The health of under-five children is a major health challenge worldwide. To alleviate the problem, several interventions have been tried for the past two decades. Though there was substantial progress in reducing mortality rate, from 87 deaths per 1000 live births in 1990 to 51 in 2011, the pace has been slow or even reversing, particularly in many sub-Saharan African countries [1] . Of the estimated 10.6 million under-five deaths worldwide, about 42 percent occur in African region. This figure is seven times higher than the burden in the European region [2] [3] . Ethiopia ranked among the top five countries in the world in the absolute number of annual deaths in under-five children [4] .

Diarrhoea has been a potential bottle-neck in reaching the Millennium Development Goal (MDG) target. Together with pneumonia, it is responsible for 29% of all child deaths [5] [6] . The burden of childhood diarrhoea in Ethiopia is well known. Several epidemiologic studies were conducted [7] -[12] . Findings of these studies indicated that diarrhoeal disease in children was one of the highest in the world, and it is mostly associated with personal and environmental hygiene.

Currently, several interventions are going on to reduce child morbidity, and mortality in Ethiopia. According to the report of Federal Ministry of Health, water supply and sanitation coverage has increased. Health exten- sion package has been implemented and scaled up for both rural and urban areas in the country which aims to empower the community to prevent classical infectious and parasitic diseases [13] . By implication, these interventions are expected to decrease diseases of poverty such as diarrhoea, intestinal worm infestation, and trachoma.

Most of these studies conducted in Ethiopia focus on rural areas [7] -[12] . Therefore, data are needed to see the progress especially in urban areas. The current study aimed at determining the magnitude and associated factors of diarrheal disease in the city administration of Bahir Dar. The finding of this study would help decision makers know the current prevalence of childhood diarrhoea which could in turn serve as a mirror to reflect successes or failures of interventions applied so far. The lesson derived from the disparities of interventions vis-à- vis outcomes regarding health gains could pass meaningful messages for international readers too.

The major objective of the present study was to assess prevalence and correlates of diarrheal disease among under-five children in an urban set up. It revealed that the two weeks prevalence of diarrhoea was 21.6%. This finding was in line with the findings in Adami Tulu [7] , North Gondar district [8] and Mecha district [9] where the prevalence rate was 22.7%, 20.7%, and 18%, respectively. Previous reports from Southwest Ethiopia (Nekemte, 2008) [10] and (Mana district, 2000) [11] where the prevalence was 28.9% and 33.7%, respectively were even worse than findings of the current study. The present study reconfirms that diarrhoeal diseases in under five children remains rampant in rural as well as in urban set ups.

The fact that the prevalence in the current study is similar to reports from Adame Tulu (1996) [7] and North Gondar Zone (2001) [8] clearly demonstrated that changes are very minimal over decades, and Ethiopia has a long way to go to eliminate this disease of poverty.

The most important predictors of diarrhoea in under-five children were personal and environmental hygiene as well as socioeconomic factors. Children from rural households were 2.82 times (95%CI: 1.66, 4.81) more likely to experience diarrhoea than those in urban households. This result was in line with the finding in Keffa Sheka Zone [12] . This might be associated with differences in access to water, sanitation and hygiene. The access for the above services in urban setting was better than that in rural settings. Hence this difference might be responsible for the low prevalence of diarrheal disease among under-five children in urban setting compared with the prevalence in those who were rural [15] .

Children from households whose monthly income was below 1500 Ethiopian birr were at a higher risk to develop diarrhoea than in those who earn above 1500 Ethiopian birr. This was also in agreement with the findings in Keffa Sheka and Eritrea [12] [16] .

In addition, children in households where human excreta was observed in the compound were 1.89 times (95%CI: 1.159, 3.07) more likely to develop diarrheal diseases than in those where no human excreta was observed. This finding was in line with the study undertaken in Nekemte [10] . This is logical that improper disposal of human excreta increases the chance for pathogenic microorganisms including the causes of diarrheal diseases to infect humans especially children [17] .

A lot has been said about success of Ethiopian Health System especially following implementation of Health Extension Package [18] [19] . Nearly 40,000 health workers are deployed across the nation to give health education by going house to house. The final goal of this mammoth national undertaking in Ethiopia is to empower households to prevent classical poverty diseases. However, the prevalence of classical poverty diseases such as diarrhoea [7] -[12] , intestinal parasites [20] trachoma [21] remains rampant. According to these studies, prevalence of childhood diarrhoea ranged from about 18% to over 30% while intestinal parasites and trachoma had a 70%, and nearly 25%, respectively.

This disparity between investment in health and comparatively low outcome in health gain require through investigation for it will be the basis for future planning.

The most important limitation of this study is that it is not supported with identification of aetiologies of diarrhoeal diseases in the study area in addition to the limitation of the study design-cross sectional. Moreover, the strength of this study design could have been enhanced had it been supported with qualitative data to answer the why questions.

Despite several interventions over decades, diarrhoeal diseases remain serious public health challenge in rural as well as urban set ups in Ethiopia with particular reference to Bahir Dar City. Therefore, interventions and strategies applied so far to eliminate diseases of poverty including diarrhoeal diseases should be re-visited.

We are very grateful to Bahir Dar University, and GAMBY College of Medical Sciences for opening Joint MPH program which motivated the staff to be engaged in research work. We thank the Regional Health of Amhara National regional Sate for writing permission letter. We would like to extend our heartfelt gratitude to study participants, data collectors, and supervisor without their cooperation this work could not have been completed.

There is no any conflict of interest.