Skip to main content
Download PDF

Determinants of diarrhoeal diseases among under-five children in Africa (2013–2023): a comprehensive systematic review highlighting geographic variances, socioeconomic influences, and environmental factors

BMC Public Health volume 24, Article number: 2399 (2024) Cite this article

Abstract

Background

Diarrhea diseases continue to present a significant threat to the well-being of children under the age of five in Africa, thereby contributing substantially to both morbidity and mortality rates. The period spanning between January 2013 and December 2023 has witnessed persistent challenges in the fight against these diseases, thereby necessitating a thorough investigation into the factors that determine their occurrence. It is important to note that the burden of diarrhea diseases is not evenly distributed across the continent, with residence, socioeconomic, and environmental factors playing pivotal roles in shaping the prevalence and incidence rates. Consequently, this systematic review aimed to consolidate and analyze the existing body of literature on the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023.

Method

The systematic review employed a rigorous methodological approach to examine the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. A comprehensive search strategy was implemented, utilizing databases such as PubMed, Scopus, and Web of Science, and incorporating relevant keywords. The inclusion criteria focused on studies published within the specified timeframe, with a specific focus on the determinants of diarrhea disease among children under the age of five in Africa. The study selection process involved a two-stage screening, with independent reviewers evaluating titles, abstracts, and full texts to determine eligibility. The quality assessment, employing a standardized tool, ensured the inclusion of studies with robust methodologies. Data extraction encompassed key study details, including demographics, residence factors, socioeconomic influences, environmental variables, and intervention outcomes.

Results

The search yielded a total of 12,580 articles across 25 African countries; however, only 97 of these articles met the inclusion criteria and were ultimately included in the systematic review. The systematic review revealed geographic and seasonal disparities in the prevalence of diarrhoeal diseases across different countries in Africa. Factors such as age-related vulnerabilities, gender disparities, maternal occupation, disposal of young children’s stools, and economic status were identified as significant determinants of the prevalence of diarrhea disease.

Conclusion

This systematic review provides a comprehensive understanding of the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. The nuanced analysis of residence variations, socioeconomic influences, environmental factors, and intervention outcomes underscores the complex nature of this issue. The findings highlight the necessity for region-specific and context-sensitive interventions to address the unique challenges faced by diverse communities. This review serves as a valuable resource for policymakers, healthcare professionals, and researchers, guiding the development of evidence-based strategies aimed at reducing the burden of diarrhea diseases and improving child health outcomes in Africa.

Peer Review reports

Background

Diarrhoeal diseases pose a persistent threat to the health of children under five, particularly in low- and middle-income countries [1]. In Africa, this challenge is notably severe, with an alarming number of reported cases annually [2]. According to the World Health Organization (WHO), diarrhoeal diseases account for a substantial proportion of child mortality across the continent [3, 4]. This emphasizes the imperative need for comprehensive understanding and targeted interventions. Despite advancements in Africa, these diseases remain a significant public health challenge, disproportionately affecting vulnerable populations like under five children due to limited access to clean water, sanitation, and adequate healthcare resources [5, 6].

Between January 2013 and December 2023, like other parts of the world, Africa underwent substantial socioeconomic, environmental, and healthcare transformations crucial for contributing to the reduction of diarrheal diseases [7, 8]. The transition encompasses research efforts, the expansion of higher education institutions [9], enhanced water accessibility, the promotion of good hygiene practices, improved access to sanitation facilities, all supported by United Nations Children’s Fund (UNICEF), WHO and other nongovernmental organizations. [7] These transitions potentially influenced the determinants and prevalence of diarrhoeal diseases among children under five. However, rapid urbanization, sustainability problems, climate fluctuations, and varying healthcare infrastructures have shaped the disease landscape [10]. Disparities in economic development and resource access among African nations have resulted in differing disease burdens [11] including under-five children. Understanding the determinants of diarrhoeal diseases is fundamental for designing effective public health interventions a head of time [12]. Investigating multifaceted factors contributing to these diseases among under-five children in Africa holds significant importance, not only for healthcare providers and policymakers but also for global health initiatives [13].

The systematic review on diarrhoeal diseases will help understand crucial aspects of how these diseases affect under-five children in Africa. Evidences from various studies indicated the existence of common factors and national variations of diarrhoeal diseases due to socio-economic strata and environmental conditions difference. Moreover, a comprehensive examination of these determinants can shed light on the impact of public health policies and interventions on disease prevalence and outcomes over time [14]. Synthesizing findings from diverse studies was not only offer a comprehensive overview but also enable the identification of factors through time [15]. These factors could highlight areas needing further research attention or where interventions might be most impactful.

Rationale

Through a systematic review between January 2013 and December 2023, this review aims to provide a comprehensive synthesis of current knowledge. It seeks to address existing gaps and offer insights critical for targeted interventions and policy formulation. The rationale for selecting the period between January 2013 and December 2023 for this systematic review is to capture the most recent and relevant data on the determinants of diarrheal diseases among under-five children in Africa. This timeframe allows for the inclusion of studies conducted after the implementation of several major public health initiatives and interventions aimed at improving child health and reducing diarrheal diseases in the region. By focusing on this period, the review aims to provide an up-to-date understanding of the current trends, emerging determinants, and the effectiveness of recent policies and interventions, ensuring that the findings are relevant to contemporary public health strategies and practices.

Method

Search strategies

A systematic search was conducted across major academic databases, including PubMed, MEDLINE, Scopus, and Web of Science, utilizing a combination of keywords related to diarrhoeal diseases, under-five children, Africa, determinants, and interventions. Studies published between January 2013 and December 2023 were included to capture the most recent and relevant information. Eligibility criteria were defined to ensure the selection of high-quality studies, including peer-reviewed articles, systematic reviews, and meta-analyses.

A systematic search was conducted across major academic databases, including PubMed, Scopus, Web of Science, Embase, Google scholar, MEDLINE, and Cochrane Library utilizing a combination of keywords “diarrhea,” “Diarrhoea,” “under-five children,” “Africa,” “determinants,” “Risk Factors”, “Preschool Children”, “child health,” “socioeconomic factors,” and “water sanitation,” search terms used in collecting relevant articles. Authors use Boolean operators (AND, OR) to combine keywords and phrases for effective searches. That was (“Diarrhea“[Mesh]OR“Diarrhoeal Diseases“[Mesh]OR“Diarrhea”OR“Diarrhoea”AND (“Child“[Mesh]OR“Pediatrics“[Mesh]OR“Under-Five” OR“Children” AND (“Determinants” [Mesh]OR"RiskFactors“[Mesh]OR"Epidemiology“[Mesh]OR"Causality“[Mesh]OR “Determinants” OR “Risk Factors” OR “Causality” AND “Africa”. Only English language was used to filters out and retrieve relevant studies published within this specified timeframe.

Screening of eligible studies

Initial screening by titles and abstracts based on predefined inclusion criteria done by two team members (EA and JA) independently. Then disparities were resolved by discussion with other team member (AM) and agreements reached on the included articles for full texts screening. Exclude studies that clearly do not meet the scope of the review. Then we obtain and review the full texts of potentially relevant articles identified in the initial screening (by titles and abstracts) to assess their eligibility based on inclusion/exclusion criteria. The full text retrieved by other two reviewers (JA and EA) independently. Again, discrepancies were solved through discussion with other team member (HF). Then the search results were reported based on the Preferred Reporting Items for Systematic Review and Meta-analysis statement (PRISMA) guideline.

Inclusion and exclusion criteria

Articles any study design, done in African countries, focused at children under five, and on determinants of diarrhoeal diseases were included under this systematic review. Studies with inadequate or unclear methodologies, studies not focusing on determinants, reviews without original data, and studies not involving under-five children were excluded. Studies other than English language also were excluded.

Data extraction

Extraction of relevant data from included studies using a predefined template. Title, first author, country, publication year, study design, sample size, prevalence and study period were the data extracted from each study.

Study quality assessment

In this systematic review, quality evaluation involved scrutinizing the methodological rigor and risk of bias of the included studies. The Newcastle-Ottawa Scale was used to appraise the quality of each study. Two independent reviewers assessed various aspects of each study, such as the clarity of the research aims, appropriateness of the methodology and research design, recruitment strategy, data collection method, researcher-participant relationship, ethical considerations, data analysis, statement of findings, and overall value of the research [16]. Discrepancies encountered during the evaluation process were resolved through thorough discussion among the reviewers. If required, the perspective of a third reviewer was sought to ensure a comprehensive and unbiased resolution. The methodological quality of each study included in the analysis was meticulously assessed, employing a rating system that categorized studies as very good (9–10 points), good (7–8 points), satisfactory (5–6 points), or unsatisfactory (0–4 points). Then based on modified Newcastle-Ottawa Scale (NOS) specifically tailored for cross-sectional studies was utilized. Studies with a score of ≥ 7 out of 10 on this scale were deemed to have achieved high methodological quality [17]. Consequently, only studies falling within the categories of good and very good quality, as per the established rating criteria, were considered for inclusion in the final analysis. It is noteworthy that studies rated as very good quality, indicating a higher level of methodological rigor, were given special attention and were ultimately included in the conclusive analysis. This meticulous approach ensures that only studies meeting stringent quality standards contribute to the overall findings and conclusions of the research.

Synthesis of findings

The phase of data synthesis in the systematic review encompassed a meticulous and comprehensive procedure to amalgamate findings from a variety of studies pertaining to the factors that contribute to cases of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. The qualitative synthesis furnished valuable insights into the contextual intricacies of these determinants, thereby illuminating the socioeconomic, breastfeeding and nutrient intake, and environmental aspects that exert an influence on diarrhea diseases. Consequently, a thematic analysis was conducted to identify recurring themes across the studies. This entailed extracting and categorizing data that pertained to similar determinants in order to facilitate a structured synthesis.

The approach used to estimate the overall pooled prevalence of diarrheal diseases involved conducting a systematic review of studies focusing on children under 5. The review compiled and synthesized prevalence from the data reported in each study, providing a comprehensive overview of diarrheal disease burden across different countries during the specified timeframe. The overall pooled prevalence and other analysis were subsequently estimated using Stata Version 17. In this review, the authors addressed heterogeneity by conducting subgroup analyses that grouped studies according to factors such as geographical variation, publication year, study season, study setting, sample size, and study design. This approach allowed to explore variations in effect size based on these characteristics.

Protocol registration

The review protocol was registered with the PROSPERO database through a registration number (PROSPERO- CRD42024500697).

Results

Search results

By searching through different electronic websites, a total of 12,580 were identified. After screening and retrieving the systematic review finally encompassed a 97 pertinent studies published across African nations between January 2013 and December 2023 (Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram for selection of studies in determinants of diarrhoea disease in Africa

Full size image

Study characteristics

The studies included a range of sample sizes, from a maximum of 30,066 in Nigeria [18] to a minimum of 300 in North Sudan [19]. The overall 338,222 individuals in 25 African countries were included in the systematic review (Table 1; Fig. 2) The overall pooled prevalence of diarrhoeal diseases among under-five children in Africa is estimated to be 16.886% with 95% CI (16.747, 17.025) with the range of 7.500% from Nigeria [20] to 67.300% at South Africa [21] during this specified period.

Table 1 Extracted data among included studies in systematic review of diarrhoeal disease determinants among under-five children in Africa (2013–2023)
Full size table
Fig. 2
figure 2

African countries included in the systematic review of diarrhoeal disease determinants

Full size image

Heterogeneity assessment

Due to the diversity in the time periods, geographic locations, sample sizes, season of study and study designs of the included studies, significant heterogeneity in prevalence of diarrheal disease was observed (Cochran’s Q Test p-value = 0.00, I² = 99.30%). Significant regional variations are comprehended, with East Africa (I² = 99.25%) and Southern Africa (I² = 99.89%) exhibiting the highest heterogeneity. These findings point to significant regional variations in the prevalence of diarrheal illnesses. According to the overall test for regional differences, which is highly significant (Q_b = 43.36, p < 0.001), regional factors have a large impact on diarrheal disease estimates. Study settings may have an impact on prevalence estimates, according to the significant test for setting differences (Q_b = 17.95, p < 0.001). Lastly, the analysis shows considerable variety by season, with spring having very little variability, minimal impact sizes, and mixed and summer seasons displaying high effect sizes and heterogeneity (Table 2).

Table 2 Subgroup analysis of diarrheal disease prevalence based on regional, temporal, setting, and seasonal variations
Full size table

Synthesized findings on determinants of diarrhoeal diseases among under-five children

Synthesizing the data from various investigations on diarrhea illnesses among children under the age of five in Africa between January 2013 and December 2023 revealed both similarities and differences. Twenty-three determinants consistently displayed connections with diarrhea diseases across multiple investigations, emphasizing their significant roles in disease incidence. Factors such as limited access to uncontaminated water, inadequate sanitation facilities, and low socio-economic status were recurring themes contributing to the prevalence of diarrhea diseases in this population.

However, the synthesis also exposed disparities among the investigations regarding the impacts of certain determinants. While most of the factors displayed consistent connections with diarrhea diseases across different circumstances, others demonstrated situation-specific effects. This variability underscores the intricate interplay of environmental, socio-economic, and cultural factors influencing the dynamics of diarrhea diseases in diverse African settings (Table 3).

Table 3 Synthesized findings on determinants of diarrhoeal diseases among under-five children in Africa (2013–2023)
Full size table

Discussion

The aim of this systematic review is to gain a comprehensive understanding of the persistent and predominant factors that contribute to diarrhea among children under the age of five in Africa. Factors such as age-related vulnerabilities, gender disparities, maternal occupation, the method of stool disposal by young children, economic influences, and environmental factors collectively contribute to the prevalence of diarrhea diseases. All these factors were themed after assessing from included studies. The economic status of households emerges as a critical determinant in the prevalence of diarrhoeal diseases among children under the age of five in Africa. This trend was consistently observed across 12 articles focusing on the wealth status of households [18, 19, 22,23,24,25,26,27,28,29,30,31]. Potential explanation for this correlation is that poverty, characterized by limited access to vital resources such as clean water, sanitation, and healthcare, functions as a significant risk factor [109]. The other reason could be families with lower income often encounter difficulties in providing adequate nutrition, maintaining hygiene, and ensuring timely medical care, thereby increasing children’s vulnerability to diarrhoeal infections. Economic constraints frequently impede access to healthcare services, including vaccination programs and medical treatment, amplifying the severity and duration of diarrhoeal episodes [110].

Another 25 studies suggests that maternal education significantly influences the prevalence of diarrhoeal diseases among children under the age of five in Africa [19, 24, 27, 29, 32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]. It appears that a mother’s level of education is intricately linked to the overall well-being of her child, as educated mothers tend to adopt healthier practices. The other possible explanation for this is that well-educated mothers are more likely to possess knowledge about proper sanitation, hygiene, and nutrition, which are crucial elements in preventing diarrhoeal infections [111]. Their ability to understand and implement preventive healthcare measures, such as timely vaccinations and appropriate child feeding practices, contributes to reducing the risk of diarrhoeal diseases. Furthermore, maternal education in child health highlights the importance of investing in educational opportunities for women as a comprehensive strategy to improve the well-being of children under the age of five in Africa [112].

From the findings of five studies, the prevalence of diarrhea disease in children under the age of five in Africa is influenced by maternal occupation [20, 45, 56, 58, 59]. Maternal jobs, often tied to socio-economic status, can impact household living conditions and resource accessibility [113]. This indicated, maternal employment is intertwined with factors such as education and healthcare access, further influencing the susceptibility of under-five children to diarrhoeal diseases [114].

The age of the mother or caregiver emerges as a crucial determinant affecting diarrhea prevalence in young children in Africa, as revealed by findings from 12 studies included in this systematic review [20, 33, 35, 41,42,43, 50, 52,53,54,55,56,57]. This variation could be explained by the unique challenges faced by younger mothers in childcare practices, potentially impacting hygiene routines and healthcare-seeking behavior [115]. Conversely, older caregivers may bring valuable experience but could encounter obstacles related to evolving childcare knowledge and changing health dynamics [116].

The evidence collected from 22 studies [20, 25, 27, 29,30,31, 36, 40,41,42, 48, 54, 56, 60,61,62,63,64,65] highlights that the age of children under five is a crucial determinant affecting the prevalence of diarrhea in Africa, showcasing distinct patterns across various age groups [117]. Infants, especially those in their first year of life, are particularly vulnerable due to their developing immune systems and reliance on breastfeeding or formula feeding [118], exposing them to potential contamination from water sources or inadequate hygiene practices. While toddlers and preschoolers exhibit a certain level of resilience compared to infants, their exploratory behaviors still render them susceptible to contaminated environments. Additionally, interconnected factors such as weaning practices, nutritional status, and access to clean water and sanitation services contribute to shaping the age-specific burden of diarrhea [117].

The impact of gender on the prevalence of diarrhea among children under five in Africa is influenced by a complex interplay of biological, cultural, and societal factors, as indicated by findings from 11 research studies [19, 33, 41, 42, 49, 56, 58, 66,67,68]. This might be due to differential care practices, nutritional disparities, and healthcare-seeking behavior may contribute to variations in diarrhea rates between boys and girls [119, 120]. Moreover, societal norms and cultural expectations could differently influence access to sanitation facilities, exposure to environmental contaminants, and overall hygiene practices based on gender. This finding supported by the study conducted in India [121].

The prevalence of diarrhoeal diseases among children under the age of five is influenced by the number of children. 12 research consistently indicates that households with a higher number of children under five tend to experience elevated rates of diarrhoeal infections [20, 25, 27, 29,30,31, 36, 40,41,42, 48, 54, 56, 60,61,62,63,64,65]. This correlation may be attributed to factors such as increased transmission opportunities within larger households, higher likelihood of shared exposure to contaminated environments, and potentially greater challenges in maintaining optimal hygiene practices. Additionally, the strain on resources in larger families, including difficulties in ensuring access to clean water, proper sanitation, and timely medical care, could contribute to the heightened susceptibility of children to diarrhoeal diseases.

Two studies conducted in Africa have explored the association between media exposure and the prevalence of diarrhea in this population [91, 105]. The findings suggest that higher media exposure, particularly to health-related information through various channels, is associated with a potential decrease in the prevalence of diarrhea. This might be access to educational programs, public health campaigns, and information about proper hygiene practices through media platforms may contribute to improved knowledge and awareness among caregivers, leading to better preventive measures against diarrhoeal diseases [122, 123].

Ensuring the adoption of optimal exclusive breastfeeding practices is essential in mitigating the prevalence of diarrhoeal diseases among children under five. This assertion is substantiated by 12 studies conducted in Africa [20, 28, 38, 49, 53, 58, 61, 68, 71, 72, 88, 93]. The significance of this may stem from the fact that initiating breastfeeding within the first hour of birth and exclusively continuing it for the initial six months establishes a strong foundation for infants’ immune systems [124]. This, in turn, provides protection against various infections, including those caused by diarrhoeal pathogens [125]. The immunological components present in breast milk, such as antibodies and enzymes, play a crucial role in preventing and alleviating the impact of diarrhoeal illnesses [126, 127].

Environmental factors exert effect on the prevalence of diarrhoeal diseases among children under five in Africa, carrying profound implications for public health [128]. The risk of diarrhoeal diseases among children under five is associated with unimproved toilet facilities and shared sanitation. Five studies revealed that the prevalence of diarrhea in children under the age of five in Africa is substantially impacted by insufficient access to proper toilet facilities and the prevalence of shared sanitation, highlighting these factors as critical contributors [30, 59, 80, 100, 103]. This can be attributed to the fact that, in many communities in developing countries, the absence of individual household toilets necessitates reliance on shared sanitation facilities, contributing to hygiene challenges and heightened disease transmission [129, 130]. Shared facilities often lack proper maintenance, increasing the risk of fecal-oral contamination. Furthermore, the proximity of these shared toilet facilities to households may vary, impacting convenience and utilization rates. Inadequate access to toilet facilities, coupled with reliance on shared sanitation, escalates the risk of diarrhoeal diseases among young children, exposing them to contaminated surfaces or water sources [131].

The findings from eight studies put forward that the high prevalence of diarrhea among children under the age of five in Africa is notably exacerbated by the widespread practice of open defecation [24, 34, 35, 38, 52, 58, 93, 103]. This is attributed to areas where inadequate sanitation is prevalent, open defecation becomes a common practice, leading to the contamination of water sources and the surrounding areas with fecal matter [132]. This combined impact of inadequate sanitation and open defecation presents a significant public health challenge, disproportionately affecting the under-five age group in Africa [133].

Based on findings from 35 studies, the choice of drinking water source has been identified as a determinant, with households relying on unimproved water sources experiencing higher disease prevalence [23, 26, 34, 36, 38, 41, 47, 48, 51, 52, 54,55,56, 58, 60, 69, 72, 74, 80, 83, 86,87,88,89,90,91,92,93,94,95,96,97,98,99]. This may be attributed to the microbial contamination of unimproved water sources by bacteria, viruses, and parasites, posing a significant health risk [134, 135]. Consequently, ingesting pathogens through contaminated water can lead to gastrointestinal infections.

Conversely, insights from 13 studies emphasize that implementing water treatment at the household level in Africa is a crucial strategy to mitigate the incidence of diarrhea among children under five [23, 34, 49, 52, 55, 59, 67, 68, 74, 82, 90, 100, 101]. The rationale behind this is that employing point-of-use at household level water treatment methods, such as boiling, chlorination, solar disinfection or filtration, could significantly reduce the microbial contamination of drinking water [136, 137]. Moreover, the integration of household water treatment aligns with broader efforts to improve water quality in resource-constrained settings where access to safe and clean water sources may be limited [138, 139].

A review of seven studies underscores the association between improper disposal of the youngest child’s stools and an increased prevalence of diarrhea diseases [25, 53, 66, 72,73,74,75]. This may be attributed to unhygienic practices, such as inadequate disposal of diapers or a lack of access to child-friendly sanitation facilities, further contributing to the spread of pathogens [140, 141]. The consequences of these insufficient disposal practices are significant, elevating the risk of fecal-oral transmission and subsequent diarrhoeal infections among the vulnerable under-five Children.

Ineffective disposal practices of both liquid waste, as demonstrated by five studies [23, 25, 45, 53, 75], and solid waste, as evidenced by 16 studies [24, 38, 39, 44, 50, 52, 59, 64, 74, 75, 87, 92,93,94, 104], significantly contribute to the increased occurrence of diarrhea among children under the age of five. This may be due to insufficient sanitation, open defecation, and the pollution of water sources resulting from inadequate management of liquid and solid waste create environments that promote the transmission of diarrheal pathogens [142]. In addition, poorly handled solid waste, including actions like open dumping and burning, releases pollutants into the air and water, contaminating food and drinking water sources [143]. The sum of these unhygienic conditions significantly contribute to the prevalence of diarrhoeal diseases, posing a critical public health challenge for children under five in affected communities.

Based on findings from four studies, inadequate food handling and consumption practices emerge as noteworthy factors influencing the prevalence of diarrhoeal diseases among children under the age of four [31, 34, 61, 99]. This could be attributed to caregivers’ insufficient hand washing, cross-contamination during food preparation, and the consumption of undercooked or contaminated foods, all of which contribute to the transmission of diarrhoeal pathogens [144]. Insufficient awareness regarding safe food handling practices, coupled with a lack of access to clean water for food preparation, intensifies diarrhoeal problem [143].

Residence determinants encompass a variety of contextual factors that differ across countries, shaping disease patterns and affecting healthcare accessibility. As highlighted by 20 studies [27, 30, 34, 40,41,42,43, 51, 52, 58, 59, 62, 68, 76, 88, 106, 107], the urban-rural disparity in the factors influencing diarrhoeal diseases among children under the age of five in Africa between January 2013 and December 2023 underscores distinctive challenges and opportunities in these environments. This may be attributed to the fact that urban areas may enjoy enhanced access to sanitation infrastructure, healthcare services, and education, potentially leading to a reduction in the incidence of diarrhoeal diseases [122]. In contrast, rural areas often face constraints in accessing clean water sources, sanitation facilities, and healthcare, increasing vulnerability to diarrhoeal diseases.

The prevalence of diarrheal diseases among children under the age of five in Africa is closely linked to vaccination coverage. The consistent findings of nine studies suggest that increased vaccination coverage is strongly correlated with a significant decrease in the incidence of diarrheal diseases among this susceptible population [25, 28, 30, 49, 61, 67, 82, 93, 98].The possible explanation, immunizing vaccines that target specific pathogens, such as rotavirus and measles, play a crucial role in defending against severe diarrheal episodes, thereby reducing the risk of complications and potential fatalities [145].

According to eight studies, spatiotemporal variation in the occurrence of diarrheal diseases among under-five children in Africa reflects the dynamic interplay of geographic variation and temporal factors influencing disease patterns [18, 41, 42, 96, 106, 108]. The prevalence of diarrheal diseases varies across regions due to differences in environmental conditions, access to clean water, sanitation facilities, and healthcare infrastructure [146, 147]. Moreover, temporal variations of diarrhoeal disease may be attributed to seasonal changes, climate conditions impact water quality, hygiene practices, and disease transmission, leading to fluctuations in diarrhoeal diseases prevalence [148].

The first limitation of the review is publication bias not assessed. The second limitation is variations in study methodologies, and the reliance on available literature, which may not capture the full spectrum of determinants of diarrhoeal diseases among under-five children in Africa. Future research should prioritize longitudinal studies employing standardized methodologies, and explore emerging determinants, ultimately informing targeted interventions for reducing the burden of diarrhoeal diseases among under-five children in Africa. The third limitation is, since the majority of the included studies were conducted in Ethiopia, which may introduce bias due to the overrepresentation of studies from Ethiopia compared to others countries.

Conclusion

This systematic review provides a comprehensive understanding of the determinants of diarrhea diseases among children under the age of five in Africa between January 2013 and December 2023. The nuanced analysis of geographical variations, socioeconomic influences, environmental factors, and intervention outcomes underscores the complex nature of diarrhoeal disease. The findings highlight the necessity for region-specific and context-sensitive interventions to address the unique challenges faced by diverse communities. This review serves as a valuable resource for policymakers, healthcare professionals, and researchers, guiding the development of evidence-based strategies aimed at reducing the burden of diarrhea diseases and improving child health outcomes in Africa.

Data availability

This research was done using a publicly available dataset found at published works.

References

  1. Fagbamigbe AF, Uthman AO, Ibisomi L. Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low-and middle-income countries. Sci Rep. 2021;11(1):8564.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Wareth G, et al. The perspective of antibiotic therapeutic challenges of brucellosis in the Middle East and North African countries: current situation and therapeutic management. Transbound Emerg Dis. 2022;69(5):e1253–68.

    Article  CAS  PubMed  Google Scholar 

  3. Ugboko HU et al. Childhood diarrhoeal diseases in developing countries. Heliyon, 2020;6(4).

  4. Alijanzadeh Maliji B, et al. Role of the World Health Organization in Management of Gastrointestinal diseases caused by Contaminated Water in Children in the Middle East: a review article. J Pediatr Rev. 2023;11(1):59–66.

    Article  Google Scholar 

  5. Ezeneme EV et al. The influence of socioeconomic inequality on maternal and child health outcomes in Nigeria: A critical analysis. GSJ, 2023;11(10).

  6. Rodrigues CM, Plotkin SA. Impact of vaccines; health, economic and social perspectives. Front Microbiol. 2020;11:1526.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Poague KI, Blanford JI, Anthonj C. Water, sanitation and hygiene in schools in low-and middle-income countries: a systematic review and implications for the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(5):3124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Silvestri G, et al. Transition management for improving the sustainability of WASH services in informal settlements in Sub-saharan Africa—An exploration. Sustainability. 2018;10(11):4052.

    Article  Google Scholar 

  9. Daniels C, Gebhardt C. Higher education, science and research systems for transformative change in Africa–what role for innovation policy? 2021, SAGE Publications Sage UK: London, England. pp. 553–8.

  10. Connolly C, Keil R, Ali SH. Extended urbanisation and the spatialities of infectious disease: demographic change, infrastructure and governance. Urban Stud. 2021;58(2):245–63.

    Article  Google Scholar 

  11. Wei J, Rahim S, Wang S. Role of environmental degradation, institutional quality, and government health expenditures for human health: evidence from emerging seven countries. Front Public Health. 2022;10:870767.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Contreras JD, Eisenberg JN. Does basic sanitation prevent diarrhea? Contextualizing recent intervention trials through a historical lens. Int J Environ Res Public Health. 2020;17(1):230.

    Article  Google Scholar 

  13. Obasohan PE. Investigating multiple overlaps in the determinants of risk factors of Anaemia, Malaria, and Malnutrition, and their Multimorbidity, among children aged 6 to 59 months in Nigeria. University of Sheffield; 2022.

  14. Talic S et al. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ, 2021;375.

  15. Peters MD, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement. 2021;19(1):3–10.

    Article  PubMed  Google Scholar 

  16. Norris JM, et al. A modified Newcastle-Ottawa scale for assessment of study quality in genetic urological research. Eur Urol. 2021;79(3):325–6.

    Article  PubMed  Google Scholar 

  17. Zang Y, Fan Y, Gao Z. Pretreatment C-reactive protein/albumin ratio for predicting overall survival in pancreatic cancer: a meta-analysis. Medicine, 2020;99(23).

  18. Awoniyi FB, Neupane S. The socio-economic difference in the prevalence and treatment of diarrheal disease in children under five years across the geo-political zones in Nigeria. medRxiv. 2021. 2021.10. 30.21265706.

  19. Elmanssury A, Elnadif D, Safa A. Prevalence of diarrhea and association with socio-demographic factors among children under five in Mayo Camp-Khartoum State Sudan. Pakistan J Med Health Sci. 2022;16(03):1100–1100.

    Article  Google Scholar 

  20. Akinyemi YC. Spatial pattern and determinants of diarrhoea morbidity among under-five-aged children in Lagos State. Nigeria Cities Health. 2022;6(1):180–91.

    Article  Google Scholar 

  21. Ntshangase SN, Ghuman S, Haffejee F. Diarrhoeal prevalence and handwashing practices of children attending early childhood development centres in KwaZulu-Natal, South Africa. Health SA Gesondheid (Online). 2022;27:1–8.

    Google Scholar 

  22. Girmay AM, et al. Associations of WHO/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia: a cross-sectional study. BMJ open. 2023;13(7):e071296.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Soboksa NE, et al. Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. PLoS ONE. 2020;15(2):e0229303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gebru T, Taha M, Kassahun W. Risk factors of diarrhoeal disease in under-five children among health extension model and non-model families in Sheko district rural community, Southwest Ethiopia: comparative cross-sectional study. BMC Public Health. 2014;14(1):1–6.

    Article  Google Scholar 

  25. Alemayehu K, et al. Prevalence and determinants of diarrheal diseases among under-five children in Horo Guduru Wollega Zone, Oromia Region, Western Ethiopia: a community-based cross-sectional study. Can J Infect Dis Med Microbiol. 2021;2021:1–9.

    Article  Google Scholar 

  26. Seidu R, et al. Risk factor analysis of diarrhoeal disease incidence in faecal sludge-applying farmers’ households in Tamale. Ghana J Water Sanitation Hygiene Dev. 2013;3(2):134–43.

    Article  Google Scholar 

  27. Apanga PA, Kumbeni MT. Factors associated with diarrhoea and acute respiratory infection in children under-5 years old in Ghana: an analysis of a national cross-sectional survey. BMC Pediatr. 2021;21(1):1–8.

    Article  Google Scholar 

  28. Getahun M, et al. Determinants of Diarrhea among under-five Children-Visiting Government Health Facilities in Nekemte Town, Western Ethiopia: unmatched Case Control Study. Appl Sci Res Periodicals. 2023;1(1):53–68.

    Google Scholar 

  29. Claudine U, et al. Association between sociodemographic factors and diarrhea in children under 5 years in Rwanda. Korean J Parasitol. 2021;59(1):61.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Oyedele O. An empirical analysis of the effects of Household demographics on Diarrhea Morbidity in Children aged 0 to 48 months in Namibia. Int J Social Determinants Health Health Serv. 2023;53(2):176–82.

    Article  Google Scholar 

  31. Bitew BD, Getachew A, Azanaw J. Diarrhea Prevalence and Associated Factors among children in Azezo Sub-city, Northwest Ethiopia: A Community-based cross-sectional study. Am J Trop Med Hyg, 2023: p. tpmd220192–220192.

  32. Mohammed S, Tilahun M, Tamiru D. Morbidity and associated factors of diarrheal diseases among under five children in Arba-Minch district, Southern Ethiopia, 2012. Sci J Public Health. 2013;1(2):102–6.

    Article  Google Scholar 

  33. Kombat MY et al. Predictors of Diarrhea Among Children Under the Age of Five Years in Ghana: Multivariate analysis of data from the 2014 Ghana Demographic and Health Survey. 2023.

  34. Melese M, et al. Prevalence of Diarrhea, Intestinal parasites, and Associated factors among under-five children in Dabat District, Northwest Ethiopia: Multicenter cross-sectional study. Environ Health Insights. 2023;17:11786302231174744.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sinmegn Mihrete T, Asres Alemie G, Shimeka Teferra A. Determinants of childhood diarrhea among underfive children in Benishangul Gumuz regional state, north West Ethiopia. BMC Pediatr. 2014;14:1–9.

    Article  Google Scholar 

  36. Woldu W, Bitew BD, Gizaw Z. Socioeconomic factors associated with diarrheal diseases among under-five children of the nomadic population in northeast Ethiopia. Trop Med Health. 2016;44(1):1–8.

    Article  Google Scholar 

  37. Hashi A, Kumie A, Gasana J. Prevalence of diarrhoea and associated factors among under-five children in Jigjiga District, Somali Region, Eastern Ethiopia. Open J Prev Med. 2016;6(10):233–46.

    Article  Google Scholar 

  38. Asfaha KF, et al. Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a community based unmatched case–control study. BMC Pediatr. 2018;18:1–9.

    Article  Google Scholar 

  39. Melese B, et al. Prevalence of diarrheal diseases and associated factors among under-five children in Dale District, Sidama Zone, Southern Ethiopia: a cross-sectional study. BMC Public Health. 2019;19(1):1–10.

    Article  Google Scholar 

  40. Mbugua S et al. Determinants of diarrhea among young children under the age of five in Kenya, evidence from KDHS 2008-09. Afr Popul Stud, 2014: pp. 1046–56.

  41. Afitiri A-R, et al. Cumulative effects of environmental factors on household childhood diarrhoea in Ghana. Water Pract Technol. 2020;15(4):1032–49.

    Article  Google Scholar 

  42. Kombat MY, et al. Prevalence and predictors of diarrhea among children under five in Ghana. BMC Public Health. 2024;24(1):154.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tampah-Naah AM. Maternal and child level factors associated with childhood (0–23 months) diarrhoea in Ghana: a pooled analysis of national representative datasets. Ghana J Dev Stud. 2019;16(2):157–77.

    Article  Google Scholar 

  44. Guillaume DA, Justus OO, Ephantus KW. Factors influencing diarrheal prevalence among children under five years in Mathare Informal Settlement, Nairobi, Kenya. J Public Health Afr. 2020;11(1).

  45. Nwaoha AF, Ohaeri CC, Amaechi EC. Prevalence of diarrhoea, and associated risk factors, in children aged 0–5 years, at two hospitals in Umuahia, Abia, Nigeria. UNED Res J. 2017;9(1):7–14.

    Article  Google Scholar 

  46. Bah D et al. Prevalence and risk factors of diarrheal diseases in Sierra Leone, 2019: a cross-sectional study. Pan Afr Med J. 2022;41(1).

  47. Davies K, et al. Reducing child mortality in Sudan by preventing diarrheal disease. Columbia Univ J Global Health. 2014;4(1):1–5.

    Google Scholar 

  48. Aderinwale O et al. Diarrhea and its Determinants in Under-five Children in Chad Republic. 2023.

  49. William GB, Kariuki JG, Kerochi A. Risk factors for Acute Watery Diarrhea among the Under five in Bentiu Protection of Civilian’s site, Unity State, South Sudan. J Int Bus Innov Strategic Manage. 2023;7(1):1–17.

    Google Scholar 

  50. Mebrahtom S, Worku A, Gage DJ. The risk of water, sanitation and hygiene on diarrhea-related infant mortality in eastern Ethiopia: a population-based nested case-control. BMC Public Health. 2022;22(1):1–14.

    Article  Google Scholar 

  51. Omona S, et al. Prevalence of diarrhoea and associated risk factors among children under five years old in Pader District, northern Uganda. BMC Infect Dis. 2020;20:1–9.

    Article  Google Scholar 

  52. Workie GY, Akalu TY, Baraki AG. Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello Zone, Northeast Ethiopia. BMC Infect Dis. 2019;19:1–7.

    Article  Google Scholar 

  53. Baye A, et al. Priorities for intervention to prevent diarrhea among children aged 0–23 months in northeastern Ethiopia: a matched case-control study. BMC Pediatr. 2021;21(1):1–11.

    Article  Google Scholar 

  54. Nantege R, et al. Prevalence and factors associated with diarrheal diseases among children below five years in selected slum settlements in Entebbe municipality, Wakiso district, Uganda. BMC Pediatr. 2022;22(1):1–8.

    Article  Google Scholar 

  55. Diouf K, et al. Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level. Global Health Action. 2014;7(1):24895.

    Article  PubMed  Google Scholar 

  56. Moon J et al. Risk factors of diarrhea of children under five in Malawi: based on Malawi demographic and Health Survey 2015–2016. J Global Health Sci. 2019;1(2).

  57. Chari S, Mbonane TP, Van Wyk RH. Social and Environmental Determinants of Diarrheal Diseases among Children Under Five Years in Epworth Township, Harare. 2023.

  58. Girmay AM et al. Associations of WHO/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia: a cross-sectional study. BMJ open. 2023;13(7).

  59. Thiam S, et al. Prevalence of diarrhoea and risk factors among children under five years old in Mbour, Senegal: a cross-sectional study. Infect Dis Poverty. 2017;6(04):43–54.

    Google Scholar 

  60. Rukambile E, et al. Determinants of diarrhoeal diseases and height-for-age z-scores in children under five years of age in rural central Tanzania. J Prev Med Hyg. 2020;61(3):E409.

    PubMed  PubMed Central  Google Scholar 

  61. Gizaw Z, Woldu W, Bitew BD. Child feeding practices and diarrheal disease among children less than two years of age of the nomadic people in Hadaleala District, Afar Region, Northeast Ethiopia. Int Breastfeed J. 2017;12:1–10.

    Article  Google Scholar 

  62. Siziya S, Muula AS, Rudatsikira E. Correlates of diarrhoea among children below the age of 5 years in Sudan. Afr Health Sci. 2013;13(2):376–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Wasihun AG, et al. Risk factors for diarrhoea and malnutrition among children under the age of 5 years in the Tigray Region of Northern Ethiopia. PLoS ONE. 2018;13(11):e0207743.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Solomon ET, et al. Diarrheal morbidity and predisposing factors among children under 5 years of age in rural East Ethiopia. Trop Med Health. 2020;48(1):1–10.

    Article  Google Scholar 

  65. Mansour A, et al. Modifiable diarrhoea risk factors in Egyptian children aged < 5 years. Epidemiol Infect. 2013;141(12):2547–59.

    Article  CAS  PubMed  Google Scholar 

  66. Soboksa NE. Associations between improved water supply and sanitation usage and childhood diarrhea in Ethiopia: an analysis of the 2016 demographic and health survey. Environ Health Insights. 2021;15:11786302211002552.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Nsubuga EJ, et al. Factors Associated with Acute Watery Diarrhea among children aged 0–59 months in Obongi District, Uganda, April 2022: a case–control study. Uganda; April, 2022.

  68. Atari DO, Mkandawire P, Lukou YS. Determinants of co-occurrences of diarrhea and fever among children under five years of age in South Sudan. Afr Geographical Rev. 2023;42(5):617–33.

    Article  Google Scholar 

  69. Natnael T, Lingerew M, Adane M. Prevalence of acute diarrhea and associated factors among children under five in semi-urban areas of northeastern Ethiopia. BMC Pediatr. 2021;21(1):290.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Tambe A, Nzefa L, Nicoline N. Childhood Diarrhea determinants in Sub-saharan Africa: A Cross Sectional Study of Tiko-Cameroon. Challenges. 2015;6:229–43.

    Article  Google Scholar 

  71. Dagnew AB, et al. Prevalence of diarrhea and associated factors among under-five children in Bahir Dar City, Northwest Ethiopia, 2016: a cross-sectional study. BMC Infect Dis. 2019;19:1–7.

    Article  Google Scholar 

  72. Getahun W, Adane M. Prevalence of acute diarrhea and water, sanitation, and hygiene (WASH) associated factors among children under five in Woldia Town, Amhara Region, northeastern Ethiopia. BMC Pediatr. 2021;21(1):1–15.

    Article  Google Scholar 

  73. Fenta A, Alemu K, Angaw DA. Prevalence and associated factors of acute diarrhea among under-five children in Kamashi district, western Ethiopia: community-based study. BMC Pediatr. 2020;20:1–7.

    Article  Google Scholar 

  74. Mernie G, Kloos H, Adane M. Prevalence of and factors associated with acute diarrhea among children under five in rural areas in Ethiopia with and without implementation of community-led total sanitation and hygiene. BMC Pediatr. 2022;22(1):1–16.

    Article  Google Scholar 

  75. Hassan KE, et al. The impact of household hygiene on the risk of bacterial diarrhea among Egyptian children in rural areas, 2004–2007. J Infect Developing Ctries. 2014;8(12):1541–51.

    Article  Google Scholar 

  76. Anteneh ZA, Andargie K, Tarekegn M. Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest Ethiopia, 2014. BMC Public Health. 2017;17(1):1–8.

    Article  Google Scholar 

  77. Bizuneh H, et al. Factors associated with diarrheal morbidity among under-five children in Jigjiga town, Somali Regional State, eastern Ethiopia: a cross-sectional study. BMC Pediatr. 2017;17:1–7.

    Article  Google Scholar 

  78. Shine S, et al. Prevalence and associated factors of diarrhea among under-five children in Debre Berhan town, Ethiopia 2018: a cross sectional study. BMC Infect Dis. 2020;20:1–6.

    Article  Google Scholar 

  79. Regassa W, Lemma S. Assessment of diarrheal disease prevalence and associated risk factors in children of 6–59 months old at Adama District rural Kebeles, eastern Ethiopia, January/2015. Ethiop J Health Sci. 2016;26(6):581–8.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Nwokoro UU et al. Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria. Pan Afr Med J. 2020;37(1).

  81. Danquah L et al. Sanitation and hygiene practices in relation to childhood diarrhoea prevalence: the case of households with children under-five years in Ghana. 2014.

  82. Nguyen TYC, et al. Diarrhoea among children aged under five years and risk factors in informal settlements: a cross-sectional study in Cape Town, South Africa. Int J Environ Res Public Health. 2021;18(11):6043.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Bennion N, et al. Association between WASH-related behaviors and knowledge with childhood diarrhea in Tanzania. Int J Environ Res Public Health. 2021;18(9):4681.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Rukambile E, Practices H, et al. Water Supply, Sanitation, and Childhood Diarrhoea in Resource-Poor settings of Rural Central Tanzania: a mixed-method study. East Afr Sci. 2023;5(1):48–66.

    Article  Google Scholar 

  85. Moon J et al. Risk factors of diarrhea of children under five in Malawi: based on Malawi demographic and Health Survey. J Glob Health Sci. 2019;1(2).

  86. Jayte M, Dahir M, Incidence of Acute Watery Diarrhea among Internally Displaced People in Burhakaba Camps, Bay Region, Somalia. medRxiv. 2023. 2023.09. 10.23295320.

  87. Asgedom AA, et al. Unimproved water and sanitation contributes to childhood diarrhoea during the war in Tigray, Ethiopia: a community based assessment. Sci Rep. 2023;13(1):7800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Yaya S, et al. Improving water, sanitation and hygiene practices, and housing quality to prevent diarrhea among under-five children in Nigeria. Trop Med Infect Disease. 2018;3(2):41.

    Article  Google Scholar 

  89. Dharod JM, et al. Examination of the Cameroon DHS data to investigate how water access and sanitation services are related to diarrhea and nutrition among infants and toddlers in rural households. J Water Health. 2021;19(6):1030–8.

    Article  PubMed  Google Scholar 

  90. Getachew B, et al. Factors associated with acute diarrhea among children aged 0–59 months in Harar town, eastern Ethiopia. East Afr J Health Biomedical Sci. 2018;2(1):26–35.

    Google Scholar 

  91. Mulatu G, et al. Association of drinking water and environmental sanitation with diarrhea among under-five children: evidence from Kersa demographic and health surveillance site, eastern Ethiopia. Front Public Health. 2022;10:962108.

    Article  PubMed  PubMed Central  Google Scholar 

  92. McClelland PH, et al. Improved water and waste management practices reduce Diarrhea risk in children under age five in rural Tanzania: a community-based, cross-sectional analysis. Int J Environ Res Public Health. 2022;19(7):4218.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Alemayehu M, Alemu T, Astatkie A. Prevalence and determinants of diarrhea among under-five children in Benna Tsemay district, south omo zone, southern Ethiopia: a community-based cross-sectional study in pastoralist and agropastoralist context. Adv Public Health. 2020;2020:1–11.

    Article  Google Scholar 

  94. Bushen G, Merga H, Tessema F. Effects of community-led total sanitation and hygiene implementation on diarrheal diseases prevention in children less than five years of age in South Western Ethiopia: a quasi-experimental study. PLoS ONE. 2022;17(4):e0265804.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Pessoa Colombo V, et al. Spatial distributions of diarrheal cases in relation to Housing conditions in Informal settlements: a cross-sectional study in Abidjan, Côte d’Ivoire. J Urb Health. 2023;100(5):1074–86.

    Article  Google Scholar 

  96. Asare EO, Warren JL, Pitzer VE. Spatiotemporal patterns of diarrhea incidence in Ghana and the impact of meteorological and socio-demographic factors. Front Epidemiol. 2022;2:871232.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Abu M, Codjoe SNA. Experience and future perceived risk of floods and diarrheal disease in urban poor communities in Accra, Ghana. Int J Environ Res Public Health. 2018;15(12):2830.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Birungi S et al. Prevalence and factors associated with diarrhea among children less than five years old in Kabarole district, Uganda. 2016.

  99. Kapwata T, et al. Diarrhoeal disease in relation to possible household risk factors in South African villages. Int J Environ Res Public Health. 2018;15(8):1665.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Thiam S et al. Prevalence of diarrhoea and risk factors among children under five years old in Mbour, Senegal: a cross-sectional study. 2018.

  101. Chilambwe M, Mulenga D, Siziya S. Diarrhoea prevalence in under-five children in two urban populations setting of Ndola, Zambia: an assessment of knowledge and attitude at the household level. J Infect Dis Ther. 2015;3(227):2332–0877.

    Google Scholar 

  102. Tambe AB, Nzefa DL, Nicoline NA. Childhood diarrhea determinants in sub-saharan Africa: a cross sectional study of Tiko-Cameroon. Challenges. 2015;6(2):229–43.

    Article  Google Scholar 

  103. Pickering AJ, et al. Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial. Lancet Global Health. 2015;3(11):e701–11.

    Article  PubMed  Google Scholar 

  104. Daffe ML, et al. Water, sanitation, and hygiene access in Senegal and its impact on the occurrence of diarrhea in children under 5 years old. J Water Health. 2022;20(11):1654–67.

    Article  PubMed  Google Scholar 

  105. Birhan TA, et al. Prevalence of diarrheal disease and associated factors among under-five children in flood-prone settlements of Northwest Ethiopia: a cross-sectional community-based study. Front Pead. 2023;11:1056129.

    Article  Google Scholar 

  106. Fagbamigbe AF, Morakinyo OM, Abatta E. Analysis of regional variations in influence of household and environmental characteristics on prevalence of diarrhoea among under-five children in Nigeria. Volume 7. Annals of Medical and Health Sciences Research| May-June; 2017. 3.

  107. Lanyero H, et al. Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study. BMC Public Health. 2021;21:1–9.

    Article  Google Scholar 

  108. Raza O, et al. Exploring spatial dependencies in the prevalence of childhood diarrhea in Mozambique using global and local measures of spatial autocorrelation. Med J Islamic Repub Iran. 2020;34:59.

    Google Scholar 

  109. Obaideen K, et al. The role of wastewater treatment in achieving sustainable development goals (SDGs) and sustainability guideline. Energy Nexus. 2022;7:100112.

    Article  Google Scholar 

  110. Mokomane M, et al. The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management. Therapeutic Adv Infect Disease. 2018;5(1):29–43.

    Article  Google Scholar 

  111. Gathogo LW. Determinants of Home Management of Diarrhea among Care Givers of children below 5 years in Ngandu Location. Nyeri County: JKUAT-COHES; 2021.

    Google Scholar 

  112. Bliznashka L, et al. Associations between women’s empowerment and child development, growth, and nurturing care practices in sub-saharan Africa: a cross-sectional analysis of demographic and health survey data. PLoS Med. 2021;18(9):e1003781.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Guhn M, et al. Associations of birth factors and socio-economic status with indicators of early emotional development and mental health in childhood: a population-based linkage study. Child Psychiatry Hum Dev. 2020;51:80–93.

    Article  PubMed  Google Scholar 

  114. Sumampouw OJ, Nelwan JE, Rumayar AA. Socioeconomic factors associated with diarrhea among under-five children in Manado Coastal Area, Indonesia. J Global Infect Dis. 2019;11(4):140.

    Article  Google Scholar 

  115. Anderson EW, White KM. This is what family does: the family experience of caring for serious illness. Am J Hospice Palliat Medicine®. 2018;35(2):348–54.

    Article  Google Scholar 

  116. Larkin M, Henwood M, Milne A. Carer-related research and knowledge: findings from a scoping review. Health Soc Care Commun. 2019;27(1):55–67.

    Article  Google Scholar 

  117. Momberg D, et al. Water, sanitation and hygiene (WASH) in sub-saharan Africa and associations with undernutrition, and governance in children under five years of age: a systematic review. J Dev Origins Health Disease. 2021;12(1):6–33.

    Article  CAS  Google Scholar 

  118. Dawod B, Marshall JS, Azad MB. Breastfeeding and the developmental origins of mucosal immunity: how human milk shapes the innate and adaptive mucosal immune systems. Curr Opin Gastroenterol. 2021;37(6):547–56.

    Article  CAS  PubMed  Google Scholar 

  119. Mahmud I et al. Gender disparity in care-seeking behaviours and treatment outcomes for dehydrating diarrhoea among under-5 children admitted to a diarrhoeal disease hospital in Bangladesh: an analysis of hospital-based surveillance data. BMJ open. 2020;10(9).

  120. Jarman AF, et al. Sex and gender differences in acute pediatric diarrhea: a secondary analysis of the Dhaka study. J Epidemiol Global Health. 2018;8(1–2):42.

    Article  Google Scholar 

  121. Mallick R, Mandal S, Chouhan P. Impact of sanitation and clean drinking water on the prevalence of diarrhea among the under-five children in India. Child Youth Serv Rev. 2020;118:105478.

    Article  Google Scholar 

  122. Morse T, et al. Developing a contextually appropriate integrated hygiene intervention to achieve sustained reductions in diarrheal diseases. Sustainability. 2019;11(17):4656.

    Article  Google Scholar 

  123. Billah SM et al. Bangladesh: a success case in combating childhood diarrhoea. J Global Health. 2019;9(2).

  124. Camacho-Morales A, et al. Breastfeeding contributes to physiological immune programming in the newborn. Front Pead. 2021;9:744104.

    Article  Google Scholar 

  125. Pérez-Escamilla R et al. Perspective: should exclusive breastfeeding still be recommended for 6 months? Advances in Nutrition, 2019. 10(6): pp. 931–43.

  126. Atyeo C, Alter G. The multifaceted roles of breast milk antibodies. Cell. 2021;184(6):1486–99.

    Article  CAS  PubMed  Google Scholar 

  127. Davis EC, et al. Gut microbiome and breast-feeding: implications for early immune development. J Allergy Clin Immunol. 2022;150(3):523–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  128. Robert E, et al. Environmental determinants of E. Coli, link with the diarrheal diseases, and indication of vulnerability criteria in tropical West Africa (Kapore, Burkina Faso). PLoS Negl Trop Dis. 2021;15(8):e0009634.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Kumwenda S. Challenges to hygiene improvement in developing countries. Volume 1. IntechOpen London, UK; 2019.

  130. Osumanu IK, Kosoe EA, Ategeeng F. Determinants of open defecation in the Wa municipality of Ghana: empirical findings highlighting sociocultural and economic dynamics among households. Journal of environmental and public health, 2019. 2019.

  131. Baker KK, et al. Fecal fingerprints of enteric pathogen contamination in public environments of Kisumu, Kenya, associated with human sanitation conditions and domestic animals. Volume 52. Environmental science & technology; 2018. pp. 10263–74. 18.

  132. Jubril I. The Effect of Open Defecation Practice in Saki Town, Nigeria. 2022.

  133. Belay DG, et al. Open defecation practice and its determinants among households in sub-saharan Africa: pooled prevalence and multilevel analysis of 33 sub-saharan Africa countries demographic and health survey. Trop Med Health. 2022;50(1):28.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Gwimbi P, George M, Ramphalile M. Bacterial contamination of drinking water sources in rural villages of Mohale Basin, Lesotho: exposures through neighbourhood sanitation and hygiene practices. Environ Health Prev Med. 2019;24:1–7.

    Article  Google Scholar 

  135. Sun S, Han J. Open defecation and squat toilets, an overlooked risk of fecal transmission of COVID-19 and other pathogens in developing communities. Environ Chem Lett. 2021;19:787–95.

    Article  CAS  PubMed  Google Scholar 

  136. Treacy J. Drinking water treatment and challenges in developing countries. The relevance of hygiene to health in developing countries, 2019: pp. 55–77.

  137. Malan A, Sharma HR. Assessment of drinking water quality and various household water treatment practices in rural areas of Northern India. Arab J Geosci. 2023;16(1):96.

    Article  CAS  Google Scholar 

  138. Wandera EA, et al. Impact of integrated water, sanitation, hygiene, health and nutritional interventions on diarrhoea disease epidemiology and microbial quality of water in a resource-constrained setting in Kenya: a controlled intervention study. Tropical Med Int Health. 2022;27(8):669–77.

    Article  Google Scholar 

  139. Akamanya R. Towards an advanced water service level: Microbial drinking water quality management at government schools and healthcare facilities in resource-constrained rural settings, Kabarole Uganda. Loughborough University.

  140. Agestika L. The association of child feces disposal, and Water, Sanitation, and Hygiene (WASH) toward child health in the urban slum, Indonesia. Hokkaido University; 2019.

  141. Bauza V, et al. Child defecation and feces disposal practices and determinants among households after a combined household-level piped water and sanitation intervention in rural Odisha, India. Am J Trop Med Hyg. 2019;100(4):1013.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Ozoh A, et al. Indiscriminate solid waste disposal and problems with water-polluted urban cities in Africa. J Coastal Zone Manage. 2021;24(S5):1000005.

    Google Scholar 

  143. Srivastava R. Solid waste management and its impact on the environment, in Handbook of research on environmental and human health impacts of plastic pollution. 2020, IGI Global. pp. 389–400.

  144. Geda NR. Inequalities in child care practices and health outcomes in Ethiopia. University of Saskatchewan; 2021.

  145. Gagneux-Brunon A, et al. Vaccines for healthcare-associated infections: present, future, and expectations. Expert Rev Vaccines. 2018;17(5):421–33.

    Article  CAS  PubMed  Google Scholar 

  146. Dimitrova A, et al. Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using demographic and Health Survey data. Lancet Planet Health. 2022;6(2):e147–55.

    Article  PubMed  Google Scholar 

  147. Chaurasia H, Srivastava S, Singh JK. Does seasonal variation affect diarrhoea prevalence among children in India? An analysis based on spatial regression models. Child Youth Serv Rev. 2020;118:105453.

    Article  Google Scholar 

  148. Aik J, Ong J, Ng L-C. The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore–A time-series analysis. Int J Hyg Environ Health. 2020;227:113517.

    Article  PubMed  Google Scholar 

Download references

Funding

There is no specific grant for doing this research.

Author information

Authors and Affiliations

  1. Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Jember Azanaw, Asmamaw Malede, Hailemariam Feleke Yalew & Eshetu Abera Worede

Authors
  1. Jember Azanaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Asmamaw Malede
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hailemariam Feleke Yalew
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eshetu Abera Worede
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Data curation: Jember Azanaw and Eshetu Abera Worede. Formal analysis: Jember Azanaw. Investigation: Jember Azanaw, Eshetu Abera Worede. Methodology: Jember Azanaw, Eshetu Abera Worede, Asmamaw Malede, and Hailemariam Feleke Yalew. Software: Jember Azanaw, Eshetu Abera Worede Validation: Jember Azanaw, Eshetu Abera Worede, WoredeAsmamaw Malede, and Hailemariam Feleke Yalew. Visualization: Jember Azanaw, Eshetu Abera Worede, Asmamaw Malede, and Hailemariam Feleke Yalew. Write-up – Jember Azanaw, Eshetu Abera Worede. Review & editing: Jember Azanaw, Eshetu Abera Worede, Hailemariam Feleke Yalew., and Asmamaw Malede.

Corresponding author

Correspondence to Jember Azanaw.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Patient and public involvement

There was no direct involvement of patients or public.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azanaw, J., Malede, A., Yalew, H.F. et al. Determinants of diarrhoeal diseases among under-five children in Africa (2013–2023): a comprehensive systematic review highlighting geographic variances, socioeconomic influences, and environmental factors. BMC Public Health 24, 2399 (2024). https://doi.org/10.1186/s12889-024-19962-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-19962-0

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us