Persistent diarrhea in under-five children at the primary healthcare center level in Morocco : Spatial patterns and risk factors.

Abstract

Background : In Morocco, studies on persistent diarrhea (PD) in under-five children are scarce. Objective : To examine spatial clustering and risk factors of PD in under-five children in Morocco with the intention to identify priority areas of research and to guide decision-making. Methods : D ata were standardized for three age groups (0-11 , 12-23 and 24-59 months). Spatial autocorrelation (Moran's Indicator of spatial association) was examined at the province/prefecture level. Covariates including malnutrition, quantity of water delivered and used for households, and living area (a province versus a prefecture) were controlled for by means of the o rdinary least squares regression. Results : The spatial distribution of PD is random in Morocco (Global Moran's I=0.032 ; p=0.248). However, geographic patterns of PD indicates that the province of Tarfaya requires further investigation. M alnutrition was found to significantly contribute to PD (Adjusted R-squared= 35.3% ; p<0.0001) while t he safe water quantity and living area were not associated with PD. Conclusion : Insight into PD in under-five children in Morocco was provided for further research and public health intervention.