Environmental and Behavioral Determinants of Diarrheal Risk in Toddlers

INTRODUCTION: Diarrhea remains a major public health issue and is defined by the World Health Organization as passing loose or watery stools three or more times per day, or more often than usual for an individual. It is a leading cause of death in children under five, accounting for about 9% of global fatalities in this age group. This study aimed to assess the relationship between environmental and behavioral factors and diarrhea occurrence among toddlers in two primary health care centers.
METHODS: This cross-sectional study (March–June 2024) included 108 parents or caregivers of toddlers visiting two health centers. Data were obtained through interviews and analyzed using univariate statistics and the Chi-square test, with statistical significance set at p<0.05.
RESULTS: Environmental factors showed significant associations with diarrheal risk. The absence or poor condition of family toilet facilities (p=0.006, odds ratio [OR]=3.18; 95% confidence interval [CI]=1.43–6.92) and inadequate waste disposal systems (p=0.018, OR=3.64; 95%CI=1.66–7.98) were associated with higher diarrhea prevalence. In contrast, housing components (p=0.902, OR=0.88; 95% CI=0.41–1.90) were not significantly related. Among behavioral factors, handwashing with soap did not show a significant association (p=0.239, OR=0.59; 95% CI=0.27–1.26).
DISCUSSION AND CONCLUSION: Findings indicate that environmental conditions, particularly toilet facilities and waste disposal, play an important role in diarrhea risk among toddlers. Strengthening sanitation infrastructure in low-resource primary care settings may help reduce the burden of diarrheal diseases among children.

Keywords: Diarrhea, hand hygiene, home environment, preschool child, primary health care, sanitation