A mixed effect hierarchical analysis to quantify variation on childhood diarrhea prevalence in Mauritania: evidence from the Mauritania demographic and health survey 2019–2021

Abstract

BACKGROUND: Diarrhea remains a major global health concern, particularly among children under five. This study aims to assess the prevalence and determinants of diarrhea in children under five in Mauritania using nationally representative data. METHODS: A secondary analysis of the Mauritania Demographic and Health Survey (2019-2021) was conducted using multilevel logistic regression to identify individual- and community-level determinants of diarrhea among children under five. The study included a weighted sample of 11,007 women aged 15-49 years for childhood diarrhea prevalence. RESULT: The prevalence of childhood diarrhea was 13.8% (95% CI: 13.1-14.5). Higher odds of diarrhea were observed among children of parents with no education (AOR = 1.28; 95% CI: 1.07-1.52) and primary education (AOR = 1.24; 95% CI: 1.03-1.51), those living in rural areas (AOR = 1.94; 95% CI: 1.77-2.14), children of working mothers (AOR = 1.25; 95% CI: 1.08-1.44), and children born small (AOR = 1.56; 95% CI: 1.02-2.38) or smaller than average (AOR = 2.06; 95% CI: 1.34-3.18). Lower odds were found among children aged 2-3 years (AOR = 0.56; 95% CI: 0.47-0.68) and 4-5 years (AOR = 0.37; 95% CI: 0.29-0.47), vaccinated children (AOR = 0.51; 95% CI: 0.33-0.71), and those from households with toilet facilities (AOR = 0.29; 95% CI: 0.08-0.54). Regional disparities were noted, with higher risk in Gorgol (AOR = 1.52; 95% CI: 1.14-2.02) and Tagant (AOR = 1.46; 95% CI: 1.06-2.01) compared with Hodh Echargui. CONCLUSION: This study identified several individual and community-level factors associated with childhood diarrhea in Mauritania. Interventions should prioritize improving sanitation access, parental education, maternal support, and vaccination coverage, particularly in high-risk rural regions. Strengthening integrated child health programs targeting these determinants will be essential to reducing the burden of diarrhea among children under five.