Relative burden of diarrheal cases in under-five children before and during COVID-19 pandemic in Ethiopia: a retrospective study

Abstract Background: The burden of diarrhea in under-five children is a problem in Ethiopia. The different measures taken to prevent COVID-19 pandemic are believed to have impact on the burden of diarrhea. However, there is no data that shows the association of COVID-19 pandemic and burden of diarrhea in under-five children. The aim of this study was to assess burden of diarrheal cases and associated factors among under-five children that attended primary health centers before and during COVID-19 pandemic in Addis Ababa and Debre Berhan, Ethiopia. Methods: This retrospective study was carried out using data extracted from under-five children registered from January 2019 to December 2020 in Teklehaymanot Health Center, Addis Ababa, and 04 kebele health center, Debre Berhan, Ethiopia. Data analysis was made by SPSS statistics version 20. Results: A total of 11, 337 under-five registers of two years were reviewed. Diarrhea was the second leading cause for visiting health facilities to under-five children. The overall prevalence of diarrhea was 19.8%, with 20.2% before and 18.6% during COVID-19. There was no statistically significant difference for diarrhea before or during COVID-19 pandemic (AOR=1.117, 95%CI=0.898, 1.389). Higher prevalence was seen in male (21%) and in age range between 12-24 months (22.6%). Male had less likelihood to have diarrhea compared to female (AOR= 0.832, 95% CI=0.756, 0.915). Children with age <6 months were 1.5 times more likelihood to have diarrhea (AOR= 1.474= 95% CI= 1.240, 1.753) compared to age range with > 24 months. Children who lived in Addis Ababa had two times more risk of getting diarrhea (AOR= 1.903, 95% CI=1.717, 2.109) compared to children who lived in Debre Berhan. Diarrhea occurred 3 times during spring (AOR= 2.615=95%=2.239, 3.053) and 1.3 times in winter (AOR= 1.319=95% CI=1.133, 1.536) compared to summer. Conclusions: The burden of diarrhea remains high. However, the impact of COVID-19 on diarrhea for under-five children was not statistically significant. Sex, age, seasonality, and study area were associated with the diarrhea. We recommend assessment of community practices of the COVID-19 prevention measures, season dependent pathogens of diarrhea, and creating active health facility based surveillance for better understanding of the impact.