Abstract
Background: Diarrhoea is a significant risk factor for childhood mortality in developing nations, especially among children under five years old. In South Africa, it contributes to 19% of deaths in this age group. The mortality due to diarrhoeal diseases is worse in areas with poor environmental measures characterised by poor hygiene and sanitation. Studies on the risk factors for diarrhoea in South Africa have mainly occurred in clinical settings, i.e., among children diagnosed/attending a clinic/facility rather than at a population-level/community setting. This limits the relevance of such studies in guiding interventions to manage and prevent diarrhoea in community settings. Identifying risk factors associated with diarrhoea at the population level would help develop preventative and management strategies. This study intended to determine the population-level prevalence and examine the environmental, socio-economic, and demographic factors associated with diarrhoea among children under five in South Africa. Methods: The study was a cross-sectional quantitative study design using secondary data from the 2016 South Africa Demographic and Health Survey, a nationally representative dataset. Statistical software STATA 16.1 (State Corporation, College Station, TX, USA) was used to analyse the data, with descriptive statistics used to summarise the data as frequencies and percentages. Bivariate and multivariable logistic regression models were used to identify potential risk factors for diarrhoea and presented unadjusted and adjusted Odds Ratios, along with 95% confidence intervals and p-values to indicate statistical significance. Results: The study revealed a diarrhoea prevalence of 11.5%, lower than the average reported in Sub-Saharan Africa but consistent with broader regional trends. One-year-olds were at higher risk (aOR: 1.466, p=0.047). Environmental factors such as access to electricity (aOR: 2.610, p=0.033), and using paraffin (aOR: 2.984, p=0.041) for cooking were associated with diarrhoea. Conclusion: The study emphasises the various factors contributing to diarrhoea risk in children, such as age, access to electricity, and using paraffin for cooking. It also suggests further investigation into the lack of protective effects from breastfeeding and immunisation. Future research should investigate the reasons behind these associations and consider interventions for high-risk populations in vulnerable regions. Recommendations include improving sanitation, addressing provincial disparities, and enhancing programs to reduce diarrhoea prevalence.