Advertisement

Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey

      Highlights

      • Diarrhea is the leading cause of children's mortality and morbidity in the Southeast Asian.
      • Children have suboptimal access to essential health services.
      • Children face multifactorial risk factors for diarrhea.
      • Multisectoral collaboration is needed to develop the prevention program for diarrhea.

      Abstract

      Purpose

      To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey.

      Design and methods

      Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed.

      Results

      A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors.

      Conclusion

      The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches.

      Practice implication

      The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Adane M.
        • Mengistie B.
        • Mulat W.
        • Kloos H.
        • Medhin G.
        Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: A community-based cross-sectional study.
        Journal of Health, Population, and Nutrition. 2017; 36: 9
        • Agustina R.
        • Sari T.P.
        • Satroamidjojo S.
        • Bovee-Oudenhoven I.M.
        • Feskens E.J.
        • Kok F.J.
        Association of food-hygiene practices and diarrhea prevalence among Indonesian young children from low socioeconomic urban areas.
        BMC Public Health. 2013; 13: 1
        • Akhondi H.
        • Simonsen K.A.
        Bacterial diarrhea.
        StatPearls Publishing, 2020
        • Aliaga A.
        • Ren R.
        Optimal sample sizes for two-stage cluster sampling in demographic and health surveys.
        United States Agency for International Development, 2006
        • Alrifai S.B.
        • Alsaadi A.
        • Mahmood Y.A.
        • Ali A.A.
        • Al-Kaisi L.A.
        Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital.
        Eastern Mediterranean Health Journal. 2009; 15: 1111-1118
        • Asia-Pacific S.D.G.P.
        Asia-Pacific sustainable development goals outlook.
        Vol. 40. 2017
        • Bawankule R.
        • Singh A.
        • Kumar K.
        • Pedgaonkar S.
        Disposal of children’s stools and its association with childhood diarrhea in India.
        BMC Public Health. 2017; 17: 1-9
        • Bawankule R.
        • Singh A.
        • Kumar K.
        • Shetye S.
        Does measles vaccination reduce the risk of acute respiratory infection (ARI) and diarrhea in children: A multi-country study?.
        PLoS One. 2017; 12: e0169713
        • Bersamin A.T.
        • Tayaben J.L.
        • Balangcod K.D.
        • Balangcod A.K.D.
        • Cendana A.C.
        • Dom-Ogen E.T.
        • Balangcod T.D.
        Utilization of plant resources among the Kankanaeys in Kibungan, Benguet Province, Philippines.
        Biodiversitas. 2021; 22: 362-372
        • Bhatia S.
        • Mathew P.
        An approach to chronic diarrhoea. Medicine update.
        (Volume 17, 2007)(November)2007: 369
        • Braimoh T.
        • Danat I.
        • Abubakar M.
        • Ajeroh O.
        • Stanley M.
        • Wiwa O.
        • Lam F.
        Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: Evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria.
        International Journal for Equity in Health. 2021; 20: 1-12
        • Bronfenbrenner U.
        Ecological models of human development. In.
        2nd ed. Elsevier, 1994
        • Cairncross S.
        • Hunt C.
        • Boisson S.
        • Bostoen K.
        • Curtis V.
        • Fung I.C.H.
        • Schmidt W.P.
        Water, sanitation and hygiene for the prevention of diarrhoea.
        International Journal of Epidemiology. 2010; 39: i193-i205
        • CaJacob N.J.
        • Cohen M.B.
        Update on diarrhea. In.
        Vol. 37. American Academy of Pediatrics, 2016: 313-322
        • Centers for Disease Control and Prevention
        Global diarrhea burden.
        Centers for Disease Control and Prevention, 2017: 1-4
        • Chen J.
        • Wan C.M.
        • Gong S.T.
        • Fang F.
        • Sun M.
        • Qian Y.
        • Dong Y.S.
        Chinese clinical practice guidelines for acute infectious diarrhea in children. In.
        Vol. 14. Institute of Pediatrics of Zhejiang University, 2018: 429-436
        • Croft T.N.
        • Marshall A.M.J.
        • Allen C.K.
        Guide to DHS statistics.
        ICF International, 2018 (file:///D:/DOWNLOAD/2018/Guide_to_DHS_Statistics_DHS-7.pdf)
        • Cronin A.A.
        • Sebayang S.K.
        • Torlesse H.
        • Nandy R.
        Association of safe disposal of child feces and reported diarrhea in Indonesia: Need for stronger focus on a neglected risk.
        International Journal of Environmental Research and Public Health. 2016; 13
        • Curtis V.
        • Cairncross S.
        Effect of washing hands with soap on diarrhoea risk in the community: A systematic review.
        Lancet Infectious Diseases. 2003; 3: 275-281
        • Degefa G.
        • Gebreslassie M.
        • Meles K.G.
        • Jackson R.
        Determinants of delay in timely treatment seeking for diarrheal diseases among mothers with under-five children in central Ethiopia: A case control study.
        PLoS One. 2018; 13: 1-12
        • Duncan G.J.
        • Lee K.T.H.
        • Rosales-Rueda M.
        • Kalil A.
        Maternal age and child development.
        Demography. 2018; 55: 2229-2255
        • Eka Susanti W.
        • Novrikasari N.
        • Sunarsih E.
        Determinant of diarrhea on children under five years in Indonesia (advanced analysis IDHS 2012).
        Jurnal Ilmu Kesehatan Masyarakat. 2016; 7: 64-72
        • George C.M.
        • Oldja L.
        • Perin J.
        • Sack R.B.
        • Biswas S.
        • Ahmed S.
        • Faruque A.G.
        Unsafe child feces disposal is associated with environmental enteropathy and impaired growth.
        Journal of Pediatrics. 2016; 176: 43-49
        • Gil A.
        • Lanata C.
        • Kleinau E.
        • Penny M.
        Children’s feces disposal practices in developing countries and interventions to prevent diarrheal diseases A literature review.
        2004
        • Gizaw Z.
        • Woldu W.
        • Bitew B.D.
        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.
        International Breastfeeding Journal. 2017; 12: 1-10
        • Hariani H.
        • Ramlah R.
        Pelaksanaan Program Penanggulangan Diare di Puskesmas Matakali.
        J-KESMAS: Jurnal Kesehatan Masyarakat. 2019; 5
        • Holcomb D.A.
        • Knee J.
        • Sumner T.
        • Adriano Z.
        • de Bruijn E.
        • Nalá R.
        • Stewart J.R.
        Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique.
        International Journal of Hygiene and Environmental Health. 2020; 226: 113496
        • Horta B.L.
        • Victora C.G.
        Short-term effects of breastfeeding: A systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality. In.
        2013
        • Htwe K.
        • Yee K.
        • Tin M.
        • Vandenplas Y.
        Effect of Saccharomyces boulardii in the treatment of acute watery diarrhea in Myanmar children: A randomized controlled study.
        The American Journal of Tropical Medicine and Hygiene. 2008; 78: 214-216
        • Humphries R.M.
        • Linscott A.J.
        Laboratory diagnosis of bacterial gastroenteritis.
        Clinical Microbiology Reviews. 2015; 28: 3-31
        • Iaen K.
        • Heang H.B.
        • Kim H.
        Cambodia's traditional healing remedies at risk of being forgotten. SBS Khmer.
        (Retrieved 25 April 2022 from)
        • International, M
        Trends in demographic and reproductive health indicators in Ethiopia: Further analysis of the 2000 and 2005 demographic and health surveys data.
        • International Renewable Energy Agency
        Renewable energy market analysis: Southeast Asia.
        2018
        • Irnawati P.Y.
        • Salimo H.
        Health belief model on the choice of medical doctor among mothers of children with diarrhea.
        Journal of Health Promotion and Behavior. 2018; 3: 100-108
        • Ivac, & Johns Hopkins Bloomberg School of Public, H
        2019 Pneumonia & Diarrhea Progress Report Card. In.
        2019
        • Jesus M.D.
        The impact of mass media health communication on health decision-making and medical advice-seeking behavior of U.S. Hispanic population.
        Health Communication. 2013; 28: 525-529
        • Kakulu R.K.
        Diarrhoea among Underfive children and household water treatment and safe storage factors in Mkuranga District.
        Tanzania Muhimbili University of Health and Allied Science, 2012
        • Kamm K.B.
        • Feikin D.R.
        • Bigogo G.M.
        • Aol G.
        • Audi A.
        • Cohen A.L.
        • Ram P.K.
        Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya.
        Tropical Medicine and International Health. 2014; 19: 398-406
        • Kamp K.
        Diarrhea among children under five in Myanmar: A systematic review.
        Journal of Health Research. 2017; 31: 77-84
        • Kementrian Pendidikan dan Kebudayaan
        UU No. 20 Tahun 2003 Tentang Sistem Pendidikan Nasional. Sistem Informasi Managemen Keuangan Kementerian Pendidikan Dan Kebudayaan RI. Kementerian Pendidikan dan Kebudayaan, Jakarta2003
        • Krisnana I.
        • Pradanie R.
        • Mustika D.A.
        Impact of complementary foods and environmental sanitation on the incidence of diarrhea in children aged 6-24 months in sidoarjo, Indonesia.
        Systematic Reviews in Pharmacy. 2020; 11: 778-782
        • Kumar S.G.
        • Subita L.
        Diarrhoeal diseases in developing countries: A situational analysis.
        Kathmandu University Medical Journal. 2012; 10: 83-88
        • Kurniawati S.
        • Martini S.
        Nutritional status and measles immunization status associated with acute diarrhoea.
        Jurnal Wiyata. 2016; 3: 126-132
        • Lamberti L.M.
        • Fischer Walker C.L.
        • Black R.E.
        Systematic review of diarrhea duration and severity in children and adults in low- and middle-income countries.
        BMC Public Health. 2012; 12: 276
        • Lamberti L.M.
        • Fischer Walker C.L.
        • Noiman A.
        • Victora C.
        • Black R.E.
        Breastfeeding and the risk for diarrhea morbidity and mortality.
        BMC Public Health. 2011; 11: S15
        • Levine M.M.
        • Nasrin D.
        • Acácio S.
        • Bassat Q.
        • Powell H.
        • Tennant S.M.
        • Kotloff K.L.
        Diarrhoeal disease and subsequent risk of death in infants and children residing in low-income and middle-income countries: Analysis of the GEMS case-control study and 12-month GEMS-1A follow-on study.
        The Lancet Global Health. 2020; 8: e204-e214
        • Li T.
        • Zhang D.
        • Oo T.N.
        • San M.M.
        • Mon A.M.
        • Hein P.P.
        • Yang X.
        Investigation on the antibacterial and anti-T3SS activity of traditional Myanmar medicinal plants.
        Evidence-based Complementary and Alternative Medicine. 2018; 2018: 2812908
        • Mao B.
        • Saint L.
        • Nit S.
        Factors associate with utilization of health Services for Childhood Diarrheaa and Fever in Cambodia: Further analysis of the Cambodia demographic and health survey.
        2005
        • Mediarti D.
        • Rosnani R.
        • Sukartini T.
        • Arifin H.
        • Kurniawati Y.
        Coverage and factors associated with complete polio vaccination among Indonesian children aged 0–18 months [article].
        Children and Youth Services Review. 2020; 118 (Article 105399)
        • Mizumoto K.
        • Takahashi T.
        • Kinoshita Y.
        • Higuchi M.
        • Bachroen C.
        • Da Silva V.
        A qualitative study of risk factors related to child malnutrition in Aileu District, Timor-Leste.
        Asia-Pacific Journal of Public Health. 2015; 27 (NP1398-NP1408)
        • Naghavi M.
        • Abajobir A.A.
        • Abbafati C.
        • Abbas K.M.
        • Abd-Allah F.
        • Abera S.F.
        • Murray C.J.L.
        Global, regional, and national age-sex specifc mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016.
        The Lancet. 2017; 390: 1151-1210
        • Nandi A.
        • Megiddo I.
        • Ashok A.
        • Verma A.
        • Laxminarayan R.
        Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis.
        Social Science and Medicine. 2017; 180: 181-192
        • Nariddh M.C.
        Traditional medicines by Kru Khmer good for many ailments.
        Khmer Times. 2021; (Retrieved 25 April 2022 from)
        • Negesse Y.
        • Taddese A.A.
        • Negesse A.
        • Ayele T.A.
        Trends and determinants of diarrhea among under-five children in Ethiopia: Cross-sectional study: Multivariate decomposition and multilevel analysis based on Bayesian approach evidenced by EDHS 2000–2016 data.
        BMC Public Health. 2021; 21: 1-16
        • Nursalam N.
        • Sukartini T.
        • Arifin H.
        • Pradipta R.O.
        • Mafula D.
        • Ubudiyah M.
        Determinants of the discriminatory behavior experienced by people living with HIV in Indonesia: A cross-sectional study of the demographic health survey [article].
        Open AIDS Journal. 2021; 15: 1-9
        • Palmeira P.
        • Carneiro-Sampaio M.
        Immunology of breast milk.
        Revista da Associação Médica Brasileira. 2016; 62: 584-593
        • Panuju R.
        Pengawasan Iklan Pelayanan Kesehatan Tradisional di Televisi.
        Jurnal Studi Komunikasi (Indonesian Journal of Communications Studies). 2017; 1: 186-205
        • Pavlinac P.B.
        • Tickell K.D.
        • Walson J.L.
        Management of diarrhea in HIV-affected infants and children.
        Expert Review of Anti-Infective Therapy. 2015; 13: 5-8
        • Pisey V.
        • Banchonhattakit P.
        Influence of socio-demographic and environmental factors on childhood diarrhea in Cambodia.
        F1000Research. 2020; 9: 303
        • Pittet D.
        • Allegranzi B.
        • Storr J.
        • Nejad S.B.
        • Dziekan G.
        • Leotsakos A.
        • Donaldson L.
        Infection control as a major World Health Organization priority for developing countries.
        Journal of Hospital Infection. 2008; 68: 285-292
        • Prasanti D.
        The portrait of media health information for urban community in the digital era.
        Iptek-Kom. 2017; 19: 149-162
        • Riskesdas
        Hasil Utama Riskesdas. 2018; : 2018
        • Sangalang S.O.
        • Prado N.O.
        • Lemence A.L.G.
        • Cayetano M.G.
        • Lu J.L.D.P.
        • Valencia J.C.
        • Borgemeister C.
        Diarrhea, helminth infection, dehydration, and malnutrition associated with water, sanitation, and hygiene facilities and poor handwashing in schools in metro Manila, Philippines: A cross-sectional study.
        SSRN Electronic Journal. 2020; 248: 1-24
        • Santika N.K.A.
        • Efendi F.
        • Rachmawati P.D.
        • Has E.M.M.
        • Kusnanto K.
        • Astutik E.
        Determinants of diarrhea among children under two years old in Indonesia.
        Children and Youth Services Review. 2020; 111
        • Schiller L.R.
        • Pardi D.S.
        • Sellin J.H.
        Chronic diarrhea: Diagnosis and management.
        Clinical Gastroenterology and Hepatology. 2017; 15: 182-193.e183
        • Sheth M.
        • Dwivedi R.
        Complementary foods associated diarrhea.
        Indian Journal of Pediatrics. 2006; 73: 61-64
        • Siregar A.Y.M.
        • Pitriyan P.
        • Walters D.
        The annual cost of not breastfeeding in Indonesia: The economic burden of treating diarrhea and respiratory disease among children (< 24mo) due to not breastfeeding according to recommendation.
        International Breastfeeding Journal. 2018; 13: 1-10
        • Sugawara T.
        • Ohsuka Y.
        • Taya K.
        • Yasui Y.
        • Wada N.
        • Sakano M.
        • Okabe N.
        Diarrhea as a minor adverse effect due to oral polio vaccine.
        Japanese Journal of Infectious Diseases. 2009; 62: 51-53
        • Syahrani A.R.T.
        • Asrina A.
        • Yusriani.
        Pengobatan Tradisional Penyakit Diare pada Anak Balita di Suku Bajo Kelurahan Bajoe Kecamatan Tanete Riattang Timur Kabupaten Bone.
        Window of Public Health Journal. 2020; 1: 70-78
        • Tietjen L.
        • Bossemeyer D.
        • McIntosh N.
        Preventing infectious diarrhea and managing infection Prevention guidelines for healthcare facilities with limited resources.
        Jhpiego and United States Agency for International Development, 2003
        • Troeger C.
        • Blacker B.F.
        • Khalil I.A.
        • Rao P.C.
        • Cao S.
        • Zimsen S.R.M.
        • Reiner R.C.
        Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: A systematic analysis for the Global Burden of Disease Study 2016.
        The Lancet Infectious Diseases. 2018; 18: 1211-1228
        • Ugboko H.U.
        • Nwinyi O.C.
        • Oranusi S.U.
        • Oyewale J.O.
        Childhood diarrhoeal diseases in developing countries.
        Heliyon. 2020; 6e03690
        • Ullah M.B.
        • Mridha M.K.
        • Arnold C.D.
        • Matias S.L.
        • Khan M.S.A.
        • Siddiqui Z.
        • Dewey K.G.
        Factors associated with diarrhea and acute respiratory infection in children under two years of age in rural Bangladesh.
        BMC Pediatrics. 2019; 19: 386
        • Vyas S.
        • Kumaranayake L.
        Constructing socio-economic status indices: How to use principal components analysis.
        Health Policy and Planning. 2006; 21: 459-468
        • Walker C.L.F.
        • Perin J.
        • Aryee M.J.
        • Boschi-Pinto C.
        • Black R.E.
        Diarrhea incidence in low- and middle-income countries in 1990 and 2010: A systematic review.
        BMC Public Health. 2012; 12: 220
      1. Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. Q. A., O'Brien, K. L., Campbell, H., Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea. The Lancet, 381, 1405–1416. https://doi.org/10.1016/S0140-6736(13)60222-6

        • WHO
        Diarrhoea.
        (Retrieved 25 April 2022 from)
        • Woldt M.
        • Moy G.G.
        Literature review on effective food hygiene interventions for households in developing countries.
        2015 (Fhi 360/Fanta)
        • World Health Organization
        Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals.
        World Health Organization, 2009
        • World Health Organization
        Preventing diarrhoea through better water, sanitation and hygiene: Exposures and impacts in low- and middle-income countries.
        World Health Organization, 2014
        • Yofrido F.M.
        • Aryana H.
        • Jaya J.H.
        • Ageng R.
        • Prastowo S.
        • R. K., Umiastuti, P., & Hadi, I. S.
        The relationship between breastfeeding patterns and incidence of diarrhea in children aged 7–23 months.
        Jurnal Widya Medika. 2019; 5: 163-169
        • Yunitasari E.
        • Pradanie R.
        • Arifin H.
        • Fajrianti D.
        • Lee B.O.
        Determinants of stunting prevention among mothers with children aged 6–24 months [article].
        Open Access Macedonian Journal of Medical Sciences. 2021; 9: 378-384
        • Zwi A.B.
        • Blignault I.
        • Glazebrook D.
        • Correia V.
        • Bateman C.R.
        • Steel E.F.
        • Pinto B.M.
        Timor-Leste health care seeking behaviour study.
        The University of New South Wales, 2009