Prevalence of diarrheal disease and its determinants among children under five in East Africa: systematic review and meta-analysis.

INTRODUCTION: Diarrhea is a public health challenge, the leading cause of malnutrition, morbidity, and mortality for children under five years globally. The disease is more common in low and middle-income countries such as Asia and Africa. While several studies were conducted on the prevalence of diarrheal disease among children under five, none of them showed the pooled prevalence of diarrheal disease. Therefore, this study aimed to determine the pooled prevalence and its determinants of diarrhea among children under five in East Africa. METHODS: We searched articles published between January 01/2020, to October 31/2024, on the prevalence of diarrheal disease among children under five years old using different databases such as PubMed, Scopus, Science Direct, and Google Scholar. We included studies that were published only in the English language and report the prevalence of diarrhea among children under five in East African countries. To get the total number of children under the age of five in our study, we summed the sample sizes from chosen studies.We checked the quality of each study using the Newcastle Ottawa Scale (NOS) quality assessment scale, and we performed the analysis by random effect model using statistical software STATA version 17 and R version 4.4.2. RESULT: A total of 162,388 children under five years were included in this review. About 93.33% of studies were conducted using cross-sectional study designs. The overall pooled prevalence of diarrhea among children under five in East Africa was 24.6% (95% CI: 22.7%, 26.6%). Improper waste disposal mechanism (OR = 1.67, 95% CI: 1.10, 2.53), large family size (OR = 1.38, 95% CI: 1.10, 1.72), two and above children under five years (OR = 1.6, 95% CI: 1.27, 2.03), unprotected source of water (OR=1.92, 95% CI: 1.39, 2.65), not vaccinated from rotavirus (OR = 2.06, 95% CI: 1.10, 3.85), unprotected toilet type (OR = 1.11, 95% CI: 1.01, 1.21), and households who spent more than thirty minutes to fetch water (OR = 1.35 95% CI: 1.05, 1.73) were risk factors responsible for the prevalence of diarrheal disease among children under five years. CONCLUSIONS: The pooled prevalence of diarrhea among children under five in East Africa is still at a high level. The finding of this study recommends intervention on family planning initiatives, improving sanitation practices, increasing access to healthcare, providing access to clean water, rotavirus vaccination, and well-established waste disposal mechanisms, which could be the critical issues to reduce the prevalence of diarrheal disease among children under five years.