DEPARTMENT OF ADULT HEALTH NURSING

A RESEARCH PROPOSAL ON ASSESSMENT OF PREVALENCE AND

ASSOCIATED FACTORS OF DIARRHEAL DISEASES AMONG UNDER-
FIVE CHILDREN ATTENDING AT KALITY HEALTH CENTER, AKAKI
KALITY SUB CITY, ADDIS ABABA ETHIOPIA, 2023.

COLLEGE OF HEALTH SCIENCES

INVESTIGETOR:BY: MESERET ENDALBABAW
ADVISOR: MR. GETAHUN FETENSA(Msc, MPH, MBA Fellow, JBI fellow, Ass’t
professor)
SUMMARY
Background: Diarrheal diseases are important causes of mortality and morbidity globally
among children under 5 years of age. There are many infectious and none infectious causes of
diarrhea. Diarrhea is both uncomfortable and dangerous to the health because, it can indicate an
underlying infection. Although most deaths from diarrhea are preventable with simple,
inexpensive measures, one in nine deaths in children worldwide is due to diarrhea. This means
2,195 children are dying per day due to diarrhea, which is equivalent to losing 32 school buses
full of children each day or 801 thousand child deaths from diarrhea every year worldwide. Since
Ethiopia is a developing country diarrhea is a major health problem, especially in under-five
children.

Objective: To assess the Prevalence and associated factors of diarrheal diseases among under
fiveunder-five children who attends at kality health center, Akaki Kality Sub-City, Addis Ababa,
Ethiopia in 2023.

Methodology: An Institutional based cross-sectional study design will be conducted at kality

health center, Akaki Kality Sub-City, Addis Ababa, Ethiopia from April to June 2023. From
under-five children who attend a health care during the study period, 287 samples will be
selected by Systematic random sampling technique. A structured questionnaire will be used to
collect socio demographic data and clinical conditions and the data will be collected from
mother’s/care givers of selected under-five children using kobo tool box through self-
administered interview. The data will be cheeked for completeness and will be exported in to
SPSS version 25.1 where bi variable and multi variable analysis will be performed to assess the
associated Risk factors of diarrheal diseases. A P-value < 0.05 will be considered statistically

significant at 95% confidence intervals . Ffinally, the data will be presented through tables,
graphs and charts.

Work plan: The research will be conducted in between April to June 2023.

II
Acknowledgment
First of all, I would like to express my heart full gratitude to Rift Valley University collage of
health science, department of Adult health nursing who gave me the opportunity to undertake
this research proposal writing on assessment of prevalence of diarrheal diseases and associated
factors among under 5 children attending at kality health center, Akaki kality subcity, Addis
Ababa, Ethiopia, in 2023.
Secondly, I would like to express my thanks to my Advisor Mr. GETAHUN FETENSA(Msc,
MPH, MBA Fellow, JBI fellow, Ass’t professor) for his constructive comments and
suggestion.
My special thanks are also goes to those who support me in developing this research proposal.

III
TABLE OF CONTENTS
summary........................................................................................................................................II
LIST OF FIGURES......................................................................................................................V
ABREVATIONS AND ACRONYMS.......................................................................................VI
CHAPTER ONE INTRODUCTION.........................................................................................11
1.1 BACKGROUND.................................................................................................................11
1.2 Statement of the problem..................................................................................................12
1.3 Significance of the study....................................................................................................14
CHAPTER TWO: LITERATURE REVIEW...........................................................................15
2.1 Literature Review:.............................................................................................................15
2.2 FACTORS ASSOCIATED WITH DIARRHEAL DISEAES........................................17
2.2.2 SOCIO DMOGRAPHIC FACTORS.........................................................................17
2.2.2.2 Socio economic factor...............................................................................................17
2.3 Conceptual Framework.....................................................................................................19
CHAPTER THREE: OBJECTIVES.........................................................................................20
3.1 General Objective:.............................................................................................................20
3.2 Specific objective:...............................................................................................................20
CHAPTER FOUR: METHODS AND MATERIALS..............................................................21
4.1 Study Area and period.......................................................................................................21
4.2 Study design........................................................................................................................21
4.3 Source and study population.............................................................................................21
4.3.1 Source population........................................................................................................21
4.3.2 Study population..........................................................................................................21
4.3.3 Sampling units.............................................................................................................21
4.4 Eligibility criteria...............................................................................................................21
4.4.1 Inclusion criteria..........................................................................................................21
4.4.2 Exclusion criteria.........................................................................................................22
4.5 Sample size determination and sampling technique.......................................................22
4.5.1 Sample size...................................................................................................................22

IV
 4.5.2 Sampling procedure....................................................................................................22
4.6 Study variables...................................................................................................................23
4.6.1 Dependent variable......................................................................................................23
4.6.2 Independent variables.................................................................................................23
4.7 Operational definition........................................................................................................23
4.8 Data collection procedure.................................................................................................24
4.9 Data processing and analysis............................................................................................24
4.10 Ethical Considerations.....................................................................................................24
4.11 Dissemination plan..........................................................................................................25
CHAPTER FIVE :WORK PLAN..............................................................................................26
REFERENCES.............................................................................................................................27
ANNEXs........................................................................................................................................29
Annex I: Study information sheet and consent form English version.................................29
ANNEX II: QUESTIONAIRE ENGLISH VERSION..........................................................31

V
LIST OF FIGURES

Figure 1 Conceptual frame work on determinants of diarrheal diseases among under 5 children attending
at kality health center, Addis Ababa, Ethiopia [22]...................................................................................19

LIST OF TABLES

Table 1 WORK PLAN..............................................................................................................................26

VI
ABREVATIONS AND ACRONYMS
AIDS..........................................................Acquired immunodeficiency syndrome

E. coli……………………………………. Escherichia coli

EDHS ……………………………………Ethiopian demographic and health survey

KM ………………………………………Kilometer

ORS………………………………………Oral Rehydration Solution

SSA ………………………………………Sub Saharan Africa

UNICEF …………………………………. United Nation Children’s Emergency Fund

VIPL………………………………………Ventilated improved pit latrine

V. cholera………………………………..Vibrio cholera

WHO……………………………………..World health organization

KHC………………………………………Kality health center

VII
CHAPTER ONE INTRODUCTION

1.1 BACKGROUND

Diarrhea is defined as a passage of three or more loose or watery stools in a 24 hours period.
However, mothers may use a variety of terms to describe diarrhea depending upon whether
the stool is loose, watery, bloody or mucoid or there is vomiting. Diarrhea that begins acutely
and lasts less than 14 days is called acute diarrhea. If diarrhea begins acutely and lasts longer
duration, usually over 14 days, it is called persistent diarrhea [1].

There are three main forms of acute childhood diarrhea, all of which are potentially life-
threatening and require different treatment courses (acute watery diarrhea, bloody diarrhea,
and persistent diarrhea [2].

Although most deaths from diarrhea are preventable with simple, inexpensive measures, one
in nine deaths in children worldwide is due to diarrhea. This means 2,195 children are dying
per day due to diarrhea, which is equivalent to losing 32 school buses full of children each day
or 801 thousand child deaths from diarrhea every year worldwide [3].

Usually the indirect mode of transmission through vehicles like water and food is common.
Sometimes, direct transmission takes place as in the case of auto infection where poor
personal hygiene, especially failure to wash hands after defecation, is responsible [4].
Examples of behaviors that help enteric pathogens to spread are: preparing food with hands
that have been soiled during defection without washing; or allowing an infant to crawl, or a
child to play in an area where human or animal faces are present [4].

The mechanism of diarrhea development can be grouped into the following parts: Secretory
Diarrhea, Motility Diarrhea, Osmotic Diarrhea, and malabsorption Syndrome [5].

Acute diarrheal disease is a common problem in infants and children and its complications
dehydration and malnutrition are major causes of morbidity and mortality in developing

11
countries. Clinically it is useful to distinguish two syndromes produced by gastro intestinal
infection: watery diarrhea and bloody diarrhea. The leading cause of diarrhea in infants is the
rotavirus followed by enteric adenoviruses. Shigella is most frequently a pathogen in children
between 1 to 5 years with bloody diarrhea. Other bacterial pathogens include campylobacter,
salmonella and Escherichia Coli [5].

Exclusive breastfeeding, maternal educational status, family monthly income, source of

drinking water, hand washing practice of mothers/caregivers and washing of water storage
tanks had a significant association with under-five child mortality [6]
Moreover, Studies in Ethiopia also showed that low maternal education, poor sanitation,
contaminated water source, duration of breast feeding, failure to wash hands, absence of
rotavirus vaccination, failure to dispose of feces hygienically, age of child and adequate food
hygiene were significant predictors of diarrheal disease occurrence in children under-5 years
[7].

Although interventions, like rotavirus vaccinations, improving breastfeeding, diarrhea

prevention focused on safe water and improved hygiene and sanitation were carried out, the
problem remains one of the leading causes of preventable morbidity and mortality among
under-five children in Ethiopia [8].

Diarrheal disease occurrence is closely connected with individual and community hygienic
practice and thus hygiene education coupled with environmental and water sanitation is the
major preventive strategy. The objectives of health education should be to enhance proper
case finding and treatment both and in the home as well as at health institution level, and to
promote and strengthen the preventive practices related to diarrheal diseases. Adequate breast
feeding, Use of Plenty of Clean Water, proper hand Washing, Use of Latrines, and
immunization are some of the common preventive measures of diarrheal diseases [1].

12
1.2 Statement of the problem
Diarrhea remains the second leading cause of morbidity and mortality in children under 5
years old worldwide [5]. Each year, an estimated 2.5 billion cases of diarrhea occur among
children under five years of age, and estimates suggest that overall incidence has remained
relatively stable over the past two decades [5].

The incidence of diarrhea diseases varies greatly with the seasons and a child’s age. The
youngest children are most vulnerable: Incidence is highest in the first two years of life and
declines as a child grows older [8].

Mortality from diarrhea has declined over the past two decades from an estimated 5 million
deaths among children under five to 1.5 million deaths in 2004, which parallels downward
trends in overall under-five mortality during this period. Despite these declines, diarrhea
remains the second most common cause of death among children under five globally
following closely behind pneumonia, the leading killer of young children. Together,
pneumonia and diarrhea account for an estimated 40 percent of all child deaths around the
world each year. Nearly one in five child deaths is due to diarrhea, a loss of about 1.5 million
lives each year [10].

Africa and South Asia are home to more than 80 per cent of child deaths due to diarrhea. Just
15 countries account for almost three quarters of all deaths from diarrhea among children
under five years of age annually [8].

The majority of morbidity and mortality related to under-five diarrhea were in Africa and
South Asia. Diarrhea can last several days, and can leave the body without the water and salts
that are necessary for survival. Most people who die from diarrhea actually die from severe
dehydration and fluid loss. It also predisposes children to malnutrition which makes children
more susceptible to other infections [10].

According to WHO, 23% of all deaths among under-five children in south Asia were caused
by diarrheal diseases.

13
In Ethiopia diarrhea is the second cause of death among under-five children secondary to
pneumonia. Poor sanitation, lack of access to clean water supply and inadequate personal
hygiene are responsible for 90% of diarrheal disease occurrence, these can be easily improved
by health promotion and education [14].

Studies and reports on child morbidity and mortality in Ethiopia show that diarrhea is a major
public health problem. A case control study done in Gilgel Gibe field research center in 2005
shows that 30.1% of under-five mortality in the study area were caused by diarrhea disease
[15].
EDHS 2011 reported that 13% of the children had diarrhea in the two weeks preceding the
survey at the national level and 11.3% in Oromia region. According to the 2010 report of the
Ministry of Finance and Economic Development, 20% of the childhood death in the country
was due to diarrhea [15].
Childhood morbidity and mortality are results of interactions among many factors in
developing countries. The interactions of behavioral, socio-economic and environmental
factors influence child morbidity [13].
Identifying the causes & prevalence of diarrhea is very crucial for the effective
implementation of child health intervention programs for policy formulation and the general
assessment of resource requirements and intervention prioritization.

14
1.3 Significance of the study

The research will show the recent magnitude of diarrheal diseases and associated risk factors
among under-five children attending at kality health center, that serves as an important tool
for, health service providers, the planning and intervention activities towards the prevention,
control of the burden of diarrheal diseases from the general population at large.

It will also provide a clue for other researchers to give more attention on the effect of diarrheal
diseases and its association with different risk factors among under-five children.

15
CHAPTER TWO: LITERATURE REVIEW

2.1 Literature Review:

Diarrhea is defined as having loose or watery stools at least three times per day, or more
frequently than normal for an individual. Though most episodes of childhood diarrhea are
mild, acute cases can lead to significant fluid loss and dehydration, which may result in death
or other severe consequences if fluids are not replaced at the first sign of diarrhea [5].

Diarrheal disease is the second leading cause of death in children under five years old, and is
responsible for killing around 525 000 children every year. Diarrhea can last several days, and can
leave the body without the water and salts that are necessary for survival. In the past, for most people,
severe dehydration and fluid loss were the main causes of diarrhea deaths[WHO., 2017].

According to WHO, Globally, there are nearly 1.7 billion cases of childhood diarrheal disease
every year. And, Diarrhea is a leading cause of malnutrition in children under five years old.

Although the major causes of under-five mortality remain the same globally, the prevalence
differs from place to place. Their real importance varies across regions of the world. While,
in low-income countries, infectious diseases account for a large proportion of under-five
deaths in which diarrhea is responsible for 15% of the deaths [1].

A cross sectional study done in India rural community (in 2008) shows that the two weeks’
prevalence of diarrhea was 25.2% [10].

A cross sectional study done in Ghana urban area in 2005 indicate that 19.2 % of the children
covered in the study have had diarrhea in the preceding two weeks of the study [11].

Similar study done in Democratic Republic of Congo and Burkina Faso revealed that two-
week prevalence of diarrhea among under five children was 16% and 10.2% respectively [12].

A Community based study from east Go jam zone shows that the two weeks’ prevalence of
diarrhea was 6.5 % [13]. Another descriptive community based cross sectional study done in

16
Benishangul- Gumuz regional state [14] and west Gojjam zone [15] shows that the two
weeks’ prevalence of diarrhea was 22.1% and18% respectively.

According to A community based cross sectional study done in Nekemte town, the prevalence
of diarrhea among children under five years of age was (28.9%). Another institution based
cross sectional study from Debre birehan referral hospital reveals that under five diarrheal
morbidities over a period of two weeks’ period preceding the study was about 31.7% [17].

A community based cross sectional study from Kersa district, Eastern Ethiopia which was
done in 2011 reveals that under five prevalence of diarrhea was 22.5% [18]. According to a
cross sectional study done in Diredawa the overall prevalence of diarrhea among children
under-five was 62.6%.

Significant variation was observed in prevalence of diarrhea between less than one year (42%)
and greater than two year (24%) age groups of the study who had diarrhea. Children in the age
group under one were highly affected. The numbers of boys (56.3%) were higher than girls
(43.6%) who had diarrhea in nearly all age groups [19].

The study shows that children below five years of age are highly exposed with diarrhea
especially if insufficient health extension services, poor knowledge on causes and
transmission of diarrheal disease by caretakers or parents and poor waste disposal practice
taking the largest contribution. Lack of latrine facility at home was considered as major risk to
diarrhea in most area. Poverty, poor environmental sanitation and hygiene are associated with
the occurrence of diarrhea in children less than five years of age [19].

17
2.2 FACTORS ASSOCIATED WITH DIARRHEAL DISEAES

2.2.2 SOCIO DEMOGRAPHIC FACTORS

2.2.2.1 Age

The risk for diarrheal diseases increases dramatically as age decreases. Most diarrhea episodes
occur during the first two years of life. Incidence is highest in the age group 6-11 months,
when weaning often occurs. This pattern reflects the combined effects of declining levels of
antibodies acquired from the mother, lack of active immunity in the infant, introduction of
food that may be contaminated with fecal bacteria, and direct contact with Human or animal
feces when the infant starts to crawl [20].

2.2.2.2 Socio economic factor

Socioeconomic inequalities in health have been attributed to a variety of mechanisms that may
act as intermediate risk factors for diarrheal diseases. These include malnutrition, the severity
and duration is increased in under nourished children, especially those with severe
malnutrition. Low socioeconomic status may also influence the development of diarrheal
diseases as a result of inadequate maternal nutrition during and even prior to Pregnancy [21].

18
2.2.3 Behavioral Factors

A number of specific behavior help enteric pathogens to spread and thus increase the risk of
diarrhea [20]. Failing to breast-feed exclusively for the first 4-6 months of life. The risk of
developing severe diarrhea is many times greater in non-breast fed infants than in infants who
are exclusively breast -fed. The risk of death from diarrhea is substantially greater [22].

Using infant feeding bottles. They easily become contaminated with bacteria and are difficult
to clean. When milk is added to a contaminated bottle, it becomes a fertile ground for
bacterial growth poor weaning practice (abrupt and/or early weaning with dilute and dirty
formula) Storing cooked food at room temperature and using them without heating adequately
[22].

When food is cooked and then stored to be used later, it may be easily contaminated, for
example, by contact with contaminated surface, or container if not covered, or when a
contaminated hand comes in to contact with water being used for drinking or food preparation
in the kitchen, failing to wash hands after defecation, after handling feces or before handling
food [23].

Failing to dispose feces off (especially infant feces) hygienically; it is often believed that
infant feces is harmless, whereas it may actually contain large numbers of infectious viruses
or bacteria. Animal feces also can transmit enteric infections to humans [24].

Failure to get children immunized for measles diarrhea and dysentery are most frequent or
severe in children with measles or who have had measles in the previous four weeks . This
presumably results from immunological impairment caused by measles. Its association with
diarrhea accounted for one third or more of diarrhea related deaths in young children [8].

19
2.2.5 Environmental Factors

Poverty and poor living conditions, Availability of latrine Sources of water supply Water
disposal facilities House shared with domestic animals are some of those environmental
factors associated with diarrheal diseases [25].

2.3 Conceptual Framework

SOCIODEMOGRAPHIC FACTORS
Age of the child
Sex of the child
BEHAVIORAL FACTORS Socio economic factor
Water disposal facilities
Latrine utilization Educational status of parents
Nutritional status Occupational status of parents
Vaccination status Family size
Time in which breast milk
initiated
Feeding practice until 6
month
Solid waste disposal

PREVALENCE OF
DIARRHEAL DISEASES

ENVIROMENTAL FACTORS
Availability of latrine
Sources of water supply
Water disposal facilities
House shared with domestic animals
Economic status of families

Figure 1 Conceptual frame work on determinants of diarrheal diseases among under 5 children [20,
22].

20
CHAPTER THREE: OBJECTIVES

3.1 General Objective:

To assess the prevalence and associated risk factors of diarrheal diseases among under-five
children attending at kality health center, Akaki Kality Sub-City, Addis Ababa, Ethiopia in
2023.

3.2 Specific objective:

 To determine the prevalence of diarrheal diseases among under-five children

attending kality health center, Akaki Kality Sub-City, Addis Ababa, Ethiopia
in 2023.
 To identify the associated risk factors of diarrheal diseases among under-five
children attending kality health center, Akaki Kality Sub-City, Addis Ababa,
Ethiopia in 2023.

21
CHAPTER FOUR: METHODS AND MATERIALS

4.1 Study Area and period

The study will be conducted at kality health center on pediatric department, which is found in
Akaki Kality Sub-City, Addis Ababa Ethiopia which is a capital city of Ethiopia. Akaki Kality
Sub-City is one of the 10 sub cities of Addis Ababa. according to 2007 national census its
population was 181,270 with an area of 2,163 square kilometers. Akaki Kality Sub-city has 3
health centers and one general hospital. kality health center is selected for my study which is
one of the 3 health centers in Akaki Kality Sub-City, established in 1971 E.C with total
number of 195 employees, it is estimated to give service for about 35,475 people per
year[source; kality health center office of medical director ]. The study will be conducted in
between April and June 2023.

4.2 Study design

Institution-based cross-sectional study design will be conducted.

4.3 Source and study population

4.3.1 Source population

All under-five children with their mothers or caregiver who will attend health care at kality
health center.

4.3.2 Study population

All under-five children with their mothers or caregiver who will attend health care at kality
health center during the study period.

4.3.3 Sampling units

Under 5 individuals who will attend at kality health center during the study period.

22
4.4 Eligibility criteria

4.4.1 Inclusion criteria

All under 5 children whose parents/care givers are able to communicate well.

4.4.2 Exclusion criteria

Those under 5 children who are critically ill.

Those under 5 children who are diagnosed for diarrheal disease for the second time with in the
study period.

4.5 Sample size determination and sampling technique

4.5.1 Sample size

The sample size (n) required for this study is calculated using single population
proportion formula with the assumptions of 95% confidence interval, considering non
response rate of 10%, and prevalence 22.5%(p=0.225) taken from a study done in Kersa
Demographic Surveillance and Health research Center, Eastern Ethiopia [18].

( )
2
α
z p ( 1− p )
2
n= 2
d

 P = prevalence of diarrhea (22.5%), from the study conducted in Kersa

Demographic Surveillance and Health research Center, Eastern Ethiopia
α
 z 2 = 95% = 1.96 confidence inter
 n= sample size
 d=5% marginal error
n = (1.96)2 (0.22) (0.78) =261.2 ~ 261
(0.05)2
By adding 10% non response rate, a total of 287 sample size is determined.

4.5.2 Sampling procedure

This study will be conducted on under-five children patients who will attend health care at
kality health center. To obtain the study participants, systematic sampling technique will be

23
used. The number of study participants will be obtained from three-month patient visit.
Accordingly, from the data taken from medical registration in kality health center, in past
three months the total number of under 5 children who visited this health center was 900.
Taking average of 900 patients that divided to sample size (287), we will obtain the k th value
of 3.13 ≈ 3 and every participant will be selected in every 3 interval and the first participant
will be selected by lottery method.

4.6 Study variables

4.6.1 Dependent variable

 Diarrheal disease

4.6.2 Independent variables

 SOCIODEMOGRAPHIC FACTORS
 Age of the child
 Sex of the child
 Socio economic factor
 Water disposal facilities
 Educational status of parents
 Occupational status of parents
 Family size
 BEHAVIORAL FACTORS
 Latrine utilization
 Nutritional status
 Vaccination status
 Time in which breast milk initiated
 Feeding practice until 6 months
 Family size
 ENVIROMENTAL FACTORS
 Availability of latrine
 Sources of water supply
 Water disposal facilities
 House shared with domestic animals

24
4.7 Operational definition
Diarrhea: a child having a history of passing loose stool more than three times per day in
the two weeks before the data collection period [3].

Proper refuse disposal: if the refuses where burned, buried in pit otherwise considered as
improper [19].

Improved water source: Water from protected springs and/or wells, from pipe and from
distribution post unless considered as unimproved [21].

Improved latrine: latrine with ventilation; hand washing facilities and slaps [21].
Index child: refers to a child that was included in the study from a household to have
information on the demographic and health characteristics [15].

4.8 Data collection procedure

First, The questionnaire will be developed from reviewing different similar works of the
literature and it will be prepared in English Then, To make the data collection process much
easier the questionnaire form will be installed in Kobo Tool Box application software through
which the data will be collected.

4.9 Data processing and analysis

All collected data were checked for completeness and consistency. And, exported and
analyzed using SPSS version 25. Candidate variables with p value < 0.25 were selected for
multivariate logistic regression model analysis. Factors with P-value < 0.05 were considered
statistically significant at 95% confidence intervals. Adjusted odd ratio was considered to
measure strength of the association.

4.10 Ethical Considerations

Before the actual data collection official letter will be taken from the management of Rift
valley university college of health science department of adult health nursing. The objective of
the study will be explained to the study participants, privacy and confidentiality will be
ensured, furthermore, the study participants will be involved in the study based on their
willingness.

25
4.11 Dissemination plan
Result of the study will be submitted to Rift Valley University academic research, College of
Health Sciences, as partial fulfillment of my postgraduate Degree in adult health nursing. The
result will also be submitted to kality health center by considering security of research.

26
CHAPTER FIVE :WORK PLAN

Table 1 WORK PLAN

Ro Activities Responsib April April 10 April25 May 23 June 15 June 27 - July3 -

ll le bodies 05 - - - - July 3 July 8
no - April 16 may 22 June 19 June 29
April
9
1 Proposal PI
preparation

2 Final proposal PI
submission

3 Data collection PI AND

DC
4 Data entry and PI
analysis

5 Submission of PI
final thesis
paper

6 Thesis final PI
defense

7 Submission of PI
corrected paper
after defense

PI = principal investigator

RS = research supervisor

DC = data collector

27
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Nelsone Text Book of Pediatrics. 20th Edn. Amsterdam: Elsevier.Inc (2016). p. 1761–4.
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Under-Five Children in Nekemte town, western Ethiopia. 2008
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among Under-Five Year’s Children in Debrebirehan Referral Hospital, Debrebirehan
Town, North Shoa Zone, Amhara Region, Ethiopia. 2014.
24. Bezatu M., Yemane B., Alemayehu W. Prevalence of diarrhea and associated risk
factors among children under-five years of age in Eastern Ethiopia. Open Journal of
Preventive Medicine. 2013.
25. Senait E. prevalence and management of diarrhea among children visiting chorea
referral hospital dire dawa town 2014.

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 26. Saha D, et al, health care utilization and attitudes survey understanding diarrheal disease
in the rural Gambia. Am j of Trop Med.Htg.2013; Gupta A, et al. study of prevalence of
diarrhea in under-5 children and its association with wasting. Indian j Sci Res. 2014
27. Tefera belachew., e tal, diarrheal diseases for the Ethiopian Health Center Team, EPHTI,
2001.
28. Tarekegn M, Enquselassie F. A case control study on determinants of diarrheal morbidity among
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2012;26(2):78–85.

ANNEXS
Annex I: Study information sheet and consent form English version.

Title of the proposal: prevalence and associated factors of diarrheal diseases among under 5
children attending at kality health center, Akaki Kality Sub-city, Addis Ababa, Ethiopia, 2023.

Principal Investigators: Meseret Endalbabaw

Department: Adult Health nursing

Introduction: Dear, Parents/ caregivers, I am a data collector of ………a post graduating

adult nurse student conducting a research on “prevalence and associated factors of diarrheal

30
diseases among under 5 children attending at kality health center, Akaki Kality Sub-city,
Addis Ababa, Ethiopia, 2023”. In addition, this questionnaire is designed to collect data on the
above issue, and Participating in this study has no special benefit or identified risk.

Procedure and Participation: For this study to be successful I need your participation. And I
am asking you to participate voluntarily in this study If you are voluntary to participate in this
study, you are expected to give an information for the questions that you will be asked from
the questionnaire.

Confidentiality: All personal information you give will be kept confidential.

Expected benefits: Your participation in this study will primarily promote your child health
and may serve as baseline data for the rest society on ongoing research studies.

Risks: there is no any Potential risk for participating in this study except that you will spend a
maximum of 20 minutes for interview.

Incentives: there are no special incentives that you will be given for participating in this
research.

Person to Contact: If you have question or problem related with the present study, you can
contact me at any time using the following address.

Address of Investigator: Meseret Endalbabaw cell phone [+251913212052]

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 ANNEX II: QUESTIONAIRE ENGLISH VERSION

Does your child experiences a diarrhea with in the past two weeks?
1. yes
2. No

Part one: socio demographic conditions of the mother/caregiver and the index
child
No Questions Response
Q101 Relation of the respondent to the child 1. Mother
2. Care giver
Q102 Age of the mother/care giver 15-24
25-34
>35
Q103 Marital status of the mother/care giver 1. Married
2. Divorced
3. Single
4. Widowed
Q104 Ethnicity of parents/care giver 1. Oromo
2. Amhara
3. Tigray
4. Others
Q104 Religion of parents/care giver 1. Orthodox
2. Muslim
3. Protestant
4. Other
Q104 Educational status of the mother/care giver 1. Illiterate
2. Read and write
3. Primary school
4. Secondary school
5. Graduate from
college
Q105 Occupation of the mother/care giver 1. Government
employee
2. House wife
3. Merchant
4. Farmer
5. Others(specify)
Q106 Gross monthly income of the family? 1. <1500
2. 1500- 3000
3. >3000

32
Q107 Age of the index child 1. < 6 months
2. 7-12 months
3. 1-2 years
4. 2-5 years
Q108 Sex of the index child 1. Male
2. Female
Q109 Does your child breast feed? 1. Yes
2. No if no go to Q111
Q110 What is his/her current breastfeeding status? 1. Exclusive breast
feeding, if 1 skip
Q112
2. Partial breast feeding
Q111 For how long did you breastfed your child? 1. < 6 months
2. Up to 6 months
3. 6-12 months
4. 12-24 months
5. > 24 month
Q112 At what age did the child start supplementary feeding 1. At 6 month
(weaning food)? 2. At 7 month
3. At 8 month and
above
Q113 Do you know that breastfeeding adequately will 1. Yes
reduce infections in a child? 2. No
Q114 Vaccination status of the child 1. Partially vaccinated
2. Fully vaccinated
3. Not vaccinated
Q115 Did your child received a vaccination at his age of 2 1. Yes
and 3 months? 2. No

Part two: Environmental health conditions

No Questions Response
Q201 Housing conditions of the family 1. Private house
2. Rent house
3. Other …… specify
Q202 How many rooms are there in your house? 1. One
2. Two
3. three and above
Q203 How many people are living in your house? …………………..
Q204 Type of floor material of the living house 1. Mud
2. Cement

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 3. Other (specify………
Q205 Do animals live in the same house where 1. Yes
the member of the family live? 2. No
Q206 Do you have latrine? 1. Yes, if yes go to Q208
2. No
Q207 Where do you defecate? 1. Open field
2. Public toilet
3. Other(specify)
Q208 What type of latrine do you have? 1. Pit latrine
2. VIP
3. pour flash
Q209 How often do you clean the latrine? 1. Every time when used
2. Daily
3. 1-2 times a week
4. Not cleaned ever
Q210 Do you think that not keeping the 1. Yes
sanitation of the latrine can facilitate the 2. No
spreading of diarrheal diseases?
Q211 Is your child able to use the latrine on 1. Yes
their own? 2. No
Q212 Where does your child defecate? 1. Open field
2. Pit latrine
3. Public toilet
Q213 What care is giving to your child after 1. With water
going to toilet? 2. With paper
3. Other, specify……
Q214 Is there a hand washing material around 1. Yes
your latrine? 2. No
Q215 Source of water for drink 1. Pipe
2. Spring
3. River
Q216 Do you treat water to make safe to drink 1. Yes, if yes go to Q 217
2. No
Q217 What do you do to make water safe to 1. Boil
drink 2. Add chlorine
3. Other
Q218 How do you dispose refuse 1. Open field
2. Burning
3. Garbage

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Part three: Behavioral conditions

No Questions Response
Q301 Does the child take other food than breast milk? 1. Yes, if yes go to Q302
2. No
Q302 What food is your child getting? 1. Serifam
2. Cow’s milk
3. Powder milk
4. Bread and injera
Q303 Do you separately prepare food using separate 1. Yes
material for the child? 2. No
Q304 What do you use to feed the child? 1. Hand
2. Bottles
3. Cup and spoon
Q305 In which condition did you wash your hand? 1. Before food preparation
and eating
2. After eating
3. After visiting latrine
4. After cleaning of child
bottom
5. Other
(specify………………
Q306 What do you use to wash your hands? 1. Soap& water
2. Ash & water
3. Only water
4. Others (specify)………
Q307 Daily activities of index child Taking care from his family
At school
Playing with neighbor children
using mud

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