Determinants of Diarrheal Diseases among under Five Years of Age at a Pediatric Hospital

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Introduction

Diarrheal disease is the second leading cause of death in children under five years of age. It is both preventable and treatable, each year diarrhea kills around 760, 000 of under five years worldwide [1]. A significant proportion of diarrheal disease can be prevented through safe drinking water, adequate sanitation, and hygiene. Globally, there are nearly 1.7 billion cases of diarrheal disease every year [2]. Diarrhea is a symptom of infections caused by bacterial, viruses, and parasitic organisms, most of which are spread by feces-contaminated food or water [3]. Infections are more common when there is a shortage of adequate sanitation, hygiene, and safe water for drinking, cooking, and cleaning. Rotavirus and Escherichia coli are the two most common agents of diarrhea in developing countries. Other causes of diarrheal disease spread from person-to-person and aggravated by poor personal hygiene [4]. Food is another major cause of diarrhea when it is prepared or stored in unhygienic conditions [5].

Objectives

General objectives: To identify the risks of diarrheal disease among under-five children at (Omdurman) pediatric hospital in Khartoum state, Sudan.

Specific Objective:

• To identify the risk factors of diarrheal disease among under five years of age

• To identify preventive measures that can be used to reduce risks of such diseases in this age group

Methodology

Study Design

This is a descriptive cross-sectional study aimed at identifying the risk factors of diarrheal disease among under-five children at Mohamed AL-Amin Hamid pediatric hospital.

Study Area

The study was carried out at (Omdurman) Pediatric Hospital in Khartoum state, Omdurman Locality. Sudan.

Study Population

Under-five children with diarrhea were attending in (Omdurman) pediatric hospital at Khartoum state, Omdurman locality.

Sample Size

The sample size determines as follows: (N=184)

n=sample size

N=Total population

e²=level of precision=0.05

Data Collection

Data were collected using structured questionnaires and interviews with mothers of children under five of age admitted to the pediatric hospital.

Data Analysis

The data were analyzed using SPSS (Statistical Package for Social Sciences), version 18.

Sampling Procedure

All mothers of under-five children attending hospital clinics during the study period of 3 months.

Ethical Clearance

Ethical clearance was obtained from the Ministry of the health research department, Number. (MOH, RD, SD.60548)

Results

Table 1 shows that 65 (35.3%) of mothers were illiterate, while 31 (16.8%) are ranging between secondary school and university level.

Table 2 shows the age of children. It was found that 129 (72%) of study group their age is from one month to one year, while 53(5%) are from two to three years.

Table 3 shows the source of water used in drinking and cooking. It was found that 153 (28.3%) water sources were pipelines, while 29 (15.8%) of their water source were wells.

Table 4 It was found that 144 (78.3%) of the mother are not treating water at home, while 40 (12.7%) treated drinking water at home.

Table 5 shows the type of feeding for a child. It was found that 154 (83.7%) of children were normally breastfed, while 20 (16.3%) of children were artificially fed.

Table 6 shows the cleaning of the breast before breastfeeding. It was found that 110 (71.5%) of mothers clean their breasts before breastfeeding, while 44 (28.5%) breastfeeding their children without cleaning their breasts.

Table 7 shows the level of awareness on symptoms of diarrhea. It was found that 68 (37.0%) of children their symptoms of diarrhea increase the number of defecations more than three times per day, while 31 (16.8%) of their symptoms were a physical weakness.

Table 8 shows practices when a child had diarrhea, It was found that 101 (54.9%) of the mothers went to the hospitals when their child had diarrhea, while 83 (45.1%) of mothers use traditional medicine.

Table 9 shows causes of diarrhea in children. It was found that 56 (30.4%) were contaminated water, while 30 (16.3%) were eating with dirty hands.

It was found that 135 (73.4%) have been died due to diarrhea, while 49 (26.6%) died due to various reasons (Table 10).

Table 11 shows the best way to prevent diarrhea. It was found that 75 (40.8%) of mothers prevent diarrhea by washing hands with water and soap before eating.

Table 12 shows the preparation of ORS at home. It was found that 98 (52 .2%) of mothers didn’t know how to prepare it.

Discussion

Diarrhea is one of the common causes of morbidity in children in developing countries. It is responsible for 4000 million episodes and 2.4 million deaths each year among children under 5 years [6].

This study clarified that 35.3% of diarrheal cases existed among children who are their mothers are illiterate, while the lower percent 16.8% range between children who’s their mother’s education ranging between secondary school and university level, this result agreed with the study of Zwane AP, and Kramer M which clarified the same conclusion [7].

The study showed 15.8% of the study group depends on wells, which are not operated by the state government, these wells’ water is not safe, which may lead to increase morbidity among the target group.

The study clarified that diarrheal incidents were lower in the children who breastfed because the milk of the mother contains antibiotics that lead to protecting the children from diarrhea. This agrees with the study of Armistead J, et al. [8].

The study explained that 28.5% of mothers breastfed their children without cleaning their breasts, while a high rate of diarrheal diseases was among the children whose mother was not cleaning their breasts.

The study explained that a high rate of mothers (45.1%) usually uses traditional medicine when their children got diarrhea, this may lead to increase mortality rates due to it, this agrees with the study of Zwane AP, and Kramer M [7]. The study showed that 52 .2% of mothers do not know how to prepare ORS at home, preparation of ORS at home can reduce the risks of the complications of diarrheal diseases. The study of Khan AM, et al. agreed with the above clarifications [9].

Conclusion

Based on the results of this study it was clear that there is a need for huge efforts from MOH, NGOs, and all other related sectors to improve socio-economic status in the slum areas of Khartoum city, improvement of water supplies to all these areas, provision of quality primary health care services including health education and promotion activities to raise awareness among the inhabitants of these areas about the healthy practices and skills necessary to reduce the incidence of diarrheal diseases especially among an under-five year of age.

Multidisciplinary, intersectoral efforts are needed to overcome the problem, because it had multiple sides, social, economic, behavioral sides need to be addressed using teamwork efforts, and the expected results of such efforts will be of great importance for the current and future generations of the country.

Recommendations

Based on what mentioned above the following is recommended:

• Improvement of socioeconomic status of most affected families including the provision of clean water supply, proper PHC services

• Training of mothers on how to prepare ORS, and other healthy practices on breastfeeding, washing hands, etc.

Declarations

Conflicts of Interest

The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

References

1. World Health Organization. "The world health report 2007: A safer future: Global public health security in the 21st century." World Health Organization, 2007.
2. Bryce, Jennifer, et al. "WHO estimates of the causes of death in children." The Lancet, Vol. 365, No. 9465, 2005, pp. 1147-52.
3. Kosek, Margaret, Caryn Bern, and Richard L. Guerrant. "The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000." Bulletin of the World Health Organization, Vol. 81, 2003, pp. 197-204.
4. Fontaine, O. "Effect of zinc supplementation on clinical course of acute diarrhoea." Journal of Health, Population, and Nutrition, Vol. 19, No. 4, 2001, pp. 339-46.
5. Sudan Ministry of Health. "Annual EPI Report." 2015, pp. 25-33.
6. Bhutta, Zulfiqar Ahmed, and Kristy M. Hendricks. "Nutritional management of persistent diarrhea in childhood: A perspective from the developing world." Journal of Pediatric Gastroenterology and Nutrition, Vol. 22, No. 1, 1996, pp. 17-37.
7. Zwane, Alix Peterson, and Michael Kremer. "What works in fighting diarrheal diseases in developing countries? A critical review." The World Bank Research Observer, Vol. 22, No. 1, 2007, pp. 1-24.
8. Armitstead, Jane, Deidre Kelly, and John Walker-Smith. "Evaluation of infant feeding in acute gastroenteritis." Journal of Pediatric Gastroenterology and Nutrition, Vol. 8, No. 2, 1989, pp. 240-44.
9. Khan, A. M., et al. "Low osmolar oral rehydration salts solution in the treatment of acute watery diarrhoea in neonates and young infants: A randomized, controlled clinical trial." Journal of Health, Population and Nutrition, Vol. 23, No. 1, 2005, pp. 52-57.