Socio-Demographic and Household Environmental Conditions Associated With Prevalence of Diarrheal Disease in Burao, Somaliland

Abstract

Background: Diarrheal diseases remain a significant public health concern in urban, resource-limited settings, including Burao City, Somaliland, where socio-demographic factors and household environmental conditions contribute to disease prevalence. This study aimed to assess household sanitation conditions, environmental exposure pathways, and associated risk factors for diarrheal diseases in this urban context. Methods: A community-based cross-sectional study was conducted from June to August 2025 in Burao City, Somaliland, involving 422 households selected through multistage sampling. Data were collected using structured questionnaires and direct environmental observations to evaluate sanitation infrastructure, hygiene facilities, waste management, and environmental contamination. The occurrence of household diarrheal disease within the previous two weeks was recorded. Bivariate and multivariate logistic regression analyses were used to identify factors independently associated with diarrheal disease. Results: The two-week household diarrheal prevalence was 7.1% (95% CI, 5.0-10.0%). Most households used municipal tap water (95.7%) and had private flush toilets (89.6%), with high availability of handwashing facilities (97.2%). The absence of soap at handwashing stations was the strongest independent predictor of diarrheal disease (adjusted odds ratio [aOR] = 8.51; 95% CI: 1.93-37.52; p < 0.005). Visible garbage near households (aOR = 4.56; 95% CI: 2.12-9.83; p < 0.001) and the presence of domestic animals in living areas (aOR = 2.47; 95% CI: 1.16-5.28; p = 0.019) were also significantly associated with increased diarrheal risk. Additionally, households with three or more children under five years (aOR = 5.05; 95% CI: 1.06-24.17; p = 0.043) and respondents lacking formal education (aOR = 5.70; 95% CI: 1.80-18.02; p = 0.003) had higher odds of diarrhea. Conclusion: Diarrheal disease in Burao City is strongly associated with modifiable household and environmental factors, particularly the absence of soap at handwashing facilities and environmental contamination. Integrated interventions focusing on sustained hygiene resource availability, improved waste management, safer human-animal interactions, and targeted health education for vulnerable populations are critical for reducing diarrheal morbidity in this urban, resource-constrained context.