Correlates of diarrhea and stunting among under-five children in Ruvuma, Tanzania; a hospital-based cross-sectional study

Undernutrition affects 20% of children under five in the developing world. Stunting is a form of undernutrition when children have low height for their age. Global prevalence of stunting in 2019 was 21.4%, while current Tanzania national average is 34%. Ruvuma region has one of highest prevalence of stunting (44%) in Tanzania, which prompted this cross-sectional study on correlates responsible for this high prevalence. The study included randomly sampled children below 5 years of age who attended outpatient clinics at hospitals from Ruvuma between April - May 2019. The mean and median ages of children were 18 and 13 respectively. Among children, 46% were females and 45.6% were stunted. More male children (52%) were stunted than females. Through bivariate analysis, stunting was associated with gender (chi(2) = 6.6759, df = 1, p = 0.009772), handwashing before food (chi(2) = 5.1213, df = 1, p = 0.02363), location of hospital (chi(2) = 3.851, df = 1, p = 0.04972) and use of Municipal garbage collection system (chi(2) = 3.6814, df = 1, p = 0.05502). Moreover, diarrhea was associated with toilet sharing (chi(2) = 5.4703, df = 1, p = 0.002), use of household's toilet (chi(2) = 4.0224, df = 1, p = 0.004) and rinsing child feces into toilet (chi(2) = 3.6814, df = 1, p < 0.01). Multivariate logistic regression analyses showed that stunting risk increased with male gender (OR (95%CI) = 1.7945 (1.1944 - 2.712), age (OR (95%CI) = 1.3122 (1.1484 - 1.507), and decreased with handwashing before meal (OR (95%CI) = 0.5403 (0.3042 - 0.940). Finally, diarrhea risk increased with toilet sharing (OR (95%CI) = 2.154 (1.153 - 3.953) and decreased with child's use of toilet (OR (95%CI) = 0.510 (0.259 - 0.945). Our study revealed important correlates that determined observed high prevalence of stunting in Ruvuma. These correlates can be modified through health interventions to reduce this high prevalence. (C) 2020 The Author(s). Published by Elsevier B.V. on behalf of African Institute of Mathematical Sciences / Next Einstein Initiative.