Multimorbidity of diarrhea and wasting and its associated factors among children aged 6-24 months in East Africa: Spatial and Multilevel analysis, DHS 2016-2022

Abstract

Background: Young children who experience both diarrhea and wasting are in need of nutritional supplements and are more susceptible to infectious diseases due to their under developed immunity. The relationship between diarrhea and wasting is interconnected, ultimately leading to decreased survival rates and long-term consequences such as stunted growth and impaired cognitive development in children. Although there are studies done for diarrhea and wasting independently there is limited information regarding the prevalence, spatial variation and factors associated with the multimorbidity of diarrhea and wasting (DW). Objective: To assess the prevalence, spatial variation and associated factors of the multimorbidity of DW among children aged 6 -24 month in East Africa. Methods: The most recent DHS datasets of East African countries were used to determine the prevalence and associated factors of multimorbidity of DW in the region. Total weighted sample size of 78,962 children aged 6-24 months were included in the study. Stata version 17 software was used for data cleaning and multilevel mixed effect analysis. Arc-GIS software was used to explore the spatial distribution multimorbidity of DW and a Bernoulli model was fitted using SaTScan software to identify significant clusters of multimorbidity of DW. The ordinary least square (OLS) and geographically weighted regression (GWR) models were used to determine factors explaining geographical variation of multimorbidity of DW across the region. Multilevel logistic regression model was fitted to identify factors associated with multimorbidity of DW. Variables with p-value < 0.2 from the bivariable model were used for the multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significant factors associated with multimorbidity of DW and adjusted odds ratio (AOR) with 95% confidence interval was reported. The multilevel models were compared using deviance. Result: The prevalence of multimorbidity of DW was found to be 3% in East Africa. The spatial distribution of multimorbidity of DW showed significant variation across the study area (Moran’s I=0.145 p-value ≤0.001). The hotspot areas of multimorbidity of DW was observed at Ethiopia, Uganda, Burundi, Tanzania, and northern parts of Kenya. The GWR model explained 37% of the geographical variation of multimorbidity of DW among children aged 6-24 months in East Africa. Male sex of a child, no maternal education, highest maternal education, unimproved latrine facility, unimproved water source, and no timely initiation of breastfeeding were significantly associated with multimorbidity of DW. The multilevel analysis further identified significant individual and community level factors associated with multimorbidity of DW. Conclusion and Recommendation: Multimorbidity of DW had a significant spatial variation across East Africa. Significant hotspot areas of multimorbidity of DW were observed at Ethiopia, Uganda, Burundi, Tanzania and northern parts of Kenya. Therefore, public health interventions which improve maternal educational empowerments, better sanitation facilities, breastfeeding practice should target hotspot areas to decrease multimorbidity of DW.