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Background. Diarrheal diseases are the major cause of morbidity and mortality among under-five children in low- and middle-income countries including Ethiopia. One of the national initiatives to reduce its burden is an implementation of an open-defecation-free program. However, information related to the comparison of diarrheal diseases among residents in open-defecation-free and non-open-defecation-free. Hence, this study assessed the magnitude of diarrheal diseases among residents in open-defecation-free and non-open-defecation-free areas of Farta District, North Central Ethiopia. Methods. A community-based comparative cross-sectional study was conducted among 758 households (378 in open-defecation-free and 380 in non-open-defecation-free kebeles) who have under-five children using a structured questionnaire. A systematic sampling technique was used to select study participants. Binary logistic regression was used to analyze factors associated with diarrheal diseases in the district. Results. Overall, 29.9% of children had diarrheal diseases in the last two weeks prior to the study. The magnitude of diarrheal diseases among under-five children living in open-defecation-free and non-open-defecation-free residents was 19.3% and 40.5%, respectively. Lack of functional handwashing facilities (AOR: 11, 95% CI (8.1–29.6)), improper excreta disposal (AOR: 3.84, 95% CI (2.15–5.65)), and residing in non-open-defecation-free areas (AOR: 2.4, 95% CI (1.72–3.23)) were factors associated with diarrheal diseases. Conclusions. The prevalence of diarrhea among children residing in open-defecation-free areas was lower than that among children those who resided in non-open-defecation-free areas. Lack of functional handwashing facilities, residing in non-open-defecation-free areas, and improper excreta disposal were significantly associated with diarrheal diseases in the district. Strengthening health promotion on non-open defecation, maintaining functional handwashing facilities, and preparing additional handwashing facilities are necessary. Continuous engagement of the community health extension workers is recommended, sustaining the implementation of open-defecation-free programs in the district.

journal of environmental and public health

Diarrheal Diseases in Under-Five Children and Associated Factors among Farta District Rural Community, Amhara Regional State, North Central Ethiopia: A Comparative Cross-Sectional Study