SSEMWOGERERE TADEO2026-11-022026-11-022026-10-06SSEMWOGERERE TADEO(2026),PREVALENCE AND FACTORS ASSOCIATED WITH ACUTE WATERY DIARRHOEA IN CHILDREN AGED UNDER-FIVE YEARS WITH SEVERE MALNUTRITION AT GULU REGIONAL REFERRAL HOSPITAL, GULU CITY, UGANDA.http://hdl.handle.net/20.500.14270/1102Background: Diarrhoea remains a leading cause of death among children under five years, and the risk is highest in children with severe acute malnutrition (SAM). This study determined the prevalence of acute watery diarrhoea (AWD) and its associated factors, and the prevalence of dehydration and shock, among children under five years with SAM at Gulu Regional Referral Hospital (GRRH), Uganda. Methods: A hospital-based cross-sectional study was conducted among 425 children under five years admitted with SAM at GRRH between July and September 2025. Every second eligible child was selected by systematic random sampling. Data were collected from caregivers using an interviewer-administered questionnaire, and dehydration was assessed at recruitment by a trained nutritionist. AWD was defined as three or more loose or watery stools in 24 hours on any day in the two weeks before the interview. Data were analysed using Stata version 18. Modified Poisson regression with robust standard errors was used to estimate crude and adjusted prevalence ratios (aPR). Variables with p<0.20 at bivariable analysis, together with child age, sex and maternal age, were entered into the multivariable model, and p<0.05 was considered statistically significant. Results: The median age of the children was 15 months (IQR: 8–25) and 52.5% (n=223) were female. The prevalence of AWD was 45.6% (95% CI: 40.9–50.4). Use of wells as the main source of drinking water (aPR: 1.31, 95% CI: 1.01–1.70) and caregiver-reported immunisation (aPR: 1.62, 95% CI: 1.03–2.54) were independently associated with AWD. Maternal education was associated with AWD at bivariable analysis but not after adjustment (p=0.063). Dehydration was present in 13.2% (95% CI: 9.9–16.4) of all children and in 28.4% of those with AWD; moderate dehydration was the most common grade (44.6%). Shock was not recorded separately from dehydration, so its prevalence could not be estimated. Conclusions: Nearly half of the children admitted with SAM had AWD and about one in eight was dehydrated. Drinking water from wells was the main modifiable factor associated with AWD. Every child with SAM should be screened for recent diarrhoea, dehydration and shock at admission, and household water safety should be part of caregiver counselling. The positive association with immunisation most likely reflects care-seeking behaviour and selection into the hospital sample rather than an effect of vaccines.enAcute Watery Diarrheal diseasedehydrationsevere acute malnutritionunder-five childrenprevalenceassociated factorsUgandaThesis