Prevalence and risk factors of diarrhea among young children in Kenya’s drylands: A longitudinal study

Diarrhea is the third leading cause of malnutrition and mortality among children under five globally. Environmental and socioeconomic conditions in the drylands of sub-Saharan Africa may increase the risk of diarrhea, yet few studies have examined the factors in these settings. We therefore aimed to estimate the prevalence of diarrhea and identify potential risk factors among young children in Kenya drylands. Data are from a longitudinal population-based study conducted in Turkana County, Kenya. Surveys were implemented across six waves (May 2021 to September 2023) among 1211 households with children under 36 months at baseline. Caregivers reported on household conditions and episodes of diarrhea in the prior two weeks. Prevalence trends were examined by survey zone, livelihood zone, and child age and sex. Multivariable logistic regressions with generalized estimating equations were used to access distal, intermediate, proximal, and immediate risk factors and reported adjusted odds ratio (AOR) together with the associated 95% confidence interval (CI). Diarrhea prevalence declined significantly over time, from 32.1% at baseline to 8.7% at end of the study. Factors associated with higher odds of diarrhea included caregiver alcohol consumption [AOR = 1.28, 95% CI: 1.02-1.60], child malnutrition (wasting: AOR = 1.20, 95% CI: 1.04-1.39; stunting: AOR = 1.40 95% CI: 1.19-1.65; underweight: AOR = 1.29, 95% CI: 1.11-1.49), household shocks (biological: AOR = 1.37, 95% CI: 1.20-1.57; climatic: AOR = 1.18, 95% CI: 0.93-1.50; conflict: AOR = 1.60, 95% CI: 1.40-1.83), and moderate (AOR = 1.25, 95% CI: 1.04-1.50) or high-water insecurity (AOR = 1.46, 95% CI: 1.19-1.81) relative to no-to-marginal household water insecurity. Protective factors included greater child age (AOR = 0.97, 95% CI: 0.96-0.98), receipt of vitamin A supplementation (AOR = 0.77, 95% CI: 0.66-0.89), deworming (AOR = 0.88, 95% CI: 0.75-1.02), and caregiver handwashing after toilet use (AOR = 0.83, 95% CI: 0.70-0.98). These findings highlight the multifactorial drivers of childhood diarrhea in drylands and underscore the need for integrated interventions that improve water security, strengthen nutrition, support hygiene practices, and enhance resilience to household shocks.