Prevalence Of Diarrhea Among Children Age 0-5 Years

Project and Seminar Material for Public Health

Abstract

Diarrhoea is among the major causes of mortality among children under five years of age. Majority of these deaths are as result of dehydration and mismanagement. This study aimed to investigate prevalence of diarrhea among children age 0-5 years. The objectives of the study were to: determine prevalence rate of diarrhoea, knowledge on diarrhoea, practices on management of diarrhoea, and the association between knowledge and practices in management of diarrhoea. Failure of caregiver to have the knowledge in identification of four critical times of handwashing increases chances of having a child suffering from diarrhoea by 4.16 times and those who reported unsafe drinking water is a predisposing factor, their child is 0.98(p= 0.0031,95% C.I 0.77-1.096) times less likely to suffer from diarrhoea. Caregivers who gave ORS and Zinc reduced progression of diarrhoea by 49% and 17.8% respectively and those introduced complementary feeding before age of 6 months were 27% times more likely of getting diarrhoea than the one who did after 6 months. The study recommends the Ministry of health to formulate programs that would help to address diarrhoeal disease (DD) among the children aged between 6 and 59 months to help educate mothers on identification of signs and symptoms, causes, preventive measures and management practices of diarrhoea.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Limitation of the Study
1.8 Definition of Terms
1.9 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background to the Study

Diarrhea is one of the leading causes of morbidity and mortality, especially among children under the age of five years. Globally, as many as 800,000 children die each year from diarrhea, with most deaths occurring in developing countries (Bhutta. A.Z, 2013). Diarrhea is defined as the passage of three or more watery or loose stools per day, or more frequent passage than is normal for an individual. This is contrary to passage of frequent formed stools or the loose pasty stools passed by breast fed babies. It is both preventable and treatable. It is also a leading cause of malnutrition in children under five years old (WHO, 2013).

Diarrheal disease affects human life both in developed and developing countries. Acute diarrhea is one of the main problems affecting children under- five in the world, reducing their well- being, and this leads to a considerable demand for health care services. Despite the fact that it affects both developed and developing countries, it is evident that there is a strong relationship between diarrhea, poverty and unhygienic environmental conditions (Mohammed.S, 2013).

According to statistics by World Health Organization (2013), children under three years of age in developing countries experience on average about three episodes of diarrhea every year. As a result diarrhea is a major cause of malnutrition, and the most severe threat posed by diarrhea is dehydration. Death can follow severe dehydration if the lost body fluids and electrolytes are not replenished. A Significant proportion of diarrhea can be prevented through safe drinking water, good sanitation and hygiene.

Diarrhea can be caused by numerous pathogens and transmitted through multiple vehicles. Some of the most common pathogenic causes of severe and fatal diarrhea in young children globally are rotavirus and shigella. Rotavirus takes the lives of over 3,600 children under five years and accounts for approximately 40% of all deaths caused by diarrhea (CIDRZ, 2013).

Risk factors for diarrhea among children include age, sex, geographic location, drinking from unprotected water supply and household economic status. While poor sanitation, limited access to potable water, inappropriate breast feeding practices contribute to the burden of the disease, there continues to be the need to further document the socio-demographic correlates of diarrhea in order to inform policy and programmatic interventions that have potential to stem the prevalence of the disease (Siziya et al, 2013).

Many studies including cohort and case control studies on diarrhea and associated factors have been done in developed and undeveloped (developing countries) and most of them were based on small hospital and community based studies. Furthermore, the prevalence and correlates of diarrhea may vary with season, geographical area and between countries (Siziya et al, 2013).

Persons living in developing countries with poor access to safe water, sanitation, or hygiene infrastructure have increased risk of exposure to viral, bacterial and parasitic pathogens that can cause diarrheal diseases (Rohmawati, 2010).

Inappropriate child feeding practices has also a major public health problem resulting in series of social and economic consequences especially in developing countries.

In Ebonyi, the prevalence of diarrhea is at 16% (non-bloody), and 3% (bloody) second to fever (21%) among the children under-five years (CSO, 2014). Approximately, 15,000 Ebonyin children under- five years suffer at least three or more episodes of diarrhea every year (Chilambwe et al, 2014) Identifying the causes of diarrhea is very crucial for the effective implementation of child health intervention programs for policy formulation and the general assessment of resource requirements and intervention prioritization in any nation. Therefore, this study was conducted to identify the risk factors for the occurrence of childhood diarrhea among children aged between 0–59 months in Ebonyi. No study has been done in Ebonyi that utilized the 2013-14 survey data to investigate the factors associated with diarrhea among under- five children.

Hence, the aim of this study was to assess the factors associated with childhood diarrhea using a large sample size from a community -based survey. This gives high power to the results obtained from the study because of the sample size, (Rowe et al, 2008). This dissertation has other sections including methods, results, discussion, conclusion, and limitations.

1.2 Statement of the Problem

Diarrhea is still responsible for high rates of mortality in children worldwide. Reducing child mortality is the 4th of the United Nations Millennium Development Goals (MDGs). The Millennium Development Goals recognize child health and survival as an important socio- development issue. It is estimated that one in ten children dies before the first birthday, and one in five before their fifth birthday (UNICEF, 2013). However, despite advances it was reported that at the current pace, the world would not meet the MDG target (UNICEF, 2013). In place of these goals, the United Nations (UN) came up with 17 sustainable development goals (SDGs) to transform our world by 2030. Some of the goals are important for this study as they address some of the variables that were identified to be determinants of diarrhea. Goal three emphasizes good health and well-being for all at all ages, goal four emphasizes quality education, goal six emphasizes clean water and sanitation and goal one which emphasizes no poverty.

The problem of diarrhea is a more complex problem in most of the low income countries due to increasing poverty levels (CIDRZ, 2013). An outstanding feature of diarrheal diseases in the developing world is that the frequency is more during and after the weaning period (Himonga, 1996). The number of diarrheal cases is still on the increase in many countries, especially in the sub-Saharan region, Ebonyi inclusive. Global organizations like World Health organization (WHO) and United Nations (UN) have put up a number of strategies and treatment procedures to control under-five child morbidity and mortality, which have been adopted by many countries.

Strategies like the Integrated Management of Childhood Illnesses (IMCI) strategy was introduced in Ebonyi in 1995 by the Central Board of Health (CBOH) in collaboration with other cooperating partners like, United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) (Chitembo, 2003). “One of the 16 key family practices promoted within IMCI is to dispose of feces safely, and wash hands with soap and water after defecation and before preparing meals and feeding children” (WaterAid, 2009). In principle therefore, sanitation should be adequately addressed within IMCI. However, in resource-poor context the preventive health elements of IMCI have been marginalized as over- stretched and under-resourced health workers are faced with long queues of sick patients outside their health centre.

This marginalization of the preventive measures against diarrhea such as sanitation has led to a reduced effectiveness of health systems and poor global progress on Millennium Development Goal (MDG4) number four (WaterAid, 2009).

Sanitation and hygiene are both essential barriers that prevent the transmission of disease by the fecal-oral route. Sanitation in particular has not been given adequate consideration by health policy makers despite evidence of its cost-effectiveness. Currently, there are almost one billion people without safe water and a staggering 2.5 billion without adequate sanitation. Faster and more cost-effective reductions in child mortality would be achieved in the long-term by promoting sanitation alongside safe drinking water as well as expanding ORT coverage and the other interventions (WaterAid, 2009).

The lack of targeting at the global level recurs at the national level. While Ebonyi has made significant reductions in child mortality over the last 10 years, financial flows are not addressing child survival priorities adequately. The Ministry of Health notes that “over 80% of the health conditions presented at health institutions in Ebonyi are diseases related to poor environmental sanitation”, yet environmental health is given little priority in its budgeting (MoH, 2010).

There is evidence that in Ebonyi the under-five diarrheal disease is still a public health concern as has been shown by the Ebonyi Demographic Health Survey (ZDHS) 2013-14 report. According to the 2007 ZDHS report, diarrhea was reported to be at 16% (CSO, 2007). The current report also states that diarrhea is second (16%) cause of morbidity and mortality, the first being fever of all types at 21% (CSO, 20140). This called for concern as it indicated health systems failure and poverty which are contributing factors to the problem of diarrhea among under-five children.

1.3 Objective of the Study

The main objective of the study is to examine the prevalence of diarrhea among children age 0-5 years. Specific objectives are

To explore the association of children’s socio-demographic characteristics with diarrhea among under-five children in Ebonyi.
To determine the association of mother’s socio-economic characteristics with diarrhea among under-five children in Ebonyi.
To explore the association between environmental factors and diarrhea among under-five children in Ebonyi.

1.4 Research Question

What factors are associated with diarrhea among under-five children in Ebonyi?
What is the the association between environmental factors and diarrhea among under-five children in Ebonyi?

1.5 Significance of the Study

Since it has been shown that diarrhea has continued to be a public health problem globally, UN decided to introduce 17 sustainable development goals (SDGs) which were adopted by many countries to end poverty, protect the planet and ensure prosperity for all. Goal three (3) states that we need to ensure healthy lives and promote well-being for all at all ages. Reducing the prevalence of diarrhea is part of this goal as it focuses on health promotion for all.

Therefore, the study sought to identify the factors that are associated with its occurrence among children under the age of five years. The factors identified would help in strengthening the implementation of already existing policies, revising them as well as dissemination of health promotion messages to all.

This study is fundamental in addressing poor child health outcomes as understanding the level of knowledge and practices of caregivers with children between ages of 0-5years, allows for awareness creation that will create a strong basis for effective Behaviour Change and Communication (BCC).

This would supplement the knowledge concerning child health in developing countries, broadening the understanding on ways to address the reduction child mortality. Mothers especially childbearing women will benefit from the result of the study as it will provide them with appropriate information concerning diarrhea in children.

1.6 Scope of the Study

The study was about diarrhea among the under-fives. It looked at the prevalence and factors associated with diarrhea among this vulnerable but important age group as far as MDGs and SDGs are concerned. This study on the prevalence of diarrhea among children age 0-5 years will be carried out in Abakaliki the state capital of Ebonyi state.

1.7 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

1.8 Definition of Terms

Diarrhoea:

Diarrhoea is usually caused by a virus, or sometimes, contaminated food. Less frequently, it can be a sign of another disorder, such as inflammatory bowel disease or irritable bowel syndrome..

Prevalence:

In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition at a specific time.

1.9 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
Chapter three deals on the research design and methodology adopted in the study.
Chapter four concentrate on the data collection and analysis and presentation of finding.
Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

Summary, Conclusion and Recommendations

5.1 Introduction

This chapter presents the summary of major findings, gives conclusion and recommendations based on findings and suggest areas of further research. The summary was done in line with the objectives of the study based on the output of the descriptive and inferential statistical analyses.

5.2 Summary of Findings

The demographic characteristics indicated that the mean age of the respondents range was 31.07 years; this showed that the caregivers were mature enough to be able to provide responses needed in the study. Of the respondents 87 (43.5%) were in the age group 28-37years, 147(73.5%) married, 91 (45.5%) housewives, 164 (82%) had 2 children below 5 years and 56% had between 6-10 people living in the house. The socio- demographic variables helped in determining the association with prevalence of diarrhoea among caregivers with children aged 0-5 years.

The study findings revealed a prevalence rate of 47%. Findings showed that the distribution of diarrhoea cases 42(45%) were from caregivers who were aged 28-37 years and 49(52%) were housewives. This was found to be similar with a study in Ethiopia by Bezatu et al., (2013) which found majority of the mothers whose children had diarrhea were aged 25-34 years and were housewives 49(52%). Furthermore, the study those who had more than five people living in the house had 62(66%) and those who do not own a latrine 50(53%) had children suffering from diarrhoea. This study proves that crowded housing conditions and lack of a latrine play a major role in diarrhoea occurrence as stated by Waddington (2009).

The study findings showed that of the 200 caregivers majority 125 (62.5%) identified dehydration as a symptom, 87(43.5%) unsafe drinking water as a cause and only 19 (9.5%) could identify handwashing as a preventive measure of diarrhoea. In general, the findings show majority of caregivers had low level of knowledge regarding symptoms, causes and preventive measures. This has been observed in other studies in Iran (Ghasemi,2013), Kenya (Othero,2008) and India (Shah,2012). Community health workers play a major role in providing first line treatment to sick children, the study found 30% of the caregivers‟ sough information and help from CHW‟s. This is in line with findings reported by UNICEF (2012) on the state of world‟s children.

The results showed that 114(57%) of the caregivers used tea for treating diarrhoea, 89(44.5%) administered fluids as usual, 179(89.5%) breastfed with 43(21.5%) exclusively breastfed, 175(80%) introduced complementary feeding before the age of 6 months and 99 (49.5%) disposed the child fecal matter in latrine. This was found to be the similar in a study done in Indonesia. (Usafar, 2010)

Caregivers‟ knowledge and practices play key roles in the management of diarrhoea in children. Having adequate information regarding diarrhoea and its management helps caregivers take appropriate measures which in turns help their children to be healthy.

Findings show that caregivers who had knowledge on vomiting and dehydration as symptoms of diarrhoea were found more likely to suffer from diarrhoea by 1.096 (p=0.0424 95% C.I= 0.897-1.274)) and 1.23(p=0.0214, 95% C.I=1.131-1.598) times respectively. This was similarly found in a study done in India by Patel (2012) where dehydration had an odd ratio (OR) of 1.32.

The study found that caregiver with knowledge that unsafe drinking water is a predisposing factor; their child is 0.98 times less likely to suffer from diarrhoea. Knowledge that unsafe fecal disposal is a preventive measure decreases the chances of a child suffering from diarrhoea by 0.39 times. Failure of the caregiver to have the knowledge in the identification of four critical times of handwashing as a preventive
measure increases chances of having a child suffering from diarrhoea by 41.6%. This was similar to a Cochrane review done by (Ejemot-Nwadiaro et al., 2015).

This study found for caregivers who sought health information on diarrhoea from a CHW their child were 0.833 times less likely to develop diarrhoea This means caregivers were taught on identification of signs ,health seeking behaviors and feeding practices of diarrhoea management. In terms management the study found that a caregiver whose child suffered from diarrhoea, used ORS, and Zinc the progression of diarrhoea reduced by 49% and 17.8% respectively.

In terms of nutrition practices a caregiver who had introduced complementary feeding to their children before age of 6 months was 27% times more likely of getting diarrhoea than the one who did after 6 months. This was found to be similar in a study done by (Ogbo et al,. 2017).

5.3 Conclusions

The following conclusions have been drawn from the findings of this study.

The study revealed about half of the children in the study had diarrhoea, which is high and needs to be addressed with a matter of urgency by the responsible authorities.
Caregivers‟ knowledge on identification of diarrhoea symptoms, its causes and preventive measures among children aged 0-5 years were low.
The study revealed that the caregivers‟ practices in management of diarrhoea among children aged 0-5 years were poor.
The findings in the study revealed that several predictors on knowledge and practices on diarrhoea management played a key role in prevention or progression of diarrhoea in children aged 0-5 years.

5.4 Recommendations

Based on the conclusions, the study recommends the following;

Creation of programs such distribution of ORS and Zinc supplementation by the Ministry of health that would help to address diarrhoeal disease (DD) among the children aged between 6 and 59 months in Ceelafweyn district since prevalence rate of 47.5% is high.