Assessment Of Knowledge On Risk Factor For The Occurrence And Strategies For The Prevention Of Diarrhea Among Children Aged 2-10 Years In Uso Community, Owo Local Government

INTRODUCTION

1.1 Background To The Study

It was in 1854 when John Snow father of Epidemiology discovered an epidemic where 616 people died after they drank water contaminated by a baby?s diaper washed in a town well (Paul Fine, 2013).

Diarrhea is one of the leading causes of morbidity and mortality, especially among children under the age of five years. Globally, as many as 800,000 children die each year from diarrhea, with most deaths occurring in developing countries (Bhutta. A.Z, 2013). Diarrhea is defined as the passage of three or more watery or loose stools per day, or more frequent passage than is normal for an individual. This is contrary to passage of frequent formed stools or the loose pasty stools passed by breast fed babies. It is both preventable and treatable. It is also a leading cause of malnutrition in children under five years old (WHO, 2013).

Diarrheal disease affects human life both in developed and developing countries. Acute diarrhea is one of the main problems affecting children under- five in the world, reducing their well- being, and this leads to a considerable demand for health care services. Despite the fact that it affects both developed and developing countries, it is evident that there is a strong relationship between diarrhea, poverty and unhygienic environmental conditions (Mohammed.S, 2013).

According to statistics by World Health Organization (2013), children under three years of age in developing countries experience on average about three episodes of diarrhea every year. As a result diarrhea is a major cause of malnutrition, and the most severe threat posed by diarrhea is dehydration. Death can follow severe dehydration if the lost body fluids and electrolytes are not replenished. A Significant proportion of diarrhea can be prevented through safe drinking water, good sanitation and hygiene.

Diarrhea can be caused by numerous pathogens and transmitted through multiple vehicles. Some of the most common pathogenic causes of severe and fatal diarrhea in young children globally are rotavirus and shigella. Rotavirus takes the lives of over 3,600 children under five years and accounts for approximately 40% of all deaths caused by diarrhea (CIDRZ, 2013).

Risk factors for diarrhea among children include age, sex, geographic location, drinking from unprotected water supply and household economic status. While poor sanitation, limited access to potable water, inappropriate breast feeding practices contribute to the burden of the disease, there continues to be the need to further document the socio-demographic correlates of diarrhea in order to inform policy and programmatic interventions that have potential to stem the prevalence of the disease (Siziya et al, 2013).

Many studies including cohort and case control studies on diarrhea and associated factors have been done in developed and undeveloped (developing countries) and most of them were based on small hospital and community based studies. Furthermore, the prevalence and correlates of diarrhea may vary with season, geographical area and between countries (Siziya et al, 2013).

Persons living in developing countries with poor access to safe water, sanitation, or hygiene infrastructure have increased risk of exposure to viral, bacterial and parasitic pathogens that can cause diarrheal diseases (Rohmawati, 2010).

Inappropriate child feeding practices has also a major public health problem resulting in series of social and economic consequences especially in developing countries.

The prevalence of diarrhea is at 16% (non-bloody), and 3% (bloody) second to fever (21%) among the children under-five years (CSO, 2014). Approximately, 15,000 Ondon children under- five years suffer at least three or more episodes of diarrhea every year (Chilambwe et al, 2014) Identifying the causes of diarrhea is very crucial for the effective implementation of child health intervention programs for policy formulation and the general assessment of resource requirements and intervention prioritization in any nation. Therefore, this study was conducted to identify the risk factors for the occurrence of childhood diarrhea among children aged between 0–59 months in Ondo. No study has been done in Ondo that utilized the 2013-14 survey data to investigate the factors associated with diarrhea among under- five children.

Hence, the aim of this study was to assess the factors associated with childhood diarrhea using a large sample size from a community -based survey. This gives high power to the results obtained from the study because of the sample size, (Rowe et al, 2008). This dissertation has other sections including methods, results, discussion, conclusion, and limitations.

1.2 Statement Of The Problem

Diarrhea is still responsible for high rates of mortality in children worldwide. Reducing child mortality is the 4th of the United Nations Millennium Development Goals (MDGs). The Millennium Development Goals recognize child health and survival as an important socio- development issue. It is estimated that one in ten children dies before the first birthday, and one in five before their fifth birthday (UNICEF, 2013). However, despite advances it was reported that at the current pace, the world would not meet the MDG target (UNICEF, 2013). In place of these goals, the United Nations (UN) came up with 17 sustainable development goals (SDGs) to transform our world by 2030. Some of the goals are important for this study as they address some of the variables that were identified to be determinants of diarrhea. Goal three emphasizes good health and well-being for all at all ages, goal four emphasizes quality education, goal six emphasizes clean water and sanitation and goal one which emphasizes no poverty.

The problem of diarrhea is a more complex problem in most of the low income countries due to increasing poverty levels (CIDRZ, 2013). An outstanding feature of diarrheal diseases in the developing world is that the frequency is more during and after the weaning period (Himonga, 1996). The number of diarrheal cases is still on the increase in many countries, especially in the sub-Saharan region, Ondo inclusive. Global organizations like World Health organization (WHO) and United Nations (UN) have put up a number of strategies and treatment procedures to control under-five child morbidity and mortality, which have been adopted by many countries.

Strategies like the Integrated Management of Childhood Illnesses (IMCI) strategy was introduced in Ondo in 1995 by the Central Board of Health (CBOH) in collaboration with other cooperating partners like, United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) (Chitembo, 2003). “One of the 16 key family practices promoted within IMCI is to dispose of feces safely, and wash hands with soap and water after defecation and before preparing meals and feeding children” (WaterAid, 2009). In principle therefore, sanitation should be adequately addressed within IMCI. However, in resource-poor context the preventive health elements of IMCI have been marginalized as over- stretched and under-resourced health workers are faced with long queues of sick patients outside their health centre.

This marginalization of the preventive measures against diarrhea such as sanitation has led to a reduced effectiveness of health systems and poor global progress on Millennium Development Goal (MDG4) number four (WaterAid, 2009).

Sanitation and hygiene are both essential barriers that prevent the transmission of disease by the fecal-oral route. Sanitation in particular has not been given adequate consideration by health policy makers despite evidence of its cost-effectiveness. Currently, there are almost one billion people without safe water and a staggering 2.5 billion without adequate sanitation. Faster and more cost-effective reductions in child mortality would be achieved in the long-term by promoting sanitation alongside safe drinking water as well as expanding ORT coverage and the other interventions (WaterAid, 2009).

The lack of targeting at the global level recurs at the national level. While Ondo has made significant reductions in child mortality over the last 10 years, financial flows are not addressing child survival priorities adequately. The Ministry of Health notes that “over 80% of the health conditions presented at health institutions in Ondo are diseases related to poor environmental sanitation”, yet environmental health is given little priority in its budgeting (MoH, 2010).

There is evidence that in Ondo the under-five diarrheal disease is still a public health concern as has been shown by the Ondo Demographic Health Survey (ZDHS) 2013-14 report. According to the 2007 ZDHS report, diarrhea was reported to be at 16% (CSO, 2007). The current report also states that diarrhea is second (16%) cause of morbidity and mortality, the first being fever of all types at 21% (CSO, 20140). This called for concern as it indicated health systems failure and poverty which are contributing factors to the problem of diarrhea among under-five children.