Prevalence of diarrheal disease and its determinants among children under five in East Africa: systematic review and meta-analysis

Abstract

Introduction

Diarrhea is a public health challenge, the leading cause of malnutrition, morbidity, and mortality for children under five years globally. The disease is more common in low and middle-income countries such as Asia and Africa. While several studies were conducted on the prevalence of diarrheal disease among children under five, none of them showed the pooled prevalence of diarrheal disease. Therefore, this study aimed to determine the pooled prevalence and its determinants of diarrhea among children under five in East Africa.

Methods

We searched articles published between January 01/2020, to October 31/2024, on the prevalence of diarrheal disease among children under five years old using different databases such as PubMed, Scopus, Science Direct, and Google Scholar. We included studies that were published only in the English language and report the prevalence of diarrhea among children under five in East African countries. To get the total number of children under the age of five in our study, we summed the sample sizes from chosen studies.We checked the quality of each study using the Newcastle Ottawa Scale (NOS) quality assessment scale, and we performed the analysis by random effect model using statistical software STATA version 17 and R version 4.4.2.

Result

A total of 162,388 children under five years were included in this review. About 93.33% of studies were conducted using cross-sectional study designs. The overall pooled prevalence of diarrhea among children under five in East Africa was 24.6% (95% CI: 22.7%, 26.6%). Improper waste disposal mechanism (OR = 1.67, 95% CI: 1.10, 2.53), large family size (OR = 1.38, 95% CI: 1.10, 1.72), two and above children under five years (OR = 1.6, 95% CI: 1.27, 2.03), unprotected source of water (OR=1.92, 95% CI: 1.39, 2.65), not vaccinated from rotavirus (OR = 2.06, 95% CI: 1.10, 3.85), unprotected toilet type (OR = 1.11, 95% CI: 1.01, 1.21), and households who spent more than thirty minutes to fetch water (OR = 1.35 95% CI: 1.05, 1.73) were risk factors responsible for the prevalence of diarrheal disease among children under five years.

Conclusions

The pooled prevalence of diarrhea among children under five in East Africa is still at a high level. The finding of this study recommends intervention on family planning initiatives, improving sanitation practices, increasing access to healthcare, providing access to clean water, rotavirus vaccination, and well-established waste disposal mechanisms, which could be the critical issues to reduce the prevalence of diarrheal disease among children under five years.

Supplementary information

The online version contains supplementary material available at 10.1186/s12879-025-11595-x.

Introduction

Diarrhea can be defined as the passage of three or more loose, watery stools in 24 h, and it can be caused by different pathogens such as viruses, protozoa, and bacteria [1, 2].

Globally, diarrhea is the primary cause of malnutrition, illness, and death for children under the age of five [2–4]. It was responsible for an estimated 533,768 children under five global deaths in 2017 [4]. Although the disease is preventable and treatable still it is the third leading cause of death in children 1–59 months of age, and approximately 1.7 billion cases of childhood diarrheal disease occur every year around the world [2].

Moreover, the diseases remain a major health challenge in children under five years old in low and middle-income countries [5], particularly the distribution of the diseases is common in Asia and the African continent as compared to the rest of the world [6]. For instance, recent study shows highest prevalence in countries like Burundi (22.84%), Uganda (22.10%), and Malawi (21.57%) in Africa [7], and Indonesia (18.21%), Cambodia (16.29%), and Myanmar (15.43%) in Asia [8]. According to [9], The prevalence of diarrhea among children under five in Sub-Saharan Africa is high.

In Sub-Saharan countries, the East African region is one of the most affected areas with diarrheal diseases among children under five. Different factors that were responsible for the prevalence of diarrhea were identified. Such factors include a source of drinking water [10–16], sex of child [13, 17, 18], age of child [10, 13, 14, 16–26], education level of mothers or caregivers [17, 20, 22, 27–30], hand washing practice [3, 14, 31–33], mother working status [13, 16, 17], rotavirus vaccination [12, 24, 34], number of children under five [10, 13, 14, 17], hygiene practices and related factors [24, 26, 27, 30, 34, 35], wealth index/income [19, 21, 22, 26], types of place of residence [13, 21, 22], latrine availability [11, 31, 36], sanitation practices [24, 30, 34, 35, 37]), family size [13, 14, 38], breast feeding practices [12, 13, 26, 32, 34], waste disposal method [12, 14, 19, 36, 39], the introduction of supplementary foods [3, 12, 23, 25], the availability of hand washing facilities [3, 15, 36, 39], toilet facilities shared with other households [18, 40], child’s vaccination status [13, 23, 25], birth order [13, 14, 18, 24].

Here there was a discrepancy among studies regarding determinants affecting diarrheal diseases. While some studies identifying certain determinants as significant, others found insignificant. Thus, identifying the major factors for diarrheal disease can help in achieving sustainability development goal which focused on good health and well-being to end all preventable deaths under five years of age by 2030.

Even though many researches have been conducted to determine the burden and to identify determinants of diarrheal diseases in each East African countries, but to the best of our knowledge still now there is no research conducted on pooled prevalence of diarrhea and its associated factors among under five children using systematic review and meta-analysis. Therefore, the objective of this study was to determine the pooled prevalence and its determinants of diarrhea among children under five years in East Africa.

Methods

Study protocol and registration

Our systematic review and meta-analysis were conducted based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42024608702.

Searching strategy

Studies conducted about the prevalence of diarrheal diseases among children under five that were published between January 01/2020 to October 31/2024 using electronic databases such as PubMed, Scopus, Science Direct, Google Scholar were searched to incorporate the most recent studies in East Africa. We have developed different searching strategies for each electronic database using keywords like diarrhea, prevalence, determinants, and East Africa with their corresponding Medical Subject Headings (MeSH) terms. The search terms were combined using Boolean operators (AND, OR, NOT). More information can be obtained from the supplementary file (supplementary Table 1).

Article selection and eligibility criteria

This study was conducted to determine the prevalence of diarrheal diseases and their determinants among children under five in East Africa. Thus, the following important points were taken into consideration for our systematic review and meta-analysis. The included studies were articles published only in English language, studies that report the prevalence of diarrhea disease among children under five years in East African countries, and articles published between January 01/2020, to October 31/2024. On the other side, articles conducted other than English, conducted using systematic review in each country, duplicate studies, and studies conducted before January 01/2020, and after October 31/2024, were excluded. We have also excluded articles that have similar study participants at a similar time and place by taking one of them. Due to this reason, from Ethiopia [13, 18, 41, 42] and from Rwanda [22] were excluded.

Outcome of the study

The primary outcome of the study was to determine the pooled prevalence of diarrhea disease among children under five years in East Africa, and the secondary outcome of the study was to identify the determinants associated with diarrhea disease among children under five years in East Africa.

Data extraction

Data such as authors’ name, year of publication, study location(country), study design, sampling technique, number children under five with diarrhea, prevalence of diarrhea for under five children, and factors associated with prevalence of diarrhea among under five children were extracted. The activities were performed by four authors (BGY, MKM, AKB, and FFA) independently using a Microsoft Excel spreadsheet for all included articles.

Quality appraisal

The Newcastle Ottawa Scale (NOS) quality assessment scale [43] was used for assessing the quality of each study, and possible criteria were set out, such as representativeness of the sample, sample size, non-response rate, and comparability of the study. Numerical scores were assigned with a maximum quality of 9 and a minimum of 1, where scores 8–9 were considered excellent quality, 6–7 very good quality, 4–5 good quality, and below 4 considered poor quality or unsatisfactory. Using this method, the quality of each study was assessed by three authors (STY, BGY, BAT), and numerical values below 4 were excluded from the study (supplementary Table 2).

Statistical analysis and synthesis

To estimate the overall pooled prevalence of diarrheal disease and to identify its determinants among children under five years in East Africa, the random-effect (DerSimonian) model was used. Graphical plot inspection and Cochran’s Q test (I²) were used to assess heterogeneity of results. The values of I² can be defined as 25%, 50%, and 75%, which were indications of low, medium, and high presence of heterogeneity, respectively [44]. Heterogeneity of results was also assessed using subgroup analysis techniques to identify potential sources of heterogeneity. Sensitivity analysis also performed for assessing the reliability and consistency of the findings.

We assessed the publication bias using graphical inspection by funnel plot and the formal Egger test [45]. As the asymmetry was detected using the funnel plot and Egger’s test; the trim-and-fill method was used to re-estimate the pooled effect size by removing the outlying effect sizes, and then added back into the funnel plot and mirrored on the opposite side to identify the best estimate of the unbiased pooled effect size [46]. The analysis was done using statistical software, STATA version 17 and R version 4.4.2.

Results

Searching results and included studies

Based on our searching strategies and quality assessment techniques, from a total of 1239 searched articles using PubMed, Scopus, Embase, Science Direct, Google Scholar, and other sources, finally 60 studies were included with a sample of 162,388 children under five years (Fig. 1).

Fig. 1.

PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases, registers, and other sources for diarrhea among children under five years in East Africa

From Ethiopia (47033), Rwanda (16977), Uganda (16522), Tanzania (11861), South Sudan (8338), Malawi (38556), Zimbabwe (386), Zambia (1216), Somalia (979), and Kenya (20520), children under five were included (Fig. 2).

Fig. 2.

Number of children under five years of age in the included study by country

Characteristics included in studies

Among 60 included studies published from January 2020 to October 2024 in East Africa, which majority, 33 (55%), studies from Ethiopia [3, 10–12, 14, 15, 17, 19, 31, 34, 39, 47–68], 3 (5%) from Rwanda [20, 21, 69], 10 (16.67%) from Uganda [16, 23–25, 38, 70–74], 4 (6.67%) from Tanzania [33, 37, 40, 75], 1 (1.67%) from South Sudan [26], 1 (1.67%) from Zimbabwe [36], 2 (3.33%) from Malawi [35, 76], 1(1.67%) from Zambia [77], 3 (5%) from Somalia [29, 30, 32], and 2 (3.33%) from Kenya [27, 28]. Regarding publication year, the maximum number of studies was published in 2020 [15], followed by 2022 [14], and the minimum number of studies was published in 2023 [8] (Fig. 3).

Fig. 3.

Number of studies conducted in each country by year of publication

About 56 (93.33%) of studies were conducted using a cross-sectional study design, and the remaining 4 (6.67%) used other study designs.

Pooled prevalence of diarrhea among children under five in East Africa

Results from the included studies showed, the overall pooled prevalence of diarrhea among children under five in East Africa was 24.6% (95% CI: 22.7%, 26.6%) with observed heterogeneity (I² = 99% (95% CI: 96.9%, 99.5%; p-value < 0.0001). The prevalence of diarrhea ranged from 7.6% (95% CI: 5.5%, 9.8%) to 62.4% (95% CI: 57.6%, 67.3%). The lowest prevalence was observed from Ethiopia, and the highest was from Uganda (Fig. 4) and (supplementary Table 3).

Fig. 4.

Forest plot for pooled prevalence of diarrhea among children under five years in East Africa

Source of heterogeneity and handling

Sub-group analysis

Subgroup analyses were performed by study location (country), year of publication, and study design (Table 1). In this sub-group, analysis of the highest pooled prevalence was observed in Tanzania 31% (95% CI: 24%, 37%), I² = 95.29%) and Uganda 31% (95% CI: 23%, 39%) I² = 97.81%) followed by the lowest pooled prevalence reported from Ethiopia 23% (95% CI: 19%, 26%) I² = 98.84%). The pooled prevalence for other (Rwanda, South Sudan, Zimbabwe, Malawi, Zambia, Somalia, and Kenya) countries jointly was 24% (95% CI: 20%, 27%) with relatively highest heterogeneity I² = 99.43%. (Supplementary Fig. 1)

Table 1.

Sub-group analysis by country, study design, and publication year

Subgroup Analysis		Number of studies	Pooled Prevalence (%) (95% CI)	P-value	I2(%)
Publication year	2020	15	23(20, 26)	< 0.0001	97.84
	2021	13	22(18, 27)	< 0.0001	98.85
	2022	14	27(22, 32)	< 0.0001	99.08
	2023	8	25(22, 28)	< 0.0001	85.18
	2024	10	26(20, 31)	< 0.0001	99.00
	Total	60	25(23, 27)	< 0.0001	98.97
Country	Ethiopia	33	23(19, 26)	< 0.0001	98.84
	Uganda	10	31(23, 39)	< 0.0001	97.81
	Tanzania	4	31(24, 37)	< 0.0001	95.29
	Other	13	24(20, 27)	< 0.0001	99.43
	Total	60	25(23, 27)	< 0.0001	98.97
Study Design	Cross Sectional	56	24(23, 26)	< 0.0001	98.66
	Other	4	27(17, 36)	< 0.0001	99.68
	Total	60	25(23, 27)	< 0.0001	98.97

The analysis also revealed that, studies conducted using other study designs techniques (longitudinal, prospective cohort study, and not used known methods) had reported high pooled prevalence 27% (95% CI: 17%, 36%) and along with high heterogeneity I² = 99.68% whereas, studies conducted using cross sectional study designs demonstrated a pooled prevalence of 24% (95% CI: 23%, 26%) with lower heterogeneity I² = 98.66%. (Supplementary Fig. 2)

Furthermore, about year of publication the highest pooled prevalence 27% (95% CI: 22%, 32%) was observed in the year 2022 along with highest heterogeneity I² = 99.08%, followed by the year 2024 with slightly difference with pooled prevalence 26% (95% CI: 20%, 31%) and heterogeneity I² = 99.00%. In contrast, the lowest pooled prevalence, 22% (95% CI: 18%, 27%), with the third highest heterogeneity I² = 98.85%, was reported in the year 2022. (Supplementary Fig. 3)

Sensitivity analysis

Sensitivity analysis was performed, and the result showed that there is no single study whose value lies outside the 95% CI of the overall estimate or pooled prevalence when each of the sixty studies was excluded at a time (Fig. 5).

Fig. 5.

Sensitivity analysis for prevalence of diarrhea among children under five years in East Africa

Publication bias

To identify the possible publication bias, both the funnel plot inspection method and Egger’s test were performed. Results from the funnel plot inspection showed an asymmetry of the plot (Fig. 6) and Egger’s test showed the presence of small study effects with a p-value of 0.002. Hence, in both methods there was an indication of the presence of publication bias. Thus, to adjust the effect of publication bias on the overall or pooled prevalence, we used the trim and fill plot (Fig. 7).

Fig. 6.

Funnel plot of prevalence with standard error.

Fig. 7.

Trim and fill plot

Pooled determinants of diarrhea among children under five

Among the candidate determinants, different studies indicated that place of residence, family size, number of children under five years, Immunization status of a child, mother or caregiver educational level, availability of television, availability of latrine, source of drink water, time spent to get water, rotavirus vaccination of a child, mother or caregiver hand washing practice, sex of a child, Children faces disposal method, vitamin A supplementation, mother working status, toilet type, waste disposal mechanisms and mother diarrhea status were significantly associated determinants of diarrhea disease among under five children. But the pooled estimate revealed that only family size, number of children under five years, source of drinking water, time spent to get water, rotavirus vaccination of a child, toilet type and waste disposal mechanisms were significant determinants of diarrhea among children under five years (Table 2).

Table 2.

Summary of pooled odds ratio for factors associated with children under five years

Risk Factors	Category	Number of studies	Pooled Odds Ratio(95% CI)	P-value	I2 (%)
Place of residence	Rural	9	1.19(1.00, 1.41)	0.054	91.2
	Urban(reference)
Family size	> 4	4	1.38(1.10, 1.72)	0.005	60
	<=4 (reference)
Number of children under five years	Two and above	4	1.6(1.27, 2.03)	< 0.0001	56.3
	One (reference)
Immunization status of a child	Vaccinated	2	0.58(0.30, 1.11)	0.099	92.5
	Not (reference)
Mother or caregiver education level	No education	8	1.32(0.82, 2.13)	0.248	89.2
	Primary		1.17(0.87, 1.57)	0.301	78.1
	Secondary and above (reference)
Availability of television	No	3	1.10(0.99, 1.22)	0.067	57.1
	Yes (reference)
Availability of latrine	No	13	0.67(0.45, 1.01)	0.058	92.8
	Yes (reference)
Source of water	Not protected	20	1.92(1.39, 2.65)	< 0.0001	96.5
	protected (reference)
Time spent to fetch/get water	More than 30 min	5	1.35(1.05, 1.73)	0.019	66
	Less than 30 min (reference)
Rotavirus Vaccination	No	9	2.06(1.10, 3.85)	0.024	96.7
	Yes (reference)
Mother/care hand washing practice	No	8	2.05(0.89, 4.74)	0.094	95.8
	Yes (reference)
Child sex	Female	16	0.93(0.85, 1.01)	0.101	85.5
	Male (reference)
Children’s faeces disposal method	Safe	3	0.76(0.42, 1.37)	0.362	98.2
	unsafe (reference)
Vitamin A supplementation	Yes	3	0.97(0.63, 1.48)	0.875	98.3
	No (reference)
Mother working status	Not working	5	1.02(0.80, 1.27)	0.869	97.2
	Working (reference)
Toilet type	Not improved	2	1.11(1.01, 1.21)	0.031	68.9
	improved (reference)
Waste disposal method	Improper	4	1.67(1.10, 2.53)	0.015	90.2
	proper (reference)
Mother diarrhea status	Absence	5	0.63(0.17, 2.37)	0.489	95.8
	Presence (reference)

Twenty studies assessed the association between the source of drinking water and diarrhea diseases. The pooled odds ratio indicated that households that used drinking water from an unprotected source were 1.92 times more likely to develop childhood diarrhea compared to the protected source (OR=1.92, 95% CI: 1.39, 2.65). (Supplementary Figure 4 (a))

Additionally, the pooled estimate from nine studies showed that the occurrence of diarrheal diseases was significantly associated with rotavirus vaccination status. Children who were not vaccinated from rotavirus 2.06 times had a higher risk of developing diarrhea disease as compared to their counterparts (OR = 2.06, 95% CI: 1.10, 3.85). (Supplementary Figure 4 (b))

Moreover, waste disposal mechanisms also have an association with children's diarrhea. According to the results of the pooled odds ratio from four studies (12, 19, 61, 64), households whose waste disposal mechanism was improper were 1.67 times more likely to have diarrhea diseases than households whose waste disposal mechanism was proper (OR = 1.67, 95% CI: 1.10, 2.53). (Supplementary Figure 4 (c))

The pooled odds ratio for family size, more than four family members in the household, from four studies (19, 31, 39, 60) was 1.38(95% CI: 1.10, 1.72). This result revealed that a number of families in the household with more than four have a likelihood of developing diarrhea 1.38 times that of families less or equal to four. (Supplementary Figure 5(a))

Toilet type was another important determinant associated with diarrheal disease. As reported by two studies (1, 2) , households that used unimproved toilet type were 1.11 times have a higher risk of developing childhood diarrheal diseases as compared to households who have improved toilet type (OR = 1.11, 95% CI: 1.01, 1.21). (Supplementary Figure 5(b))

In addition, the pooled odds ratio for household with two or more children under five years from four studies [19, 31, 58, 63] was 1.6(95% CI: 1.27, 2.03). This showed that the number of children under five years in a household where they are two or more, were 1.6 times more likely to develop childhood diarrhea than those who are less in number (that is, One) in a household (supplementary Fig. 5(c)).

The pooled odds ratio from five studies [10, 15, 19, 58, 61] also revealed the association between the times spent getting water and diarrhea disease. Households that spent more than thirty minutes to get or fetch water 1.35 times had the likelihood of diarrhea for under five children than households that spent thirty or less minutes (OR = 1.35, 95% CI: 1.05, 1.73). (Supplementary Fig. 5(d))

Discussion

This systematic review and meta-analysis were a five-year summary from 2020 to 2024 about the pooled prevalence and its associated determinants of diarrhea among children under five years in East Africa. The analysis included a total of sixty studies, with a majority, 55%, of studies conducted in Ethiopia.

A result showed that from a total of 162,388 study participants (children under five years), the pooled prevalence in East Africa was 24.6% (95% CI: 22.7%, 26.6%). The finding was in line with a study conducted in Afghanistan [78], in India [79]. However, this finding was larger than a study conducted in low and middle-income countries [5], in Ethiopia [80], in Sub-Saharan Africa [9]. However, the findings of this study were less than as compared to a study conducted in Yemen [81]. The possible reason might be due to differences in knowledge, attitude, and practices regarding diarrheal diseases [6].

The findings of this study showed that number of families in the household more than four have a likelihood of developing diarrhea 1.38 times than number of families less or four. Similar findings were reported in reference [82] and in Pakistan [83], demonstrating a similar pattern in the data. Possible factors include a household with many family members facing economic and environmental issues. Due to economical constraint household with large number of families may have less healthcare access. In a large family there is overcrowding which leads to the chance of exposure from diarrheal disease and the spread of different pathogens such as virus and bacteria will increase.

The pooled odds ratio for two or more children under five years in the household from four studies done in Ethiopia found that the number of children under five years was 1.6 times more likely to develop childhood diarrhea than number of children one in the household. The findings of this study are further supported by another study conducted in Ethiopia [84] and also supported by a global systematic review [1]. The reason may be due to large number of under five children in the household who may share playing materials such as toys, which may facilitate the spread of infectious disease-like diarrhea. Another possible reason might be families with many children in the household; may face economic challenge to afford adequate healthcare, may face challenge to provide adequate nutrition for all household members. Additionally with fewer under five children, mothers/caregivers can provide more adequate and timely care than with a large number.

This study showed that, there was association between source of drinking water and diarrhea diseases among children under five years. The result indicated that households using drinking water from an unprotected source were 1.92 times more likely to develop childhood diarrhea compared to those using a protected source. Our study aligns with findings from other studies from a global systematic review [1], from Ethiopian [84–86] and from Bangladesh [87], showing an association between the source of drinking water and diarrhea in children under five. The possible explanation could be unprotected water sources might be the leading risk factor for waterborne and related diseases. Another possible explanation might be that unprotected water sources may increase the likelihood of infection from bacteria and viruses which are responsible for vulnerable groups like children under five years [81].

This study noted the time to get water as an important determinant for diarrheal diseases among children under five years. Households that spent more time getting or fetching water have a higher risk of developing diarrhea for children under five than households that spent less time. The conclusion was further reinforced by the previously reported data from Ethiopia [88], which offered more evidence of the link between water availability and the prevalence of diarrhea in young children, emphasizing the necessity of improving water sources for better health outcomes. Moreover, other factor contributing to diarrheal disease at various homes could be inadequate sanitation and hygiene standards at home.

Additionally, there was a significant association between rotavirus vaccination and diarrheal disease among children under five years. Children not vaccinated against rotavirus had a 2.06 times greater chance of acquiring diarrhea than children who had been immunized. This finding was consistent with other studies conducted in Ethiopia and Rwanda [88, 89]. The possible explanations could be that vaccinating children under five years with rotavirus vaccination may reduce the incidence of diarrheal disease. On the contrary, unmanaged access to healthcare by infected individuals, misinformation about rotavirus vaccination, and cultural beliefs may increase the presence of diarrheal disease among children under five years. This might be children who lack adequate access to healthcare are more likely to contract diarrheal illnesses since waiting for treatment may increase the rate of affection via person to person transmission.

On the other hand, our study identified toilet type as one of the determinants for diarrheal disease among children under five years and showed a strong association with the disease. Households that used an unimproved toilet type were more likely to have a higher risk of developing childhood diarrheal diseases as compared to households who have an improved toilet type. The finding is supported by the WHO report [2] and the study conducted in Pakistan [90], which documented that areas with better toilet facilities decreases in diarrheal illness prevalence, underscoring the vital significance of sanitation in public health initiatives.

This study also discovered that inappropriate waste disposal mechanisms were a significant risk factor for diarrheal illness among children under the age of five. There was a clear link between waste disposal mechanisms and diarrhea in children under the age of five. According to our findings, households with an improper waste disposal system were more likely to develop diarrhea than households with an appropriate waste disposal method. This finding was further supported by other studies done in Ethiopia [86, 91, 92], which found a clear correlation between good waste management techniques and a decreased prevalence of diarrheal disorders, emphasizing the need of better sanitation in communities.

This systematic review and meta-analysis had some limitations. One of the limitations for this study was the inclusion of only published studies, in some occasions studies with negative results may not be published, this may affect the overall conclusion for analysis. Additionally, the review was limited to only studies published in English language, introducing the possibility of language bias. Furthermore, the existing researches were distributed geographically skewed, with majority of researches conducted in Ethiopia. This makes it difficult to generalize the prevalence and determinants of diarrheal disease across East Africa.

Conclusion and recommendation

This systematic review and meta-analysis showed that nearly one quarter of children under five years of age in East Africa are affected by diarrhea, with a pooled prevalence of 24.6%. The study identified several risk factors including large family size in the household, large number of children under the age of five, unprotected source of drinking water, longer wait times to fetch water, lack of rotavirus vaccination, unprotected toilet type, and improper waste disposal mechanisms were notably linked to contributing to the high prevalence of diarrhea among children under the age of five in East Africa.

The finding of this study recommends intervention on family planning initiatives, improving sanitation practices, increase access to healthcare, providing access to clean water, rotavirus vaccination, and well-established waste disposal mechanisms are critical issues to reduce the prevalence of diarrheal disease among children under five years.

Authors’ contributions

The contribution of each author is as follows: Conceptualization of the study were developed by BGY, MKM and BAT; searching articles were conducted by BGY, AKN, and BAT; data extraction were performed by BGY, MKM, AKB and FFA; quality of each study were assessed by STY, BGY, BAT; analysis, interpretation and discussion of results were conducted by BGY, BAT, MKM; and all authors participated, read and approved the final manuscript.

Funding

No funding is available.

Data availability

All relevant data are within the manuscript and its supporting information files.

Declarations

Ethics approval and consent to participate

As the study was used existing public recorded primary studies; hence ethical approval was not necessary for this study and there are no names of individual or household address in the data file.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.