Childhood diarrhea in sub-Saharan Africa: Stalled progress and failure to meet the sustainable development goal 3.2 under-five mortality target by 2030 - A pooled analysis of 1.3 million children from 40 countries.

OBJECTIVE: To determine trends in childhood diarrhea prevalence among children under five years in sub-Saharan Africa (SSA) (2000-2024), identify associated demographic and socioeconomic factors, project prevalence to 2030, and evaluate whether SSA will meet the Sustainable Development Goal (SDG) 3.2 under-five mortality target (10% benchmark). METHODS: Data was pooled from 148 Demographic and Health Surveys (DHS) (2000-2024) across 40 SSA countries. Weighted prevalence was computed, and survey-weighted logistic regression identified associated factors. Logit-transformed linear models using 2015-2024 data projected prevalence to 2030. Sensitivity analyses excluded conflict-affected countries and tested alternative intervals. RESULTS: Continental prevalence declined from 19.5% in 2000 to 13.5% in 2015 (31% reduction) but plateaued thereafter. The post-2015 slope was -0.04 percentage points per year (95% Confidence Interval [CI]: -0.12, 0.04). Projected 2030 prevalence is 14.8% (95% prediction interval [PI]: 12.5, 17.4), 48% above the 10% benchmark, with no region on track. Wealth (odds ratio [OR] = 0.78) and higher education (OR = 0.67) were associated with lower odds; children aged 12-23 months had the highest odds (adjusted odds ratio [aOR] = 1.59). Sensitivity analyses confirmed robustness. CONCLUSIONS: SSA will miss the 10% benchmark by 2030. Urgent, context-specific investments in water, sanitation, and hygiene (WASH), immunization, nutrition, and conflict-sensitive programmes are required.