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Many of the simple and low-cost child diarrhea morbidities interventions, such as adequate home care, access to health care services, and improved sanitation and hygiene practices, are far beyond the reach of many households in developing countries, and Namibia is not an exception to this. In this study, a quantitative cross-sectional study design using a multivariable log-binomial model was used to examine the effect of household demographic characteristics on diarrhea morbidity in children aged zero to 48 months using data collected from the 2013 Namibia Demographic and Health Survey. Household demographic characteristics such as household’s wealth index and main language spoken at home had lower risks on child diarrhea morbidity, while characteristics such as age of household head, toilet facilities shared with other households, current age of child, residency of the child, and child vaccination status had higher risks. The Namibian government, together with nongovernmental organizations, should make necessary vaccines interventions compulsory to prevent diarrheal diseases during the first few years of the child’s life and continuously enhance initiatives that invest in good sanitation and hygiene infrastructure within Rukwangali- and Lozi-speaking communities in the country.
The data used in this study were obtained from the 2013 Namibia Demographic and Health Survey (NDHS). The Demographic and Health Survey (DHS), funded by the U.S. Agency for International Development, is part of the worldwide measure DHS programs designed to collect information on fertility, family planning, infant and child mortality, maternal and child health, nutrition, domestic violence, and knowledge and prevalence of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other noncommunicable diseases, which allows monitoring progress through time with respect to these issues and provides an international database that can be used by researchers investigating topics related to population, health, and nutrition.9 The 2013 NDHS is the fourth and latest comprehensive, national-level population and health survey conducted in Namibia in collaboration with the Ministry of Health and Social Services as part of the global DHS program, with the study initiated in April 2012 and the data collection aspect carried out from May to September 2013.9 The sampling design used in the 2013 NDHS was designed to provide estimates of most key variables for all of the then-13 administrative regions in Namibia.9 Currently, Namibia has 14 administrative and official regions, after the Kavango region was split into Kavango East and Kavango West. More detailed information about the sampling methods and the entire survey can be found in the 2013–2014 NDHS report, freely available online on the DHS website. Furthermore, the 2013 NDHS data were obtained after the author of this study completed the mandatory user’s agreement of the DHS program online, via the DHS website. No separate permission was required for the DHS data usage and resulting study publications. The inclusion criteria for this study were all children aged 0 to 48 months whose mothers participated and provided information for them in the 2013 NDHS. Children with incomplete, non-response, or missing information were excluded from this study. The household demographic characteristics considered in this study were the age of household head, toilet facilities shared with other households, household’s wealth index, current age of child, residency of the child, child vaccination status, and main language spoken at home. The individual children considered in this study were identified from the NDHS as per the inclusion criteria for this study. The responses to question such as “Has (NAME) had diarrhea in the last two weeks?” as captured in the NDHS data were used to determine the children’s diarrhea morbidity status in this study. Similarly, the responses to the “Did you ever have a vaccination card for (NAME)?”, “Do you have a card where (NAME)’s vaccinations are written down?”, “Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?”, and “Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?” questions as captured in the NDHS data were used to determine the children’s vaccination status in this study. More detailed information about these demographic characteristics and the remaining characteristics considered in this study can be found in the 2013–2014 NDHS report, freely available online on the DHS website. Pearson’s chi-square test was performed to examine the association between the household demographic characteristics and diarrhea morbidity among children aged 0 to 48 months. Moreover, the effect of the household demographic characteristics on child diarrhea morbidity was determined using a multivariable log-binomial model. This model uses a log-link function to connect a set of predictor variables X on a single binary response y and offers the description of the relationship between X and y in terms of relative risks.10 Let p be the probability of an event in the exposed group and 1−p the probability of an event not in the exposed group. Relative risk can be estimated as In this study, X was the household demographic characteristics (age of household head, toilet facilities shared with other households, household’s wealth index, current age of child, residency of the child, child vaccination status, and main language spoken at home), while y was the children’s diarrhea morbidity status. Significant characteristics from the chi-square tests (P-value <.05) were used in the fitted multivariable log-binomial model. The statistical analyses were performed using the R programming language (version 4.2.1).
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