Climate variability is expected to increase the risk of diarrhea diseases, a leading cause of child mortality and morbidity in Sub-Saharan Africa (SSA). The risk of diarrhea is more acute when populations have poor access to improved water and sanitation. This study seeks to determine individual and joint effects of climate variation, water supply and sanitation on the occurrence of diarrhea among children under five in SSA using multilevel mixed-effect Poisson regression including cross-level interaction. We merged 57 Demographic and Health Surveys (DHS) from 25 SSA countries covering the period 2000–2019 with climatic data from the DHS geolocation databases. The results of the research indicate that 77.7% of the variation in the occurrence of diarrhea in Sub-Saharan households is due to climatic differences between clusters. Also, a household residing in a cluster with a high incidence of diarrhea is 1.567 times more likely to have diarrhea cases than a household from a cluster with a low incidence. In addition, when average temperature and rainfall increase, households using unimproved sanitation or unimproved water have more cases of diarrhea. For SSA, the results of the multilevel analysis suggest the adoption at both levels; macro (national) and micro (household), of climate change adaption measures in the water sector to reduce the prevalence of diarrhea.

气候变化预计会增加腹泻病的风险，腹泻病是撒哈拉以南非洲 (SSA) 儿童死亡率和发病率的主要原因。当人们难以获得改善的水和卫生设施时，腹泻的风险会更加严重。本研究旨在使用多层次混合效应泊松回归（包括跨层次交互）来确定气候变化、供水和卫生对 SSA 中 5 岁以下儿童腹泻发生的个体和联合影响。我们将 2000-2019 年期间来自 25 个 SSA 国家的 57 次人口与健康调查 (DHS) 与来自 DHS 地理定位数据库的气候数据进行了合并。研究结果表明，撒哈拉以南地区家庭腹泻发生率的 77.7% 是由于集群之间的气候差异造成的。还，居住在腹泻发病率高的集群中的家庭发生腹泻病例的可能性是居住在腹泻发病率低的集群中的家庭的 1.567 倍。此外，当平均气温和降雨量增加时，使用未经改善的卫生设施或未经改善的水的家庭出现更多腹泻病例。对于 SSA，多层次分析的结果表明在两个层次都采用了；宏观（国家）和微观（家庭）水部门的气候变化适应措施，以减少腹泻的流行。多层次分析的结果表明在两个层次都采用了；宏观（国家）和微观（家庭）水部门的气候变化适应措施，以减少腹泻的流行。多层次分析的结果表明在两个层次都采用了；宏观（国家）和微观（家庭）水部门的气候变化适应措施，以减少腹泻的流行。