Incidence of caregiver-reported diarrhea and associated risk factors among under-five children in Hosanna Town, central Ethiopia: a prospective cohort study

Diarrhea remains a leading cause of illnesses and death among children under five in developing countries, including Ethiopia. However, longitudinal studies on the incidence and risk factors of childhood diarrhea are limited, particularly in Ethiopia. Therefore, this study aimed to measure the incidence of diarrhea and identify associated risk factors among under-five children in the peri-urban and informal settlements of Hosanna town, central Ethiopia. A prospective cohort study was carried out on 292 households in three kebeles of Hosanna town. The data was collected using a pretested structured questionnaire, an observation spot-check method, and a questionnaire for recording diarrhea incidence. Bivariate logistic regression and Generalized Estimating Equations (GEEs) models were used to analyze the data. GEEs were chosen over mixed models because the study aimed to estimate population-averaged effects of risk factors on diarrhea incidence rather than subject-specific effects. The overall incidence of diarrhea was 1.6 episodes per child per year. Households lacking piped water on premises had an incidence rate of 2.2 episodes per child per year, while households connected with piped water on premises had a lower rate of 1.0 episodes per child per year. The findings demonstrated a significant association between children aged 24–35 and 36–59 months and reduced risk of diarrhea incidence. The study also verified that piped water off premises (AIRR = 1.57), unsafe disposal of child stool (AIRR = 1.47), eating unheated food (AIRR = 1.43) and poor handwashing practices at critical times contributed to the increased incidence of diarrheal diseases (AIRR = 1.95). Consuming water contaminated with E. coli significantly increased diarrhea during both dry and rainy seasons. Conversely, better hygienic practices were found to be protective against childhood diarrhea. The study found a high incidence rate, indicating a notably a high burden of diarrhea, which significantly impact child health. Improving on-premises water access, promoting mothers’ handwashing at critical times, encouraging household water treatment, and strengthening hygiene and food safety practices are essential to reduce diarrheal disease. These findings provide evidence to guide interventions aimed at reducing childhood diarrhea in Ethiopia and other developing countries. Not applicable.