Trends and determinants of diarrhea among under-five children in Gambia, evidence from 2013 – 2019/20 Gambian demographic and health survey; multilevel binary logistic regression and multivariate decomposition analysis

Abstract Background Diarrhea is the opening of three and more movable or liquid stools per day, or more frequently than is common for the individual. It is usually an indicator of gastrointestinal infection which can be caused by a variety of bacterial, viral, and parasitic organisms. Objective This study aimed to analyze the trend and determinants of diarrhea prevalence among under-five children within the Gambia for the last five years (2013–2019/20). Methods A total of 6,705 in 2013, and 5,780 in 2019/20 under-five aged children were involved in this study. Multivariate decomposition and multilevel analysis based on a binary logistic regression analysis approach were performed. Results 74.57% of the change in diarrhea prevalence over time was attributable to differences in behavior. Unimproved water source (AOR = 1.4061; 95% CI: 1.0415–1.8982), Wollof ethnicity (AOR = 1.5442; 95% CI: 1.2196–1.9551), not vaccinated for rotavirus (AOR = 3.1476; 95% CI: 2.1486–4.6110) and for measles (AOR = 1.5128; 95% CI: 1.2384–1.8479), average birth size (AOR = 0.8038; 95% CI: 0.6555–0.9855), child age less than one year (AOR = 0.6160; 95% CI: 0.4710–0.8057). Conclusion The prevalence of diarrhea was significantly increased over the last five years and the decline was due to differences in behavior between the surveys. Source of drinking water, ethnicity, birth size, age of children, rotavirus, and measles vaccine were significantly associated with diarrhea among under-five children in the Gambia. Therefore, the Gambian régime should attention to the creation and topping up of behavioral change packages of the public regarding the protection of hygiene and sanitation of the community and their environment, vaccinating of their children to prevent diarrheal disease.