Household Practices and Environmental Conditions Associated with Diarrhea Occurrence in School-Age Children of Karachi: A Cross-Sectional Study

Abstract

Background: Diarrheal disease remains a leading cause of morbidity in low- and middle-income countries. Whereas most research focuses on children under five, the burden in school-age children (5–15 years) is poorly characterized. This study examined the frequency of diarrhea in this age group in Karachi, Pakistan, and explored associations with household hygiene practices and environmental conditions.

Methods: A cross-sectional study was conducted across 30 randomly selected clusters in Karachi between October 2018 and March 2019. One child aged 5–15 years per household was enrolled using systematic sampling. A modified version of the Multiple Indicator Cluster Survey (MICS) questionnaire was administered to mothers. Univariate and multivariate logistic regression were used to identify predictors of diarrhea in the past two weeks.

Results: Among 241 enrolled children (mean age 10 years), 79 (32.8%) had diarrhea in the preceding two weeks. The majority of households had improved sanitation (80.9%), water available for handwashing (95.9%), and soap present (93.4%). In multivariate analysis, renting the household dwelling was the only independent predictor of diarrhea (adjusted OR 2.32, 95% CI 1.04–5.18, p = 0.041).

Conclusions: Diarrhea prevalence of 32.8% in school-age children is substantial. Household tenure—a proxy for socioeconomic stability and residential mobility—emerged as the primary modifiable predictor. Expanded longitudinal studies are needed in this under-researched age group, with particular attention to socioeconomic determinants and residential mobility.