Descriptive results of socio-demographic, environmental and behavioural characteristics
The study included 8,041 under-five children. Out of these 3938(49.0%) were females, 891(11.1%) were less than 6 months and 3265(40.6%) were age greater than 35 months [Table 1]. The majority of the children 5459(67.9%) were currently breastfeeding at the time of the survey. Around 4774(60%) of children’s households had six and above family members. Regarding mothers/caregivers, 5801(72.1%) had no formal education and 7659(95.2%) were married.
Concerning the environmental and behavioural characteristics of the respondents, 3713(46.7%) of mothers/caregivers have used unimproved source of drinking water [Table 2]. There were 3262(41%) unimproved toilet facility and 4103(51.6%) no toilet facility in the household. Furthermore, around 3171(61%) of the mothers/caregivers were not properly removed the youngest child's stools.
Magnitude of Diarrhoea
The overall occurrence of diarrhoea among under-five children was 11.2% (95% CI: 10.5%-11.9%) in rural Ethiopia. The result displayed in Tables 1 and Table 2 showed that the occurrence of diarrhoea was the highest among children age 6-11 months (18.9%) and 12-23 months (18.1%). Figure 1 also shows that the occurrence of diarrhoea, on average, was high among children aged from 6 to 23 months. The highest magnitude of diarrhoea was also observed on children lives in SNNPR Region (14.3%), whose household shared toilet facility with other households (13.9%), protestant followers’ children (13.5%) and widowed/separated respondents’ children (13.1%). Table 1 and Table 2 also shows that there are other socio-demographic, environmental and behavioural categories of children that the occurrence of diarrhoea was above the overall average (11.2%).
Results of bivariate and multivariable logistic regression analysis
In Bivariate analysis, the chi-square test results in Tables 1 and Table 2 and the estimated crude odds ratios in Table 3 showed that there were a significant association between occurrence of diarrhoea and respondent's current age, sex of child, current age of child, region, number of under-five children, wealth index of the household, religion, number of household members, current breastfeeding status, type of toilet facility and toilet facilities shared with other households at 5% level of significance.
In multivariable analysis, a multilevel binary logistic model was proposed to identify associated factors of diarrhoea occurrence by handling the effect of variations of the outcome occurrence at regional level and individual child level in rural Ethiopia. However, during the analysis, the variation of diarrhoea across regions was not significant in the random intercept model. So this result suggests that the variation of occurrence of diarrhoea among under-five children due to regional difference was zero. Hence, I conclude that the regional difference did not contribute to the variation in the occurrence of diarrhoea among under-five children in rural parts of Ethiopia. As a result, the fixed effect multivariable binary logistic regression model was used instead to study the overall effect of the socio-demographic, environmental and behavioural associated factors on the response variable (occurrence of diarrhoea).
The Hosmer-Lemeshow goodness-of-fit test result (P-value = 0.763) showed that the final multivariable binary logistic regression model was a good fit to the data. In the final model, the estimated crude odds ratio (COR), adjusted odds ratio (AOR) and their 95% confidence interval are included.
The result showed that current age of child [6-11 months (AOR: 3.5; 95% CI: 2.58-4.87), 12-23 months (AOR: 3.1; 95% CI: 2.33-4.04) and 24-35 months (AOR: 1.7; 95% CI: 1.26-2.34)], sex of child[male (AOR: 1.3; 95% CI: 1.05-1.58)], region [Afar (AOR: 1.92; 95% CI: 1.01-3.64), Somali (AOR: .42; 95% CI: (.217-.80) and Gambela (AOR: 2.12; 95% CI: 1.18- 3.81)], birth order [4th (AOR: .1.81; 95% CI: 1.17-2.79), 5th and above (AOR: 1.85; 95% CI: 1.22-2.81)], toilet facilities shared with other households (AOR: 1.4; 95% CI: 1.09-1.77) and the interaction of number of under-five children with mother’s current age (AOR: 4.7; 95% CI: 1.64-13.45) were statistically significant associated factors of diarrhoeal occurrence among under five children at 5% level of significance [Table 3].