Risk correlates of diarrhea in children under 5 years of age in slums of bankura, west bengal

Exploring the Association Between Floods and Diarrhea among Under-five Children in Rural India

OBJECTIVE

Flood is one of the major public health concerns increasing the risk of childhood diarrhea. This study aims to explore the association of floods with diarrhea among under-five children in rural India.

METHODS

A cross-sectional study was carried out using large-scale nationally representative data from the National Family Health Survey-5. The Central Water Commission reports between the years 2018 and 2020 were used to group all the districts as non-flood-affected districts or flood-affected districts. Bivariate and multivariate logistic regression models were employed to assess the association of floods with childhood diarrhea.

RESULTS

The prevalence of diarrhea was higher among children exposed to three consecutive floods during the year 2019-21 than those children not exposed to flood. Children exposed to flood three times between the year 2018-19 to 2020-21 were associated with a 34% higher likelihood of developing diarrhea than those children exposed to flood one or two times.

CONCLUSIONS

Our study suggests that community health workers should target mothers belonging to the poor wealth quintile, young mothers, and mothers with young infants and more children to receive child health related counseling in flood-prone areas.

A Longitudinal Study of Acute Diarrhoeal Diseases Among Children Under Five Years in an Urban Area of Goa

Background

Acute diarrhoeal diseases (ADD) account for a large number of preventable deaths in India, especially in children less than five years who are more at risk than adults with respect to the degree of dehydration and complications. (1) To measure the incidence of ADD among children under 5 years; (2) Determine risk factors associated among children; (3) Study treatment-seeking behaviour of their mothers. Community-based, prospective, longitudinal study conducted in an urban area of Goa.

Material and Methods

250 children enrolled in the study with their mothers by stratified random sampling technique, conducted house-to-house visits every three months and mothers were interviewed with pre-tested semi-structured questionnaire. The duration of study was one year from January to December 2018. Data entered using EpiData Entry Client®, Analysed using SPSS® software version 22. Student's t-tests and Chi-square tests were used.

Results

The incidence of ADD was 0.124 episodes/child/year. Significant association was noted between ADD in children and certain socio-demographic factors like child's sex, birth order, birth weight, immunization status, malnutrition, mother's age group, mother's education, and mothers' hygiene practices.

Conclusions

Efforts should be made to educate all mothers about the seeking timely treatment, awareness about home-based management and their types, awareness of ORS, zinc, importance of hygienic practices like hand washing for mother and child.

An overview of diarrhea among infants and under-five in Punjab-Pakistan

BACKGROUND

Diarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0-59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030.

AIM

This study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0-59 months in Punjab Pakistan.

METHODS

The study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017-18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis.

FINDINGS

The results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0-59 months).

DISCUSSION

The results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after.

APPLICATION TO PRACTICE

Interventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan.

The clinical characteristics, etiologic pathogens and the risk factors associated with dehydration status among under-five children hospitalized with acute diarrhea in Savannakhet Province, Lao PDR

BACKGROUND

Acute diarrhea is a common health problem in children, especially those under five years of age (U5). The mortality rate due to acute diarrhea among U5 children accounted for 11% in Lao PDR in 2016. No study has been done to investigate the etiologic pathogens of acute diarrhea and the risk factors associated with dehydration status among U5 children hospitalized with acute diarrhea in this region.

OBJECTIVES

The study aimed to evaluate the clinical characteristics, etiological agents and associated factors of dehydration status of acute diarrhea among hospitalized U5 children in Savannakhet Province, Lao PDR.

METHODS

This retrospective study reviewed paper-based medical records with available stool examination results of 33 U5 children hospitalized with acute diarrhea in Savannakhet Provincial Hospital, Lao PDR between Jan. 2018 and Dec. 2019. Descriptive statistics were used to describe clinical characteristics and etiologic agents of acute diarrhea of the children. Nonparametric test, Pearson's Chi-square test and Fisher exact test were used to determine the risk factors associated with level of dehydration of the participants.

RESULTS

Vomiting was the most common symptom (66.6%), followed by fever (60.6%). Dehydration was found in 48.4% of subjects. Rotavirus was the most common identified pathogen with a prevalence of 55.5%. Bacterial enteric infection was identified in 15.1% of patients. There is a significantly higher prevalence of dehydration among children with acute diarrhea caused by rotavirus compared to those with negative rotavirus testing (70.0% vs. 12.5%, p = 0.02).

CONCLUSIONS

Rotavirus was the most prevalent pathogen of acute diarrhea among U5 children. Pediatric patients with acute diarrhea caused by rotavirus had a higher prevalence of dehydration compared to those with negative rotavirus testing.

The Burden of Diarrheal Diseases and Its Associated Factors among Under-Five Children in Welkite Town: A Community Based Cross-Sectional Study

Objective: This study assessed the magnitude of diarrhea and associated risk factors among under-five children in Welkite town.

Methods: We used a community-based cross-sectional study design. Data collection period was February to March 2021 and 426 parents/guardians of under-five children were the study participants. A structured questionnaire and observation checklist were used to collect the data.

Results: The 2 weeks prevalence of diarrhea among under-five years old children was 20.7% (88/426); 95% CI (17.1, 24.6). The child’s mother/caregiver being merchant (AOR: 5.34; 95% CI: 2.1, 13.8) compared to housewife, partial immunization status (AOR: 2.67; 95% CI: 1.2, 5.8), disposing child’s stool into the garbage (AOR: 5.05; 95% CI: 1.1, 23.3) compared to putting in a toilet, not covering water storage materials (AOR: 2.4; 95% CI: 1.2, 4.7) and presence of flies in food preparation area (AOR: 2.24; 95% CI: 1.05, 4.8) were associated with increased odds of having diarrhea.

Conclusion: The prevalence of diarrhea among under-five old children is high and it is associated with the occupation of the mothers/caregivers, the immunization status of children, unhygienic water storage condition and non-hygienic household practice.

Individual and community-level factors associated with under-five diarrhea in Bangladesh: Evidence from Demographic and Health Survey 2014

Background

Diarrheal disease is among the leading causes of morbidity and mortality among children younger than age 5 years in Bangladesh.

Objective

The objective of this study is to assess the prevalence of diarrhea among children younger than age 5 years and its associated risk factors.

Methods

Data were sourced from the Bangladesh Demographic and Health Survey, a nationally representative study conducted in 2014. We used multilevel logistic regression models to identify factors associated with diarrheal disease.

Results

Children aged 6 to11 months (odds ratio = 2.26; 95% CI, 1.50–3.42), and 12 to 23 months (odds ratio = 2.31; 95% CI, 1.62–3.31) were more likely to have diarrhea than older children. Other significant risk factors for diarrheal infection included households without access to drinking water (odds ratio = 1.39; 95% CI, 1.03–1.88) and mothers lacking mass media access (odds ratio = 1.32; 55% CI, 1.01–1.73).

Conclusions

Childhood diarrhea in Bangladesh was associated with individual- and community-level factors. The finding of this study suggests that diarrhea prevention programs in the country can effectively be delivered by targeting young children through expanding community-based education and increasing access to health information through mass media.

Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0-59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0-59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015-2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12-23 months, 24-35 months, 36-47 months, and 48-59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children.

Associations of diarrhea episodes and seeking medical treatment among children under five years: Insights from the Zimbabwe Demographic Health Survey (2015-2016)

Diarrhea is a significant pediatric public health concern globally and places a significant burden on healthcare systems. In resource-limited settings, the problems of diarrhea could be worse than reported. Continuously monitoring and understanding the changing epidemiology of diarrhea, including risk factors, remain an important aspect necessary to design effective public health interventions to reduce the incidence, outcomes and strain on healthcare resources caused by diarrheal illness. We, therefore, undertook this study to understand the factors associated with diarrhea as well as describe determinants for seeking medical treatment in children under-five in Zimbabwe using the Zimbabwe Demographic and Health Survey 2015-2016 Data. Children with recent diarrhea were on average younger (mean age 22 months), compared to those who did not have an episode of diarrhea (mean age 30 months) p = .001. Incidence of recent diarrhea was lower among female children compared to their male counterparts (16% vs. 19%), p = .013. Incidence of diarrhea decreased with increasing maternal education level and so was the same for increasing wealth quintile. Those with unimproved sources of drinking water had a higher incidence of diarrhea. The wealth quintile remained the only factor associated with seeking medical attention for a recent diarrhea episode among children less than 6 years, with those in the highest wealth quintile being 2.49 times likely to do so, p = .031. The results are useful in informing pediatric public health policies and strategies for them to be successful in significantly reducing the incidence, morbidity, mortality and significant healthcare costs and burden to society associated with caring for children with diarrheal illnesses.

Acute Diarrhoeal Disease in Children Aged 6 Months to 24 Months: An In-Hospital Cross-Sectional Study

Introduction:

Diarrheal disease comes second among the causes of death in children under 5 years of old. We are well aware that this common disease is preventable and treatable. But the practice of preventive strategies is not as efficient as it should be.

Aims and Objectives:

1. To determine the frequency of acute diarrheal disease in children aged 6 months to 24 months attending the immunization clinic of Lourdes Hospital, Kochi, Kerala. 2. To assess the associated factors and practices involved with acute diarrheal disease in the study group.

Material and Methods:

A cross-sectional study was done in children above 6 months attending immunization clinic in Lourdes hospital during the period from 1^st October 2017 to 31^st March 2019. After receiving their informed consent, a pretested, semistructured, and validated questionnaire was given to the mothers/caregivers to gather data on socio-demographic characteristics and practices. In order to assess the prevalence of diarrhea, details of the diarrheal episode after the 6 months of age were included in the questionnaire. To eliminate repeats, caution was taken not to include previously recorded data on the diarrheal episode.

Discussion and Conclusion:

The proportion of children with diarrhea in the study population was 38.7% which was high compared with other studies in the same age group. Many of the practices associated were found faulty and needing rectification which is a Family Physician's area of expertise. The study concludes that there is a need for identifying novel risk factors for diarrhea and educating the caregivers regarding the prevention of diarrhea. Primary Care Physicians/Family Physicians can play an effective role in educating the caregivers.

Socio-demographic and environmental factors associated with diarrhoeal disease among children under five in India

BACKGROUND

Globally, diarrhoea is the second leading cause of death in children under five and a major public health problem. Despite several health care initiatives taken by the government, a large proportion of children still experience diarrhoeal diseases which cause high childhood death in India. This study aims to examine the socio-demographic and environmental factors associated with diarrhoea in children under five in India.

METHODS

A cross-sectional study was designed using secondary data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A total of 247,743 living children below 5 years of age were included in the analysis. Bivariate and multivariate logistic regression models were carried out to assess the factors associated with childhood diarrhoeal disease.

RESULTS

In India, about 9% of under-five children experience diarrhoeal disease in the past 2 weeks preceding the survey. Children living in rural areas (Adjusted odds ratio [aOR]: 1.05; 95% CI: 1.01, 1.09), children belonged to scheduled tribe (aOR: 0.83; 95% CI: 0.79, 0.89) and other castes (aOR: 0.92; 95% CI: 0.88, 0.97), Muslim children (aOR: 1.18; 95% CI: 1.13, 1.24), and children resided in the central (aOR: 1.61; 95% CI: 1.52, 1.70) and west (aOR: 1.08; 95% CI: 1.01, 1.15) regions were significantly associated with higher likelihood of diarrhoea in the past 2 weeks. Concerning environmental factors, child stool disposal (aOR: 1.06; 95% CI: 0.98, 1.09), floor materials (aOR: 1.08; 95% CI: 1.03, 1.12) and roof materials (aOR: 1.08; 95% CI: 1.04, 1.13) of the household were found to be significant predictors of childhood diarrhoea occurrence.

CONCLUSIONS

Diarrhoeal disease is common among children who lived in rural areas, scheduled castes, Muslims, and children from poor families. Regarding environmental factors, stool disposal practices in the household, dirt floor, and thatch roof materials of the household unit are risk factors for diarrhoeal disease. Targeted approach should be initiated to mitigate the problem of the poor health status of children by providing adequate health care. The policy-makers and stakeholders should address adverse environmental conditions by the provision of latrine and improved housing facilities.

Factors influencing diarrheal prevalence among children under five years in Mathare Informal Settlement, Nairobi, Kenya

Globally, diarrhoea is the second major cause of death among children under five years. The aim of the study was to establish factors influencing diarrhoeal prevalence among children under five years in Mathare Informal Settlement. Cross-sectional survey was used. Data was collected from 1^st July to 1^st August 2019 among primary caregivers (PCGs) of children under five years in Mathare Informal Settlement, in Nairobi, Kenya. This urban informal settlement in Kenya was purposively sampled. Simple random sampling was used to select the households and the respondents. P<0.05 was considered as statistically significant. A total of 324 primary caregivers selected from 324 households were included in the study. Fifty six point seventeen percent of the respondents were aged 25-31 years old. Prevalence of diarrhoea among children was 18.7%. Sex, relationship of the primary caregivers, number of people and children in the households were found to be statistically significant with diarrhoea prevalence with p=0.008, p<0.001, p<0.001, p<0.001 respectively. One hundred and seventy one (52.78%) primary caregivers had no formal education. primary caregivers disposed of the child's faeces in garbage in 38.89% of the cases. Education level of the primary caregivers, renting, presence of flies, faeces, and open garbage near or within the compound were found to be associated with diarrhoea prevalence with p<0.001, p=0.024, p<0.001, p<0.001 respectively. Several factors were found to be associated with diarrhoeal prevalence among children under five years.

Socioeconomic Factors Associated with Diarrhea among Under-Five Children in Manado Coastal Area, Indonesia

Background:

Diarrhea is a condition where individuals experience defecation as much as 3 or more per day with a soft consistency. Diarrhea in children is one of the environmentally-based diseases, and Manado is one of the cities faced with this environmental lead diarrhea problems. The purpose of this study is to analyze the influence of socioeconomic factors on the occurrence of diarrhea among under-five children in the coastal area of Manado city.

Materials and Methods:

A cross-sectional study design was conducted in August 2017. The numbers of respondents were a total of 120 mothers or caregivers with children under five who suffered from diarrhea in the coastal area of Manado. The respondent candidates were selected from the community health center's records of the diarrhea program and further selected by the inclusion/exclusion criteria. The characteristics of mothers and family income were used as indicators of socioeconomic factors. All of the respondents were questioned about the occurrence of their child's diarrhea that they had experienced in the previous 6 months. A structured and well-designed questionnaire was used to obtain data, which were related to sociodemographic, economic, and diarrhea. Generalized structured component analysis in GeSCA software was applied for data analysis.

Results:

The findings of this study showed significant influence from socioeconomic factors on diarrhea incidence in under-five children (critical ratio = 2.74). In other words, as socioeconomic factors improve, the incidence of diarrhea decreases (B = −0.246). The characteristics of the mother are the indicator of the highest influence (loading value = 0.846).

Conclusions:

This study identified that the socioeconomic factors are influencing the diarrhea incidence among children under five in the coastal area of Manado city. Thus, to minimize a childhood diarrheal disease, socioeconomic factors are considered when promoting health and community empowerment among the coastal communities of Manado city.

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.

Co-Infection by Waterborne Enteric Viruses in Children with Gastroenteritis in Nepal

Enteric viruses are highly contagious and a major cause of waterborne gastroenteritis in children younger than five years of age in developing world. This study examined the prevalence of enteric virus infection in children with gastroenteritis to identify risk factors for co-infections. In total, 107 stool samples were collected from patients with acute gastroenteritis along with samples of their household drinking water and other possible contamination sources, such as food and hand. The presence of major gastroenteritis-causing enteric virus species (group A rotaviruses, enteroviruses, adenoviruses, and noroviruses of genogroup I) in stool and water samples was examined using quantitative polymerase chain reaction. Among the 107 stool samples tested, 103 (96%) samples contained at least one of the four tested enteric viruses, and the combination of group A rotaviruses and enteroviruses was the most common co-infection (52%, n = 54/103). At least one viral agent was detected in 16 (16%) of 103 drinking water samples. Identical enteric viruses were detected in both the stool and water samples taken from the same patients in 13% of cases (n = 13/103). Group A rotaviruses were most frequently found in children suffering from acute diarrhea. No socio-demographic and clinical factors were associated with the risk of co-infection compared with mono-infection. These less commonly diagnosed viral etiological agents in hospitals are highly prevalent in patients with acute gastroenteritis.

Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors

Background: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions. Objectives: The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6-8 months in India. Methods: Survey data on 13,548 infants aged 6-8 months were obtained from the 2015-16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6-8 months in India. Results: The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0-23.7%) and 10.0% (95% CI: 9.0-11.0%) among infants aged 6-8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09-1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01-1.45) among infants aged 6-8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting. Conclusion: Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6-8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.

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

BACKGROUND

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

METHOD

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

RESULT

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

CONCLUSION

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

Trends for Diarrhea Morbidity in the Jasikan District of Ghana: Estimates from District Level Diarrhea Surveillance Data, 2012-2016

About 22% of childhood deaths in developing countries are attributable to diarrhea. In poor resource settings, diarrhea morbidities are correlated with poverty and socio-contextual factors. Diarrhea rates in Ghana are reported to be high, with cases estimated at 113,786 among children under-five years in 2011. This study analyzed the trends of diarrhea morbidity outcomes in the Jasikan District of Ghana. A retrospective analysis of records on diarrhea data for a five years' period (January 2012 to December 2016) was undertaken. There was a total of 17740 diarrhea case reports extracted from District Health Information Management System (DHIMS) II database in an Excel format which was then exported to Stata version 14 for data cleaning, verification, and analysis. Excel version 2016 was used to plot the actual observed cases by years to assess trends and seasonality. There was a period incidence rate of 272.02 per 1000 persons with a decreasing annual growth rate of 1.85%. Declines for diarrhea generally occurred from November to December and increased from January upwards, evidence that most cases of diarrhea in this study were reported in the harmattan season. High incidence of diarrhea was found to be common among under-five children and among females. Decreasing trend of diarrhea incidence which was identified in this research within the five years' period understudied shows that, by the year 2020, there will be a sharp decline in the incidence rate of diarrhea reported cases in Jasikan District, given improvements in the external environmental conditions in the district, all things being equal.

Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study

BACKGROUND

Childhood mortality remains high in resource-limited third world countries. Most childhood deaths in hospital often occur within the first 24 h of admission. Many of these deaths are from preventable causes. This study aims to describe the patterns of mortality in children presenting to the pediatric emergency department.

METHODS

This was a five-year chart review of deaths in pediatric patients aged 7 days to 13 years presenting to the Tikur Anbessa Specialized Tertiary Hospital (TASTH) from January 2012 to December 2016. Data were collected using a pretested, structured checklist, and analyzed using the SPSS Version 20. Multivariate analysis by logistic regression was carried out to estimate any measures of association between variables of interest and the primary outcome of death.

RESULTS

The proportion of pediatric emergency department (PED) deaths was 4.1% (499 patients) out of 12,240 PED presentations. This translates to a mortality rate of 8.2 deaths per 1000 patients per year. The three top causes of deaths were pneumonia, congestive heart failure (CHF) and sepsis. Thirty two percent of the deaths occurred within 24 h of presentation with 6.5% of the deaths being neonates and the most common co-morbid illness was malnutrition (41.1%). Multivariate analysis revealed that shortness of breath [AOR=2.45, 95% CI (1.22-4.91)], late onset of signs and symptoms [AOR=3.22, 95% CI (1.34-7.73)], fever [AOR=3.17, 95% CI (1.28-7.86)], and diarrhea [AOR=3.36, 95% CI (1.69-6.67)] had significant association with early mortality.

CONCLUSION

The incidence of pediatric emergency mortality was high in our study. A delay in presentation of more than 48 hours, diarrheal diseases and shortness of breath were significantly associated with early pediatric mortality. Early identification and intervention are required to reduce pediatric emergency mortality.

Diarrhea Morbidities in Small Areas: Accounting for Non-Stationarity in Sociodemographic Impacts using Bayesian Spatially Varying Coefficient Modelling

Model-based estimation of diarrhea risk and understanding the dependency on sociodemographic factors is important for prioritizing interventions. It is unsuitable to calibrate regression model with a single set of coefficients, especially for large spatial domains. For this purpose, we developed a Bayesian hierarchical varying coefficient model to account for non-stationarity in the covariates. We used the integrated nested Laplace approximation for parameter estimation. Diarrhea morbidities in Ghana motivated our empirical study. Results indicated improvement regarding model fit and epidemiological benefits. The findings highlighted substantial spatial, temporal, and spatio-temporal heterogeneities in both diarrhea risk and the coefficients of the sociodemographic factors. Diarrhea risk in peri-urban and urban districts were 13.2% and 10.8% higher than rural districts, respectively. The varying coefficient model indicated further details, as the coefficients varied across districts. A unit increase in the proportion of inhabitants with unsafe liquid waste disposal was found to increase diarrhea risk by 11.5%, with higher percentages within the south-central parts through to the south-western parts. Districts with safe and unsafe drinking water sources unexpectedly had a similar risk, as were districts with safe and unsafe toilets. The findings show that site-specific interventions need to consider the varying effects of sociodemographic factors.

Prevalence of multi drug resistant enteropathogenic and enteroinvasive Escherichia coli isolated from children with and without diarrhea in Northeast Indian population

Background

Diarrheagenic Escherichia coli are associated with infantile diarrhea in the developing countries. The present study was conducted to determine the occurrence and antimicrobial resistance pattern of enteropathogenic and enteroinvasive E. coli associated with diarrhoea among the paediatric patients.

Methods

A total of 262 stool samples were collected from children with and without diarrhea from Mizoram, Northeast India. E. coli were isolated and subjected to multiplex PCR to detect virulent genes of EPEC (eaeA and bfpA) and EIEC (ial). Isolates were subjected to antimicrobial sensitivity assay using disc diffusion method. Selected eaeA genes were sequenced for identification and genetic relationship.

Results

A total of 334 E. coli was isolated, of which 17.37% were carrying at least one virulent gene. Altogether, 14.97 and 2.40% isolates were categorized as EPEC and EIEC, respectively. Among the DEC isolates, 4.79% were EPEC and 7.78% were EIEC. A total of 8 (2.40%) isolates were EIEC (ial+), of which 6 (1.80%) and 2 (0.60%) were from diarrhoeic and non-diarrhoeic patients, respectively. A total of 24 (41.40%) DEC isolates were MDR (resistance against ≥5 antimicrobials).

Conclusions

A high frequency of EPEC pathotypes associated with paediatric diarrhea was observed in Mizoram, Northeast India and majority of the isolates are resistant to antibiotics with a high frequency of MDR, which is a matter of concern to the public health. This also raises an alarm to the world communities to monitor the resistance pattern and analyse in a global scale to combat the problems of resistance development.

Spatial variation and hot-spots of district level diarrhea incidences in Ghana: 2010-2014

BACKGROUND

Diarrhea is a public health menace, especially in developing countries. Knowledge of the biological and anthropogenic characteristics is abundant. However, little is known about its spatial patterns especially in developing countries like Ghana. This study aims to map and explore the spatial variation and hot-spots of district level diarrhea incidences in Ghana.

METHODS

Data on district level incidences of diarrhea from 2010 to 2014 were compiled together with population data. We mapped the relative risks using empirical Bayesian smoothing. The spatial scan statistics was used to detect and map spatial and space-time clusters. Logistic regression was used to explore the relationship between space-time clustering and urbanization strata, i.e. rural, peri-urban, and urban districts.

RESULTS

We observed substantial variation in the spatial distribution of the relative risk. There was evidence of significant spatial clusters with most of the excess incidences being long-term with only a few being emerging clusters. Space-time clustering was found to be more likely to occur in peri-urban districts than in rural and urban districts.

CONCLUSION

This study has revealed that the excess incidences of diarrhea is spatially clustered with peri-urban districts showing the greatest risk of space-time clustering. More attention should therefore be paid to diarrhea in peri-urban districts. These findings also prompt public health officials to integrate disease mapping and cluster analyses in developing location specific interventions for reducing diarrhea.

Careseeking for childhood diarrhoea at the primary level of care in communities in Cross River State, Nigeria

Risk factors for care-seeking choices for childhood diarrhea in Nigeria are poorly understood. They are essential to the control of childhood illnesses because diarrhea is an important cause of childhood mortality. This study explored the contributors to care-seeking choices in Cross River State, Nigeria. Caregivers of children aged 0-59months in 1240 randomly selected households in Cross River State were involved in this cross-sectional study. Questionnaires were used to collect information on demographics, knowledge of illness, and care-seeking patterns, and observed associations were explored using logistic regression. Care was given at home (50.4%, n=142; as recommended), at the health center (27%, n=76), and at the local drug store (19.1%, n=54). Main reasons for care sought were health education (31.9%, n=94), treatment cost (18%, n=53), and experiences (16.6%, n=49). Caregivers living in the mainly urban area of Calabar Municipality [Adjusted Odds Ratio (AOR)=2.81 (1.26-6.26)] and the mainly rural area of Obanliku [AOR=3.59 (1.94-6.64)], were more likely to give home treatment. Choice of treatment was only associated with area of residence. Influencers of care-seeking behavior, especially for childhood diarrhea, are complex and need to be better understood to encourage enhanced care for young children with diarrhea.

Under-five mortality pattern and associated risk factors: a case-control study at the Princess Marie Louise Children's Hospital in Accra, Ghana

BACKGROUND

Millions of children under the age of 5 years die every year. Some of these deaths occur in hospitals and are related to both clinical characteristics and modifiable risk factors. This study investigates the association between malnutrition and mortality and profiles the presenting features in a case-control study of children under 5 years of age who attended Princess Marie Louise Children's Hospital (PML) in 2011.

METHODS

A total of 120 cases of children under the age of 5 years who were admitted to hospital and died there were matched by sex and age to 120 controls who were children who survived on 1:1 basis from a record of patients admitted to PML in 2011. Data on socio-demographic and clinical characteristics were extracted from the medical records of the study participants. The association between malnutrition and mortality was determined by conditional logistic regression reported as odds ratios (OR) and their 95 % confidence interval (95 % CI). P < 0.05 was considered significant in all analyses.

RESULTS

Malnutrition was significantly associated with mortality in children under-5 years of age attending PML. In the adjusted analysis, the odds of dying was significantly higher in malnourished children compared with well-nourished children (adjusted OR = 4.32 [95 % CI, 1.33-13.92], p = 0.014]). In addition, a previous episode of diarrhoea within the last year was associated with mortality (adjusted OR = 7.25 [95 % CI, 1.68-31.22], p = 0.008). The proportion of patients with noisy or difficulty breathing, pallor, lethargic appearance, ill-looking appearance, febrile convulsion, altered sensorium, skin lesions, hepatomegaly or oedema was significantly higher among cases than in controls (p < 0.05).

CONCLUSIONS

Malnutrition and a previous episode of diarrhoea within the last year were the main risk factors for mortality. Efforts to prevent malnutrition and diarrhoea must be intensified and a protocol to follow-up diarrhoea patients may be beneficial. Six out of the nine clinical features that were proportionally higher in children who died than those who survived, are captured by the Emergency Triage Assessment and Treatment (ETAT) screening protocol as emergency or priority signs, giving credence to the use of ETAT in this setting. Thus education of health professionals on the use of the tool to triage patients should be on-going. However, further studies are needed to establish whether the other clinical signs are consistently associated with mortality and if so, whether they can be included among triage criteria, danger signs or in a prognostic scoring system for this setting.

Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis

BACKGROUND

Acute diarrhea accounts for a huge burden of infectious diseases in under-five children.

OBJECTIVE

This systematic review was carried out to study the prevalence and associated risk factors of diarrhea among Indian children aged <5 years.

METHODS

Papers were identified by a comprehensive electronic search of relevant medical subject heading (MeSH) terms in PubMed. Identified articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 15 articles were abstracted and reviewed to identify the reported prevalence and risk factors for childhood diarrhea. Meta-analysis was done for calculating the pooled prevalence of diarrhea and point estimates of risk factors using random effects model with use of appropriate population weights, and depicted using forest plot.

RESULTS

The overall prevalence of diarrhea between 2002 and 2013 was 21.70% (95% confidence interval [CI]: 11.24-34.46). The significantly associated risk factors were malnutrition (odds ratio [OR]: 1.73, 95% CI: 1.53-1.96) and anemia (OR: 1.71, 95% CI: 1.29-2.28) in child, and low socioeconomic status (OR: 7.14, 95% CI: 2.19-23.32). Age of the child <24 months, not breastfeeding, mothers' low literacy status and untreated drinking water did not show a significant association. Sex of the child, religion, higher education of mothers, and seasonality were found to be inconsistently associated in single studies.

CONCLUSION

It was concluded that there is sufficient evidence on the association of childhood diarrhea with socio-demographic factors, but evidence on other contributory factors including breastfeeding and vaccination is inconclusive. There is need to conduct more analytical studies on lesser known risk factors of diarrhea to establish their risk factors in Indian children.