Contribution of meteorological and environmental attributes to childhood diarrhea in Sidama region, southern Ethiopia

In a rapidly changing world, environmental variability due to climate change has been one of the major challenges to children’s health. In Ethiopia, including the Sidama region, diarrhea is still the third leading cause of under-five morbidity. However, whether the combination of water, exposure to animal feces, sanitation and hygiene and meteorological variability in the Sidama region is the casuse for the insufficient improvement in diarrheal morbidity is uncertain. Hence, this study is aimed at investigating the meteorological and environmental attributes to the incidence of under-five diarrhea in the Sidama region, southern Ethiopia. A prospective time-series study was conducted over one year, from November 2022 to October 2023. The study enrolled children under five years old with diarrhea who visited selected healthcare facilities during this period. Socio-demographic and environmental determinant data related to the study children were collected at their residences using the KoboCollect application, while temperature (°C) and rainfall (mm) data were obtained from the Hawassa Meteorology Agency. Correlations between independent variables and diarrhea incidence were assessed using the Spearman correlation coefficient. The individual and interaction effects of exposure variables on diarrhea were analyzed using negative binomial regression. All analyses were performed using R version 4.1.3, and results were reported as incidence rate ratios (IRRs) with 95% confidence intervals (CI). The study comprised of 1852 children with diarrhea, with a 99.4% response rate from caretakers. Among the factors considered in the analysis, diarrhea was positively associated with monthly cumulative rainfall [IRR = 1.033, 95% CI (1.018, 1.041)], thatched-roof houses [IRR = 1.20, 95% CI (1.148, 1.246)], disposal of animal feces in inappropriate places [IRR = 1.18, 95% CI (1.10, 1.23)], improper latrine placement [IRR = 1.56, 95% CI (1.22, 1.88)], and water collection by children (aged < 15 years) [IRR = 1.20, 95% CI (1.15, 1.27)]. Additionally, the final model demonstrated that the interactions between monthly cumulative rainfall and improper latrine placement [IRR = 2.78, 95% CI (1.94, 3.02)]; disposal of animal feces in inappropriate places [IRR = 1.33, 95% CI (1.21, 1.35)]; unavailability of handwashing object [IRR = 2.15, 95% CI (1.89, 2.26)]; and monthly maximum temperature interactions with disposal of animal feces in inappropriate places [IRR = 2.20, 95% CI (1.98, 2.78)] and unavailability of handwashing object [IRR = 1.70, 95% CI (1.21, 1.89)] were strongly associated with diarrhea incidence. The findings indicated that the incidence of diarrhea among children under five rose when cumulative rainfall was combined with thatched-roofed houses, inappropriate latrine placement, improper animal fecal disposal, a lack of handwashing facilities, and water collected by children (less than 15 years old).