Acute Diarrhea and Its Associated Factors among Under-Five Children in Kabul, Afghanistan: A Hospital-Based Cross-Sectional Study

Abstract

Background: Acute diarrhea remains one of the leading causes of morbidity and mortality among children under five years of age in low- and middle-income countries. This study aimed to determine the prevalence of acute diarrhea and to examine its associated individual, familial, socioeconomic, and environmental factors among children under five years attending Maywand Hospital in Kabul.

Methods: This descriptive-analytic cross-sectional study was conducted in the pediatric inpatient department of Maywand Hospital during 2024. Of the 247 children under five years who visited the department, 147 children meeting the WHO case definition of acute diarrhea were enrolled through consecutive sampling. Data were collected using a structured questionnaire via face-to-face interviews with mothers or primary caregivers and analyzed using SPSS version 26.

Results: Among the 247 children, 147 (59.5%) had acute diarrhea, with the highest frequency observed in one-year-old children (70 cases, corresponding to 55.1% within that age group). Univariable analysis showed that the use of unimproved toilet facilities was associated with a 1.77-fold increased risk of diarrhea (95% CI: 1.05 to 2.99). A distance greater than 15 meters between the latrine and the house was associated with a 3.67-fold increased risk (95% CI: 1.83 to 7.33) and was the strongest environmental factor in this study. The presence of flies around the latrine increased the risk 2.43-fold (95% CI: 1.30 to 4.54), and the presence of solid waste within the household compound increased it 1.88-fold (95% CI: 1.02 to 3.46).

Conclusion: Acute diarrhea accounts for a considerable proportion of pediatric visits at Maywand Hospital. Environmental factors—particularly toilet type, distance of the latrine from the house, and the presence of flies and solid waste—were the most important correlates of acute diarrhea. Strengthening water, sanitation, and hygiene (WASH) programs, maternal health education, and rotavirus vaccination is recommended to reduce the burden of this disease in Kabul.