Bishwajit Ghose

Prevalence of unmet need for contraception and its association with unwanted pregnancy among married women in Angola.

 

  Abstract  

 

Unmet need for contraception and unwanted pregnancy are recognised as significant barriers to promoting women’s reproductive health and well-being. Currently there is no research evidence on these two crucial indicators of reproductive care in Angola. Therefore, we conducted this study with the objectives of exploring the current prevalence of unmet need for contraception and unintended pregnancy as well as their relationship among married women in Angola. This study was based on cross-sectional data from Angola Demographic and Health Survey (DHS) conducted in 2015-16. Participants were 7,808 married women aged 15-49 years. Unwanted pregnancy was measured in terms of the mistimed and unintended conception for the last-born child. Unmet need for contraception included those who reported unmet need for spacing and limiting. Data were analysed using bivariate and multivariable techniques. The combined prevalence of mistimed and unwanted pregnancy was 38.3% (95%CI = 35.9-40.7), and that of unmet need for contraception for spacing and limiting was 51.7% (49.9-53.5). Among the 18 regions, Luanda had the highest prevalence of unmet need for contraception and of unwanted pregnancy with the prevalence being higher than more than one-third of the women. Multivariable analysis significantly revealed a significantly positive association between unmet need and unwanted pregnancy. In all the models, the odds of unwanted pregnancy were found to be as high as four times among women with unmet need compared with those had no unmet need. Compared to women who had no unmet need, those who had unmet need had respectively four (OR = 4.380; 95%CI = 3.690-5.198) and seven (OR = 6.951; 95%CI = 4.642-10.410) times higher odds of experiencing unwanted pregnancy. This study concludes that the prevalence of unmet need for contraception and unwanted pregnancy are high with significant disparities across the regions. Women in the capital city had the highest prevalence of both unmet need for contraception and unwanted pregnancy. Although the data were cross-sectional and do not indicate causal relationships, the findings showed a strong positive association between unmet need for contraception and unwanted pregnancy. However, it is recommended to conduct further studies to replicate the findings and to explore the influence behavioural and cultural practices on unwanted pregnancy.

 



Prevalence of Alcohol and Tobacco Use among Men and Women in Namibia.

 

  Abstract  

 

Namibia is known to have a high prevalence of tobacco smoking and alcohol consumption. Individuals who smoke are more likely to drink, and vice versa. It was reported that the individual rewarding effect of drinking and smoking were reported to be higher than when they are used at the same time. In this study our objective was to examine the individual and combined prevalence of drinking and smoking and investigate their sociodemographic correlates among adolescent and adult men and women in Namibia. This study was based on data from Namibia Demographic and Health Survey (NDHS 2013). Sample population were 14,185 men and women aged between 15 and 64 years. Self-reported tobacco smoking and alcohol consumption patterns were the outcome variables. Data were analysed using complex sampling techniques to account for survey design. Bivariate and multivariate techniques were used to measure the association between drinking and smoking with the sociodemographic factors. The prevalence of alcohol and tobacco use was, respectively, 53.1% (51.5⁻54.6) and 8.8% (8.1⁻9.5), and that of both drinking and smoking was 6.9% (6.3⁻7.6). In the regression analysis, several sociodemographic factors were found to be significantly associated with alcohol and tobacco use including age, area of residence, religion and educational status. Overall, women had higher rates of drinking alcohol; however, men had higher rates of engaging in high risk drinking. Men and women who reported drinking alcohol had, respectively, 2.57 and 4.60 times higher odds of smoking. Findings suggest that the prevalence of drinking was higher than that of smoking, with men having higher prevalence of high risk drinking. Men and women who drink alcohol were more likely to be smokers. The prevalence of both alcohol and tobacco use showed important sociodemographic patterns which need to be taken into consideration in designing prevention and intervention programs. Strategic tobacco control and smoking cessation approaches should pay particular attention to alcohol users.

 


Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries.

 

  Abstract  

 

Women’s empowerment has a direct impact on maternal and child health care service utilization. Large scope measurement of contraceptive use in several dimensions is paramount, considering the nature of empowerment processes as it relates to improvements in maternal health status. However, multicountry and multilevel analysis of the measurement of women’s empowerment indicators and their associations with contraceptive use is vital to make a substantial intervention in the Sub-Saharan Africa context. Therefore, we investigated the impact of women’s empowerment on contraceptive use among women in sub-Saharan Africa countries. Secondary data involving 474,622 women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 32 Sub-Saharan Africa region was used in this study. Contraceptive use was the primary outcome variable. Multilevel analysis was conducted to examine the impact of women’s empowerment on contraceptive use. Percentages were conducted in univariate analysis. Furthermore, multilevel logistic regression models were used to analyze the association between individual, compositional and contextual factors of contraceptive use. Results showed large disparities in the number of women who reportedly ever use contraceptive methods; this range from as low as 6.7% in Chad and as much as 72% in Namibia. More than one-third of the respondents had no formal education and more than half were active labor force. Contraceptive use was significantly more common among respondents from the richest households (28.5% versus 18.9%). Various components of women’s empowerment were positively significantly associated with contraceptive use after adjusting for demographic and socioeconomic factors. There was a significant variation in the odds of contraceptive use across the 32 countries (σ 2 = 1.12, 95% CrI 0.67 to 1.87) and across the neighbourhoods (σ 2 = 0.95, 95% CrI 0.92 to 0.98). Our findings suggest that an increase in contraceptive use and by better extension maternal health care services utilization can be achieved by enhancing women’s empowerment. Also, an increase in decision-making autonomy by women, their participation in labour force, reduction in abuse and violence and improved knowledge level are all key issues to be considered. Health-related policies should address inequalities in women’s empowerment, education and economic status which would yield benefits to individuals, families, and societies in general.

 



Wealth Inequality as a Predictor of Subjective Health, Happiness and Life Satisfaction among Nepalese Women.

 

  Abstract  

 

Socioeconomic status has shown to be associated with subjective health, well-being, satisfaction with overall life and estimation of happiness. The body of research concerning the question of whether higher economic status leads to better health and well-being are mostly from developed countries. The present study was therefore conducted among women in Nepal with an aim to investigate whether household wealth status is associated with satisfaction about (1) self-reported health, (2) happiness, and (3) life overall.  Methods:  Subjects were 5226 Nepalese women aged between 15 and 24 years. Cross-sectional data were extracted from round 5 of the Nepal Multiple Indicator Cluster Survey (NMICS), conducted in 2014, and analyzed using chi-square tests of association, bivariate and multivariable regression methods.  Results:  Wealth status was significantly associated with satisfaction about health, estimation of happiness and satisfaction. Compared with women in the poorest households, the odds of positive estimation about overall happiness were respectively 30% higher for poorer ( p  < 0.0001; 95% CI = 1.653⁻3.190), 80% higher for middle ( p  = 0.001; 95% CI = 1.294⁻2.522), 64% higher for richer ( p  = 0.006; 95% CI = 1.155⁻2.326), and 40% higher for richest households. The odds of reporting satisfaction about life were respectively 97% higher for poorer ( p  < 0.0001; 95% CI = 1.680⁻2.317), 41% higher for middle ( p  < 0.0001; 95% CI = 1.165⁻1.715), 62% higher for richer ( p  < 0.0001; 95% CI = 1.313⁻2.003), and 31% higher for richest households ( p  = 0.043; 95% CI = 1.008⁻1.700).  Conclusion:  Our results conclude that women in households with lower wealth status report poorer subjective health, quality of life and happiness. However, the findings need to be interpreted in light of the existing sociocultural conditions mediating the role of household wealth status on women’s lives.

 



Chronic Musculoskeletal Pain, Self-Reported Health and Quality of Life among Older Populations in South Africa and Uganda.

 

  Abstract  

 

Chronic musculoskeletal pain (CMP) is a serious health concern especially among the elderly population and has significant bearing on health and quality of life. Not much is known about the relationship between chronic pain with self-reported health and quality of life among older populations in low-resource settings. Based on sub-national data from South Africa and Uganda, the present study aimed to explore whether the older population living with CMP report health and quality of life differently compared to those with no CMP complaints. This study was based on cross-sectional data on 1495 South African and Ugandan men and women collected from the SAGE Well-Being of Older People Study. Outcome variables were self-reported physical and mental health and quality of life (QoL). Mental health was assessed by self-reported depressive symptoms during the last 12 months. CMP was assessed by self-reported generalised pain as well as back pain. Multivariable logistic regression models were used to measure the association between health and QoL with CMP by adjusting for potential demographic and environmental confounders. The prevalence of poor self-rated health (61.2%, 95% CI = 51.7, 70.0), depression (37.2%, 95% CI = 34.8, 39.6) and QoL (80.5%, 95% CI = 70.8, 87.5) was considerably high in the study population. Mild/moderate and Severe/extreme generalised pain were reported respectively by 34.5% (95% CI = 28.9, 40.5) and 15.7% (95% CI = 12.2, 19.9) of the respondents, while back pain was reported by 53.3% (95% CI = 45.8, 60.4). The prevalence of both types was significantly higher among women than in men ( p  < 0.001). In the multivariate analysis, both generalised pain and back pain significantly predicted poor health, depression and QoL, however, it varied between the two different populations. Back pain was associated with higher odds of poor self-rated health [OR = 1.813, 95% CI = 1.308, 2.512], depression [1.640, 95% CI = 1.425, 3.964] and poor QoL [1.505, 95% CI = 1.028, 2.202] in South Africa, but not in Uganda. Compared to having no generalised pain, having Mild/Moderate [OR = 2.309, 95% CI = 1.219, 7.438] and Severe/Extreme [OR = 2.271, 95% CI = 1.447, 4.143] generalised pain was associated with significantly higher odds of poor self-rated health in South Africa. An overwhelmingly high proportion of the sample population reported poor health, quality of life and depression. Among older individuals, health interventions that address CMP may help promote subjective health and quality and life and improve psychological health.

 



Fruit and vegetable consumption among adults in Namibia: analysis of a nationally representative population.

 

  Abstract  

 

Background:  Prevalence of F&V consumption in Namibia is not known. In this study we aimed to address this gap by using nationally representative data with the objectives of measuring the prevalence of adequate F&V consumption among adult men and women and their socio demographic determinants.  Methods:  This study is based on data from Namibia Demographic and Health Survey (NDHS2013). Sample population were 14 185 men and women aged between 15 and 49 years.Amount of fruit and vegetable consumption was measured by self-reported frequencies and was defined as adequate (at least 5 servings/day) according to World Health Organization (WHO)guidelines.  Results:  Overall, only 4.3% (3.8-4.9%) of the men and women reported consuming at least 5 servings of F&V a day, with the percentage being slightly higher among women (4.8%,95% CI=3.7-6.2) compared with men (4.2%, 95% CI=3.6-4.8). In the multivariable analysis,education level and household wealth status appeared to be the only factors associated with adequate F&V intake. Men and women who had primary level education had higher odds of eating at least 5 servings of F&V a day compared with those who had no education. Regarding wealth status, men and women from non-poor households had respectively 2.13 times(OR=2.13, 95% CI=1.01-4.48) and 2.2 times (OR=2.19, 95% CI=1.56-3.38) higher odds of eating at least 5 servings of F&V a day.  Conclusion:  Only a small proportion of the men and women consumed adequate amount of F&V on daily basis. Having primary level education and non-poor household wealth status were positively associated with adequate amount of F&V intake.

 




Intake of supplementary food during pregnancy and lactation and its association with child nutrition in Timor Leste.

 

  Abstract  

 

There is little evidence on maternal consumption of supplementary food on nutritional status of children. The objectives of this study were to measure the prevalence and determinants of supplementary food intake during pregnancy and lactation, and their association with nutritional status of under-five children in Timor Leste. Cross-sectional data from Timor Leste Demographic and Health Survey on 5,993 mother (15-49 years) child dyads (<5 years) were included in the analysis. Self-reported intake of supplementary food intake was the explanatory variable. Child’s nutritional status was assessed by stunting, wasting, and underweight and categorized according to WHO recommendations. The prevalence of taking supplementary food during pregnancy and lactation was, respectively, 29.1% (95% CI [27.2-31.0]) 31.0% (95% CI [29.1-33.0]), and that of taking iron supplement during pregnancy was close to three-fifths (63.1%, 95% CI [60.9-65.3]). The odds of taking supplementary food during pregnancy and lactation were lower among those in the younger age groups and higher among urban residents. Compared with mothers who had supplementary food during pregnancy and lactation, those did not have had respectively 1.36 (OR = 1.360, 95% CI [1.191-2.072]) and 1.15 times (OR = 1.152, 95% CI [1.019-1.754]) higher odds of having stunted, and 1.30 (OR = 1.307, 95% CI [1.108-1.853]) and 1.43 (OR = 1.426, 95% CI [1.140-1.863]) times higher odds of having underweight children. Those who had none of the supplements had respectively 1.67 (OR = 1.674, 95% CI [1.118-2.087]) and 1.63 (OR = 1.631, 95% CI [1.130-2.144]) times higher odds of having stunted and underweight children. A great majority of the mothers in Timor Leste are not taking supplementary food during pregnancy and lactation. We found a positive relationship between supplementary food intake during pregnancy and lactation with stunting and wasting among under-five children.

 




Socioeconomic Inequalities in the Risk Factors of Noncommunicable Diseases Among Women of Reproductive Age in Sub-saharan Africa: A Multi-Country Analysis of Survey Data.

 

  Abstract  

 

Background:  Understanding the socioeconomic discordance associated with the risk factors of non-communicable diseases (NCDs) can help direct effective interventions to end its persistent occurrence. We examined the prevalence of high blood pressure, overweight/obesity, alcohol consumption and tobacco use among women and compared across wealth quintiles in sub-Saharan Africa countries.  Methods:  This study included 454,080 women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) conducted between 2008/09-2017 across 33 sub-Saharan Africa countries. The outcome variables were high blood pressure, overweight/obesity, alcohol consumption and tobacco use. The prevalence of the risk factors of NCDs and sample characteristics across different levels of wealth quintiles were examined. Furthermore, socioeconomic inequalities were measured using concentration index (CI) and Lorenz curve considering urban-rural differentials.  Results:  The prevalence of high blood pressure and overweight/obesity were 1.2-17.3% and 6.7-44.5% respectively with significant wealth quintile differences. More so, alcohol consumption prevalence was 4.1-47.3% and tobacco use was 0.3-9.9%. The overall prevalence of high blood pressure was 5.5%, overweight/obesity accounted for about 23.1%, alcohol consumption and tobacco users were 23.9 and 2.4%, respectively. The socioeconomic inequalities in high blood pressure (CI = 0.1352,  p  < 0.001); overweight/obesity (CI = 0.2285,  p  < 0.001), and alcohol consumption (CI = 0.0278,  p  < 0.001) were significantly more in the higher socioeconomic group, compared to the lower socioeconomic group. In contrast, the prevalence of tobacco use ( CI  = -0.2551,  p  < 0.001) was significantly more in the lower socioeconomic group, compared to the higher socioeconomic group. The test for differences in rural vs. urban concentration indices for high blood pressure, overweight/obesity, alcohol consumption, and tobacco use were statistically significant in all the health indicators ( p  < 0.05).  Conclusion:  An effective intervention should incorporate a high-risk approach to terminate risk distribution by directing resources to key population women. To improve the benefit to risk ratio and enhance the cost effectiveness of preventive health programmes, it is paramount to understand the worth of equity-based strategies. Integrating equity elements to interventions is a key measure toward ensuring that policies and programmes meet their milestones. Government should strengthen living standards, literacy and healthcare system to curtail the increasing prevalence of the risk factors of NCDs.

 




Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis.

 

  Abstract  

 

Under-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths. Demographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15-49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality. The current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97-1.25; DR Congo- HR = 1.24, 95%CI = 1.11-1.40; Mali- HR = 2.43, 95%CI = 1.63-3.64; Niger- HR = 1.59, 95%CI = 1.24-2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06-1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00-1.77; DR Congo- HR = 1.20, 95%CI = 1.01-1.43; Mali- HR = 1.42, 95%CI = 1.08-1.85; Niger- HR = 1.43, 95%CI = 1.06-1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03-2.15). Despite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.

 



Alcohol consumption and sleep deprivation among Ghanaian adults: Ghana Demographic and Health Survey.

 

  Abstract  

 

Heavy consumption of alcohol has shown to be associated with sleep disturbances among adult and elderly people in high income settings. So far, the relationship between alcohol drinking and sleeping pattern has not been studied in an African setting. Therefore, in this study we investigated whether alcohol consumption has any influence on sleeping hours among adult men and women in Ghana. Data for this survey were extracted from Ghana Demographic and Health Survey (GDHS 2008). GDHS is the only cross-sectional survey conducted on men and women aged above 15 years that collected information on variables such as sleeping hours and alcohol consumption. The analysis was controlled for various demographic, socioeconomic, household level factors, and smoking. Prevalence of sleeping 1-3 h, 4-6 h, and >7 h was respectively 1.5% (1.2-2.0), 14.1% (12-16.5), and 84.4% (82.1-86.4), and that of alcohol use was 26.9% (23.4-30.6). In the multivariable regression analysis, compared with non-drinkers, those reported drinking had significantly lower odds of sleeping for at least 7 h. In the adjusted model, drinkers had 0.8 times (adjusted OR = 0.803, (95% CI [0.690-0.935])) lower odds of sleeping for at least 7 h. The odds for sleeping 4-6 h were not statistically significant. In the stratified analysis, the odds of sleeping for at least seven were comparatively lower among women (adjusted OR = 0.657, (95% CI [0.509-0.849]) then among men (adjusted OR = 0.867, (95% CI [0.740-0.965]). Men and women who reported consuming alcohol had significantly lower odds of getting adequate sleep (>7 h). The sleep-disrupting effect of alcohol appeared to be more prominent among women than among men. Currently there is not sufficient evidence on alcohol consumption and sleep disorder among Ghanaian population or any other country in the region. Further studies are required to understand sleeping patterns and the burden of alcohol drinking in this population to design intervention programs.

 




Analysis of the behavior change mechanism of township hospital health workers in Hubei Province, China: A cross-sectional study.

 

  Abstract  

 

This study aims to analyze the behavior changes of health workers in township hospitals by exploring their individual service, health information utilization, and health information exchange before and after intervention.A cross-sectional survey was conducted from September, 2016 to December, 2016 in Qianjiang city, Hubei Province, China. A total of 432 township hospital health workers were investigated from 12 township hospitals. t test and chi-square test were adopted in the difference analysis to compare the behavior changes and factors of the control and intervention groups before and after intervention. t test and U test were used to analyze the behaviors and the key impact factors of health workers in township hospitals. The hypothesis test of the behavior changes in the township hospitals were analyzed using the partial least squares (PLS) method.No significant difference was observed between the control and intervention groups of health workers in township hospitals. Significant differences were observed in the behavior attitude (BA), perceived behavior control (PBC), behavior intention (BI), and behaviors of information utilization and exchange in the intervention group. A significant difference was observed in the indicators of subjective norm (SN), BI, and behaviors with respect to information exchange. A large increment was observed in the intervention group. Based on results of PLS, the individual service, health information utilization, and health information exchange established relationships with BA, SN, PBC, and BI to a certain degree.A cause and effect relationship can be observed among BA, SN, PBC, BI, and behaviors of health workers in the township hospitals. BI can promote behavior changes among township hospital health workers. Moreover, different behaviors are demonstrated by different people because of BA, SN, PBC, and BI. The results of this study can contribute to improving the feasibility, pertinence, and effects of health service, and can serve as the guide in understanding health workers’ behaviors.

 





Differentials in prevalence and correlates of metabolic risk factors of non-communicable diseases among women in sub-Saharan Africa: evidence from 33 countries.

 

  Abstract  

 

Even with the widespread recognition of non- communicable diseases (NCDs) in sub-Saharan Africa region, yet, sufficient evidence-based surveillance systems to confirm the prevalence and correlates of these diseases is lacking. In an attempt to understand the problem of NCDs in resource-constrained settings, this study was conducted to establish the pattern of the risk factors of NCDs in sub-Sahara Africa region. The current Demographic and Health Survey (DHS) data sets from 33 countries in sub-Sahara Africa region were used in this study. The individual woman component of DHS 2008-2016 was used. The outcome variables include anemia, hypertension and body mass index (underweight, overweight and obesity). BMI was categorized into; underweight (BMI < 18.5 kg/m 2 ), normal (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ) and obesity (BMI ≥30 kg/m 2 ). Hemoglobin level: anemic < 12.0 g/dL (< 120 g/L) for women. Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Binary and multinomial logistic regression models were used to investigate the correlates of the variables. The percentage of hypertension was highest among women in Lesotho with about 17.3% and lowest among women in Burundi (1.0%). Anemia was prevalent among sub-Saharan Africa women; where more than half of the women from several countries were anemic with Gabon (60.6%) reporting the highest prevalence. The percentage of obesity in sub-Saharan Africa showed that Lesotho (19.9%), Gabon (18.9%) and Ghana (15.6%) were the prominent countries with obese women, while Madagascar (1.1%) had the minimum obese women. Body mass index was significantly associated with hypertension and anemia. The behavioural or modifiable factors of hypertension and body mass index were; smoking, fruits, vegetables and alcohol consumption. While the non-modifiable significant factors include; age, residence, religion, education, wealth index, marital status, employment and number of children ever born. However, anemia shared similar factors except that smoking and vegetable consumption were not statistically significant. In addition, involvement in exercise was associated with anemia and hypertension. The problem of NCDs and associated factors remains high among women of reproductive age in sub-Sahara region. The findings of this study suggest that promotion of regular positive health care-seeking behaviour, screening and early treatment are essential to mitigate the burden of NCDs. Furthermore, preventive interventions of NCDs risk factors should be strengthened among key population through behavior change communication with support from government and stakeholders in health care.

 




Improving Water, Sanitation and Hygiene Practices, and Housing Quality to Prevent Diarrhea among Under-Five Children in Nigeria.

 

  Abstract  

 

Sub-Saharan Africa as a region accounts for the bulk of the global under-five mortality rate, to which diarrhea is major contributor. Millions of children die from diarrheal diseases each year and those who survive often do so facing suboptimal growth. Preventing the common pathways of transmission for diarrhea-causing pathogens, including improved water, sanitation, and hygiene (WASH) are regarded as the most cost-effective measures for tackling this life-threatening disease. This study aimed to quantitatively assess the quality of living arrangement and access to WASH, and their impact on diarrheal outcomes among under-five children in Nigeria.  Methods : Data were collected from the 2013 Nigeria Demographic and Health survey (NDHS). Study participants included 28,596 mother-child pairs. Household construction material for wall, floor, and ceiling, access to electricity, and improved water and toilet, were included as the main explanatory variables. Data were analyzed using descriptive and multivariable regression methods.  Results : The prevalence of diarrhea was 11.3% (95% CI = 10.2⁻12.6), with the rate being markedly higher in rural (67.3%) as compared to urban areas (32.7%). In the regression analysis, lacking access to improved toilet and water facilities were associated with 14% and 16% higher odds, respectively, of suffering from diarrhea as compared to those who had improved access.  Conclusion : There is evidence of a weak, but statistically significant, relationship between the quality of living environment, including water and sanitation facilities, and diarrhea among under-five children in Nigeria. The study concludes that investing in living conditions and WASH may have potential benefits for child mortality prevention programs in the country.