<p>PRISMA [10] flow diagram of study selection.</p>

Background

Childhood diarrhea remains a leading cause of morbidity and mortality in low- and middle-income countries. Educational interventions targeting caregivers may promote preventive behaviors, but the overall evidence base has not yet been comprehensively synthesized. This systematic review evaluates the effectiveness and types of community-based educational interventions in caregivers of children under five years of age to prevent diarrhea.

Methods and findings

We systematically searched MEDLINE/PubMed, EMBASE, Cochrane Library and LILACS with relevant keywords and MeSH terms from inception to December 2025. Of 1,917 records screened, 15 controlled trials (1985–2018) from Asia, Africa, and Latin America met inclusion criteria. Interventions included home visits, audiovisual materials, group education sessions, and behavior change communication (BCC) strategies. The primary outcomes were diarrhea incidence and prevention and hygiene-related behavioral changes. Risk of bias was assessed using RoB-2 for all studies. Most interventions reported positive outcomes, such as reduced diarrhea incidence and improved caregiver knowledge and enhanced hygiene behaviors. Multicomponent approaches, especially those combining home visits with audiovisual tools and BCC, were particularly effective. However, heterogeneity in follow-up periods, population characteristics, and settings limited comparability. Several studies had high or unclear risk of bias, often due to inadequate reporting of randomization or lack of blinding.

Conclusion

Community-based educational strategies show potential for reducing childhood diarrhea, particularly when tailored to local contexts and combined multicomponent approaches. Future high-quality, standardized RCTs are needed to build a more robust evidence base and guide policy and program development.