Diarrhoeal disease is one of the leading causes of mortality among under-5 children globally and affects the low socio-economic population. Objectives This study aimed at evaluating the socioeconomic differences in the prevalence and its effect on the treatment of diarrheal disease in children in the different geopolitical zone in Nigeria. Methods Data of children under-5 from the 2018 Nigeria Demographic and Health Survey (NDHS) was used. A total of 30,068 women, that had at least a child

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... -5 year of age and answered diarrhoea specific questions were analysed for the prevalence, while data on 3885 children that reported symptoms of diarrhoea during the 2 weeks preceding the NDHS survey interview were analysed for treatment intervention offered during diarrhoea episodes. Logistic regression models adjusted for socio-demographic factors were used to study the association. Results The overall prevalence of diarrhoea was 12.9% with the highest prevalence in the North East (24.7%), among the poor (17.1%) and the children of uneducated mothers (16.4%). Compared to South-West region, children in North-East (AOR 4.64, 95% CI 3.90, 5.51), North-West (AOR 2.34, 95% CI 1.97, 2.78) and North Central (AOR 2.02, 95% CI 1.69, 2.42) had a high likelihood of having diarrhoea. Children from a poor household (AOR 1.49, 95% CI 1.31, 1.70) had more chance of having diarrhoea. Children in North-East (AOR 2.11, 95% CI 1.49, 3.01) and North-West (AOR 2.52, 95% CI 1.77, 3.60) were more likely to receive treatment in a health care facility and also had less likely to receive more amount of drink and food during diarrhoea compared to South-West region. Conclusions Diarrhoea prevalence is high in Nigeria with significant regional difference both in the prevalence and treatment of diarrheal disease which is also associated with household socio-economic status.