 3.93 | 0.03 |
Associated factors
Table 3 shows factors associated with diarrhea among children under five years old in Myanmar. After running the final analysis model, household hygiene service level was found to be a significant associated factor for childhood diarrhea among 6- to 59-month-old children. Fathers’ handwashing steps, water collection times, shared use of toilet facilities, hygiene health literacy, house floor type, parity and main food type were found to be factors associated with childhood diarrhea among children under five years old in Myanmar.
In terms of hygiene practices, children who received limited hygiene services were 2.85 times more likely to suffer from diarrhea disease than children who received basic hygiene services (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01). Similarly, children who do not have access to handwashing facilities are approximately 2.63 times more likely to have diarrhea than children who do have access to basic hygiene services (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01).
Other associated variables were father's handwashing procedures, water collection time, shared toilet usage with others, hygiene promotion health literacy, house floor type, parity, and major meal among Myanmar's under five children. Children whose father cleaned his hands less than four times were approximately twice as likely as other children whose father washed his hands more than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01). Children whose families needed 15 to 60 minutes to gather water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03) were 77% more likely to have diarrhea disease than children whose families needed less than 15 minutes to get water.
Furthermore, children who lived in a household sharing the toilet were twice as likely as other children to have diarrhea (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01). Children with inadequate and problematic hygiene promotion health literacy levels were twice as likely as children with adequate and excellent hygiene promotion health literacy levels (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01).
The type of house floor also has an impact on childhood diarrhea. Children from houses with earth or bamboo floors were more likely to have diarrhea than children from houses with concrete or wood floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01). Children under the age of five in families with three or more children were 86% more likely to have diarrhea than children with one to two siblings (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05). Furthermore, 6- to 5-year-old children who ate breastmilk as their primary food were substantially more likely to have diarrhea than children who ate rice or other foods as their main food (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03).