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ORIGINAL ARTICLE
Year : 2012  |  Volume : 11  |  Issue : 4  |  Page : 217-221  

Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria


Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos, Nigeria

Date of Web Publication24-Oct-2012

Correspondence Address:
Christopher S Yilgwan
Department of Paediatrics, Jos University Teaching Hospital, PMB 2076, Jos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.102852

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   Abstract 

Background: Diarrhea is widely recognized as a major cause of childhood morbidity and mortality in many developing countries, particularly in sub-Saharan Africa. According to World Health Organization (WHO) report in the African region, diarrheal diseases are still leading causes of mortality and morbidity in children under five years of age. This same report indicates that each child in the said region has five episodes of diarrhea per year and that 800,000 die each year from diarrhea and dehydration.
Materials and Methods: This study examined diarrheal morbidity and associated risk factors in children under five years in Jos. A total of 340 children were seen in the Diarrhea Training Unit (DTU) of the Jos University Teaching Hospital (JUTH), Jos, over a period of 24 months (Jan 2008-Dec 2009). A semi-structured interviewer administered questionnaire was used to generate the data. All women whose children presented with diarrhea were interviewed and data generated analyzed using Epi info version 3.5.1 statistical software.
Results: During the study period, 13,076 children were seen in our facility, of which 340 were suffering from diarrhea, thus giving a diarrhea prevalence of 2.7%. There were 183 (54%) male and 157 (40%) female children seen with diarrhea. The mean age was 11 ± 8.5 months. The mean duration of diarrhea was found to be 4 ± 3.6 days. A majority of children were aged less than 6 months, consisting of 235 infants, 95 toddlers, and 10 pre-schoolers. Of the number of women seen, 242 (61%) had at least primary education, while 98 (29%) had no formal education. Diarrheal episodes were found to have a bivariate association with mothers' educational status, family type, family size, breastfeeding, and sex of child. However, only mother's educational status, diarrhea in other sibling, and breast feeding were significantly associated with the occurrence of diarrhea. Although there were more male children with diarrhea, the odds of having diarrhea was not significantly related to sex.
Conclusion: Our study demonstrated an important relationship between diarrheal morbidity and low maternal education, nonexclusively breastfed infant, and previous diarrheal episode in a sibling. It thus meant that diarrhea morbidity is still an important problem for infants in our environment. Moreover, maternal education and exclusive breastfeeding are still relevant viable measures in curbing diarrhea in infants.

   Abstract in French 

Contexte: Diarrhée est largement reconnue comme une cause majeure de morbidité infantile et de mortalité dans de nombreux pays en développement, particulièrement en Afrique subsaharienne. Selon le World Health Organization (WHO) signaler dans la région de l'Afrique, les maladies diarrhéiques sont toujours en tête les causes de mortalité et de morbidité chez les enfants de moins de cinq ans. Ce même rapport indique que chaque enfant dans la région de ladite a cinq épisodes de diarrhée par an et que 800 000 meurent chaque année de diarrhée et de déshydratation.
Méthodes et matériaux: Cette étude a examiné la morbidité diarrhéique et associés à des facteurs de risque chez les enfants de moins de cinq ans à Jos. Un total de 340 enfants ont été vus dans la diarrhée formation unité (UTD) de le Jos University Teaching Hospital (JUTH), Jos, plus une période de 24 mois (janvier 2008-décembre 2009). Un questionnaire semi-structuré intervieweur administré a été utilisé pour générer les données. Toutes les femmes dont les enfants se présentent y compris les diarrhées ont été interviewées et analysé les données générées à l'aide du logiciel Epi info version 3.5.1.
Résultats: Au cours de la période d'étude, 13 076 enfants ont été vus dans nos installations, dont 340 souffraient de diarrhée, ce qui donne une prévalence de diarrhée de 2,7%. Il y avait 183 (54%) hommes et 157 (40%) enfants de sexe féminin vus souffrant de diarrhée. L'âge moyen était de 11±8.5 mois. La durée moyenne de diarrhée s'est avérée 4±3.6 jours. La majorité des enfants étaient âgés de moins de 6 mois, consistant en 235 nourrissons et 95 tout-petits 10 enfants d'âge préscolaire. Le nombre de femmes se, 242 (61%) avait au moins primaire, 98 (29%) n'avait aucune éducation formelle. Les épisodes diarrhéiques se sont avérées être une association bivariée avec mères scolarité, type de famille, taille de la famille, l'allaitement au sein et sexe de l'enfant. Cependant, seulement de mère scolarité, diarrhée dans d'autres frères et sœurs et allaitement maternel étaient significativement associés à la survenue de la diarrhée. Bien qu'il y avait plusieurs enfants de sexe masculin souffrant de diarrhée, les chances d'avoir la diarrhée n'était pas significativement corrélée à sexe.
Conclusion: Notre étudea démontré un lien important entre la morbidité diarrhéique et faible scolarité de la mère, non bébé nourri au sein et précédent épisode diarrhéique dans un frère.Cela signifiait donc que la morbidité diarrhée est toujours un problème important pour les enfants dans notre environnement. En outre, scolarité de la mère et l'allaitement maternel exclusif sont toujours d'actualité mesures viables dans la lutte contre la diarrhée chez les nourrissons.
Mots clés: Diarrhée, la morbidité, au Nigeria, les facteurs de risque

Keywords: Diarrhea, morbidity, Nigeria, risk factors


How to cite this article:
Yilgwan CS, Okolo S N. Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria. Ann Afr Med 2012;11:217-21

How to cite this URL:
Yilgwan CS, Okolo S N. Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria. Ann Afr Med [serial online] 2012 [cited 2017 Mar 30];11:217-21. Available from: http://www.annalsafrmed.org/text.asp?2012/11/4/217/102852


   Introduction Top


Diarrhoeal disease remains one of the most important causes of morbidity and mortality in developing countries, especially in African countries. [1] Diarrhea is defined as an abnormal increase in daily stool fluidity, frequency, and volume from what is considered normal for an individual. [2] Diarrhea kills an estimated 2.5 million people each year, with about 60-70% of them being children under five years of age. [3],[4] The disease is responsible for over a quarter of the deaths of children in the world today. [5] Most of these deaths occur in developing countries where an estimated 25% of under-five mortality is directly attributed to diarrhea disease. [3],[4],[5]

Despite the widespread use of oral rehydration therapy (ORT), the incidence of acute diarrheal diseases has not decline much, though a substantial reduction in annual diarrheal deaths from 4.5 million in the 1980s to the present level of about 2 million children is attributable to the promotion of ORT. [3] This is because most populations of the world, especially developing countries, lack access to potable water and are still afflicted by poverty, poor sanitation, and lack of hygiene. ORT is an important tool in the prevention of dehydration resulting from diarrhea. Mothers all over the world, especially in developing countries, have been taught the types, use, and importance of this all important tool with regard to diarrhea and its attendant sequelae in antenatal clinics and child welfare. Moreover, even print and electronic media are other ways of giving health education. [6],[7] Also, basic hygiene, household sanitation and adequate appropriate feeds are emphasized in different health clinics and well child visits. Although these efforts have been shown to decrease the severity of acute diarrheal episodes and sharply reduce the number of subsequent death, [3],[7] a large number of children are still afflicted with diarrhea that has a negative impact on their growth and development.

Many cases of acute diarrhea may be treated at home or may recover without any treatment, but a few children may develop severe dehydration and so will necessitate emergency room care with intravenous fluids.

Studies have been conducted in the past to establish risk factors diarrhea. In Ethiopia, Yohannes and his colleagues [8] found the incidence of diarrhea to be higher in the second half of the infant's life when inborn immunity is weak and exposure to contaminated weaning foods increases. They also showed that children living in households with some kind of toilet facility are less likely to be sick than children in households that do not have toilet facilities. Lack of access to a toilet facility is associated with a high incidence of diarrhoea. [9] The greatest reductions in diarrhoea are associated with flush toilets compared with pit latrines. [10] Public latrines are generally unhygienic and unhealthy for children due to the presence of flies and dirty floors, which promote infections such as cholera, shigella,  Salmonella More Details, and rotavirus, all of which have been shown to be major causes of diarrhea in children. [9],[10] The same study indicates that the prevalence of diarrhea varies according to education of mother, being significantly lower among children of more educated mothers than among children of mothers with no education. This is probably because education provides the knowledge of the rules of hygiene, feeding and weaning practices, and the interpretation of symptoms which enhances timely action on childhood illness. [10]

The aim of the present study was to assess the prevalence of diarrhea among children aged 6-60 months presenting to the diarrhea training unit (DTU) of the Jos University Teaching Hospital (JUTH) by collecting current and reliable information on the incidence and some determinants of acute diarrheal diseases, with a view of adding to the existing body of knowledge as well as help in policy change that will improve childcare in Nigeria.


   Materials and Methods Top


A total of 350 children were studied between January 2008 and December 2009. Data were collected by interviewing mothers and prepared questionnaires were completed by the researchers and residents in the DTU. The information obtained were as folllows: parents' age, literacy level and occupation, number of children aged 6-60 months in the family, gender, number of passage of loose stools per day, and duration of acute diarrhea. Finally, the prevalence of acute diarrhea during the past 24 months was calculated among children aged 6-60 months and its association with sociodemographic, environmental, and domestic factors was evaluated.

In this study, acute diarrhea was defined as the passage of three or more loose or watery stools per day, lasting less than 14 days. Data were analyzed using Epi info version 3.5.1 statistical software and Chi-square and t test were used to compare proportions and means, respectively.


   Results Top


General characteristics

During the study period spanning 2 years, a total of 23,876 children were seen in our emergency pediatric unit, of which 350 presented with diarrhea, giving a diarrhea prevalence of 1.5%. Among the children seen with diarrhea 185 (54%) were male and 168 (40%) female. The mean age was 11 ± 8.5 months. The mean duration of diarrhea was found to be 4±3.6 days. Most children were aged 6 months (infants, 69%; toddlers, 28%' and pre-schoolers, 3%) [Table 1]. A total of 143 (40.9%) children were exclusively breastfed while 207 (59.1%) were not. Of the number of children not exclusively breastfed, 15 were HIV exposed neonates on breast milk substitute.
Table 1: Sociodemographic characteristics of study subjects

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A total of 189 (54%) mothers had recevied at least primary education, while 161 (46%) had no formal education [Figure 1]. There is a trend towards being underweight as the age increases in both sexes as depicted by the weight for age z scores [Figure 2]. Similarly, from the age of 20 months onwards, the children are stunted [Figure 3].
Figure 1: Educational status of mothers

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Figure 2: Weight for age z scores. fldWHOWAZ = weight for age, fldAge = Child's age in months

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Figure 3: Length/height for age. fldWHOHAZ = Height for age, fldAge = Child's age

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Duration of Diarrhea Vs Some Risk Factors

[Table 1] shows the results of testing the association of five factors found to influence diarrhea in previous studies. The duration of diarrhea has bivariate associations with mother's educational status, sex of child, breastfeeding, family type, diarrhea in other siblings and place of residence. Only three variables reached the statistical significance level (P < 0.05) in the logistic regression multivariable model predicting duration of diarrhea. Mother's educational status (odds ratio [OR] = 0.0769, 95% confidence interval [CI] = 0.01-1.47), breastfeeding (OR = 0.73, 95% CI = 0.41-1.27), and diarrhea in other siblings (OR = 0.73, 95% CI = 0.40-1.19).


   Discussion Top


The present study examined children presenting to the diarrhea training unit of JUTH and found a prevalence of 2.6%. This value is lower than that reported by Kolahi et al.[11] in Iran, reporting a prevalence of 10.3%. This is also lower than the prevalence reported by Shah [12] et al. in India. However, Shah studied children aged less than 3 years, in whom we know even in the present study to have a high risk of diarrhea. The low prevalence of diarrhea recorded in the present study may not be unconnected with the success of the child survival strategies instituted in the past decades, which aimed at enlightening and educating mothers on common childhood ailments, immunization, breastfeeding, and nutrition, all of which have been shown to reduce the incidence of diarrhea. The diarrhea training unit in JUTH, apart from managing cases of diarrhea, provides education on diarrhea prevention and home management to mothers presenting to our facility. This enlightenment might have succeeded in empowering the mothers with skills for home management of diarrhea, and thus reducing the number of children necessitating hospital care for the same. [13],[14],[15]

This study also found more boys than girls presenting with diarrhea. This is in contrast with the higher number of girls reported by Kolahi et al. in Iran [11] Shah et al. in Pakistan, [12] and Gascon [16] in Tanzania. The reason for our finding is not known but may be connected with the cultural practices in our country where there is preference for boys over girls, which could also affect care giving.

Infants form the largest group with diarrhea, especially those around 6 months of age, which is similar to what other researchers have reported. [3],[5],[11],[12],[13],[16],[17] Also, a large proportion of these cases of diarrhea seen in this age group were among those not exclusively breastfed, and thus conferring higher odds of having diarrhea [Table 2]. Exclusive breastfeeding in infancy is known to protect against diarrhea with maternally acquired antibodies helping to fight infective agents responsible for the disease. However, at this stage, there is a general decline in these antibodies and more so in those not exclusively breastfed, and hence the high risk of developing diarrhea. Besides, complementary feeds are usually introduced at this stage with an attendant increase risk of contamination, especially in the developing world like ours where safe water and basic sanitation is lacking. It was also noticed that 15 of these infants were neonates on breast milk substitute. These are HIV-exposed neonates residing in rural areas where safe water and basic hygiene are unavailable. Early Introduction of complementary feeds has been shown to increase the risk of diarrhea due to possible contamination of the feeds. [16]
Table 2: Bivariate associations of duration of diarrhea with different independent variables

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Most children were wasted, with their weight for age scores below the mean for age. Diarrhea has major effects on the nutrition of the child, with loss of nutrients as the main pathopysiologic mechanism. [13] Also, most mothers tend to withhold feeds during episodes of diarrhea thinking that will reduce the stool bulk, and hence stop the disease. Besides, the diarrhea episode, which usually results from infection places a metabolic demand on the child and if it is recurrent, it will affect the growth and development of the child with consequent malnutrition setting in, which thus brings in a cascade of vicious cycle. [18]

The risk of having diarrhea was also found to be higher in children whose mothers had no formal education. This is similar to reports by Dikassa et al. [14] in Congo and Ekanem et al. [6] in Lagos, Nigeria. Both studies were case control and demonstrated a strong association between the risk of having diarrhea and low or no education in mothers. Education is a vital tool in enlightening mothers and also changing their healthcare seeking behavior and practice. [10],[11],[12],[16],[17] This knowledge is said to affect their behavior, especially as it relates to child rearing practices and healthcare. For example, Ahmed et al. [15] in Sudan found that illiterate mothers in rural areas were more likely to stop breastfeeding their child who developed diarrhea and resort to traditional remedies such as gum cautery in an attempt to stop teething. However, Okunribido and his colleagues [19] found a slightly different scenario in their study of cultural perceptions of diarrhea management among Yoruba women, where they reported a high likelihood of combination of western and traditional remedies, even though a few were inclined towards western remedies alone.


   Conclusion Top


This study indicates that maternal education bears a significant impact on morbidity caused by diarrhea. Educated mothers are more exposed to the importance of hygiene, better childcare and feeding practices, and are more aware of disease causation factors and preventive measures. The present study indicates that there is an urgent need for effective intervention measures to curtail the incidence of diarrhea among children. Also, health intervention programs, including exclusive breast feeding, which enhance children's physiological resistance against diseases, and maternal hygiene education should be strengthened in order to reduce the incidence of diarrhea. It is hoped that the results of the study will provide guidance for policy makers in formulating strategies to improve child health in Nigeria.

 
   References Top

1.Kosek M, Bern C, Guerrant RL. The magnitude of the global burden of diarrhoeal disease from studies published 1992-2000. Bull World Health Organ 2003:81:197-204.  Back to cited text no. 1
    
2.WHO. The treatment of diarrhoea: A manual for physicians and other senior health workers. WHO/FCH/CAH/Available from http://whqlibdoc.who.int/publications/2005/9241593180.pdf. [Last cited on 2005, Jan 5].  Back to cited text no. 2
    
3.Ruxin JN. Magic bullet: The history of oral rehydration therapy. Med Hist 1994;38:363-97.  Back to cited text no. 3
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5.Gutierrez G, Tapia-Conyer R, Guiscafre H, Reyes H, Martínez H, Kumate J. Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico. Bull the World Health Organization 1996;74:189-97.  Back to cited text no. 5
    
6.Ekanem EE, Akitoye CO, Adedeji OT. Food hygiene behavior and childhood diarrhea in Lagos, Nigeria: A case-control study. J Diarrhoeal Dis Res 1991;9:219-26.  Back to cited text no. 6
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7.Babaniyi OA. Oral rehydration of children with diarrhea in Nigeria: A 12-year review of impact on morbidity and mortality from diarrheal diseases and diarrheal treatment practices. J Trop Pediatr 1991;37:57-63.  Back to cited text no. 7
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10.Levine OS, Levine MM. Houseflies (Musca domestica) as mechanical vectors of shigellosis. Rev Infec Dis 1991:13:688-96.  Back to cited text no. 10
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11.Kolahi AA, Nabavi M, Sohrabi MR. Epidemiology of acute diarrheal diseases among children under 5 years of age in Tehran, Iran. Iranian J Clin Infect Dis 2008;3:193-8.  Back to cited text no. 11
    
12.Shah SM, Yousafzal M, Lakhani N, Chotani RA, Nowshad G. Prevalence and correlates of diarrhea. Indian J Pediatr 2003;70:207-11.  Back to cited text no. 12
    
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14.Dikassa L, Mock N, Magnani R, Rice J, Abdoh A, Mercer D, et al. Maternal behavioral risk factors for severe childhood diarrheal disease in Kinshasa, Zaire. Int J Epidemiol 1993;22:327-33.  Back to cited text no. 14
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15.Ahmed IS, Eltom AR, Karrar ZA, Gibril AR. Knowledge, attitudes and practices of mothers regarding diarrhea among children in a Sudanese rural community. E Afr Med J 1994;71:716-9.  Back to cited text no. 15
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16.Gascon J, Vargan M, Schellenberg D, Urassa H, Casals C, Kahigwa E, et al. Diarrhea in children under five year of age from Ifakara, Tanzania: A case control study. J Clin Microbiol 2000;38:4459-62.  Back to cited text no. 16
    
17.El-Gilary AH, Hammad S. Epidemiology of diarrhea disease among children under five years in Dakhalia, Egypt. Eastern Mediterr Health J 2005;11:762-75.  Back to cited text no. 17
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]


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