131 / 2019-11-05 10:25:52

Diarrhea in children under five years old in Nepal: a spatial-temporal analysis based on the demographic and health survey data

spatiotemporal analysis,Bayesian analysis,diarrhea,child health,Nepal

Background Diarrhea in children under five years old remains a challenge in the child mortality worldwide, and the risk is even higher in Nepal. Understanding the spatial-temporal pattern and the influencing factors of the disease is important for disease control and intervention.
Method Data regarding the disease and its potential influencing factors were extracted from the public database Demographic and Health Surveys conducted in Nepal in the year 2006, 2011 and 2016. Spatial autocorrelation was explored using Moran’s I test. Univariate analysis was used to compare the differences of potential influencing factors between children with diarrhea and those without diarrhea. Bayesian logistic regression model with time and location-specific random effects was applied to examine the spatial-temporal pattern of diarrhea specifically in children under five and explore its potential influencing factors.
Result There was no spatial autocorrelation of the disease in Nepal. Whereas there was an overall decreasing trend of the incidence of diarrhea temporally. Statistical differences between children with and without diarrhea were found in children’s gender and age, water source, sanitation, fuel type, mother’s age and education year. In the Bayesian model, the disease risk was significantly negatively associated with the age of children (OR: 0.61, 95% BCI: -0.55, -0.43) and sanitation (OR: 0.83, 95% BCI: -0.33, -0.06), while positively associated with the male gender: (OR: 1.25, 95% BCI: 0.14, 0.35) . Different areas showed slightly diversity of location-specific disease risk.
Conclusion This study identified several influencing factors of diarrhea in Nepalese children under the age of five and show spatial-temporal patterns of the disease in Nepal. Promoting sanitation improvement, focusing on prevention and intervention of diarrhea in male children and infants, especially in districts where the incidence of diarrhea continues to be high, is very important for improving the diarrhea situation of Nepal and improving the health of Nepalese children.