Evaluation of diarrhea management appropriateness and its determinants among children under five years of age in regional and national referral hospitals in Eritrea: a cross-sectional study

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BACKGROUND: Diarrhea is a major global public health concern, accounting for 18% of deaths in children under five. Timely and appropriate management at both household and healthcare levels is crucial for reducing mortality associated with childhood diarrhea. However, adherence to recommended guidelines for managing childhood diarrhea is often suboptimal worldwide. This study aimed to assess the overall appropriateness of diarrhea management and its associated factors in children under five, with or without co-morbid illnesses. METHODS: Hospital-based cross-sectional study was conducted. Data were collected retrospectively from the medical records of diarrhea cases using a two-stage stratified sampling technique. The appropriateness of diarrhea management was evaluated based on WHO and national guidelines. Descriptive statistics and logistic regression were employed using IBM SPSS (V.23). RESULTS: Out of the 756 children under five, only 15.9% were appropriately managed. The most common factors for inappropriate management were lack of counseling (77.8%) and the failure to prescribe zinc (49.9%). Factors significantly associated with appropriate management included vomiting (AOR = 1.64, 95% CI: 1.03-2.62), some dehydration (AOR = 0.24, 95% CI: 0.08-0.71), and the prescriber qualification being a medical intern (AOR = 3.86, 95% CI: 1.91-7.81) or a degree nurse (AOR = 0.31, 95% CI: 0.14-0.72). CONCLUSION: This study highlighted a high prevalence of inappropriate diarrhea management in children under five, indicating an urgent need for interventions to reduce associated risks.