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Background  Diarrheal diseases remain a leading cause of preventable death among children under-five in low- and middle-income countries (LMICs). In Ethiopia, diarrhea is the major contributor to deaths for children under the age of 5 years. In order to develop prevention strategies for the alleviation of childhood diarrhea, it is necessary to identify the important predisposing factors. These predisposing factors have been observed to vary by location across Eastern Ethiopia. Moreover, the evidence on prevalence and determinants of diarrhea among children under 5 years of age in Dire Dawa and its suburbs is very limited and those available have been erratic. The objective of this study was to determine the prevalence and predisposing factors of diarrhea among children under the age of 5 years in rural Dire Dawa, East Ethiopia.    Methods  A community-based cross-sectional study was conducted in rural Dire Dawa City Administration in May 2018. Multistage sampling technique was employed to recruit 1180 under-five children from the rural population of Dire Dawa City Administration. Data on socio-demographic, environmental, and child hygiene-related factors were collected by trained data collectors using a structured questionnaire. Logistic regression was used to identify independent risk factors for childhood diarrhea.    Results  The 2-week prevalence of diarrhea among the under-five children was 23% (95% CI 20.8–25.7%). Maternal diarrhea (AOR = 2.22, 95% CI 1.10–4.47), handwashing after contact with child feces (AOR = 6.27, 95% CI 2.01–19.55), use of a dipper to draw water from containers (AOR = 2.88, 95% CI 1.41–5.89), and presence of a refuse disposal facility (AOR = 2.47, 95% CI 1.09–5.60) were the significant predisposing factors of diarrhea.    Conclusion  Our study identified a high burden of childhood diarrheal disease in rural Dire Dawa City Administration in Eastern Ethiopia. The identified risk factors were maternal diarrhea, handwashing after contact with child feces, use of a dipper to draw water from containers, and presence of refuse disposal facility. To minimize the risk of diarrhea, health education programs focusing on good hygiene practice and sanitation as well as early treatment are recommended.

Diarrheal morbidity and predisposing factors among children under 5 years of age in rural East Ethiopia