Prevalence and Risk Factors of Diarrhea Among Children Under Five Years in Northern Kenya’s Drylands: A Longitudinal Study

Abstract

Abstract Diarrhea is the third leading cause of malnutrition and mortality in children under five globally. However, a few studies have examined predictors of child diarrheal disease in arid or semi-arid regions of sub-Saharan Africa. This study aimed to assess the prevalence and risk factors of diarrhea among children under five in the drylands of Northern Kenya. Data are from a longitudinal, population-based study of children younger than 36 months at recruitment (N = 1,211) and their caregivers in Turkana County, Kenya. Households were followed from May 2021 to September 2023, with survey data collected every four months across six waves. Caregivers reported on household conditions and observed episodes of diarrhea among index children in the two weeks before the survey. Trends in the prevalence of diarrhea were stratified by administrative zone, livelihood zone, and child sex. Risk factors of child diarrhea across survey waves were identified using multivariable generalized estimating equations. Diarrhea prevalence decreased from 32.1% [95% confidence interval (CI): 28.3%-36.1%] at Wave 1 to 8.7% (95% CI: 6.3%-11.7%) at Wave 6. Risk factors for diarrhea included caregivers alcohol consumption [adjusted odds ratio (AOR) = 1.30; 95% CI: 1.04-1.62], households experiencing three (AOR = 1.78; 95% CI: 1.29-2.45) or four (AOR = 2.58; 95% CI: 1.86-3.58) climatic, biological, economic or conflict shocks in the prior 4 months compared to those experiencing less than 2 shocks, households with moderate (AOR = 1.25; 95% CI: 1.04-1.50) or high (AOR = 1.50; 95% CI: 1.22-1.85) water insecurity in the prior 4 weeks compared to those with no-to-marginal water insecurity, and child wasting (AOR = 1.22; 95% CI: 1.05–1.41). These findings suggest that multisectoral interventions that reduce alcohol consumption among women, improve access to safe water services, manage malnutrition, and mitigate household shocks could reduce the burden of diarrhea among child under five in this region.