Child diarrhea in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with diarrhea in children under five years

Diarrhea is a global public health problem that is the third leading cause of death in under five years, with an estimated 1.7 billion cases in 2023 and 1.8 million deaths from diarrhea diseases every year. To better understand child diarrhea in Cambodia, we examined descriptively temporal and geospatial trends of diarrhea and used multivariate logistic regression to analyze its association with individual and household characteristics and diarrhea among children aged 0-59 months using data from the Cambodia Demographic and Health Survey for 2005 to 2022. The prevalence of diarrhea among children aged 0–59 months decreased from 19.7% in 2005 to 6.2% in 2022. The highest prevalence of childhood diarrhea in Kampong Cham (30.1%), in Mondul Kiri/Ratanak Kiri (24.6%), Battambang/Pailin (20.9%), and Mondul Kiri/Ratanak Kiri (12.9%) for 2005, 2010, 2014 and 2022. After adjusting for other variables, factors independently associated with childhood diarrhea included mothers aged 25-34 years (adjusted odds ratio (AOR) = 0.68; 95% CI: 0.48–0.96), 35-49 years (AOR = 0.60; 95% CI: 0.42–0.87), completed higher education (AOR = 0.61; 95% CI: 0.41–0.91), and employed (AOR = 0.79; 95% CI: 0.72– 0.96). Children were less likely to have diarrhea if they were older than 36 months, richest household (AOR = 0.69; 95% CI: 0.55–0.86), coastal region (AOR = 0.53; 95% CI: 0.41–0.69), born to smoker mothers (AOR = 1.61; 95% CI: 1.25–2.08), had barrier access to healthcare services (AOR = 1.20; 95% CI: 1.07–1.35), or children aged 6–23 months. Diarrhea remains highly prevalent among children in Cambodia. Public health interventions and policies to alleviate diarrhea should be prioritized to address these factors across geographical. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The original CDHS protocol was approved by the National Ethical Committee for Health Research, Ministry of Health of Cambodia (Ref#: 043 for 2005, Ref#: 153 for 2010, Ref#: 056 for 2014, Ref #: 083 for 2022), and the Institutional Review Board (IRB) of ICF in Rockville, Maryland, USA. Moreover, for the protection of using the secondary data in this study, permission to analyze the data was granted through registering with the DHS program website and submitting an application outlining the intended use of the datasets (). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The CDHS data are publicly available from the website at (URL: ). * ACS : American Cancer Society AOR : adjusted odds ratio CDHS : Cambodia Demographic Health Survey EA : enumeration areas PPS : probability proportional to size