Predictors of diarrhea among children under 24 months in Nepal: A multilevel analysis of multiple indicator cluster survey 2019

BACKGROUND: Diarrhea has remained an unmet challenge in global child health. Its severity may be worse than reported in resource-limited settings. Understanding changing epidemiology is critical to combat diarrheal morbidity. Therefore, this study aimed to understand factors associated with diarrhea among under two years children in Nepal. METHODS: A total of 2,348 samples from Multiple Indicator Cluster Survey 2019 were used to estimate the significant child, maternal, household and external environmental predictors of diarrhea using multilevel analysis. RESULTS: The prevalence of diarrhea was 11.9% (95% CI: 10.2%-13.6%). Children residing in Koshi Province [AOR (Adjusted Odds Ratio): 2.23, 95% CI: 1.22–4.08], Karnali Province (AOR: 2.28, 95% CI: 1.11–4.70), and Sudurpaschim Province (AOR: 4.49, 95% CI: 2.39–8.42) were at higher risk of diarrhea. Children aged 7–23 months (AOR: 1.56, 95% CI: 1.10–2.20), children with ARI symptoms (AOR: 4.14, 95% CI: 2.21–7.72) and children whose mothers had no access to prenatal care (AOR: 1.87, 95% CI: 1.01–3.45) had a higher risk of diarrhea. Children from below the richest household wealth group (AOR: 1.76, 95% CI: 1.01–3.08) and those from households practicing open defecation, with unimproved or limited sanitation facilities (AOR: 1.52, 95% CI: 1.09–2.11) were more likely to have diarrhea. CONCLUSION: The findings underscore the need for public health policy-makers to improve sanitation facilities, especially focusing on poor households from Karnali and Sudurpaschim Provinces practicing open defecation to protect the children from the life risk of diarrhea in Nepal.