The Causes, Effect and Prevention of Diarrhea Among Children

The Causes, Effect and Prevention of Diarrhea Among Children

CHAPTER ONE

Objectives Of Study

1. To determine the causes of diarrhea among children 1-5 years in Urhezen community in Ovia south West L.G.A., Edo state, Nigeria.
2. To assess the effect of diarrheal disease among in Urhezen community in Ovia south West L.G.A., Edo state, Nigeria.
3. To assess the attitude of caregivers towards prevention of childhood diarrheal disease in Urhezen community in Ovia south West L.G.A., Edo state, Nigeria.

CHAPTER TWO

LITERATURE REVIEW

The Burden of Diarrheal Diseases in Children

Each year, an estimated 2.5 billion cases of diarrhea occur among children under five years of age, and estimates suggest that overall incidence has remained relatively stable over the past two decades (Boschi Pinto, 2009). More than half of these cases are in Africa and South Asia, where attacks of diarrhea are more likely to result in death or other severe outcomes.

The incidence of diarrheal diseases varies greatly with the seasons and a child’s age (UNICEF/WHO, 2009a). The youngest children are most vulnerable; Incidence of diarrhea is highest in the first two years of life and declines as a child grows older (WOH/UNICEF, 2011a; WHO, 2009c)

Mortality from diarrhea has declined over the past two decades from an estimated 5 million deaths among children under five to 1.5 million deaths in 2004 which parallels downward trends in overall under-five mortality during this period (Boschi Pinto, 2009). However, diarrhea remains the second most common cause of death among children under five globally following closely behind pneumonia, the leading killer of young children (UNOCH,2018). Together, pneumonia and diarrhea account for an estimated 40 percent of all child deaths around the world each year. Nearly one in five child deaths is due to diarrhea, a loss of about 1.5 million lives each year. It is greater than deaths caused by AIDS, Malaria and Measles combined. Africa and South Asia are home to more than 80% of child deaths due to diarrhea (UNOCH,2018; UNICEF/WHO, 2009a). Just 15 countries account for almost three quarters of all deaths from diarrhea among children under five years of age annually (UNICEF/WHO, 2009a).

In Nigeria, diarrhea is the second most common cause of under-five mortality in Nigeria and it is 19% of all deaths of children aged less than 5 years (WHO/UNICEF, 2011a). Infants are particularly susceptible to severe diarrhea with fatal outcome due to unsafe drinking water or when given substitutions for breast milk prepared with unsafe water (UNOCHA, 2018). In this way the infant is exposed to harmful pathogens at an early stage and may soon suffer from acute diarrhea because of delay in commencement of breastfeeding until several days after delivery and the fact that newborn baby’s are given sugar-water prepared with unsafe water (FSNAU, 2007). The fatal course of diarrhea is very often combined with malnutrition. Nigeria is among the seven most affected countries in the world in terms of mortality resulting from rotavirus caused diarrhea (WHO, 2009b).

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CHAPTER THREE

RESEARCH METHODOLOGY

Study Design

This study adopted a cross-sectional descriptive study design utilizing mixed methods approach where both quantitative and qualitative data were collected at the same time.

Study Population

The study population consisted of children 1-5 years and their caregivers living in Urhezen community in Ovia south West L.G.A., Edo state, Nigeria.

Inclusion and Exclusion Criteria

Inclusion criteria

Any consented households with children below five years in the Urhezen community in Ovia south West L.G.A. were included in the study.

Exclusion criteria

Households were excluded in the study if:

1. They had children above 5 years of age,
2. They had children 1-5 years of age who were critically ill,
3. The caregivers refused to consent.

CHAPTER FOUR

RESEARCH FINDINGS

Socio-demographic characteristics of participants

A majority of participants were mothers (88.7%), followed by fathers (10.2%), and only 1.2% were grandparents. The majorities of the participants were aged between 18 and 35 years (72.5%), married (78%) and had no formal education (76%). The median age of the caregivers was 30 (IQR=11) years. Most household were headed by men (72%). Slightly more than a half of sampled households had unemployed caregivers (57%). About 79% of the household had more than 4 members, and the mean household size was 6.59 members.

Prevalence of diarrhea among children 1-5 years

The study found that 20.8% (95% CI: 16.8 – 25.6) of participating caregivers reported that their children had experienced at least one episode of diarrhea 14 days prior to the study.

CHAPTER FIVE

DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS

Discussions

The main objective of the study was to determine the causes, effect and prevention of diarrhea among children 1-5 years in Urhezen community Ovia south West L.G.A., Nigeria.

The prevalence of diarrhea among children 1-5 years in Ovia south West Urhezen community was 20.8% (95% CI: 16.8 – 25.6). These findings suggest that one in every five children living in Ovia south West Urhezen community are at risk of dying from diarrheal disease. This finding is in line with Nigeria prevalence of diarrhea in children 1-5 years which is 19% (WHO/UNICEF, 2011a). However, this result was lower than 33% of prevalence of diarrhea among children 1-5 years in Dharkenley Urhezen community in Nigeria (Yusuf, 2018). Furthermore, the finding was also lower than 43.3% of prevalence of diarrhea among children under five years in refugee camps in Uganda (Izale, 2015).

More than 70% of caregivers in this study were aware of the main symptoms of diarrhea among the under 5 years’ old children as being loose stools and dehydration. The loose stool and dehydration leads to excessive loss of fluids and minerals from the body (WHO, 2005a; Mobalk .2000; Guerrant & Van Gilders, 2001). However, this study focused only on reported causes of diarrhea among children 1-5 years and did not investigate the microbiological. The findings from this study suggested that diarrhea in children was caused by germs and worm infestation. This is in line with other studies which reported that diarrhea is likely to be caused by infectious agents, such as, bacterial, worm or viral invasion (Amerine & Keirsey, 2006; Blanca Ochoa, 2012; David, 2013). These agents are spread by poor hygiene, drinking dirty water and eating contaminated food. Local communities are characterized by high population density, poor sanitation and inadequate WASH programs. The spread of diarrhea through eating contaminated food or drinking dirty water, or poor hygiene has been observed in other similar studies (WHO, 2013; Tefera Belachew, 2001; UNICEF/WHO, 2009a; Kakulu, 2012; Edward Buzigi, 2015). Correct knowledge on the causes of diarrhea as well as its mode of transmission is critical in prevention of the diarrhea in children. It helps caregivers understand the route cause and spread of the disease.

The factors that were significantly associated with diarrheal disease among children 1-5 years in this study were the age of the child, caregivers’ marital status and the water, sanitation and hygiene practices.

In this study, younger children below 25 months of age were more likely to experience diarrheal disease than the older children. These findings from Ovia south West Urhezen community were expected from an Urhezen community settlement environment which are often densely populated with poor water and sanitation facilities. These findings are in agreement with other studies (Alambo, 2015; Bezatu Mengistie, 2013; Thomas, Getahun, & Alemayehu, 2014). When children start moving around the house and feed on other foods apart from breast milk they are exposed to organism causing diarrhea. Furthermore, young children are at risk of ingesting contaminated materials which they pick from the environment. The risk of diarrhea, however, decreases after the age of 25 months probably because the children begin to develop immunity to pathogens after repeated exposure (WHO/UNICEF, 2011a; WHO, 2009c).

Conclusions

There is high prevalence of diarrhea among children in Urhezen community in Ovia south West L.G.A. in Nigeria. The diarrhea is more likely to occur among children who are less than 25 months of age. Other factors that are independently associated with diarrhea in Ovia south West Urhezen community are the caregivers’ marital status, as well as their water, sanitation and hygiene practices.

Recommendations

1. The government, the community and health and WASH implementing agents in Nigeria should consider:
2. Increasing awareness on care for the children under 25 months of age who are most vulnerable to diarrhea.
3. Increasing awareness among the caregivers in Ovia south West Urhezen community on appropriate hand washing
4. Creating awareness among the caregivers on treatment and use of treated water in the households for food preparation and drinking.
5. Increasing awareness among the population of Ovia south West Urhezen community on important of use toilet facilities in disposal of feacal
6. More rigorous qualitative studies should be conducted in the Ovia south West Urhezen community to understand the factors associated with diarrhea among children under five years of age.

References

• Alambo. (2015). The Prevalence of Diarrheal Disease in under Five Children and associated Risk Factors in Wolitta Soddo Town, Southern, Ethiopia. ABC Research Alert, Vol 3, Number 2/ 2015.14-22.
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• Amerine & Keirsey, M. (2006). Managing acute diarrhea. Nursing 2006.
• APHRC. (2002). Health and Livelihood Needs of Residents of Informal Settlements in Edo City. Edo: African Population and Health Research Center (APHRC).
• Ayuk, Leonie, & Nchang. (2015). Childhood Diarrhea Determinants in Sub-Saharan Africa: A Cross Sectional Study of Tiko-Cameroon. Challenges — Open Access Journal, 6, 229-243;.
• Bani, Saeed, & Othman. (2002). Diarrhea and child feeding practices in Saudi Arabia. Public Health Nutr, 2002 Dec; 5(6):727-31.
• Bbaale. (2011 ). Determinants of diarrhea and acute respiratory infection among under-fives in Uganda . Australasian Medical Journal , [AMJ 2011, 4, 7, 400-409.
• Bezatu Mengistie. (2013). Prevalence of diarrhea and associated risk factors among children under-five years of age in Eastern Ethiopia: A cross-sectional study. Open Journal of Preventive Medicine, Vol.3, No.7, 446-453.
• Black R.E., Allen L.H. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet , 2008; 371: 243–260.
• Blanca Ochoa. (2012). Diarrheal Diseases – Acute and Chronic. Seattle: American college of Gasterology.

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