PREVALANCE OF DIARRHEA AND ASSOCIATED FACTORS AMONG CHILDREN UNDER FIVE YEARS IN INTERNALLY DISPLACED POPULATIONS OF HODAN DISTRICT, SOMALIA MOHAMUD MOHAMED HERSI H57/69607/2013 A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH IN THE SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF NAIROBI 2019 DECLARATION OF ORIGINALITY Name of student: Mohamud Mohamed Hersi Registration Number: H57/69607/2013 College: College of Health Sciences Department: School of Public Health Course: Master of Public Health Title of Research work: Prevalence of diarrhea and associated factors among children under 5 Years in internally Displaced Populations of Hodan District, Somalia. Declaration I understand what plagiarism is and I am aware of the University’s policy in this regard; 1. I declare that this dissertation is my original work and has not been submitted elsewhere for examination, award of a degree or publication. Where other people’s work or my own work has been used, this has been properly acknowledged and referenced in accordance with the University of Nairobi’s requirements; 2. I have not sought or used the services of any professional agencies to produce this work; 3. I have not allowed, and shall not allow anyone to copy my work with the intention of passing it off as his/her own work; 4. I understand that any false claim in respect of this work shall result in disciplinary action, in accordance with University Plagiarism Policy. Signature_____________________________________Date__________________________ i DECLARATIONS I, Mohamud Mohamed Hersi, hereby declare that this is my original work and has not been submitted to any other university for a degree. Signature _______________________________ Date: _______________________ APPROVALS Academic supervisors: This dissertation has been submitted for examination with our approval as University supervisors: Dr. Rose O. Opiyo (PhD, MSc, B.Ed) School of Public Health, University of Nairobi Signature _______________________________ Date: _______________________ Mr. Lambert Nyabola (B.Sc, MSc, M.S, Dip. Epid) School of Public Health, University of Nairobi Signature: ______________________________ Date: _____________________ Director: Prof. Mutuku A. Mwanthi (BSc; MSEH; PhD) School of Public Health, University of Nairobi Signature _______________________________ Date: _______________________ ii DEDICATION This dissertation is dedicated to my wife Naima, my parents, my lovely children and my entire family. Your support, motivation and encouragement were truly an inspiration. iii ACKNOWLEDGEMENTS Writing this dissertation has been one of the most significant academic challenges I have had to face, and without the collaborative effort of several people, it would have never been a success. My special tributes go to my supervisors, Dr. Rose Opiyo and Mr. Lambert Nyabola for nourishing me academically and for their tireless encouragement, guidance, availability, and overall supervision of the study period. I appreciate Mr. Wycliffe Ayieko for incredible assistance in study methodology and analysis of this work; I acknowledge Mohamed Dahir, who has always encouraged and supported me to successfully complete this work. My thanks extend to my parents and my wife for their love and support has taught me so much about sacrifice and compromise. My sincere appreciation goes to Ministry of Health & Human Services, District Commissioner and Hodan Camp Leader for permission to conduct this study. I acknowledge my research assistants for helping in data collection. Lastly, I thank the entire School of Public Health, my colleagues and friends who provided an enabling environment for the successful completion of this work. May God bless you all! iv TABLE OF CONTENTS DECLARATION OF ORIGINALITY ............................................................................................... i DECLARATIONS ............................................................................................................................. ii APPROVALS .................................................................................................................................... ii DEDICATION .................................................................................................................................. iii ACKNOWLEDGEMENTS .............................................................................................................. iv TABLE OF CONTENTS ................................................................................................................... v LIST OF TABLES .......................................................................................................................... viii LIST OF FIGURES .......................................................................................................................... ix ABSTRACT ....................................................................................................................................... x LIST OF ABBREVIATIONS AND ACRONYMS ......................................................................... xii DEFINITION OF OPERATIONAL TERMS ................................................................................. xiii CHAPTER ONE: INTRODUCTION ................................................................................................ 1 1.1 Background .................................................................................................................................. 1 1.2 Statement of the Problem ........................................................................................................... 3 1.3 Study Objectives .......................................................................................................................... 4 1.3.1 Broad Objective ................................................................................................................. 4 1.3.2 Specific Objectives ............................................................................................................ 4 1.4 Research Questions ..................................................................................................................... 4 1.5 Justification of the Study .............................................................................................................. 5 1.6 Conceptual Framework ................................................................................................................ 5 CHAPTER TWO: LITERATURE REVIEW .................................................................................... 7 2.1 The Burden of Diarrheal Diseases in Children ............................................................................. 7 2.3 Water, Sanitation and Hygiene Practices..................................................................................... 8 2.4 Feeding Practices ....................................................................................................................... 11 2.4.1 Breast Feeding ................................................................................................................ 11 2.4.2. Complementary Feeding ................................................................................................ 12 2.4.3 Malnutrition .................................................................................................................... 13 2.5 Measles and Rotavirus Vaccine .................................................................................................. 14 2.6 Health Seeking Behaviors........................................................................................................... 14 CHAPTER THREE: RESEARCH METHODOLOGY................................................................... 18 3.1 Study Design ............................................................................................................................ 18 3.2 Study Area .................................................................................................................................. 18 3.3 Study Population ........................................................................................................................ 19 v 3.4 Inclusion and Exclusion Criteria ................................................................................................. 19 3.4.1 Inclusion criteria .............................................................................................................. 19 3.4.2 Exclusion criteria ...................................................................................................... 19 3.5 Sample Size Determination. ....................................................................................................... 19 3.6 Sampling and Recruitment Procedure: ...................................................................................... 20 3.7 Data Collection Procedure ......................................................................................................... 22 3.8 Validity and Reliability of data ................................................................................................... 22 3.9 Ethical Considerations ................................................................................................................ 23 3.10 Data Management and Analysis .............................................................................................. 23 CHAPTER 4: RESEARCH FINDINGS .........................................................................................