Spatial variation of management of childhood diarrhea in Malawi

This study reports the spatial variability in household management of diarrhea among under-fives in Malawi. Using data from 2010 Malawi Demographic and Health Survey, we examined oral rehydration and feeding practices of mothers and caregivers of 3105 children with an episode of diarrhea by mapping district effect residual in geo-additive probit model and analyzing residual spatial effects in a Bayesian approach. The findings suggest that although diarrhea is relatively less prevalent in the Northern Region, this region lags behind in terms of adoption of appropriate practices for home-based management of diarrhea in children compared to the Central Regions and Southern Regions. A cluster of five predominantly rural districts in the eastern part of the Southern Region showed remarkably high level of household care for childhood diarrhea relative to the rest of the country. The fixed effects show the importance of breastfeeding, paternal education, wealth index, and ethnicity on oral rehydration, while paternal education, marital status, and ethnicity show significant influence on feeding for children with a diarrhea episode. The paper discusses the apparent inverse relationship between regional prevalence of diarrhea episodes and care-seeking practices for childhood diarrhea in Malawi, and makes relevant recommendations for policy.