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Background: Oral rehydration salts (ORS) therapy for diarrheal diseases is considered an effective therapy that can be applied in many resource-poor settings. Nevertheless, it has been consistently underutilized, and as a result, its potential to reduce child mortality has not been fully exploited. In Ethiopia, the use of ORS therapy for children under five has been inadequate. Like any other health behavior, the provision of ORS therapy to children during diarrheal episodes by caregivers is complex and context dependent. Identifying the factors may help promote wider application. Design and methods: We used data from the 2016 Ethiopia Demographic and Health Survey (EDHS-2016). Samples were selected by a two-stage stratified cluster sampling method. We used data on children under five years of age whose mothers (aged 15-49 years) reported that the child had had diarrhea within two weeks before the survey was conducted (n=1221). The dependent variable was whether these children received ORS therapy. The contextual independent factors were socio-demographic variables (mothers’ age, child’s age, child’s sex, child’s place of residence, household wealth, and mother/ husband/partner’s education levels and work status), as well as media exposure and healthcare utilization. Results: The prevalence of ORS therapy use among the children was 30%. Mothers who had made at least four prenatal visits during their last pregnancy were 87% more likely to use ORS therapy for their children than those who had fewer prenatal visits (OR=1.874; CI: 1.140-3.082; p=0.013). Conclusions: Integrating efforts for scaling-up ORS use with prenatal health care services may have an extra benefit of promoting children’s wellbeing and survival. Significance for public health In Ethiopia, diarrheal diseases are the second leading cause of death among children under five years of age. One of the United Nation’s Sustainable Development Goals is aimed at substantially reducing preventable child mortality by 2030. Oral rehydration salts (ORS) therapy is the most effective intervention for diarrheal case management, but it is consistently underutilized. Understanding the contextual factors of caregivers of children and their association with ORS use in children under five may help achieve wider use. Our results show that ORS therapy use for children under five with diarrhea was inadequate at just 30%. We also found that women who had visited prenatal health facilities four times or more during their last pregnancies were 87% (OR=1.874; CI: 1.140-3.082; p=0.013) more likely to use ORS therapy for their children with diarrhea than women with fewer prenatal visits. In scaling-up ORS therapy, integrating efforts with prenatal health care services for pregnant women may contribute to expanded use and improved child survival.

Oral Rehydration Salts Therapy Use among Children under Five Years of Age with Diarrhea in Ethiopia