Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest Ethiopia, 2014

Assessment of Socio-Demographic Factors, Mother and Child Health Status, Water, Sanitation, and Hygienic Conditions Existing in a Hilly Rural Village of Nepal

In many low income developing countries, socioeconomic, environmental and demographic factors have been linked to around half of the disease related deaths that occur each year. The aim of this study is to investigate the sociodemographic factors, mother and child health status, water, sanitation, and hygienic conditions of a Nepalese community residing in a hilly rural village, and to identify factors associated with mother and child health status and the occurrence of diarrheal and febrile disease. A community-based cross-sectional survey was carried out and 315 households from the village of Narjamandap were included in this study. Factors associated with diarrhea, febrile disease, and full maternal and under-five immunizations were assessed using logistic regression. Results showed that higher education level (middle school versus primary education; Odds Ratio (OR): 0.55, p = 0.04; high school versus primary education; OR 0.21, p = 0.001) and having a toilet facility at home were significantly associated with a lower risk of developing diarrhea and febrile disease (OR 0.49, p = 0.01), while, interestingly, the use of improved water supply was associated with higher risk (OR 3.07, p = 0.005). In terms of maternal immunization, the odds of receiving a tetanus toxoid vaccination were higher in women who had regular antenatal checkups (OR 12.9, p < 0.001), and in those who developed complications during pregnancy (OR 4.54, p = 0.04); for under-five immunization, the odds of receiving full vaccination were higher among children from households that reported diarrhea (OR 2.76, p < 0.001). The findings of this study indicated that gaps still exist in the mother and child healthcare being provided, in terms of receiving antenatal checkups and basic immunizations, as evidenced by irregular antenatal checkups, incomplete and zero vaccination cases, and higher under-five deaths. Specific public health interventions to promote maternal health and the health of under-five children are suggested.

Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia

BACKGROUND

Globally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association.

RESULTS

In this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child's age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease.

CONCLUSION

There was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.

Effectiveness of a community-based water, sanitation, and hygiene (WASH) intervention in reduction of diarrhoea among under-five children: Evidence from a repeated cross-sectional study (2007-2015) in rural Bangladesh

Diarrhoea, the most common disease directly related to water, sanitation, and hygiene (WASH), still remains one of the most significant health problems among children under-five worldwide. In this reality, BRAC, the largest NGO in the world initiated a comprehensive WASH intervention in 50 upazilas (sub-districts) of Bangladesh in 2007 which was later scaled up to cover 150 upazilas in two subsequent phases. The intervention period of the programme was 2007-2011. The present study encompassed 30 upazilas of the first phase of intervention. The aim of the study was to investigate the effectiveness of this intervention on reduction of diarrhoea among under-five children, and to identify the factors associated with childhood diarrhoea. A repeated cross-sectional study design was followed, and a population-based survey was carried out on four occasions: baseline (2007), midline (2009), endline (2011), and post-endline (2015) among 4,775 households. This analysis considers only households having at least one under-five children. Absence of handwashing practice with soap after defecation and before eating food, unclean latrine condition, and unsafe disposal of child faeces were identified as significant risk factors associated with under-five diarrhoea from Log-binomial regression. The prevalence of under-five diarrhoea within the past 2 weeks of the survey declined from 13.7% at baseline to 3.6% at end-line (p < 0.001) in the WASH intervention area. However, the progress seemingly stalled after 2011, which may have occurred due to the lack of improvement in unsafe disposal of child faeces and unclean latrine condition after the intervention period. Study findings suggest that, to reduce the prevalence of childhood diarrhoea it is important to promote safe disposal of child faeces, maintaining cleanliness of latrines, and washing hand with soap at critical times, beyond merely increasing the sanitation coverage. Findings also underline the necessity of maintaining a small-scale monitoring component involving local community, such as a WatSan committee (a local committee comprising the user communities for supervising WASH related activities) for periodic monitoring at household level for a certain period after the program intervention works to make the behavioural change more sustainable and to keep the reduction rate of under-five diarrhoeal prevalence steady.

Prevalence and associated factors of safe and improved infant and young children stool disposal in Ethiopia: evidence from demographic and health survey

BACKGROUND

Infant and young children stools are often considered innocuous, and are not disposed of safely despite having a higher pathogen load than adult feces. In Ethiopia, sanitary management of young children's stool is often overlooked and transmission of fecal-oral diseases is still a significant health burden. The study, therefore, describes the prevalence and associated factors of safe and improved child stool disposal.

METHODS

Data from the fourth round of the Ethiopian Health and Demographic Survey (EDHS) conducted in 2016 was used for this analysis. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with safe and improved child stool disposal.

RESULTS

The prevalence of safe and improved child stool disposal in Ethiopia was 36.9% (95%CI: 33.4-40.5%) and 5.3% (95%CI: 4.3-6.5%) respectively. There was regional variation in the prevalence of safe and improved child stool disposal. The odds of safe stool disposal among households with richest wealth index had 4.54 (AOR: 4.54; 95%CI: 2.89-7.12), richer 3.64 (AOR: 3.64; 95%CI: 2.46-5.38), middle 3.26 (AOR: 2.26; 95%CI: 2.27-4.68), and poorer 1.93 (AOR: 1.93; 95%CI: 1.39-2.68) times higher odds of practicing safe child stool disposal than households with poorest wealth index. Similarly, households found in richest, richer, middle, and poorer wealth index had also (AOR: 20.23; 95%CI: 8.59-47.66), (AOR: 12.53; 95%CI: 5.59-28.10) (AOR: 4.91; 95%CI: 1.92-12.55), and (AOR: 4.50; 95%CI: 2.06-9.84) higher odds of practicing improved child stool disposal than households from poorest wealth index respectively. The odds of safe child stool disposal were higher among households whose children age between 6 and 11 months (AOR: 1.57; 95%CI: 1.17-2.09), 12-17 months (AOR: 1.39; 95%CI: 1.00-1.95), and 18-23 months (AOR: 1.43; 95%CI: 1.03-1.99) than households whose children age between 0 and 5 months. The odds of safe child stool disposal were 1.31 (AOR: 1.31; 95%CI: 1.00-1.72) and 1.44 (AOR: 1.44; 95%CI: 1.04-2.01) times higher among mothers whose age between 25 and 34 and greater than 34 years compared to mothers whose age between 15 and 24 years, respectively. In addition, children's stools are more likely to be disposed of safely in urban households than in rural households (AOR: 3.12; 95%CI: 1.86-5.22). The present study also revealed households with access to improved sanitation facilities fail to use them for disposal of child stool (AOR: 0.99; 95% CI: 0.67-1.45).

CONCLUSIONS

The prevalence of safe and improved child stool disposal in Ethiopia was found to be very low. Household socio-demographic and economic determinate were the key factors associated with child stool disposal. Appropriate strategic interventions to ensure safe and improved child stool disposal in Ethiopia is necessary. In addition, integrating child stool management into the existing sanitation interventions programs should be strongly recommended.

Evaluation of the performance of a multiplex reverse transcription polymerase chain reaction kit as a potential diagnostic and surveillance kit for rotavirus in Kenya

Background

Diarrhea is a serious concern worldwide, especially in developing countries. Rotavirus is implicated in approximately 400,000 infant deaths annually. It is highly contagious elevating the risk of outbreaks especially in enclosed settings such as daycare centers, hospitals, and boarding schools. Reliable testing methods are critical for early detection of infections, better clinical management, pathogen surveillance and evaluation of interventions such as vaccines. Enzyme immunoassays have proved to be reliable and practical in most settings; however, newer multiplex reverse transcription polymerase assays have been introduced in the Kenya market but have not been evaluated locally.

Methods

Stool samples collected from an ongoing Surveillance of Enteric Pathogens Causing diarrheal illness in Kenya (EPS) study were used to compare an established enzyme immunoassay, Premier™ Rotaclone® (Meridian Bioscience, Cincinnati, Ohio, U.S.A.), that can only detect group A rotavirus against a novel multiplex reverse transcription polymerase chain reaction kit, Seeplex® Diarrhea-V ACE Detection (Seegene, Seoul, Republic of Korea), that can detect rotavirus, astrovirus, adenovirus, and norovirus genogroups I and II. Detection frequency, sensitivity, specificity, turnaround time, and cost were compared to determine the suitability of each assay for clinical work in austere settings versus public health work in well-funded institutes in Kenya.

Results

The Premier™ Rotaclone® kit had a detection frequency of 11.2%, sensitivity of 77.8%, specificity of 100%, turnaround time of 93 min and an average cost per sample of 13.33 United States dollars (USD). The Seeplex® Diarrhea-V ACE Detection kit had a detection frequency of 16.0%, sensitivity of 100%, specificity of 98.1%, turnaround time of 359 min and an average cost per samples 32.74 United States dollars respectively. The detection frequency sensitivity and specificity of the Seeplex® Diarrhea-V ACE Detection kit mentioned above are for rotavirus only.

Conclusions

The higher sensitivity and multiplex nature of the Seeplex® Diarrhea-V ACE Detection kit make it suitable for surveillance of enteric viruses circulating in Kenya. However, its higher cost, longer turnaround time and complexity favor well-resourced clinical labs and research applications. The Premier™ Rotaclone®, on the other hand, had a higher specificity, shorter turnaround time, and lower cost making it more attractive for clinical work in low complexity labs in austere regions of the country. It is important to continuously evaluate assay platforms' performance, operational cost, turnaround time, and usability in different settings so as to ensure quality results that are useful to the patients and public health practitioners.

Association of mother's handwashing practices and pediatric diarrhea: evidence from a multi-country study on community oriented interventions

Introduction

Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia.

Methods

Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother’s handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained.

Results and Conclusion

Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (> 80%), than those in Cambodia and Kenya (< 63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (< 10%), for Kenya and Zambia, compared to Cambodia and Guatemala (> 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p < 0.001, Guatemala, 3.0 vs 2.5, p < 0.001, Kenya, 2.6 vs 2.3, p < 0.001). Factors significantly associated with lower odds of diarrhea were; mother’s marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (> 24 m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.

Prevalence of diarrhea and associated factors among under-five children in Bahir Dar city, Northwest Ethiopia, 2016: a cross-sectional study

Background

In Ethiopia, morbidity and mortality due to diarrhea is significantly high. Most importantly, burden of diarrhea is disproportionately high among under-five children. Therefore, the objective of this study was to assess the prevalence and factors associated with diarrhea among children younger than 5 years old in Bahir Dar city, Northwest, Ethiopia, 2016.

Methods

This community-based cross-sectional study was conducted among under-five years-old children from March 24 to April 12, 2016. Systematic sampling technique was used to select 498 households. Data were collected by using an interviewer administered questionnaire. Both bivariate and multivariate logistic regression analyses were employed to identify predictor variables. Factors with a p-value of < 0.05 were considered as independently associated with diarrhea.

Results

The 2 weeks prevalence of diarrhea among under five children was 14.5%. Lack of hand washing facilities in the household (AOR = 3.910 (1.770, 8.634)), lack of separate feeding materials (AOR = 5.769 (1.591, 9.220)), poor hand washing practice (AOR = 6.104 (2.100, 17.738)) and not breastfeeding (AOR = 2.3 (1.023, 5.46)) were predictors of the concurrence of diarrhea.

Conclusions

The prevalence of diarrhea in the study area was slightly higher than the 2016, Ethiopian Demography and Health Survey finding which was 12%. Thus, improving handwashing facilities and practices, serving the food to the child with a separate materials and encourage optimal breastfeeding were recommended.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4030-3) contains supplementary material, which is available to authorized users.

Epidemiological investigation and management of bloody diarrhea among children in India

BACKGROUND

The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context.

METHODS

We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years.

FINDINGS

The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics.

CONCLUSION

The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Prevalence of and factors associated with diarrhoeal diseases among children under five in Malaysia: a cross-sectional study 2016

Background

Globally, diarrhoea is one of the major causes of morbidity and mortality among children under than 5 years of age. There is a scarcity of published data on acute gastroenteritis (AGE) prevalence in Malaysia among children. This study aims to determine factors associated with diarrhoea in children aged less than 5 years in Malaysia.

Method

Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF’s Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors.

Result

The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the ‘Other Bumiputera’ group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea.

Conclusion

There is a higher risk of diarrhoea among children of ‘Other Bumiputera’ ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.

Risk factors for diarrhoea and malnutrition among children under the age of 5 years in the Tigray Region of Northern Ethiopia

BACKGROUND

Diarrhoea and malnutrition are the leading cause of morbidity and mortality among children in areas with poor access to clean water, improved sanitation, and with low socioeconomic status. This study was designed to determine the prevalence of diarrhoea, malnutrition and risk factors among children aged 6-59 months in the Tigray Region of Northern Ethiopia.

METHODS

A community based cross-sectional study design was conducted from June to August 2017 to assess the magnitude and factors associated with diarrhoea and malnutrition among children. A standardized questionnaire was used to collect data on diarrhoea, environmental, demographic and behavioural factors from 610 mother-child pairs. Anthropometric measurements were collected from the children. SPSS ver.21 statistical software was used for analysis. Factors associated with diarrhoea and nutritional status were identified using bivariate and multivariate logistic regression. A p-value ≤ 0.05 was considered statistically significant.

RESULTS

Of the 610 children monitored in this study, the incidence of diarrhoea among 6-59 month-old children in the two weeks preceding the day of the interview day was 27.2% (95% CI: 23.6-31%). Specifically, 35.9%, 9.7%, and 1.8% had 1-2, 3-4 and 5-6 times of diarrhoea episodes in a one year of time, respectively. The prevalence of stunting, underweight, wasting, and acute under-nutrition were 36.1% (95% CI: 31-38.6%), 37% (95% CI: 32-39.6%), 7.9% (95% CI: 5.5-9.7%), and 5.4% (95% CI: 3.8-7.4%), respectively. In a multivariate logistic regression analysis, type of drinking water source [AOR = 3.69; 95% CI: 2.03-6.71], mothers not hand washing at critical times [AOR = 15.42; 95% CI: 2.02-117.78], improper solid waste disposal [AOR = 12.81; 95% CI: 2.50-65.62], and child age (36-47 months) [AOR = 2.57; 95% CI: 1.45-4.55] were found to be predictors of diarrhoea. Being within the age range of 12-23 months was a predictor for wasting [AOR = 4.38; 95% CI: 1.61-11.90] and being underweight [AOR = 4.4; 95% CI: 1.7-11.2]. Similarly, the age range of 36-47 months was associated with wasting [AOR = 2.3; 95% CI: 1.45-3.85] and stunting [AOR = 1.7; 95% CI: 1.03-2.67]. Family size (less than 4) [AOR = 0.56; 95% CI: 0.368-0.959] was inversely associated for wasting.

CONCLUSIONS

Our study revealed that the problem of diarrhoea and malnutrition amongst 6-59 months children in the study area was significant. Access to clean water was the main problem in the study area. Hence, improving access to clean water and providing health education to mothers on personal and environmental hygiene, and proper waste disposal could improve diarrhoea in the study area. Intervention on children's nutrition should also be implemented to minimize the problem of malnutrition.

Exclusive breastfeeding and rotavirus vaccination are associated with decreased diarrheal morbidity among under-five children in Bahir Dar, northwest Ethiopia

BACKGROUND

More than one in every ten (14%) of under-five child deaths is associated with diarrheal morbidity in Ethiopia. Although Ethiopia has implemented different health interventions like its immunization program, childhood diarrhea morbidity, on which literature is limited, continues as a public health problem. Hence, the aim of this study was to assess the prevalence of diarrheal morbidity and associated factors among under-five children in Bahir Dar, northwest Ethiopia.

METHOD

A community based cross-sectional study was carried out from March 05 to April 03/2015 in Bahir Dar in which 553 mother-child pairs participated. A structured questionnaire was adapted from the World Health Organization (WHO) and the Ethiopian Demography and Health Survey (EDHS) to collect the data. Bivariate and multivariate logistic regression analyses were carried out to identify the independent predictors of diarrheal morbidity.

RESULT

The overall prevalence of diarrheal morbidity was 9.4% [95% Confidence Interval (CI): 4.8, 14.0%]. No receipt of Rotavirus vaccine dose 2 [AOR = 3.96, 95%CI; 2.13, 7.33], non-exclusive breastfeeding [AOR = 2.69, 95%CI; 1.39, 5.19], unavailability of solid waste disposal system [AOR = 2.62, 95%CI; 1.19, 5.77], employed and private business occupational status of mothers [AOR = 2.10, 95%CI; 1.02, 4.31)], and less than Ethiopia Birr (ETB) 600 household monthly income [AOR = 2.10, 95% CI; 1.2, 7.2] were independently associated with diarrheal morbidity.

CONCLUSION

In Bahir Dar, one in every ten of the under-five children surveyed suffered from diarrheal morbidity. Thus, implementing effective rotavirus vaccination programs, encouraging exclusive breastfeeding and emphasizing appropriate solid waste management would reduce childhood diarrheal morbidity in the region. In addition, the finding suggests that improved child care mechanisms, especially for mothers working outside the home, and efforts to increase household income should be intensified to reduce incidence of diarrhea.

Appropriate household water treatment methods in Ethiopia: household use and associated factors based on 2005, 2011, and 2016 EDHS data

BACKGROUND

Diarrheal disease attributable to water and sanitation can be prevented using point-of-use water treatment. In Ethiopia, a small number of households treat water at point-of-use with appropriate methods. However, evidence on factors associated with household use of these treatment methods is scarce. Therefore, this study is intended to explore the household use of appropriate point-of-use water treatment and associated factors in Ethiopia.

METHODS

The data of 2005, 2011, and 2016 Ethiopian demographic and health surveys were used for analysis. Households reportedly treating water with bleach, boiling, filtration, and solar disinfection in each survey are considered as treating with appropriate treatment methods. Household water treatment with these treatment methods and factors associated was assessed using bivariate and multivariable regression. In addition, a region level difference in the treatment use was assessed by using multilevel modeling.

RESULTS

The number of households that reported treating water with appropriate water treatment methods was 3.0%, 8.2%, and 6.5% respectively in 2005, 2011, and 2016. Household heads with higher education had 5.99 (95% CI = 3.48, 10.33), 3.61 (95% CI = 2.56, 5.07), and 3.43 (95% CI = 2.19, 6.37) times higher odds of using the treatment methods respectively in 2005, 2011, and 2016 compared to household heads who had no education. There was a significantly high number of households that used appropriate water treatment methods in 2011 (AOR = 2.78, 95% CI = 2.16, 3.57) and 2016 (AOR = 2.18, 95% CI = 1.64, 3.89) compared to 2005 data. In pooled data analysis, the reported use of the treatment methods is associated with household head education, residency, drinking water sources, and owning radio and television. From a multilevel modeling, within-region variation is higher than between-region variations in the use of treatment methods in each survey.

CONCLUSIONS

Below 10% of households reportedly treating water at point-of-use in each survey attributable to different factors. Designing intervention strategies for wide-scale use of treatment methods at the country level is fundamental.

The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia

BACKGROUND

Solar Disinfection (SODIS) of water is an economical, user-friendly, and environmentally safe household water treatment method that has been advocated as a means of decreasing the burden of diarrhea among children under 5 years of age. Laboratory studies have consistently shown the efficacy of the SODIS method to destroy waterborne pathogens. However, the evidence-based health effect of a SODIS intervention at the household level is limited. The main aim of the study was to examine the effectiveness of a SODIS intervention in reducing the incidence of diarrhea among under-five children.

METHODS

A community-based, cluster randomized controlled trial was conducted, over 6 months from 10 January to 7 July 2016, in 28 rural villages of northwest Ethiopia. In the intervention group, 384 children in 279 households received polyethylene terephthalate (PET) bottles, and in the control group 394 children in 289 households who continued to use their usual drinking-water sources were included in the trial. The study compared diarrheal incidence among the intervention group children who were exposed to SODIS household water treatment and the control group children who were not exposed to such water treatment. A generalized estimating equation (GEE) model was used to compute the adjusted incidence rate ratio and the corresponding 95% confidence interval.

RESULTS

In this trial, the overall SODIS compliance was 90.6%. The incidence of diarrhea was 8.3 episodes/100 person-week observations in the intervention group compared to 15.3 episodes/100 person-week observations in the control group. A statistically significant reduction was observed in the incidence of diarrhea in the intervention group compared to the control (adjusted IRR 0.60 (95% CI 0.52, 0.70) with a corresponding prevention of 40% (95% CI: 34, 48).

CONCLUSION

The SODIS intervention substantially reduced the incidence of diarrhea among under-five children in a rural community of northwest Ethiopia. This indicates that a SODIS intervention is an invaluable strategy that needs to be integrated with the National Health Extension Program to be addressed to rural communities.

TRIAL REGISTRATION

Clinical Trial Registry India, ID: CTRI/2017/09/009640 . Registered retrospectively on 5 September 2017.

Prevalence and determinants of diarrhea among under-five children in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Despite remarkable progress in the reduction of under-five mortality, childhood diarrhea is still the leading cause of mortality and morbidity in this highly susceptible and vulnerable population. In Ethiopia, study findings regarding prevalence and determinants of diarrhea amongst under-five children have been inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled prevalence of diarrhea and its determinants among under-five children in Ethiopia.

METHODS

International databases, including PubMed, Web of Science, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library, were systematically searched. All identified observational studies reporting the prevalence and determinants of diarrhea among under-five children in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. STATA Version 13 statistical software was used. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. A random effects model was computed to estimate the pooled prevalence of diarrhea. Moreover, the associations between determinant factors and childhood diarrhea were examined using the random effect model.

RESULTS

After reviewing of 535 studies, 31studies fulfilled the inclusion criteria and were included in the meta-analysis. The findings from the 31 studies revealed that the pooled prevalence of diarrhea among under-five children in Ethiopia was 22% (95%CI: 19, 25%). Subgroup analysis of this study revealed that the highest prevalence was observed in Afar region (27%), followed by Somali and Dire Dawa regions (26%), then Addis Abeba (24%). Lack of maternal education (OR: 2.5, 95% CI: 1.3, 2.1), lack of availability of latrine (OR: 2.0, 95%CI: 1.3, 3.2), urban residence (OR: 1.9, 95%CI: 1.2, 3.0), and maternal hand washing (OR: 2.2, 95%CI: 2.0, 2.6) were significantly associated with childhood diarrhea.

CONCLUSION

In this study, diarrhea among under-five children in Ethiopia was significantly high. Lack of maternal education, lack of availability of latrine, urban residence, and lack of maternal hand washing were significantly associated with childhood diarrhea.

Diarrhea Prevalence and Sociodemographic Factors among Under-Five Children in Rural Areas of North Gondar Zone, Northwest Ethiopia

Background

Diarrheal disease remains one of the principal causes of morbidity and mortality in infants and children in developing countries, including Ethiopia. Risk factors for diarrhea vary by settings and have important implications for developing intervention strategies to reduce the burden of the disease. Thus, the aim of this study was to assess diarrhea prevalence and sociodemographic factors among under-five children in rural areas of North Gondar Zone.

Methods

A community-based cross-sectional study was conducted from April to June 2016 among 736 randomly selected households with one child under five years old. A structured questionnaire was used for collecting information on sociodemographic characteristics and diarrheal occurrence. Data was analyzed using SPSS version 20. The bivariate and multivariable logistic regression analysis were used to determine the association between risk factors and diarrheal occurrence, and a p value < 0.05 was taken as statistically significant.

Results

A total of 736 under-five children and their respondents were enrolled during the study period. Almost all respondents were biological mothers 96.4% (709/736), married 94.2% (693/736), and house wives 86% (632/736). The overall prevalence of diarrheal disease among under-five children was 22.1% (163/743). Of these, children with age group of less than one year old, 7.7 % (57/736), were commonly infected with diarrheal diseases. Children less than or equal to one year [AOR=1.82, 95% CI= (1.39, 4.63)], guardians [AOR=4.37, 95% CI= (1.73, 11.1)], and children with no breast feeding practice [AOR=3.13, 95% CI= (1.62, 6.03)] were the major risk factors for the occurrence of diarrhea.

Conclusion

Childhood diarrhea remains an important health concern in the study area. Occurrence of diarrhea was statistically associated with child age less than or equal to one year, educational status of mother/guardians, and breast feeding. To minimize the magnitude childhood diarrhea, various designing and implementing strategies, such as health education, child care, breast feeding, and weaning practice, integrated with the existing national health extension are quite essential.

[Profile and antibiotic susceptibility pattern of bacterial pathogens associated with diarrheas in patients presenting at the Kousseri Regional Hospital Anne, Far North, Cameroon]

Introduction

In most of the health facilities in Cameroon, the management of patients with diarrhea is based on presumptive diagnosis due to limited laboratory resources. This study aimed to determine germs profile and their susceptibility to antibiotics usually prescribed against pathogenic bacteria associated with diarrheas at the Kousseri Regional Hospital Annex from July to October 2015.

Methods

We conducted a descriptive and cross-sectional study of all consenting individual presenting with diarrhea to the Kousseri Regional Hospital Annex during the study period. Stool samples were collected from each patient. Patient data were collected via anonymous questionnaire with face to face interview. Each stool sample was grown on media for enterobacteria and analyzed following the standard stool culture method. The sensitivity of the isolated strains to the most frequently prescribed antibiotics was assessed and the proportions of patients with each pathogen germ and of germ sensitive to each antibiotic were estimated.

Results

Out of 150 patients with diarrhea included in the study 45(30.0%) had enteropathogenic bacteria, of which 37(82.2%) in children aged 0-5 years. Escherichia coli was the the most common bacterium(30 cases, 66%) followed by Salmonella spp(7 cases, 16%), Vibrio spp,(5 cases, 11%), Aeromonas spp(2 cases, 4%), and Shigella spp(1 cases, 2%). Susceptibility tests were performed which showed that 17(56.7%), 14(46.7%) and 5(16.7%) E. coli were susceptible to ciprofloxacin, ceftriaxone, cotrimoxazole respectively; 4(57.14%), 2(28.57%) Salmonella spp. were susceptible to ceftriaxone and cotrimoxazole respectively.

Conclusion

Nearly a third of the cases of diarrheas at the Kousseri Regional Hospital Annex in the season of rain were associated with at least a pathogenic bacterium. The susceptibility of isolated germs to commonly prescribed antibiotics was very limited. Health staff in the facilities in the extreme north of Cameroon prescribe antibiotic against diarrheas on the basis of presumptive diagnosis. Hence, the necessity to implement a system for the monitoring of the associated germ profile and of their susceptibility to commonly prescribed antibiotics.

Factors associated with diarrheal morbidity among under-five children in Jigjiga town, Somali Regional State, eastern Ethiopia: a cross-sectional study

BACKGROUND

The prevalence of underfive diarrhea in Somali Regional State, Ethiopia is one of the highest in the country. This study attempted to examine the multiple factors associated with underfive diarrhea and how they might influence its prevalence in Jigjiga, Somali regional state, Ethiopia.

METHODS

A community based cross-sectional study was conducted from February 15 to 28, 2015. Multistage sampling technique was used to collect data from 492 mothers via household survey. A pre-tested, structured questionnaire was used to collect data through face-to-face interview. Ethical clearance was obtained before data collection. Stepwise multivariable logistic regression was used to calculate adjusted odds ratios.

RESULTS

The two weeks prevalence of under five diarrhea in Jigjiga town was 14.6%. Up on multivariable analysis, maternal educational level of primary school and above was found to be protective against childhood diarrhea [AOR: 0.227(0.100-0.517)] whereas, unavailability of water [AOR: 2.124(1.231-3.664)] and lack of hand washing facility [AOR: 1.846(1.013-3.362)] were associated with diarrhea.

CONCLUSION

Poor water supply, lack of hand washing facilities and lack of formal maternal education were associated with underfive diarrhea in the study area. Improved access to water supply along with environmental health intervention programs designed to promote good hygiene behavior could be of paramount importance to alleviate burden of childhood diarrhea.