Hygiene practice and diarrhea prevalence among underfive children in Myanmar: A cross- sectional study

Abstract Background: Over 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global underfive child deaths in 2019. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among children under five years of age in Myanmar. Method: This cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea. Result: This study found that 86 (7.13%) underfive children experienced diarrhea disease. This study identified that children who received limited hygiene services were 2.85 times (AOR=2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR=2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than children with basic hygiene services. Father’s handwashing less than four steps (AOR=2.20, 95% CI: 1.29 to 3.74; p value 0.01), need for more than 15 minutes to collect water (AOR=1.77, 95% CI: 1.06 to 2.97; p value 0.03), sharing toilet usage (AOR=2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR=2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses with bamboo or not having floors (AOR=2.31, 95% CI: 1.38 to 3.89; p value 0.01), three or more children families (AOR=1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk as primary food after 6 months of age (AOR=2.07, 95% CI: 1.09 to 3.93; p value 0.03) were other associated factors. Conclusions: Accessing basic hygiene services, getting water at home twenty-four seven, using one’s own toilet without sharing with others, promoting hygiene health literacy, improving house floor, family planning and eating varieties of food after age 6 months could be helpful for diarrhea prevention among children under five years old in Myanmar.