International Journal of Medical Science and Pharmaceutical Research

Background: Childhood diarrhoea remains among the foremost causes of preventable morbidity and mortality among children under five years of age globally, particularly in low-resource communities across sub-Saharan Africa. In Nigeria, the situation is compounded by inadequate water and sanitation infrastructure, low maternal education levels, and entrenched cultural practices. Objectives: This study investigates the environmental, socio-economic, and cultural factors influencing the occurrence and recurrence of diarrhoeal disease among children under five years in Ikere Local Government Area, Ekiti State, Nigeria. Methods: A descriptive cross-sectional survey design was employed, utilizing a structured questionnaire administered to 271 purposively and randomly selected caregivers of children under five across three wards of Ikere-Ekiti. Data were analysed using descriptive and inferential statistics with SPSS software. Results: Findings reveal that 72.0% of caregivers had access to clean water, yet 28.0% lacked it, exposing their children to waterborne diarrhoeal risk. Environmental hygiene deficits were also noted, with 31.4% reporting poorly maintained toilets and 25.1% practising improper waste disposal. Handwashing with soap was strongly endorsed (55.0% strongly agreed it prevents diarrhoea), while 36.5% of caregivers had no formal education, limiting health literacy. Religion exerted minimal negative influence, with 88.9% endorsing religious leaders as hygiene advocates. Recurrence was high: 79.7% of children had diarrhoea within two weeks, and 59.0% experienced multiple episodes annually. Prolonged episodes (>3 days) were reported by 88.9%. Conclusion: Childhood diarrhoea in Ikere-Ekiti is driven by multifactorial determinants spanning environmental, socio-economic, and cultural domains. Integrated, community-responsive public health interventions are urgently required. Recommendations: Government investment in water and sanitation infrastructure, community-based maternal health education, engagement of faith leaders, and subsidised healthcare access are recommended to reduce the burden of childhood diarrhoea.

Childhood diarrhoea, under-five children, Ikere-Ekiti, environmental risk factors, socio-economic determinants, sanitation, Nigeria.

1. Adam Birhan, N., Workineh, A. Y., Meraf, Z., Abich, E., Alemayehu, G. M., Alemu, Y., Nigussie, A., & Birhan, T. Y. (2024). Prevalence of diarrhea and its associated factors among children under five years in Awi Zone, Northwest Ethiopia. BMC Pediatrics, 24(1), 701. https://doi.org/10.1186/s12887-024-05191-2
2. Abate, B. B., Zemariam, A. B., Wondimagegn, A., Abebe, G. K., Araya, F. G., Kassie, A. M., Bizuayehu, M. A. (2024). Knowledge, attitude and practice of home management of diarrhea among under-five children in East Africa: A systematic review and meta-analysis. PloS one, 19(2), e0298801.
3. Alemu, T. G., Fentie, E. A., Asmamaw, D. B., Shewarega, E. S., Negash, W. D., Eshetu, H. B., ... & Teklu, R. E. (2023). Multilevel analysis of factors associated with untreated diarrhea among under-five children in Ethiopia using Ethiopian demographic and health survey. Scientific Reports, 13(1), 16126.
4. Ali, M., Abbas, F., & Shah, A. A. (2022). Factors associated with prevalence of diarrhea among children under five years of age in Pakistan. Children and Youth Services Review, 132, 106303.
5. Alum, E. U., Obeagu, E. I., & Ugwu, O. P. C. (2024). Curbing diarrhea in children below five years old: the sub-Saharan African standpoint. Journal of New Medical Innovations and Research, 5(1).
6. Anampiu, J., Rutto, J., Kaimuri, M., & Kubai, P. (2024). Sanitation risk factors contributing to diarrhea in children below five years in Igembe South Sub-County, Meru County, Kenya. African Journal of Science, Technology and Social Sciences, 2(2), 130–137.
7. Boadi, K. O., Kuitanen, M., Raheem, K., & Hanninen, K. (2005). Urbanization without development: Environment and health implications in African cities. Environment, Development and Sustainability, 7, 465–500.
8. Briggs, D. (2003). Making a difference: Indicators to improve children's environmental health. WHO/UNEP. Geneva: World Health Organization.
9. Briggs, D. (2008). Introduction and classification of childhood diarrhoea: Indicators to improve children's environmental health. Geneva: World Health Organization.
10. Chari, S., Mbonane, T. P., & Van Wyk, R. H. (2023). Social and environmental determinants of diarrheal diseases among children under five years in Epworth Township, Harare. Children, 10(7), 1173.
11. Charyeva, Z., Cannon, M., Oguntunde, O., Garba, A. M., Sambisa, W., & Bassi, A. P. (2015). Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria. Journal of Health, Population and Nutrition, 34(1), 4.
12. Desmennu, A. T., Oluwasanu, M. M., John-Akinola, Y. O., Oladunni, O., & Adebowale, S. A. (2017). Maternal education and diarrhoea among children aged 0–24 months in Nigeria. African Journal of Reproductive Health, 21(3), 27–36.
13. Geremew, G., Cumming, O., Haddis, A., Freeman, M. C., & Ambelu, A. (2024). Rainfall and temperature influences on childhood diarrhea and the effect modification role of water and sanitation conditions: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 21(7), 823.
14. Kemajou, D. N. (2022). Climate variability, water supply, sanitation and diarrhea among children under five in Sub-Saharan Africa: a multilevel analysis. Journal of Water and Health, 20(4), 589–600.
15. Kombat, M. Y., Kushitor, S. B., Sutherland, E. K., Boateng, M. O., & Manortey, S. (2024). Prevalence and predictors of diarrhea among children under five in Ghana. BMC Public Health, 24(1), 154.
16. Kotloff, K. L. (2017). The burden and etiology of diarrheal illness in developing countries. Pediatric Clinics of North America, 64(4), 799–814.
17. Kurniawati, M. R., & Astutik, E. (2023). Socioeconomic factors associated with diarrhea among children under five years in Indonesia. Periodic Epidemiology Journal (Jurnal Berkala Epidemiologi), 11(2).
18. Lakew, G., Yirsaw, A. N., Bogale, E. K., Andarge, G. A., Getachew, D., Getachew, E., & Tareke, A. A. (2024). Diarrhea and its associated factors among children aged under five years in Madagascar, 2024: a multilevel logistic regression analysis. BMC Public Health, 24(1), 2910.
19. Liheluka, E., Gibore, N. S., Lusingu, J. P. A., Gesase, S., Minja, D. T. R., Lamshöft, M., ... & Bali, T. (2023). Community perceptions on the effectiveness of herbal medicines and factors associated with their use in managing diarrhoea among under-five children in North-eastern Tanzania. Tropical Medicine and Health, 51(1), 48.
20. Manetu, W. M., M'masi, S., & Recha, C. W. (2021). Diarrhea disease among children under 5 years of age: A global systematic review. Open Journal of Epidemiology, 11(03), 207–221. https://doi.org/10.4236/ojepi.2021.113018
21. Muriithi, D. I. (2024). Socio-economic determinants of diarrhea occurrence among children under five years old in Kenyan slums: A case study of Korogocho, in Nairobi County, Kenya. World Wide Journal of Multidisciplinary Research and Development.
22. Musa Mohammed, M. O. (2024). Prevalence and risk factors associated with under-five years children diarrhea in Malawi: Application of survey logistic regression. Heliyon, 10(7). https://doi.org/10.1016/j.heliyon.2024.e29335
23. National Population Commission (NPC) Nigeria. (2006). Population and housing census of the Federal Republic of Nigeria. Abuja: NPC.
24. Odo, C., Onalu, C., Nwatu, U., Nwafor, N., & Ebimgbo, S. (2023). Factors associated with the prevalence of diarrhoea among children in rural areas of Enugu State, Nigeria: Practice considerations for social workers. International Social Work, 66(2), 518–533.
25. Oloruntoba, E. O., Folarin, T. B., & Ayede, A. I. (2014). Hygiene and sanitation risk factors of diarrhoeal disease among under-five children in Ibadan, Nigeria. African Health Sciences, 14(4), 1001–1011.
26. Sadiq, K., Mir, F., Jiwani, U., Chanar, S., Nathwani, A., Jawwad, M., ... & Bhutta, Z. A. (2023). Risk factors for acute diarrhoea in children between 0 and 23 months of age in a peri-urban district of Pakistan: A matched case-control study. International Health, 15(3), 281–288. https://doi.org/10.1093/inthealth/ihac022
27. Sambo, J., Cassocera, M., Chissaque, A., Bauhofer, A. F. L., Roucher, C., Chilaúle, J., ... & Anapakala, E. (2022). Characterizing undernourished children under-five years old with diarrhoea in Mozambique: A hospital-based cross-sectional study, 2015–2019. Nutrients, 14(6), 1164.
28. Soe, T. K., Laohasiriwong, W., Sornlorm, K., & Mahato, R. K. (2024). Hygiene practice and diarrhea prevalence among under-five children in Myanmar: a cross-sectional study. BMC Pediatrics, 24(1), 675.
29. Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. R., ... (2018). 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. Lancet Infectious Diseases, 18(11), 1211–1228.
30. Ugboko, H. U., Nwinyi, O. C., Oranusi, S. U., & Oyewale, J. O. (2020). Childhood diarrhoeal diseases in developing countries. Heliyon, 6(4). https://doi.org/10.1016/j.heliyon.2020.e03690
31. UNICEF. (2024). Diarrhoeal disease data. UNICEF Data. New York: United Nations Children's Fund.
32. Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., ... & Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea. Lancet, 381(9875), 1405–1416.
33. World Health Organization. (2022). Diarrhoeal disease fact sheet. Geneva: WHO. https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
34. World Health Organization. (2023). Diarrhoeal disease. Geneva: WHO.
35. Yamane, T. (1967). Statistics: An introductory analysis (2nd ed.). New York: Harper and Row.
36. Yüksel Kaçan, C., Palloş, A., & Özkaya, G. (2022). Examining knowledge and traditional practices of mothers with children under five in Turkey on diarrhoea according to education levels. Annals of Medicine, 54(1), 674–682.