Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level

Predictive modeling and socioeconomic determinants of diarrhea in children under five in the Amhara Region, Ethiopia

Background

Diarrheal disease, characterized by high morbidity and mortality rates, continues to be a serious public health concern, especially in developing nations such as Ethiopia. The significant burden it imposes on these countries underscores the importance of identifying predictors of diarrhea. The use of machine learning techniques to identify significant predictors of diarrhea in children under the age of 5 in Ethiopia's Amhara Region is not well documented. Therefore, this study aimed to clarify these issues.

Methods

This study's data have been extracted from the Ethiopian Population and Health Survey. We have applied machine learning ensemble classifier models such as random forests, logistic regression, K-nearest neighbors, decision trees, support vector machines, gradient boosting, and naive Bayes models to predict the determinants of diarrhea in children under the age of 5 in Ethiopia. Finally, Shapley Additive exPlanation (SHAP) value analysis was performed to predict diarrhea.

Result

Among the seven models used, the random forest algorithm showed the highest accuracy in predicting diarrheal disease with an accuracy rate of 81.03% and an area under the curve of 86.50%. The following factors were investigated: families who had richest wealth status (log odd of -0.04), children without a history of Acute Respiratory Infections (ARIs) (log odd of -0.08), mothers who did not have a job (log odd of -0.04), children aged between 23 and 36 months (log odd of -0.03), mothers with higher education (log odds ratio of -0.03), urban dwellers (log odd of -0.01), families using electricity as cooking material (log odd of -0.12), children under 5 years of age living in the Amhara region of Ethiopia who did not show signs of wasting, children under 5 years of age who had not taken medications for intestinal parasites unlike their peers and who showed a significant association with diarrheal disease.

Conclusion

We recommend implementing programs to reduce the incidence of diarrhea in children under the age of 5 in the Amhara region. These programs should focus on removing socioeconomic barriers that impede mothers' access to wealth, a favorable work environment, cooking fuel, education, and healthcare for their children.

Correlates of infant mortality in Benshangul-Gumuz regional State, Ethiopia

BACKGROUND

Infant mortality is one of the commonest health-related indicators that are used to assess the health status of the society of a nation. Despite the decline in global infant mortality rate, the rate of decline in low-and middle-income countries including Ethiopia is below the rate expected to attain Sustainable Development Goal targets. Benshangul-Gumuz regional state is among the regions in Ethiopia with high infant mortality rate. Therefore, this study aimed at determining the infant mortality rate and identifying risk factors associated with the infant mortality in Benshangul-Gumuz regional state, Ethiopia.

METHODS

This study used data drawn from 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS). Multivariable logistic regression model was used to identify the risk factors associated with infant mortality.

RESULTS

A total of 530 live births were included in this study. The infant mortality rate in this study was 81 (95% CI: 59, 108) per 1000 live births. Females (AOR: 0.690, 95% CI: 0.342, 0.899), multiple births (AOR: 3.067, 95% CI: 2.313, 10.139), mothers with secondary and higher education (AOR: 0.460, 95% CI: 0.287, 0.885), mothers aged 34 years and older (AOR: 1.539, 95% CI: 1.183, 9.802), mothers having ANC visits (AOR: 0.597, 95% CI: 0.326, 0.709) and health institution delivery (AOR: 0.611, 95% CI: 0.0.294, 0.0.899) were significant risk factors associated with infant mortality.

CONCLUSION

Factors sex of child, type of birth, maternal educational status, age of mother, ANC visits and place of delivery were found to be correlates of infant mortality in Benshangul-Gumuz regional state, Ethiopia. Thus, enhancing mothers to have the ANC follow up during pregnancy and deliver at health institution is recommended in the region.

Exploring the association between household access to water, sanitation and hygiene (WASH) services and common childhood diseases using data from the 2017-2018 Demographic and Health Survey in Benin: focus on diarrhoea and acute respiratory infection

OBJECTIVE

The paper aimed to study the association between household access to water, sanitation and hygiene (WASH) services and the occurrence of diarrhoea and acute respiratory infection among children under 5 years in Benin.

DESIGN

We performed secondary analyses using Benin's Fifth Demographic and Health Survey datasets. The dependent variables were diarrhoea and acute respiratory infection (yes=1, no=0). Among the independent variables were the household access to individual WASH services, grouped as follows: 'basic', 'limited', 'unimproved' and 'no service'. Multivariate logistic regression was used to determine the association between household access to WASH services and the occurrence of diarrhoea and acute respiratory infection. Results from the multivariate logistic regression were presented using adjusted Odds Ratios (aORs) with 95% Confidence Intervals (95% CIs).

SETTING

Benin.

PARTICIPANTS

Children under 5 years successfully surveyed during Benin's Fifth Demographic and Health Survey.

OUTCOME MEASURES

Diarrhoea and acute respiratory infection.

RESULTS

In the current study, 12 034 children under 5 years met the selection criteria and were included in the analyses. The prevalence of diarrhoea and acute respiratory infection was 10.5% (95% CI=9.8% to 11.3%) and 2.9% (95% CI=2.5% to 3.4%), respectively. Children living in households without sanitation service, that is, practising open defecation (aOR=1.9, 95% CI=1.4 to 2.6), and with unimproved (aOR=1.9, 95% CI=1.3 to 2.7) and limited (aOR=1.5, 95% CI=1.1 to 2.2) services were more likely to have diarrhoea compared with children with basic sanitation services. Household access to WASH services was not associated with acute respiratory infection.

CONCLUSION

We suggest reinforcing household access to basic sanitation services to combat diarrhoea in children under 5 years. Further research is needed on the effects of WASH interventions on diarrhoea and acute respiratory infection in children under 5 years.

Diarrhea Prevalence and Associated Factors among Children in Azezo Sub-City, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Globally, diarrheal disease continues to be a major cause of morbidity and mortality among children under 5 years of age, especially in low-income countries such as Ethiopia. However, there is still limited evidence in the study area quantifying the burden of diarrheal disease among children under 5 years. A community-based cross-sectional study was conducted in April 2019 to estimate the prevalence of childhood diarrhea and to identify its associated factors in Azezo sub-city, northwest Ethiopia. A simple random sampling technique was applied to recruit the eligible cluster villages with children under 5 years. Data were collected by interviewing mothers or guardians using structured questionnaires. The completed data were entered into EpiInfo version 7 and exported to SPSS version 20 for analysis. Binary logistic regression model was used to identify factors associated with diarrheal disease. Adjusted odds ratio (AOR) with 95% CI was used to measure the strength of association between the dependent and independent variable. The period prevalence of diarrheal disease among children under 5 years was 24.9% (95% CI: 20.4-29.7%). Age group between 1 and 12 months [AOR: 9.22, 95% CI: (2.93-29.04)] and 13 and 24 months [AOR: 4.44, 95% CI: (1.87-10.56)], as well as low monthly income (AOR: 3.68, 95% CI: (1.81-7.51)] and poor handwashing practice [AOR: 8.37, 95% CI: (3.12-22.52), were significantly associated with high risk of childhood diarrhea. In contrast, small family size [AOR: 0.32, 95% CI: (0.16-0.65)], and immediate consumption of prepared meals [AOR: 0.39, 95% CI: (0.19-0.81)] were significantly associated with low risk of childhood diarrhea. Diarrheal diseases were a common health problem among children under 5 years of age in Azezo sub-city. Therefore, an appropriate hygiene intervention program through health education is recommended with a focus on identified risk factors to reduce the burden of diarrheal diseases.

Geographical variation of common childhood illness and its associated factors among under-five children in Ethiopia: spatial and multilevel analysis

Although substantial progress has been made in reducing child mortality over the last three decades, the magnitude of the problem remains immense. Ethiopia is one of the countries with a high under-five mortality rate due to childhood illnesses including acute respiratory infections, diarrhea, and fever that varies from place to place. It is vital to have evidence of the factors associated with childhood illnesses and the spatial distribution across the country to prioritize and design targeted interventions. Thus, this study aimed to investigate the spatial cluster distribution and associated factors with common childhood illnesses. Secondary data analysis based on the 2016 Ethiopian Demographic and Health Survey data was carried out. A total weighted sample of 10,417 children was included. The study used ArcGIS and SaTScan software to explore spatial distribution. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with the problem. ICC, MOR, PCV, and deviance (-2LLR) were used to check model fitness and model comparison. In this study, the prevalence of common childhood illnesses among under-five children was 22.5% (95% CI: 21.6-23.3%). The spatial analysis depicted that common childhood illnesses have significant spatial variation across Ethiopia. The SaTScan analysis identified significant primary clusters in Tigray and Northern Amhara regions (log-likelihood ratio (LLR) = 60.19, p < 0.001). In the multilevel analysis, being rural residence [AOR = 1.39, 95% CI (1.01-1.98)], small child size at birth [AOR = 1.36, 95% CI (1.21-1.55)], high community poverty [AOR = 1.26, 95% CI (1.06-1.52)], mothers aged 35-49 [AOR = 0.81, 95% CI (0.69-0.94)], the household had electricity [AOR = 0.77, 95% CI (0.61-0.98)], the household had a refrigerator [AOR = 0.60, 95% CI (0.42-0.87)], improved drinking water [AOR = 0.82, 95% CI (0.70-0.95)], improved toilet [AOR = 0.72, 95% CI (0.54-0.94)], average child size at birth [AOR = 0.83, 95% CI (0.75-0.94)] were significantly associated with common childhood illnesses. Common childhood illnesses had spatial variations across Ethiopia. Hotspot areas of the problem were found in the Tigray, Northern Amhara, and Northeast SNNPR. Both individual and community-level factors affected common childhood illnesses distribution and prevalence in Ethiopia. Therefore, public health intervention should target the hotspot areas of common childhood illnesses to reduce their incidence in the country.

Inequality of handwashing practice using antimicrobial agents in Bangladesh: a household level analyses

OBJECTIVES

About 2.3 billion individuals worldwide are still deprived of the amenity of handwashing with antimicrobial agents. The progress of handwashing with antimicrobial agents in Bangladesh is relatively slower than in many developing countries. The objective of this study was to capture the inequality of the prevalence of handwashing with antimicrobial agents and to identify the factors that are potentially contributing to socio-economic inequalities of handwashing practice in Bangladesh.

STUDY DESIGN

Cross-sectional study.

METHODS

The present study used the nationally representative cross-sectional data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18. A total of 19,457 households were included in the analysis of this study. A regression-based decomposition method was applied to assess the socio-economic contributors of inequality.

RESULTS

This study showed that only 38% of Bangladeshi households wash their hands with antimicrobial agents while a pro-rich socio-economic inequality was observed. Household's wealth index was responsible for about 46% of the overall inequality of handwashing with antimicrobial agents while the type of place for handwashing variable contributed 38% of total inequalities. Hygienic toilet facilities (12%) and exposure to mass media (7.4%) are other determinants of total inequalities of handwashing with antimicrobial agents.

CONCLUSIONS

Despite recent declines in attributable mortality, handwashing with antimicrobial agents remains an important determinant of public health problems in many developing countries like Bangladesh. The regular programs aimed at promoting best hand hygiene practices and ensuring the availability of the necessary infrastructure at the community level will be important measures to eliminate this inequality at the population level.

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

BACKGROUND

Diarrhoea remains the major cause of morbidity and mortality of children under five years in Africa. Several studies have shown that inadequate and unsafe water, lack of sanitation, and poor hygiene practices are complex issues for different pathogens and accountable for the occurrence of diarrhoea diseases. We assessed the combined effect of household's source of drinking water and type of toilet facility and residential wellbeing on the incidence of childhood diarrhoea in 33 Sub-Saharan Africa countries while accounting for relevant compositional and contextual factors.

METHODS

The 2010-2019 datasets from the Demographic and Health Surveys were drawn for analyses. The outcome variable used in this study was the incidence of childhood diarrhoea. Three negative log-log generalized linear regression models were then sequentially fitted to the data to examine the joint effect of household water and sanitation practices on child diarrhoea. The results were presented using crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence intervals (CIs). Using ArcGIS software, maps were design to unveil the spatial distribution of key variables.

FINDINGS

Approximately 16% of the 307,741 mothers interviewed reported an incidence of diarrhoea disease among children under-five years in their households. The results showed that a household depending on an unimproved source of drinking water and with an unimproved type of toilet facility was not significantly associated with childhood diarrhoea. However, those with improved drinking water but an unimproved type of toilet facility had higher odds of reporting childhood diarrhoea (AOR = 1.020, 95% CI = 1.003-1-036) compared to those in households with both improved source of drinking water and type of toilet facility. Across the geographical regions, Eastern (aOR = 1.102, 95% CI = 1.084-1.120) and Central Africa (aOR = 1.102, 95% CI = 1.083-1.121) were more likely to experience child diarrhoea.

CONCLUSION

Water and sanitation practices such as the source of drinking water and toilet facility, and geographic region had significant effects on childhood diarrhoea in sub-Saharan Africax. The findings suggest the need for multi-sectoral actions that recognise the geo-spatial and temporal characteristics identified in the study through regional to national policies. Water and sanitation community-based interventions that seek to improve equitable access to safe water and sanitation in the sub-region should be intensified.

Prevalence and associated factors of common childhood illnesses in sub-Saharan Africa from 2010 to 2020: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and determinants of common childhood illnesses in sub-Saharan Africa.

DESIGN

Cross-sectional study.

SETTING

Sub-Saharan Africa.

PARTICIPANTS

Under-5 children.

PRIMARY OUTCOME

Common childhood illnesses.

METHODS

Secondary data analysis was conducted using data from recent Demographic and Health Survey datasets from 33 sub-Saharan African countries. We used the Kids Record dataset file and we included only children under the age of 5 years. A total weighted sample size of 208 415 from the pooled (appended) data was analysed. STATA V.14.2 software was used to clean, recode and analyse the data. A multilevel binary logistic regression model was fitted, and adjusted OR with a 95% CI and p value of ≤0.05 were used to declare significantly associated factors. To check model fitness and model comparison, intracluster correlation coefficient, median OR, proportional change in variance and deviance (-2 log-likelihood ratio) were used.

RESULT

In this study, the prevalence of common childhood illnesses among under-5 children was 50.71% (95% CI: 44.18% to 57.24%) with a large variation between countries which ranged from Sierra Leone (23.26%) to Chad (87.24%). In the multilevel analysis, rural residents, mothers who are currently breast feeding, educated mothers, substandard floor material, high community women education and high community poverty were positively associated with common childhood illnesses in the sub-Saharan African countries. On the other hand, children from older age mothers, children from the richest household and children from large family sizes, and having media access, electricity, a refrigerator and improved toilets were negatively associated.

CONCLUSIONS

The prevalence of common illnesses among under-5 children was relatively high in sub-Saharan African countries. Individual-level and community-level factors were associated with the problem. Improving housing conditions, interventions to improve toilets and strengthening the economic status of the family and the communities are recommended to reduce common childhood diseases.

Estimating the seasonally varying effect of meteorological factors on the district-level incidence of acute watery diarrhea among under-five children of Iran, 2014-2018: a Bayesian hierarchical spatiotemporal model

Under-five years old acute watery diarrhea (U5AWD) accounts for most diarrheal diseases' burden, but little is known about the adjusted effect of meteorological and socioeconomic determinants. A dataset containing the seasonal numbers of U5AWD cases at the district level of Iran is collected through MOHME. Accordingly, the district-level standardized incidence ratio and Moran's I values are calculated to detect the significant clusters of U5AWD over sixteen seasons from 2014 to 2018. Additionally, the author tested twelve Bayesian hierarchical models in order to determine which one was the most accurate at forecasting seasonal number of incidents. Iran features a number of U5AWD hotspots, particularly in the southeast. An extended spatiotemporal model with seasonally varying coefficients and space-time interaction outperformed other models, and so became the paper's proposal in modeling U5AWD. Temperature demonstrated a global positive connection with seasonal U5AWD in districts (IRR: 1.0497; 95% CrI: 1.0254-1.0748), owing to its varying effects during the winter ((IRR: 1.0877; 95% CrI: 1.0408-1.1375) and fall (IRR: 1.0866; 95% CrI: 1.0405-1.1357) seasons. Also, elevation (IRR: 0.9997; 95% CrI: 0.9996-0.9998), piped drinking water (IRR: 0.9948; 95% CrI: 0.9933-0.9964), public sewerage network (IRR: 0.9965; 95% CrI: 0.9938-0.9992), years of schooling (IRR: 0.9649; 95% CrI: 0.944-0.9862), infrastructure-to-household size ratio (IRR: 0.9903; 95% CrI: 0.986-0.9946), wealth index (IRR: 0.9502; 95% CrI: 0.9231-0.9781), and urbanization (IRR: 0.9919; 95% CrI: 0.9893-0.9944) of districts were negatively associated with seasonal U5AWD incidence. Strategically, developing geoinformation alarm systems based on meteorological data might help predict U5AWD high-risk areas. The study also anticipates increased rates of U5AWD in districts with poor sanitation and socioeconomic level. Therefore, governments should take appropriate preventative actions in these sectors.

Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania: A Community-Based, Cross-Sectional Analysis

Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18−0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27−0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24−0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52−0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65−1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.

Risk Factors of Infant Diarrhea and Under-five Children Diarrhea

BACKGROUND: Infant and under-five children diarrhea in Indonesia is a health problem that seriously impacts death. AIM: The main objective of this study was to determine the most significant factors that influence infant and under-five children diarrhea between the years 2012 and 2017. METHODS: This study used data from the Indonesia Demographic and Health Survey of 2012 and 2017 with a cross-sectional design. We modeled the infant and under-five of age children diarrhea as categorical dependent variable (diarrhea vs. no diarrhea of the infant and under-five of age children). At the same time, 14 covariates are used as an independent variable using χ2 statistic and multiple logistic regression (MLR). FINDINGS: For infant diarrhea, television as an information resources showed the highest positive coefficient (OR = 1.966; β = 3.35; and p = 0.001) significant covariate for 2012. Higher mother education was negative correlation (β = –2.31 and p = 0.021) for infant diarrhea in 2017. For under-five children diarrhea, reading newspaper and magazine < 1 a week showed positive coefficients (OR = 1.059; β = 2.62; and p = 0.009) for 2012. Sex of household head female showed the highest positive coefficient (OR = 1.387; β = 2.82; and p = 0.005) for under-five children diarrhea in 2017. CONCLUSIONS: The finding has important policy implications for infant and under-five of age diarrhea intervention programs. Thus, activities focus on the proper hygienic toilet, improving health information from newspapers, magazines, and TV.

OUP accepted manuscript

BACKGROUND

Diarrhoea is a leading cause of preventable childhood morbidity and mortality worldwide. Unfortunately, Pakistan has the third-highest burden of diarrhoea-related deaths in children <5 y of age. Therefore we aimed to evaluate factors associated with diarrhoea among Pakistani children.

METHODS

A retrospective 1:2 matched case-control study nested in a baseline cross-sectional survey was conducted from October to December 2018 in Taluka Kotri, a two-thirds urban locality in the Jamshoro district. Children between the ages of 0 and 23 months with a history of diarrhoea in the 2 weeks preceding the survey were labelled as cases. Age-matched controls were children without symptoms of diarrhoea. Univariate and multivariable conditional logistic regression was performed to identify diarrhoea-related factors.

RESULTS

A total of 1558 cases were matched with 3116 controls. Factors significantly associated with lower odds of diarrhoea in the multivariate analysis included increasing maternal age (odds ratio [OR] 0.78 [95% confidence interval {CI} 0.67 to 0.90]), breastfeeding (OR 0.77 [95% CI 0.66 to 0.90]), higher paternal education (OR 0.79 [95% CI 0.65 to 0.97]) and belonging to the rich (OR 0.66 [95% CI 0.54 to 0.80]) and richest quintiles (OR 0.54 [95% CI 0.44 to 0.66]).

CONCLUSIONS

This study identifies risk factors associated with diarrhoea in children <23 months of age, including younger maternal age, higher paternal education, not breastfeeding and poverty, which has implications for developing preventive programs and strategies that target populations with a higher risk of diarrhoea.

Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling

BACKGROUND

In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa.

METHODS

A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children's survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality.

RESULTS

Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1-3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24-48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality.

CONCLUSION

Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn't have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.

Water, Sanitation, and Hygiene Risk Factors on the Prevalence of Diarrhea among Under-Five Children in the Rural Community of Dangila District, Northwest Ethiopia

Background

Under-five diarrhea is one of the major causes of morbidity and mortality in developing countries. Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhea is still the major causes of morbidity and mortality in resource-limited countries like Ethiopia due to the absence of clean water and poor sanitation and hygiene.

Objective

This study aimed to assess the association of water, sanitation, and hygiene on the prevalence of diarrhea among under-five children in the rural community of Ethiopia.

Methods

A cross-sectional study was conducted among randomly selected 419 under-five children from October to December 2021 in Dangila district, Northwest Ethiopia. A structured questionnaire was used to collect sociodemographic, environmental, and behavioral data. Data were entered into Epi Info and analyzed using SPSS software. Descriptive analysis was used to calculate the prevalence of diarrhea. Univariate and multivariate logistic regression were used to compute the association of water, sanitation, and hygiene with diarrhea. Statistical significance was considered if P < 0.05.

Results

Among 419 participants, the prevalence of diarrhea was 106 (25.3%). The absence of handwashing habit of children (AOR = 7.70; 95% CI: 2.71–21.79) and caregivers after toilet (AOR = 19.10; 95% CI: 5.46–66.52), absence of latrine (AOR = 3.87; 95% CI: 1.24–12.08), playing with soil (AOR = 8.40; 95% CI: 4.58–36.66), and eating soil (AOR = 6.24; 95% CI: 1.99–19.78) were significantly associated with under-five diarrhea. Children who drink unprotected water were 2.21 times (AOR = 2.21; 95% CI: 0.51–9.69) more exposed to under-five diarrhea than who drink protected water, but it is not statistically significant (P = 0.29).

Conclusion

The prevalence of under-five diarrhea is high in Dangila district. The absence of clean water and poor handwashing practice and the absence of latrine are the main factors associated with diarrhea. Therefore, strengthening water, sanitation, and hygiene strategy in the rural community should be prioritized.

Evaluation of Water, Sanitation, and Hygiene, Behavioral Aspects, Household State for the Diarrhea Prevalence among Students in the Valley of Sinabung Volcano, North Sumatera, Indonesia

Diarrhea stands as a result of the inter-variable relationships, including behavior, environmental aspect, and household states. The study aimed to conduct an epidemiologic survey of diarrhea prevalence and several existing risk factors of diarrhea. A community-based surveillance and in-depth interview were conducted following the JMP ladder service for WASH and government regulation and it enrolled 135 children of a public primary school, SDN 040494, and households in the Valley of Sinabung Volcano, North Sumatera, Indonesia between June and October 2019. There were only two lowest categories of each WASH (Water, Sanitation and Hygiene) indicator. Multivariate analysis has also demonstrated a high likelihood of diarrhea among the population in limited settings for hygiene (p-value 0.012, AOR 7.892 95%CI 2.485, 25.064) and low daily income (p-value 0.015, AOR 3.079 95%CI 1.148, 8.260). Improvement of hygienic practices is mandatory as well as preventing volcanic eruption implications to the economy of the local community.

Socio-Economic Inequalities in Access to Drinking Water among Inhabitants of Informal Settlements in South Africa

While evidence from several developing countries suggests the existence of socio-economic inequalities in the access to safe drinking water, a limited number of studies have been conducted on this topic in informal settlements. This study assessed socio-economic inequalities in the use of drinking water among inhabitants of informal settlements in South Africa. The study used data from “The baseline study for future impact evaluation for informal settlements targeted for upgrading in South Africa.” Households eligible for participation were living in informal settlements targeted for upgrading in all nine provinces of South Africa. Socio-economic inequalities were assessed by means of multinomial logistic regression analyses, concentration indices, and concentration curves. The results showed that the use of a piped tap on the property was disproportionately concentrated among households with higher socio-economic status (concentration index: +0.17), while households with lower socio-economic status were often limited to the use of other inferior (less safe or distant) sources of drinking water (concentration index for nearby public tap: −0.21; distant public tap: −0.17; no-tap water: −0.33). The use of inferior types of drinking water was significantly associated with the age, the marital status, the education status, and the employment status of the household head. Our results demonstrate that reducing these inequalities requires installing new tap water points in informal settlements to assure a more equitable distribution of water points among households. Besides, it is recommended to invest in educational interventions aimed at creating awareness about the potential health risks associated with using unsafe drinking water.

Diarrhea and associated factors among under five children in sub-Saharan Africa: Evidence from demographic and health surveys of 34 sub-Saharan countries

INTRODUCTION

Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa.

METHODS

The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model.

RESULT

The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1-15.4). Those children of mothers aged 15-24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25-34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57-1.82), primary education (AOR = 1.73; 95%CI: 1.61-1.86) and secondary education (AOR = 1.49; 95%CI: 1.38-1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08-1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04-1.12) households had higher chance of having diarrhea compared to their counterparts.

CONCLUSION

This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.

Prevalence of diarrhoea, acute respiratory infections, and malaria over time (1995-2017): A regional analysis of 23 countries in West and Central Africa

Backgound

The global community recognizes the urgent need to end preventable child deaths, making it an essential part of the third Sustainable Development Goal. Pneumonia, diarrhoea, and malaria still remain the leading causes of deaths among children under five years, especially in one of the poorest geographic regions of the world – West and Central Africa. This region carries a disproportionately high share of the global burden, both in terms of morbidity and mortality. The study aims to assess levels and trends of the prevalence of these three childhood diseases in West and Central Africa to better inform ongoing and future programmes to improve child survival.

Methods

Demographic and Health Surveys and Multiple Indicator Cluster Surveys available from 1995 to 2017 for 23 countries in West and Central Africa were analysed. We estimated the prevalence of diarrhoea, acute respiratory infections (ARI), malaria, and fever as a proxy for malaria, and split the data into three time periods to assess these trends in disease prevalence over time. Further analyses were done to assess the variations by geographic location (urban and rural) and gender (boys and girls).

Results

In West and Central Africa, the reduction of the prevalence rates of diarrhoea, acute respiratory infections, malaria, and fever has decelerated over time (1995-2009), and little improvements occurred between 2010 and 2017. The reduction within the region has been uneven and the prevalence rates either increased or stagnated for diarrhoea (nine countries), ARI (four countries), and fever (six countries). The proportion of affected children was high in emergency or fragile settings. Disaggregated analyses of population-based data show persistent gaps between the prevalence of diseases by geographic location and gender, albeit not significant for the latter.

Conclusions

Without intensified commitment to reducing the prevalence of pneumonia, malaria, and diarrhoea, many countries will not be able to meet the SDG goal to end preventable child deaths. Evidence-driven programmes that focus on improving equitable access to preventive health care information and services must be fostered, especially in complex emergency settings. This will be an opportunity to strengthen primary health care, including community health programmes, to achieve universal health coverage.

Prevalence of acute diarrhea and associated factors among children under five in semi-urban areas of northeastern Ethiopia

BACKGROUND

Diarrheal disease is still one of the most common causes of mortality and morbidity in children under five in developing countries, including Ethiopia. Lack of specific data on the prevalence of acute diarrhea and associated factors among under-five children in the semi-urban areas of Gelsha, found in northeastern Ethiopia's South Wollo zone, remains a major gap. Therefore, this study was designed to provide data that is important for proper planning of intervention measures to reduce the problem in this area.

METHODS

A community-based cross-sectional study was conducted among 340 systematically selected children under five in semi-urban areas of Gelsha from January to March 2019. The data was collected using a structured questionnaire and an observational checklist. Bivariable (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were employed using binary logistic regression model with 95% CI (confidence interval). Variables with a p-value < 0.05 from the multivariable analysis were declared as factors significantly associated with acute diarrhea.

RESULT

The prevalence of acute diarrhea among children under five in the study area was 11% (95%CI: 7.8-14.3%). About two-thirds (63.60%) of study participants used water from improved sources. About half (54.90%) of study participants practiced poor handwashing and 45.10% practiced good handwashing. We found that factors significantly associated with acute diarrhea were a child's age of 12-23 months (AOR = 4.68, 95% CI: 1.45-1.50), the presence of two or more under-five children in the house (AOR = 2.84, 95% CI: 1.19-6.81), unimproved water sources (AOR = 2.97, 95% CI: 1.28-6.87) and presence of feces around the pit hole/slab/floor of the latrine (AOR = 3.34, 95% CI: 1.34-8.31).

CONCLUSION

The prevalence of acute diarrhea among children under five was relatively high. To reduce the problem, various prevention strategies are essential, such as the provision of health education to mothers/caregivers that focuses on keeping sanitation facilities clean and child care, and construction of improved water sources. Furthermore, implementing a strong health extension program, advocating an open defecation-free environment, and practicing a community-led total sanitation and hygiene approach might be helpful to sustainably reduce childhood diarrhea.

Prevalence and Determinants of Diarrheal Diseases among Under-Five Children in Horo Guduru Wollega Zone, Oromia Region, Western Ethiopia: A Community-Based Cross-Sectional Study

Background

Diarrheal diseases are the leading cause of preventable death, especially among under-five children in developing countries, including Ethiopia. Although efforts have been made to reduce the morbidity and mortality resulting from diarrheal diseases, there is scarce information on the progress of the interventions against the burdens. Therefore, this study aimed to assess the prevalence of diarrhea and its associated factors in under-five children in Horo Guduru Wollega Zone, Oromia Region, Western Ethiopia.

Methods

A community-based cross-sectional study was conducted. Of 12,316 households, 620 households that had under-five children were selected by simple random sampling technique from randomly selected kebeles. Before data collection, a pretest of the structured questionnaires was done on nonselected kebeles. Binary logistic regression was used to assess the association of the diarrheal diseases with independent variables. Finally, the odds ratio along with a 95% confidence interval was used to report the significant association between the outcome variable and its associated factors. A P value of ≤0.05 was considered statistically significant.

Results

The prevalence of diarrhea among under-five children was 149 (24%) (95% CI: 20.8, 27.3). Diarrhea was significantly associated with poor knowledge of mothers/caretakers on diarrhea prevention methods (AOR: 2.05, 95% CI (1.14, 3.69), being in the age group of 6-11(AOR = 1.546 (1.68, 3.52), and 12-23 months (AOR = 1.485 (1.84, 2.63)), families with poor wealth index (AOR: 2.41, 95% CI (1.29, 4.51)), children who were not vaccinated against measles (AOR: 4.73, 95% CI (2.43, 9.20)), unsafe child feces disposal (AOR = 3.75; 95% CI (1.91, 7.39)), inappropriate liquid waste disposal (AOR = 3.73 (1.94, 7.42)), and having two or more siblings (AOR: 3.11, 95% CI (1.81, 5.35)). Conclusion and Remarks. The prevalence of diarrhea among under-five children was high. There was a statistically significant association between diarrhea and age of the child (6-11 and 12-23), poor knowledge of mothers/caretakers on diarrhea prevention methods, families with poor wealth index, being unvaccinated against measles, improper liquid waste disposal, unsafe child feces disposal, and having at least two siblings. The findings have a significant policy inference for childhood diarrheal disease prevention programs. Therefore, educating mothers/caregivers on diarrheal disease prevention methods, child spacing, regular hand washing practice after disposing child feces, safely disposing liquid waste, and vaccinating all eligible children against measles should be a priority area of intervention for diarrheal disease prevention. Moreover, since these associated factors are preventable, the government needs to strengthen the health extension workers program implementations to reduce childhood diarrhea.

Prevalence of acute diarrhea and water, sanitation, and hygiene (WASH) associated factors among children under five in Woldia Town, Amhara Region, northeastern Ethiopia

BACKGROUND

Diarrhea among children under five is one of the significant public health concerns in developing countries, such as Ethiopia that is mainly attributed to inadequate water, sanitation and hygiene (WASH) services. Lack of data on the prevalence and factors associated with acute diarrhea in Woldia Town impedes the effectiveness of WASH programs in the area. Therefore, the aim of this study was to investigate the prevalence and WASH-associated factors of acute diarrhea among under-five children in this area. This study will help guide local diarrhea prevention and control programs.

METHODS

A community-based cross-sectional study was conducted among 485 children under age five from March to June 2018. The study participants were allocated proportionally and then households with children of this age group were selected from each kebele (the smallest administrative unit in Ethiopia) using a systematic random sampling technique. Data were collected from mothers/caregivers of the under-five children using a structured questionnaire and on-the-spot observation checklist. A binary logistic regression model with 95 % CI (confidence interval) was used to measure the association between dependent and independent variables. From the multivariable analysis, variables with a p-value < 0.05 were taken as factors significantly associated with acute diarrhea among under-five children.

RESULTS

The prevalence of acute diarrhea among the children was 17.6 % (95 % CI: 14.2-21.0 %). Almost two-thirds 307 (63.4 %) of study participants' main source of drinking water was a private tap; 320 (66.1 %) of households used less than 20 l per capita per day. About one-fifth 99 (20.5 %) of households used an improved sanitation facility. Only one-fifth (21.1 %) of the latrines had nearby handwashing facilities. Less than half 225 (46.5 %) of mothers/caregivers had good handwashing practice at critical times. Water consumption of less than 20 l per capita per day (adjusted odds ratio [AOR] = 2.45; 95 % CI: 1.36-5.84), unimproved sanitation facility (AOR = 3.57; 95 %CI: 1.64-6.51), practicing unsafe child feces disposal (AOR = 2.51; 95 % CI: 1.69-4.64), poor handwashing practice at critical times (AOR = 1.85; 95 % CI: 1.34-3.56) and having no information about diarrhea being prevented by handwashing with water and soap (AOR = 3.12; 95 % CI: 1.64-6.27) were significantly associated with acute diarrhea.

CONCLUSIONS

More than one in six children under age five had acute diarrhea, a proportion that could be considered relatively high. We recommend that government organizations and concerned stakeholders strengthen urban WASH programs to focus on increasing the availability of sufficient water for adequate daily consumption, and promote safe disposal of child feces and good handwashing practices at critical times. Further effort is needed to sensitize mothers/caregivers about diarrhea prevention through effective WASH activity to reduce the burden of this problem among children under five.

Prevalence and socio-demographic determinants of diarrhea among children below 5 years in Bondhere district Somalia

Introduction

globally diarrhea is rated as the second leading cause of mortality among children below the age of five years. The highest rates of morbidity and mortality as a result of diarrhea are reported in sub-Saharan Africa and South East Asia. Studies have documented Somalia as among the countries with significant high rates of diarrhea among children below the age of 5 years. The aim of the study was to assess the prevalence and socio-demographic determinants of diarrhea.

Methods

the study employed a descriptive cross-sectional study design where data was collected using semi structured questionnaires. Simple random sampling was employed to identify caregivers that were included in the study. The data collected was analyzed using SPSS version 20 at 95% confidence interval. Both descriptive and regression analysis were carried out. The data was presented using tables and graphs. Ethical clearance was sought from University of Eastern Africa Baraton ethical review committee. Permission and consent were sought from the administrative leadership of Bondhere district and caregivers respectively.

Results

the prevalence of diarrhea among children under 5 years was 22.4%. Socio-demographic factors reported to significantly influence the prevalence of diarrhea among children under years were caregiver education level and number of children under 5 years.

Conclusion

the prevalence of diarrhea among children under 5 years was considerably high. Several socio-demographic factors were associated with diarrhea. The study recommends improvement of education and sensitization of communities on family planning.

Priorities for intervention to prevent diarrhea among children aged 0-23 months in northeastern Ethiopia: a matched case-control study

BACKGROUND

The global public health problem of diarrhea is most prevalent in developing countries including Ethiopia, especially among children under two years of age. Limited information on the determinants of diarrhea among children aged 0-23 months hinders the design and prioritization of intervention strategies to address childhood diarrhea in Dessie City, northeastern Ethiopia. Therefore, this study was designed to assess the determinants of diarrhea in order to identify priority interventions for its control.

METHODS

A community-based matched case-control study was conducted among children aged 0-23 months during January-February 2018. Cases defined as children with acute diarrhea, and controls defined as children without acute diarrhea, were matched by child's age (months) and place of residence (residing in the same kebele, the lowest local administrative unit, each of which has a population of approximately 5000) during the two weeks prior to data collection. Data were collected from mothers/caregivers of the 119 cases and 238 matched controls using a pre-tested structured questionnaire and an observational checklist. Data were analyzed using conditional logistic regression model with 95% confidence interval (CI); variables with p < 0.05 from multivariable analysis were considered as significantly associated with acute diarrhea among children aged 0-23 months.

RESULTS

Age of mothers/caregivers (> 35 years of age) (adjusted matched odds ratio [adjusted mOR] = 2.00; 95% CI: 1.37-5.8); divorced/widowed marital status (adjusted mOR = 1.40; 95% CI: 1.26-3.3); lack of exclusive breastfeeding (adjusted mOR = 2.12; 95% CI: 1.15-3.70); presence of feces within/around latrines (adjusted mOR = 1.37; 95% CI: 1.21-3.50); lack of handwashing facility near latrine (adjusted mOR = 1.50; 95% CI: 1.30-5.30); presence of domestic sewage discharge within and/or outside the compound (adjusted mOR = 3.29; 95% CI: 1.85-7.50) and practice of handwashing at fewer than three of the five critical daily times (adjusted mOR = 4.50; 95% CI: 2.54-9.50) were significantly associated with acute diarrhea among children aged under two years.

CONCLUSION

To reduce acute diarrheal disease among children under two, priority should be given to interventions that focus on improving exclusive breastfeeding practices, regular cleaning of latrines, advocating for availability of handwashing facility within/around latrines, use of proper domestic sewage discharge methods and improving handwashing practice at the five critical times each day. Strengthening communication that promotes hygiene and behavioural change may also raise awareness among mothers/caregivers and empower them to enhance handwashing practices at critical times.

Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria

Introduction

diarrhoea remains a public health problem globally with majority of diarrhoea morbidity and mortality occurring in low resource settings. This study assessed the prevalence of diarrhoea and factors associated with diarrhoea in a rural community in Enugu, South East Nigeria.

Methods

a community-based cross-sectional survey was conducted between May and June, 2017. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhoea history was obtained from 534 community residents using a structured interviewer administered questionnaire. Data were analyzed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance.

Results

prevalence of diarrhoea in the two weeks preceding the study was 7.47% and 10.77% among all ages and children younger than five years respectively. Of 469 residents aged five years and above, 206 (43.92%) accessed source of drinking water within 30 minutes round trip walking distance from their households, 275 (58.64%) practiced open defecation while 456 (97.23%) and 455 (97.01%) reported washing hands with soap or ash and water before eating and after using the toilet respectively. Two or more households sharing a toilet facility [AOR = 4.78 (95% CI 2.03-11.24)] was a risk factor for diarrhoea while washing hands with soap or ash and water before eating [AOR = 0.23 (95% CI 0.06-0.90)] and after using the toilet [0.16 (95% CI 0.04-0.55)] protected against diarrhoea.

Conclusion

increasing access to improved sanitary sewage disposal methods and promoting hand washing with soap and water at critical moments would improve diarrhoeal disease control.

Sociodemographic Determinants of Healthcare-Seeking Options and Alternative Management Practices of Childhood Diarrheal Illness: A Household Survey among Mothers in Iraq

Diarrhea remains a significant cause of child morbidity and mortality in Iraq. The objective of this study was to examine the current practices of home-based management of diarrheal illnesses among Iraqi children. We surveyed mothers of children aged less than 5 years to identify the sociodemographic factors associated with maternal healthcare-seeking practices. A total of 500 mother-child pairs were interviewed in a cross-sectional household survey in Thi-Qar Governorate, southeastern Iraq, between March 2016 and February 2017. Logistic and multinomial regression models were used to infer sociodemographic predictors of the healthcare-seeking and alternative management practices adopted by the mothers. The interviewees reported that 35.2% of their children had diarrhea in the 2 weeks before the survey. The least likelihood of reported occurrence of diarrhea was among mother-child pairs where the mothers had received university education, as compared with mothers who were illiterate or received only primary or secondary education. Lower odds (odds ratio = 0.4, P-value < 0.001) of reported childhood diarrhea was revealed among mothers aged > 25 years than among those younger. Self-ordered medicine from a pharmacy was the most preferred alternative management option in almost half (52.4% [262/500]) of the interviewed mothers in Thi-Qar. Interestingly, 69.6% (348/500) of the mothers reported supplying their children suffering from diarrhea with antibiotics. Relative to mothers with university education, those with high school education had more likelihood of selecting medical center (relative risk ratio [rrr] = 2.4) and pharmacy (rrr = 3.7) as against no treatment. Lower maternal educational level, mothers' age < 25 years, and the district of residence were important factors associated with diarrhea occurrence among children younger than 5 years. In light of the findings from this study, intervention aimed at improving healthcare seeking for managing diarrhea in Iraqi children should jointly consider the influence of mothers age, education, as well as the level of economic status of the communities in which mothers of these children reside. The results of this study indicate the need for enhancing public health education to improve the maternal management of diarrheal disease and the avoidance of unnecessary use of antimicrobials.

Predictors of immunization coverage among 12-23 month old children in Ethiopia: systematic review and meta-analysis

BACKGROUND

Immunization is one of modern medicine's greatest achievements in the last three decades. Annually it can prevent nearly 2 to 3 million deaths. Understanding the determinants of effective immunization coverage is a critical undertaking. Accordingly, we set out to check the best available evidence of outstanding predictors of immunization coverage among children aged 12-23 months in Ethiopia.

METHOD

Electronic databases including PubMed, Google Scholar, HINARI, and SCOPUS, Web of Science, African Journals Online, Ethiopian Medical Journals were searched. The search process, study selection, critical appraisal, and data extraction were done independently by two reviewers using Joanna Briggs Institute Meta-analysis for Review Instrument (JBI-MAStARI). The difference between reviewers was resolved with a third person. The risk of bias was assessed by the Newcastle Ottawa Tool for observational studies. Data were extracted using the Microsoft Excel checklist and exported to STATA 13. Heterogeneity was assessed using I2, Funnel plot and Egger's test was used to check for publication bias.

RESULTS

We identified 26 studies with 15,042 children with mothers/caretakers to assess factors associated with immunization coverage and significant factors were: maternal formal education, (OR = 2.45; 95% CI: 1.62-3.72), paternal formal education, (OR = 1.01; 95% CI: 0.27-3.77), residence, (OR = 2.11; 95% CI: 1.00-4.45), birth at health facility (OR = 1.86; 95% CI: 0.99-3.49), family size less than four, (OR = 1.81; 95% CI: 1.16-2.84), knowledge on age of immunization to be completed (OR = 6.18;95% CI: 3.07-12.43), knowledge on immunization schedule (OR = 2.49; 95% CI: 1.35-4.59), time to travel to health faculties, (OR = 1.74; 95% CI: 0.62-4.89), antennal care, (OR = 3.11; 95% CI: 1.64-5.88), and tetanus toxoid vaccination, (OR = 4.82; 95% CI: 2.99-7.75).

CONCLUSION

Our findings showed that literacy, residence, awareness, family size, maternal health services use, and proximity of the health facilities were factors associated with full immunization. This implies that there is a need for primary health service expansion and health education to "hard to reach areas" to improve immunization coverage for children aged 12-23 months.

Assessing the Sustainability and Acceptance Rate of Cost-Effective Household Water Treatment Systems in Rural Communities of Makwane Village, South Africa

The current study investigated the acceptance rate and long-term effectiveness of cost-effective household water treatment systems deployed in Makwane Village. A structured questionnaire was used prior to implementation to collect information such as level of education, level of employment, and knowledge about point-of-use water treatment systems in the target area. The long-term effectiveness was determined by factors such as the Escherichia coli removal efficiency, turbidity reduction, silver leached, and flow rate of the household water treatment devices. The results of the survey prior to deployment revealed that only 4.3% of the community had a tertiary qualification. Moreover, 54.3% of the community were unemployed. The results further revealed that 65.9% of the community were knowledgeable about other point-of-use water treatment methods. The acceptance rate, which was found to be initially higher (100%), reduced after three months of implantation (biosand filter with zeolite-silver clay granular—82.9%; silver-impregnated porous pot filters—97.1%). Moreover, the long-term effectiveness was determined, taking into consideration the adoption rate, and it was found that silver-impregnated porous pot filters have a long life compared to biosand filter with zeolite-silver clay granular. Although household water treatment systems can effectively reduce the burden of waterborne diseases in impoverished communities, the success of adoption is dependent on the targeted group. This study highlights the significance of involving community members when making the decision to scale up household water treatment devices in rural areas for successful adoption.

Determinants of diarrhoeal diseases and height-for-age z-scores in children under five years of age in rural central Tanzania

INTRODUCTION

Childhood diarrhoeal diseases and stunting are major health problems in low- and middle-income countries (LMICs). Poor water supply, sanitation services and hygiene, frequently encountered in resource-poor settings, contribute to childhood diarrhoea and stunting.

METHODS

Data on demographic characteristics, hygiene practices, sanitation and human-animal interactions (predictors) and child height-for-age z-scores (HAZ) (outcome) were collected once, while diarrhoea incidences were collected fortnightly for 24 months (outcome).

RESULTS

Drinking water from public taps (OR = 0.51, 95% CI. 0.44-0.61; p < 0.001) and open wells (OR = 0.46, 95% CI. 0.39-0.54; p < 0.001) and older age of children (OR = 0.43, 95% CI. 0.27-0.67; p < 0.001) were protective against diarrhoea. Inappropriate disposal of children's faeces (OR = 1.15, 95% CI. 1.02-1.31; p = 0.025), sharing water sources with animals in the dry season (OR = 1.48, 95% CI. 1.29-1.70; p < 0.001), overnight sharing of houses with cats (OR = 1.35, 95% CI. 1.16-1.57; p < 0.001) and keeping chickens inside the house overnight regardless of room (OR = 1.39, 95% CI. 1.20-1.60; p < 0.001) increased the risk of diarrhoea. The Sukuma language group (p = 0.005), washing hands in running water (p = 0.007), access of chickens to unwashed kitchen utensils (p = 0.030) and overnight sharing of the house with sheep (p = 0.020) were associated with higher HAZ in children.

CONCLUSIONS

Until a more precise understanding of the key risk factors is available, these findings suggest efforts towards control of diarrhoea and improved linear growth in these areas should be directed to increased access to clean and safe water, hand-washing, sanitation, and improved animal husbandry practices.

Predictors of diarrhea episodes and treatment-seeking behavior in under-five children: a longitudinal study from rural communities in Zambia

Introduction

globally, diarrhea is the second leading cause of mortality in children aged below five years, and is responsible for killing about 760 000 children every year. Poor treatment-seeking behavior among caretakers remains a major challenge in low-income countries. The current study aimed to determine the predictors of diarrhea episodes and treatment-seeking behavior among under-five children of Chivuna and Magoye in Zambia.

Methods

we conducted a community-based longitudinal study among 1216 children aged 12-59 months between July 2006 and June 2007. A structured interviewer-administered questionnaire was used to collect data on demographic factors, diarrhea episodes and treatment-seeking behavior from caretakers. Chi-square, one-sample test of proportions and logistic regression were the statistical methods used in this study.

Results

of the 1216 children who participated in the study, 698 (57%) were from Chivuna and 518 (43%) from Magoye. Factors associated with diarrhea episodes were location (children in Chivuna had increased episodes of diarrhea; aOR 1.32; 95%CI 1.15, 1.52) and age distribution (children aged 37-59 months vs. 12-36 months had reduced episodes of diarrheal aOR 0.81; 95%CI 0.72, 0.91). Fifty two percent (52%) of the diarrhea cases had their treatment sought within 24 hours of onset (early treatment). Thirty one percent (31%) of the diarrhea cases had their early treatment at a health facility. Female children (52%) had the majority of their diarrhea episodes treated within 24 hours of onset. The higher proportion of diarrhea episodes had their treatment at home (52%). Children who did not have home treatment had a significantly reduced chance of having early treatment (aOR 0.62; 95%CI 0.47, 0.82).

Conclusion

this study revealed that diarrhea episodes and treatment seeking behavior in under-5 children is of public health concern. There is need to re-enforce the preventative and control measures aimed at reducing diarrhea in under-5 children, and interventions should take into account the different predictors of diarrhea and treatment seeking behavior in different settings, like the ones highlighted in this study.

Immunization coverage in Ethiopia among 12-23 month old children: systematic review and meta-analysis

Background

Immunization is a cost-effective public health strategy. Immunization averts nearly three million deaths annually but immunization coverage is low in some countries and some regions within countries. The aim of this systematic review and meta-analysis is to assess pooled immunization coverage in Ethiopia.

Method

A systematic search was done from PubMed, Google Scholar, EMBASE, HINARI, and SCOPUS, WHO’s Institutional Repository for Information Sharing (IRIS), African Journals Online databases, grey literature and reviewing reference lists of already identified articles. A checklist from the Joanna Briggs Institute was used for appraisal. The I² was used to assess heterogeneity among studies. Funnel plot were used to assess publication bias. A random effect model was used to estimate the pooled prevalence of immunization among 12–23 month old children using STATA 13 software.

Result

Twenty eight articles were included in the meta-analysis with a total sample size of 20,048 children (12–23 months old). The pooled prevalence of immunization among 12–23 month old children in Ethiopia was found to be 47% (95%, CI: 46.0, 47.0). A subgroup analysis by region indicated the lowest proportion of immunized children in the Afar region, 21% (95%, CI: 18.0, 24.0) and the highest in the Amhara region, 89% (95%, CI: 85.0, 92.0).

Conclusion

Nearly 50% of 12–23 month old children in Ethiopia were fully vaccinated according to this systematic review and meta-analysis this indicates that the coverage, is still low with a clear disparity among regions. Our finding suggests the need for mobile and outreach immunization services for hard to reach areas, especially pastoral and semi-pastoral regions. In addition, more research may be needed to get more representative data for all regions.

PROSPERO registration number

CRD42020166787.

Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis

Background

Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities.

Methods

A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016).

Results

The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services.

Conclusions

The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.

Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia

INTRODUCTION

Diarrhea is one of the leading causes of child morbidity and mortality in low- and middle-income countries like Ethiopia. The use of safe drinking water and improved sanitation are important practices to prevent diarrhea. However, limited research has been done to link water supply, sanitation and hygiene practices and childhood diarrhea. Therefore, this study aimed at assessing the association between microbial quality of drinking water, sanitation and hygiene practices and childhood diarrhea.

METHODS

Community-based matched case-control study design was applied on 198 paired children from June to July 2019 in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. Cases are children < 5 years of age with diarrhea during the two weeks before the survey. The controls are children without diarrhea during the two weeks before the survey. Twenty-five percent matched pair samples of water were taken from households of cases and controls. Data were collected using structured questionnaire by interviewing mothers/caregivers. A sample of water was collected in nonreactive borosilicate glass bottles and analyzed by the membrane filtration method to count fecal indicator bacteria. A conditional logistic regression model was used; variables with p-value less than 0.05 were considered as significantly associated with childhood diarrhea.

RESULTS

A total of 396 (each case matched with control) under-five children with their mothers/caregivers were included in this study. In the analysis, variables like presence of under-five child in their home (AOR = 2.76; 95% CI: 1.33-5.71), wealth status (AOR = 5.39; 95% CI: 1.99-14.55), main sources of drinking water (AOR = 4.01; 95% CI: 1.40-11.44), hand washing practice before water collection (AOR = 4.28; 95% CI: 1.46-12.56), treating water at household level (AOR = 1.22; 95% CI: 0.48-3.09), latrine use all the times of the day and night (AOR = 0.22; 95% CI: 0.06-0.78), using pit as method of waste disposal (AOR = 4.91; 95% CI: 1.39-13.29) and use of soap for hand washing (AOR = 2.89; 95% CI: 1.35-6.15) were significantly associated with childhood diarrhea. Moreover, 30% of sampled water from cases and 26% of sampled water from controls families were free from Escherichia coli whereas all sampled water analyzed for Total coliforms were positive.

CONCLUSIONS

We conclude that the main sources of drinking water, hand washing before water drawing from a storage container, domestic waste disposal place and use of soap for hand washing were the most important factors for the prevention of childhood diarrhea.

Contextual and Psychosocial Factors Influencing the Use of Safe Water Sources: A Case of Madeya Village, uMkhanyakude District, South Africa

Background: Schistosomiasis is a public health problem that affects over 240 million people worldwide. It is mostly prevalent in tropical and sub-tropical areas among communities with limited access to clean water and adequate sanitation. This study was conducted in uMkhanyakude District in rural South Africa, where water resources are limited. In this community, individuals frequently come into contact with freshwater bodies for various reasons. The objective of the study was to identify critical contextual and psychosocial factors for behaviour change to reduce risk of schistosomiasis transmission in Madeya Village, uMkhanyakude district. Methods: Structured household interviews were held with 57 primary caregivers to assess their thoughts and attitudes towards collecting water from a safe source. We used the Risk, Attitude, Norm, Ability, and Self-regulation model (RANAS) to estimate the intervention potential for each factor by analysing differences in means between groups of current performers and nonperformers who use safe water sources. Results: The subscale vulnerability belonging to the risk factor on the RANAS was scored as low. Furthermore, attitudinal factors towards the use of safe water sources were found to be low. Ability factors (confidence in performance and confidence in recovery) towards the use of safe water sources were low as well, indicating that these factors should be the target of the intervention in the study area. Discussion: Based on this study, it is recommended that a community-based empowerment intervention strategy it appropriate. The strategy should prompt behavioural practice and public commitment, use persuasive language to boost self-efficacy and target younger low-income caregivers between 18 and 35 years of age.

Proximate determinants of infant mortality in Ethiopia, 2016 Ethiopian demographic and health surveys: results from a survival analysis

BACKGROUND

In Ethiopia, large scale health care efforts had been done to promote infant health and survival. However, nationwide data is lacking on the survival status and proximate determinants of infant mortality in Ethiopia. Therefore, this study was aimed to identify the survival status and determinants of infant mortality in Ethiopia using Ethiopian Demographic and Health Survey (EDHS).

METHODS

The data source for this study was the 2016 Ethiopian Demographic and Health Survey. Records of all 10,641 live births and survival informations of all 2826 infants born 5 years before the survey were reviewed. Kaplan-Meier method and Cox proportional hazards regression model were employed to identify the proximate determinants associated with the infant mortality.

RESULTS

The results of Kaplan-Meier estimation showed that the highest infant deaths occurred in the early months of life immediately after birth and declined in the later months of follow-up time. About 65% of infant deaths occurred during the first month's of life. Using the Cox proportional hazard model we found that: mothers' level of education, preceding birth interval, plurality, size of child at birth and sex of child as significant predictors of infant mortality. The risk of dying in infancy was lower for babies of mothers with secondary education (RR = 0.68, 95% CI: 0.56-0.98), higher education (RR = 0.51, 95% CI:0.45-0.80), for preceding birth interval longer than 47 months (RR = 0.51, 95% CI: 0.27, 0.92) and higher for birth interval shorter than 24 months (RR = 2.02, 95% CI:1.40-2.92), for multiple births (RR = 4.07, 95% CI: 1.14-14.50), for very small size of infants (RR = 3.74, 95% CI:1.73-8.12), for smaller than average size infants (RR = 3.23, 95% CI: 1.40-7.41) and for female infants (RR = 1.26, 95% CI: 1.01-1.56) compared to the reference category.

CONCLUSIONS

A significant proportion of infants died during the study period of which nearly two third of deaths occurred during the first months of life. Thus, close monitoring and supporting reproductive age mothers to increase the uptakes of family planning and antenatal care and follow-up is highly recommended to increase the infant survival.

Mothers' Handwashing Knowledge as a Predictor of Diarrheal Disease Among Under-Five Children Visiting Pediatric Ward in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019

Background

Diarrheal disease is one of the leading causes of mortality and morbidity among under-five children in the world and often results from contaminated food and water. The aim of this study was to assess the prevalence of diarrheal disease among under-five children visiting the pediatric ward in University of Gondar Comprehensive Specialized Hospital and its association with their mothers’ handwashing knowledge.

Methods

An institutional-based cross-sectional study was conducted from May to July 2019 among under-five children visiting the pediatric ward in University of Gondar Comprehensive Specialized Hospital. An interviewer-administered questionnaire was used to collect the data. Chart review was undertaken using a data abstraction form. A simple random sampling technique was used to select the study participants. Data were entered using Epi Info version 7 and analyzed using STATA version 14.0. A binary logistic regression analysis was employed between dependent and independent variables to determine association. The statistical significance was declared at P<0.05.

Results

In this study, the prevalence of diarrheal disease among under-five children visiting the pediatric ward in University of Gondar Comprehensive Specialized Hospital was 30.09% (95% CI: (26%, 35%)). Age of mothers (AOR=3.72, 95% CI: (1.67, 8.28)), mothers’ educational status (AOR=0.44, 95% CI: (0.23, 0.80)), malnutrition (AOR=6.72, 95% CI: (3.44, 13.11)), and maternal knowledge of handwashing (AOR=0.49, 95% CI: (0.27, 0.90)) were factors associated with diarrheal disease among under-five children.

Conclusion

The prevalence of diarrheal disease was higher in the current study, which is a major public health concern. Age of mothers, malnutrition, and mothers’ handwashing knowledge and educational status were significantly associated with diarrheal disease of under-five children. In order to reduce diarrheal disease and improve child health, attention should be given to improving mothers’ educational status and knowledge regarding handwashing.

Prevalence of diarrheal diseases and associated factors among under-five children in Dale District, Sidama zone, Southern Ethiopia: a cross-sectional study

BACKGROUND

Globally childhood diarrhoeal diseases continue to be the second leading cause of death, while in Ethiopia it kills half-million under-five children each year. Sanitation, unsafe water and personal hygiene are responsible for 90% of the occurrence. Thus, this study aimed to assess the prevalence and associated factors of diarrheal diseases among under-five children in Dale District, Sidama Zone, Southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted. A face to face interview using a structured questionnaire and observation checklist was used. A total of 546 households with at least one under-five children were selected using simple random sampling techniques. The data entry and cleaning were performed using Epidemiological information software (EPI Info) 3.5.1 and then exported to Statistical Package for Social Science (SPSS) version 16.0 for analysis. Frequencies and proportions were computed as descriptive analysis. Initially using bivariate analysis a crude association between the independent and dependent variables was investigated. Then, those variables with p-value ≤0.25 were included in multivariable analysis to determine the predictor variables for the outcome variables. Finally, further analyses were carried out using multivariable analysis at a significance level of p-value ≤0.05.

RESULTS

A total of 537 children under the age of 5 years were included. The 2 weeks prevalence of diarrhea among children under the age of 5 years was 13.6, 95% CI (10.7, 16.5%). Educational level [AOR: 3.97, 95% CI (1.60, 8.916)], age of indexed child [AOR: 12.18, 95% CI (1.78, 83.30)], nutritional status [AOR: 6.41, 95% CI (2.47, 16.77.)], hand washing method [AOR, 3.10, 95% CI (1.10, 8.67)], hand washing after latrine [AOR: 2.73, 95% CI (1.05, 6.56)], refuse disposal method [AOR, 3.23, 95% CI (1.37, 7.60)] and housing floor material [AOR: 3.22, 95% CI (1.16, 8.91] were significantly associated with the occurrence of childhood diarrheal diseases.

CONCLUSION

Childhood diarrhea remains the commonest health problem in the study area. The findings have important policy implications for childhood diarrhoeal disease intervention programs. Thus, activities focusing on proper handwashing techniques at all appropriate times, proper refuse disposal, improving nutrition and better childcare also highly recommended.

The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries

BACKGROUND

Millions of people carry water home from off-plot sources each day and lack improved sanitation. Research on the health outcomes associated with water fetching is limited, and with usage of improved sanitation is inconclusive.

OBJECTIVES

To analyse the association of water fetching, unimproved water supplies, and usage of improved sanitation facilities with indicators of women's and children's health.

METHODS

49 Multiple Indicator Cluster Surveys from 41 countries were merged, creating a data set of 2,740,855 people from 539,915 households. Multilevel, multivariable analyses were conducted, using logistic regression for binary outcomes, negative binomial regression for count data and ordinary linear regression for linear data. We adjusted for confounding factors and accounted for clustering at survey, cluster and household level.

RESULTS

Compared to households in which no-one collects water, water fetching by any household member is associated with reduced odds of a woman giving birth in a health care facility (OR 0.88 to 0.90). Adults collecting water is associated with increased relative risk of childhood death (RR 1.04 to 1.05), children collecting water is associated with increased odds of diarrheal disease (OR 1.10 to 1.13) and women or girls collecting water is associated with reduced uptake of antenatal care (β-0.04 to -0.06) and increased odds of leaving a child under five alone for one or more hours, one or more days per week (OR 1.07 to 1.16). Unimproved water supply is associated with childhood diarhhoea (OR 1.05), but not child deaths, or growth scores. When the percentage of people using improved sanitation is more than 80% an association with reduced childhood death and stunting was observed, and when more than 60%, usage of improved sanitation was associated with reduction of diarhhoea and acute undernutrition.

CONCLUSION

Fetching water is associated with poorer maternal and child health outcomes, depending on who collects water. The percentage of people using improved sanitation seems to be more important than type of toilet facility, and must be high to observe an association with reduced child deaths and diarhhoea. Water access on premises, and near universal usage of improved sanitation, is associated with improvements to maternal and child health.

Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis

INTRODUCTION

Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever.

MATERIALS AND METHODS

A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity.

RESULTS

The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage.

CONCLUSIONS

High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Infection, colonization and shedding of Campylobacter and Salmonella in animals and their contribution to human disease: A review

Livestock meat and offal contribute significantly to human nutrition as sources of high-quality protein and micronutrients. Livestock products are increasingly in demand, particularly in low- and middle-income settings where economies are growing and meat is increasingly seen as an affordable and desirable food item. Demand is also driving intensification of livestock keeping and processing. An unintended consequence of intensification is increased exposure to zoonotic agents, and a contemporary emerging problem is infection with Campylobacter and Salmonella spp. from livestock (avian and mammalian), which can lead to disease, malabsorption and undernutrition through acute and chronic diarrhoea. This can occur at the farm, in households or through the food chain. Direct infection occurs when handling livestock and through bacteria shed into the environment, on food preparation surfaces or around the house and surroundings. This manuscript critically reviews Campylobacter and Salmonella infections in animals, examines the factors affecting colonization and faecal shedding of bacteria of these two genera as well as risk factors for human acquisition of the infection from infected animals or environment and analyses priority areas for preventive actions with a focus on resource-poor settings.

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.

Water Quality Assessment of Surface and Groundwater Sources Using a Water Quality Index Method: A Case Study of a Peri-Urban Town in Southwest, Nigeria

Sustainable access to safe drinking water remains a global problem as more people in the world still consume water from unimproved sources. This study was carried out to evaluate the quality of 12 different water sources and 2 treated water used by a peri-urban town in the Southwest region of Nigeria to assess their suitability for drinking and domestic use. Water quality parameters studied include pH, temperature, acidity, total alkalinity, chloride content and total CO2. A Flame Atomic Absorption spectrophotometer was used to determine the concentrations of Ca, Mg, Cu, Cr, and Pb in the water samples. The total coliform was determined using the most probable number technique while a qualitative method was used to detect the presence of faecal coliform and E. coli in the water samples. All the physicochemical water quality parameters complied with regulatory standards. Similarly, most of the heavy metals also complied except for some sites. Faecal coliform and E. coli tested positive for all the samples except one of the tap water sample. Majority of the water samples (86%) were rated as excellent based on the physicochemical parameters. One sample each was rated as having poor and good water quality, respectively. All the samples tested positive for faecal coliform bacteria and E. coli except one (treated water). It is recommended that Microbial water quality parameters be included in all Water Quality Index (WQI) analyses in order to give the true status of the quality of a water resource.

Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladesh

INTRODUCTION

Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh.

METHODS

This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented.

RESULTS

The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42).

CONCLUSIONS

The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.

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.

Diarrheal status and associated factors in under five years old children in relation to implemented and unimplemented community-led total sanitation and hygiene in Yaya Gulele in 2017

PURPOSE

The aim of this study was to assess the diarrheal status and associated factors of under five-years old children among implemented and unimplemented community-led total sanitation and hygiene (CLTSH) in Yaya Gulele district, Ethiopia, in 2017.

METHODS

Community-based comparative cross-sectional study involving 380 households from each implemented and unimplemented CLTSH area was conducted from December 1 to June 30, 2017. Pretested structured questionnaire and a complete observational checklist were used to collect data. Qualitative data were collected via focused group discussions and analyzed manually. Data were checked and entered to Epi-info 3.5.4 and analyzed by SPSS version 20. Bivariate and multivariable logistic regression analyses were computed.

RESULTS

In this study, 88% implemented and 66% unimplemented CLTSH had latrine. Of households owning latrine, 85% in implemented and 75% in unimplemented CLTSH utilize latrine properly. In the study area, 12% in implemented and 34% in unimplemented CLTSH area practice open defecation. Two weeks period diarrhea prevalence was 13.4% (95% CI: 10.2-17.3%) in implemented CLTSH and 36.3% (95% CI: 31.7-41.6%) in unimplemented CLTSH. Having two or more children under five years old (adjusted odds ratio [AOR] = 2.33; 95% CI: 1.09-4.96), lack of clean water storage (AOR = 2.36; 95% CI: 1.16-4.80), negative attitude of mothers/caregivers toward diarrhea (AOR = 2.07; 95% CI: 1.06-4.04), presence of feces in the compound (AOR = 1.88; 95% CI: 1.10-3.22), and lack of hand washing facility in the compound (AOR = 2.64; 95% CI: 1.47-4.74) were associated factors of the outcome.

CONCLUSION

Implementation of CLTSH is the applicable tool to reduce diarrhea prevalence. Having two or more children under five years old, unclean water storage, negative attitude of mothers toward diarrhea, existence of feces in the compound, and lack of hand washing facility in the compound were associated factors to the diarrheal status of children under five years old. Health workers and local authorities inspire the community to clean water-storage facilities and the environment, to change mothers' behavior toward diarrhea, as well as construct hand washing facility in the compound.

Causes of Morbidity and Mortality among Neonates and Children in Post-Conflict Burundi: A Cross-Sectional Retrospective Study

The risk of a child dying before age five in Burundi is almost 1.6 times higher than that in the World Health Organization (WHO) African region. However, variations in the all-cause mortality rates across Burundi have not yet been measured directly at subnational levels, age group and by gender. The objective of this study was to describe the main causes of hospitalization and mortality in children during the neonatal period and at ages 1 to 59 months, for boys and girls, and to assess the total annual (2010) burden of under-five morbidity and mortality in hospitals using hospitalization records from 21 district hospitals. We found variation in the gender and regional distribution of the five leading causes of hospitalization and death of children under five. Although the five causes accounted for 89% (468/523) of all neonatal hospitalizations, three causes accounted for 93% (10,851/11,632) of all-cause hospitalizations for children ages 1 to 59 months (malaria, lung disease, and acute diarrhea), malaria accounted for 69% (1086/1566) of all deaths at ages 1 to 59 months. In Burundi, human malarial infections continue to be the main cause of hospitalization and mortality among under-five children.

Environmental factors of diarrhea prevalence among under five children in rural area of North Gondar zone, Ethiopia

BACKGROUND

In the sub-Saharan countries, many of the children including found in health facilities are not having sufficient care of diarrhea. Diarrheal disease in these countries is one of the main causes of deaths for under-five children.

METHODS

A community-based cross-sectional study design was used to collect data from May-June, 2016 to determine environmental factors of diarrhea prevalence among under five children in North Gondar Zone. Structured interview questionnaire and observational checklist were used to collect data. Using probability proportion to size, number of households was determined in each district. The multivariable binary logistic regression analysis with a 95% confidence interval and p < 0.05.was used to identify environmental factors associated with childhood diarrheal disease.

RESULTS

Of the total 736 individuals surveyed from 736 households, a total of 163 (22.1%) with [95% CI (19.1-25.1)] under -five children had 2 week period diarrhea prevalence. Roof material [AOR: 1.99, 95% CI (1.1-3.82)], hand washing facility [AOR: 0.52, 95%CI (0.33-0.82)], presence of Latrine facility [AOR: 1.65, 95% CI (1.01-2.72)], presence of feces around the pit hole [AOR: 1.65, 95% CI (1.01-2.72)], presence of feces around the house compound [AOR: 1.65, 95% CI (1.01-2.72)] and risk of contamination of household storage had significant associations with diarrheal morbidity.

CONCLUSION

The prevalence of childhood diarrheal disease among under - five children in rural settings of northwest Ethiopia was high. Type of roof material, hand washing facility, presence of Latrine facility, presence of feces around the pit hole, presence of feces around the house compound and risk of contamination of household storage had significant associations with diarrheal morbidity.

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.

Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a community based unmatched case-control study

Background

Globally, childhood diarrhea is amongst the most prevalent health problems and accounts for 9% of all deaths in children under-five. In Ethiopia, childhood diarrhea is a major public health problem in which the prevalence ranges from 13.5 to 30.5% and experienced by multiple factors. Although health extension program has been implementing for couples of years; diarrheal disease remains the second cause of morbidity and continues an important public health problem in the study district. Thus, this study assessed determinants of diarrheal disease among under-five children in the Medebay Zana district, northwest Tigray, Ethiopia, 2015.

Method

A community based case-control study was used. A multistage sampling procedure was employed to enroll the study participants. Data were collected using face to face administered questionnaire. The collected data were entered into Epi Info version 3.5.4 and exported to SPSS Version 21 for analysis. Frequencies with percentages were computed using univariate analysis. Finally, logistic regression model was fitted to identify factors associated with childhood diarrhea where P-values of less than 0.05 were considered statistically significant.

Results

Socio-demographic factors such as low maternal educational level [AOR = 2.88, 95% CI (1.70, 4.88)], being index child of older age, households with ≥3 number of children under-five [AOR = 4.05, 95% CI (1.91, 8.60)] and maternal history of diarrhea [AOR = 2.10, 95% CI (1.09, 4.05)] were statistically associated with childhood diarrhea. This study also revealed that child feeding practice; not exclusively breastfed [AOR = 4.84, 95% CI (2.21, 10.60)] and initiation of complementary feeding above 6 months [AOR = 1.78, 95% CI (1.09, 2.92)] were statistically associated with outcome variable. Environmental and behavioral practices such as unavailability toilet facility [AOR = 2.10, 95% CI (1.34, 3.30)], improper solid waste disposal [AOR = 2.29, 95% CI (1.53, 3.44)] and unprotected drinking water [AOR = 1.83, 95% CI (1.12, 2.98)] were also found significant factors of childhood diarrhea.

Conclusion

Maternal educational status, age of index child, number of < 5 children, child feeding practices, maternal history of diarrhea, toilet facility, solid waste disposal and household drinking water were found determinants of childhood diarrhea. These findings have policy implications and insight the strengthening for health intervention programs.