Diarrhoeal disease, oral rehydration, and childhood mortality in rural Egypt

Is oral rehydration therapy associated with early childhood caries in children resident in Ile-Ife, Osun State, Nigeria?

BACKGROUND

Oral rehydration therapy may increase the risk of early childhood caries (ECC) because of reduced pH in the oral environment.

AIM

To investigate associations between the use of oral rehydration therapy and the prevalence and severity of ECC in children resident in the Ife Central Local Government Area of Osun State, Nigeria.

DESIGN

This observational study assessed the prevalence and severity of caries, using the International Caries Detection and Assessment System (ICDAS) II index. The outcome variables were the prevalence and severity of ECC. The explanatory variable was the use of oral rehydration solution for the management of diarrhea in the 12 months preceding the study. A multivariable logistic regression analysis was conducted to determine associations between the explanatory and outcome variables.

RESULTS

Only 217 (14%) of the 1564 children had used oral rehydration solution for the management of diarrhea. Seventy-three (4.7%) children had ECC. The use of oral rehydration solution was not significantly associated with the prevalence and severity of ECC.

CONCLUSION

The study findings suggest that the use of oral rehydration therapy in the management of diarrhea may not be a risk factor for ECC in communities with low prevalence and severity of ECC and high prevalence of gastroenteritis.

Socio-economic inequalities in curative health-seeking for children in Egypt: analysis of the 2008 Demographic and Health Survey

Background

The existence and magnitude of socio-economic inequalities in health-seeking behaviours for child curative care in Egypt and mechanisms underlying these associations have not been comprehensively assessed. This study examined whether socio-economic position (SEP) was associated with health-seeking behaviours for diarrhoea and acute respiratory infection (ARI) in children and explored potential mechanisms underlying these associations using mediation analysis.

Methods

Children aged under-five years living with their mothers sampled by the 2008 Egypt Demographic and Health Survey were used to estimate the prevalence of diarrhoea and ARI in the two-week period preceding the survey. If either illness was reported, three dimensions of health-seeking were examined in adjusted mediation models, separately by illness: whether medical care was sought, whether such care was timely (within one day of symptom onset), and whether it was sought from private providers. Latent variables of parental socio-cultural capital and household-level economic capital were the main exposures of interest.

Results

In the sample of 10,006 children, 8.4 % had diarrhoea and 7.6 % had ARI. Care was sought for 62.0 % of children with diarrhoea and 78.5 % with ARI; two-thirds of care-seeking for both illnesses was timely. More than 7 in 10 children who sought care were taken to private providers. Socio-cultural capital or economic capital were not independently associated with seeking care for either illness. Socio-cultural capital was positively associated with timely care-seeking, and economic capital was positively associated with private provider use in adjusted analyses for both illnesses.

Conclusions

SEP was not a strong determinant of care-seeking for diarrhoea or ARI, but there was a modest positive effect of SEP on timely receipt of care and private provider use. Further research is needed to explore perceptions of illness severity and the availability and quality of care from public and private providers.

Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review

BACKGROUND

Harmful practices in the management of childhood diarrhea are associated with negative health outcomes, and conflict with WHO treatment guidelines. These practices include restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. We conducted a systematic review of English-language literature published since 1990 to assess the documented prevalence of these four harmful practices, and beliefs, motivations, and contextual factors associated with harmful practices in low- and middle-income countries.

METHODS

We electronically searched PubMed, Embase, Ovid Global Health, and the WHO Global Health Library. Publications reporting the prevalence or substantive findings on beliefs, motivations, or context related to at least one of the four harmful practices were included, regardless of study design or representativeness of the sample population.

RESULTS

Of the 114 articles included in the review, 79 reported the prevalence of at least one harmful practice and 35 studies reported on beliefs, motivations, or context for harmful practices. Most studies relied on sub-national population samples and many were limited to small sample sizes. Study design, study population, and definition of harmful practices varied across studies. Reported prevalence of harmful practices varied greatly across study populations, and we were unable to identify clearly defined patterns across regions, countries, or time periods. Caregivers reported that diarrhea management practices were based on the advice of others (health workers, relatives, community members), as well as their own observations or understanding of the efficacy of certain treatments for diarrhea. Others reported following traditionally held beliefs on the causes and cures for specific diarrheal diseases.

CONCLUSIONS

Available evidence suggests that harmful practices in diarrhea treatment are common in some countries with a high burden of diarrhea-related mortality. These practices can reduce correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality.

Differences in disability among older women and men in Egypt and Tunisia

Research on child survival and health has indicated disparities between boys and girls in selected Middle Eastern countries. Health disparities in later life are understudied in this region. In this article, we examine differences between women and men in later-life activity limitation in Egypt and Tunisia. Difficulty executing physical tasks is more common for women than for men in both study sites, although differences are smaller after adjustment for underlying illness. Differences in the difficulty of executing physical tasks also are sensitive to environmental controls in variable ways across the study sites. The findings caution against the sole use of reported disability in comparative studies of gender and aging.

Global illness and deaths caused by rotavirus disease in children

To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000-592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 65 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, particularly to prevent childhood deaths in developing nations.

Provider bias in the treatment of diarrhea among boys and girls attending public facilities in Minia, Egypt

Girls' excess mortality in early childhood persists in all regions of the world and has been attributed to parental discrimination in the allocation of food and healthcare. Consequently, researchers have paid scant attention to the potential for unequal treatment of boys and girls by health providers. Data from a longitudinal study of child morbidity conducted between 1995 and 1997 in Minia, Egypt are used to compare the frequency with which diarrheal cases of boys and girls were treated with oral rehydration solution (ORS) among children ever presenting at a formal source of care. Multivariate analysis suggests that public providers have marginally higher adjusted odds of administering ORS to boys than to girls and significantly higher adjusted odds of giving and recommending ORS to the caretakers of boys than of girls. Findings expose a need for further research on the supply side determinants of girls' disadvantaged treatment in Upper Egypt and in other settings where son preference persists.

Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt

There is a general agreement that childhood mortality in Egypt has substantially declined during the last two decades. The decline has been traditionally attributed to the impact of the National Control of Diarrhoeal Diseases Program (NCDDP). However, a controversy still exists over the magnitude of that decline and the claimed impact of the NCDDP on diarrhoea related mortality. This study was carried out in six sites in rural Upper Egypt to determine indices, leading causes, and sociodemographic determinants of childhood mortality. Verbal autopsy was conducted with mothers or caretakers who had reported the death of a child under the age of five (U5) before the study to determine the leading cause of death. Then, the association between childhood mortality and a wide set of sociodemographic risk factors was examined by comparing these children with 1025 living U5 children using a multivariate logistic regression analysis. Results showed that the average infant and U5 mortality rates are 97.2 and 130.8 per 1000 live births respectively. Verbal autopsy revealed that the leading causes of U5 mortality are: diarrhoeal diseases (39.4%), acute respiratory infection (26.8%), combined episode of both (5.1%), febrile illnesses including meningitis (10.6%), neonatal causes (12.6%), and accidents (2.5%). Diagnosis was not determined in 3.0% of the cases. Child age (< 12 month) and mother age at childbirth are the strongest determinants of childhood mortality. Other determinants include parental illiteracy, parental age difference, house ownership, child order and average household meat consumption.

Estimating the completeness of under-5 death registration in Egypt

To evaluate the completeness of registration of infant and child deaths in Egypt, reinterviews were conducted with families who had reported a death of a child under age 5 in the five years before the survey for two national surveys recently conducted in Egypt: the United Nations PAPCHILD survey of 1990–1991 and the Egyptian Demographic and Health Survey (EDHS) of 1992. The survey instrument included questions regarding notification of the death at the local health bureau. If the family said the death had been notified, separate employees searched the health bureau records for the registration. Overall 57% of infant deaths were reported as notified and 68% of those death reports were found; the corresponding figuresfor child deaths were 89% and 74%. Using the percentage reported as notified as an estimate for completeness of registration, we adjusted upward the national infant and child mortality rates from registration data, giving values of 73 per 1,000 for infant mortality and 99 for 5q0 for the period 1987–1990. These values are approximately 20% above the corresponding direct estimates from the PAPCHILD and EDHS surveys.