Diarrhea has been one of the major causes of morbidity in under-five children in Malawi. About 86% of the population lives in rural areas where poverty is very rife. The aim of the study was to investigate environmental, demographic and socio-economic factors associated with diarrheal morbidity in under-five children in Solola, one of rural areas of Malawi.

A cross-sectional study was conducted in seven villages of Solola area, from 10th November to 29th November 2003. A total of seven from thirty-three villages, and thereafter 302 children were recruited using systematic sampling whose mothers totaling 261 were interviewed using a questionnaire. An observational guide was used to gather more information regarding environmental factors.

About 41% of the children had diarrhea out of which 73% and 27% were watery and bloody diarrhea respectively. Only 36% was ongoing diarrhea. About 60.3% (182/302) of children were living in an environment of an overall poor sanitation/rubbish disposal; 72.1% (217/301) in that of poor food hygiene related practices; and 80.4% (242/251) in that of poor drinking water handling practices.

Low education and poor knowledge (about diarrhea) among mothers, inadequate breastfeeding, poor care of hands after defecating, shorter distance to latrine from house, sharing of latrines, unsafe disposal of feces/garbage, unsafe water source, sharing hand-washing water at meals, and uncleanliness of kitchen were significantly associated with diarrhea morbidity in the children (X² test = p<0.05).

The unavailability of safe water, lack of knowledge and having been used to not treating water before use, laziness and not being used to using a rubbish pit, and gender were the main reasons among mothers for not using good practices regarding water and sanitation/rubbish disposal.

The community including mothers must be adequately educated or informed about the importance of using good hygiene practices regarding water, sanitation and food preparation to reduce or control diarrhea. Provision of safe water and more education to women is also important in combating diarrhea in rural areas.