"Spatial Disparities and Multilevel Determinants of Diarrhea Among Under-Five Children in Mozambique: Evidence from the 2022/2023 Demographic and Health Survey"

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Abstract Background Diarrhea remains a major health challenge in Mozambique, with its burden varying across regions. An updated, detailed analysis using the 2022/2023 DHS data is essential for informed public health planning and prioritize resource allocation. This study explores the spatial distribution and key determinants of diarrhea among children under five to design targeted interventions. Methods This study used data from 9,799 under-five children in the 2022/2023 Mozambique DHS to assess diarrhea prevalence and determinants. Weighted analysis, SaTScan, hotspot mapping, and multilevel logistic regression were used to assess individual and community factors influencing diarrhea among under-five children. Significant predictors were identified using AORs (95% CI, p ≤ 0.05). ICC, MOR, and PCV assessed model variation, and spatial patterns were mapped using ArcGIS. Results The weighted prevalence of diarrhea among under-five children in Mozambique was 8.8% (95% CI: 7.8–9.6), with the highest rates in Niassa (14.5%), Cabo Delgado (14.0%), and Maputo City (13.4%), and the lowest in Maputo Province (5.1%), Zambézia (5.5%), and Manica (5.8%). Multilevel analysis revealed children aged 12–23 months had significantly higher odds of experiencing diarrhea (AOR = 1.36, 95% CI: 1.11–1.66), while those aged 24–59 months (AOR = 0.49, 95% CI: 0.41–0.59), compared to infants aged 0–11 months, Maternal education (AOR = 0.77, 95% CI: 0.63–0.96), Rural residence (AOR = 0.69, 95% CI: 0.52–0.91) were protective, and children residing in regions such as Nampula (AOR = 0.42), Zambézia (AOR = 0.35), Manica (AOR = 0.30), Sofala (AOR = 0.51), and Maputo Province (AOR = 0.26) showed significantly lower odds compared to Niassa. Health-seeking behavior showed a strong positive association with diarrhea occurrence (AOR = 4.85, 95% CI: 4.10–5.74). Conclusions Diarrhea among under-five children in Mozambique shows marked regional variation, with higher rates in Niassa, Cabo Delgado, and Maputo City, and lower rates in Maputo Province, Zambézia, and Manica. Risk was linked to child age, maternal education, and region, while rural residence and certain regions were protective. Targeted, region, and age-specific interventions are needed.

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