PREVALENCE OF DIARRHEA AMONG CHILDREN (1-5YRS) IN NGOR OKPALA
Background:Diarrhoea disease is a worldwide public health issue and it was responsible for approximately 751,000 childhood deaths in 2010. Low and middle-income countries (LMIC) of Africa and part of Asia are more affected. Risk factors for diarrhoea have important implications for planning suitable interventions and appropriate strategies to decrease the impact of the disease.
Methods: This is a primary data analysis design that involved 7856 under five years children from 12,793 households in NgorOkpala, Imo State, Nigeria. Data analysis was done with SPSS. Descriptive statistics were computed to obtain the prevalence of diarrhoeal among under five. Additionally, to identify risk factors associated with diarrhoea, univariate and multivariate analysis were computed.
Results: The result obtained showed prevalence of diarrhoea occurrence was 12.1% and Children in the age range between 6 – 24 months were more at risk (OR= 2.942; CI=2.392 – 3.617; p<.001). The study found that wealth index plays important roles in childhood diarrhea includes poorest (OR=2.036; CI=1.618-2.562; p<0.001), poorer (OR=1.913; CI=1.510-2.424; p<0.001) and middle (OR=1.459; CI= 1.135-1.874; p<0.003). The more people are poor the more the risk of childhood diarrhea. Access to improved facilities decreased the risk of contracting diarrheic diseases (OR= 0.703, CI=0.607- 0.815, p<0.001). The same applies for child immunization with rotavirus vaccine; immunized children are less likely to develop diarrheic diseases (OR=0.377; CI= 0.317 – 0.488; p<.001). Prevention and control measures are needed to obtain a lasting solution to diarrhea diseases.
This chapter describes the background, problem statement, significance of the study, research objectives including specific objectives and research questions, and organization of the study.
This study is intended to come up with the general picture of the study.
Diarrhoea is among top ten killers worldwide and causes 11% of child deaths globally (Services, 2013 P.2). In addition, UNICEF (2016) reported that global diarrhoea mortality in children under five years old accounted for 9% in 2015. According to WHO, 2017 (Factsheet Nᵒ 330) diarrhoea deaths in children under five reach 525,000 and children global diarrhoea cases was 1.7 billion every year. In the last decade, global diarrhoea was responsible for 1.7 million deaths per year among children under 5 years (Walker, et al. 2013, p. 4). Many cases are from low and middleincome countries (Ejemot-Nwadiaro, et al. 2015, p. 6) of Africa and part of Asia (Murray, et al. 2012 p. 2).
For example, a study conducted in Tanzania indicated that the incidence of the diarrheal disease was estimated at 6.1% and affected mostly children aged between 12 to 23 months (11.6% to 15.8%) (Mashoto, et al. 2014 p.1). A study conducted in Burundi found that diarrhoea episodes affected 32.6% of children under 5 years old (Diouf, et al. 2014 p. 1). In Uganda, diarrhea affected 32 to 48% of children under 5 years in the two weeks preceding Uganda Demographic and Health Survey (UDHS, 2011 p.400).
Diarrheic diseases have many different consequences to childhood development, beside morbidity and death, diarrhoea affects the nutritional status of children through different mechanisms ranging from poor nutrients intake, poor nutrients absorption, and forced micronutrients excretion (Ferdous et al. 2013, p. 223). Poor absorption of nutrients lead to malnutrition which adds to childhood low immunity and this makes the child more prone to complex infectious diseases and inhibits the natural childhood growth (Ngure, et al., 2014). Several concomitant infections in African children cause permanent immunological damage (Immunology, pp.125-132).
Different pathogens like viruses, bacteria, parasites can cause diarrhoea. But many of them are mostly transmitted via faecal-oral route (Ejemot-Nwadiaroet al., 2015). Diarrhoea pathogens that are transmitted through the fecal-oral channel, involve consumption of unsafe food, drinking contaminated water, or interpersonal contact, or through getting in touch with fecal matter. For the water-borne-diarrhea, people are affected when in-house water storage or/and source of water are contaminated with one of the causative agents. The last is transmitted in at least one of the following channels: either it is person to person, environmental contact, animal to human or vice versa via environment (Van den Bold., 2012 pp.7-36).
In the efforts to prevent diarrhoea, governments are struggling to implement effective therapy by establishing treatment guideline (Löfgren et al., 2012 pp. 1-6). Most of the available guidelines are base on rehydration. This strategy is aiming at preventing the serious consequences of diarrhea including death, but it does little in the primary prevention (Lassiet al., 2014 p. 1).
Researchers believe that around 90% of diarrheic diseases among children under five result from inadequate sanitation and poor hygiene (Montgomery et al, 2007, p. 7). Consequently, to address the root causes of the diarrhoea problem there is a need to understand the environmental and behavioral issues that result in diarrheic diseases. From that perspective, it is true that diarrhea has a multi factorial cause and addressing one cause is at risk of registering a little gain. Studies identified biological-socioeconomic and environmental factors that might offer a conducive environment to biological cause’s development (Ngabo, Tate, et al., 2016) (Mukabutera, et al. 2016, pp.1-9). In many cases, human contact with faecal matters happens through behavioral factors that include: type of stool disposal, open defecation and inadequate hand washing (Mattioli, et al., 2015 pp.1912-1920). The mentioned connection chain can be broken down through effective hand washing and the adequate use of toilettes. However, the gain from hand washing and hygiene cannot happen when people do not have access to safe water and adequate sanitation.
Nigeria is attempting to address all the potential risk factors. The Ministry of health has been working hard tto control diarrheic diseases among children under five and policies have been implemented. For example, the Ministry of Health, through a process of task shifting principles, have enabled Community Health Workers to play a pivotal role in identifying cases in early stages, treat them or refer them to health facilities as before it becomes late (Haver, et al. 2015, p. 33). In relation to access to safe water and sanitation, Nigeria has made tremendous progress. This study therefore intends to examine the prevalence of diarrhoea among children under 5 years in NgorOkpala. L.G.A, Imo State.
Diarrhoeal diseases continue to be a public health issue in developing countries, especially in Sub-Saharan Africa. The diseases have many consequences that include high morbidity/mortality especially among young children (Ejemot-Nwadiaro, et al., 2015 p.6) and can lead to childhood malnutrition which leaves children vulnerable to infections and delayed growth (Ferdous, et al., 2013). Many competing factors might explain the vulnerability of sub-Saharan Africa. These include poverty, socio-political instability and lack of resources, all of these factors constitute an open ground for pathogens to develop (Stewart et al., 2013 p. 1). Finally, the transmission from infected feces to people through poorly prepared food and unsafe drinking water, interpersonal contact, or manipulation of faecal matter, constitutes a major danger in relation to controlling diarrhoeal diseases.
Despite the efforts made by Government of Nigeria, diarrhoeal diseases continue to be among the top ten leading causes of mortality and morbidity for children under 5 years in Nigeria.This study therefore intends to examine the prevalence of diarrhoea among children under 5 years in NgorOkpala. L.G.A, Imo State by accessing the following objectives:
The general objective of this research is to examine the prevalence of diarrhoea among children (1-5) years in NgorOkpala, Imo State.
- To describe the prevalence of diarrhoeal diseases among children under 5 years old.
- To determine the proportion of the mothers/care givers of children under five years old that practice hygienic measures applied in the prevention of diarrhoeal disease.
- To identify the Risk factors associated with diarrhoeal diseases among children under 5 years.
- What is the prevalence of diarrhoeal diseases among children under 5 years old?
- What is the proportion of the mothers/care givers of children under five years old that practice hygienic measures applied in the prevention of diarrhoeal disease?
- What are the risks factors associated with diarrhoeal disease among children under 5
For the effective prevention of diarrhoeal diseases, it is necessary to understand risk factors and pathogens. The available literature emphases the biological causes and environmental factors but the behavioral aspect of the matter is in many cases overlooked. This study focuses on socioeconomic and environmental factors, especially the access to water and sanitation as well as on the practices of hygiene as part of the preventive measures that break down the faecal-oral transmission of the diarrhoeal diseases among children under five years old. The results of this study may contribute to the scanty body of knowledge on independent risk factors associated with diarrhoealdiseases among children under five years old in NgorOkpala L.G.A and Nigeria as a whole.
The results to this study can inform decision makers on factors associated with diarrhoea among children and they may set adequate and suitable strategies to address diarrhoea diseases among children under five years old. Furthermore, the health professionals such as nurses may use results of this study to design and implement responsive health programmes targeting to tackle morbidity and mortality related to diarrhoea disease among children. Moreover, the findings of the current study may be used by nursing education institutions to develop and implement responsive educational programmes aimed at equipping graduates to deliver safe and quality promotive, preventive and curative care to children under years of age and contribute to reduction of diarrhoea related mortality and morbidity rate and achieving sustainable development goals. Finally, the results from the study establish the baseline information which may be used by other researchers to conduct other studies on diarrhoea diseases in children under five years of age.
This study comprises six chapters. The first chapter provides the review of the general information on the research topic that describes the background, the problem statement, the objectives and rationale of the study. The second chapter deals with the literature review which describing global situation of diarrhoea in worldwide, describing the potential risk factors associated with diarrhoea to under five years children, describing impact of diarrhoea to under five children, outlining the role of open defecation in relation with diarrhoea, and to recommend the prevention and control measures in order to limit the prevalence of diarrhoea.
The third chapter is devoted to the methodology of the study that will be used from research design The fourth chapter focuses on the presentation of results from the data analysis; the data are presented in tables. Clear explanations to understand well the meaning and relevance of the findings are mentioned in discussion. The fifth chapters discusses the findings obtained from second data analysis, and the last chapter is the summary, conclusion and recommendations of the study.
1.6 Definition of Terms
Children: Children in this study referred to any person who was under- five years
Diarrhoeais defined as frequent loose stools resulting from malabsorption of gastrointestinal contents, and the net secretion of fluids and electrolytes into the intestinal lumen (Woods 1990, p. 457; Guandalini, 2015). Over 200 grams of watery stool or over 10 g/kg per day are considered as diarrhoea. (Menkir et al, 2014). In the context of the study, diarrhoea is a condition which can develop to under five children due to poor hygiene practice of their mothers and themselves throughout Milestone development.
Prevalence is defined as a number of diseases cases a population at risk at a particular point in time or within a specified time and it is expressed in percentage. In this study, prevalence illustrates the number of children under 5 years who were reported to have diarrhoea in the last two weeks preceding the survey.
PREVALENCE OF DIARRHEA AMONG CHILDREN (1-5YRS) IN NGOR OKPALA