A multilevel analysis of the predictors of diarrhea among children under 5 years of age in Eswatini.

Diarrhea remains a public health challenge and persistently affect children under 5 years of age, primarily in developing countries. The aim of the study was to investigate the effects of individual, household and community level factors on child diarrhea. Using combined data 2010 and 2014 Eswatini Multiple Indicator Cluster surveys, data for 4,363 under five children was analysed. Univariable, bivariable and multivariable multilevel logistic regression models were used for data analysis. We found that the prevalence of diarrhea was 16.2%, (95% confidence interval (CI): 15.3-18.1). Higher odds of diarrhea were observed among children aged 6-11 months (AOR: 2.67, 95% CI: 1.93, 3.71) and 12-23 months (AOR=2.12, 95% CI: 1.56, 2.87) compared to those aged less than 6 months. However, lower odds of diarrhea were observed among children aged 36-47 months (AOR=0.68, 95% CI: 0.48, 0.97) and 48-59 months (AOR=0.39, 95% CI: 0.26, 0.58), compared to children aged less than 6 months. Children born to mothers aged 35-39 years had lower odds of having diarrhea, (AOR=0.48, 95%CI: 0.30, 0.79) compared to those born to mothers aged 15-19 years. Higher odds of having diarrhea were observed among children from communities with a low proportion of households with improved toilet facility (AOR=1.29, 95% CI: 1.01, 1.66) compared to those from communities with a high proportion of households with improved toilet facility. We found that individual- and community-level factors were associated with child diarrhea in Eswatini. Programmes and policies that aim to mitigate child morbidity due to diarrhea should pay attention to the individual and community factors.