Prevalence of diarrhea disease and risk

factors in Jos University Teaching Hospital,

Nigeria
Yilgwan, Christopher; Okolo, ! Annals of African
Medicine""!# $%ec &'"&() &"*+&"!
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/ackgro,nd) %iarrhea is widely recogni0ed as a 1a2or ca,se of
childhood 1or-idity and 1ortality in 1any developing co,ntries,
partic,larly in s,-+aharan .frica! .ccording to 3orld Health
Organi0ation $3HO( report in the .frican region, diarrheal diseases
are still leading ca,ses of 1ortality and 1or-idity in children ,nder
five years of age! This sa1e report indicates that each child in the
said region has five episodes of diarrhea per year and that 4'','''
die each year fro1 diarrhea and dehydration! 5aterials and
5ethods) This st,dy e6a1ined diarrheal 1or-idity and associated
risk factors in children ,nder five years in Jos! . total of 7#'
children were seen in the %iarrhea Training Unit $%TU( of the Jos
University Teaching Hospital $JUTH(, Jos, over a period of &#
1onths $Jan &''4+%ec &''8(! . se1i+str,ct,red interviewer
ad1inistered 9,estionnaire was ,sed to generate the data! .ll
wo1en whose children presented with diarrhea were interviewed
and data generated analy0ed ,sing :pi info version 7!;!" statistical
software! <es,lts) %,ring the st,dy period, "7,'*= children were
seen in o,r facility, of which 7#' were s,ffering fro1 diarrhea, th,s
giving a diarrhea prevalence of &!*>! There were "47 $;#>( 1ale
and ";* $#'>( fe1ale children seen with diarrhea! The 1ean age
was "" ?+ 4!; 1onths! The 1ean d,ration of diarrhea was fo,nd to
-e # ?+ 7!= days! . 1a2ority of children were aged less than =
1onths, consisting of &7; infants, 8; toddlers, and "' pre+
schoolers! Of the n,1-er of wo1en seen, &#& $=">( had at least
pri1ary ed,cation, while 84 $&8>( had no for1al ed,cation!
%iarrheal episodes were fo,nd to have a -ivariate association with
1others@ ed,cational stat,s, fa1ily type, fa1ily si0e, -reastfeeding,
and se6 of child! However, only 1other@s ed,cational stat,s,
diarrhea in other si-ling, and -reast feeding were significantly
associated with the occ,rrence of diarrhea! .ltho,gh there were
1ore 1ale children with diarrhea, the odds of having diarrhea was
not significantly related to se6! Concl,sion) O,r st,dy de1onstrated
an i1portant relationship -etween diarrheal 1or-idity and low
1aternal ed,cation, none6cl,sively -reastfed infant, and previo,s
diarrheal episode in a si-ling! At th,s 1eant that diarrhea 1or-idity
is still an i1portant pro-le1 for infants in o,r environ1ent!
5oreover, 1aternal ed,cation and e6cl,sive -reastfeeding are still
relevant via-le 1eas,res in c,r-ing diarrhea in infants!
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Antrod,ction
%iarrhoeal disease re1ains one of the 1ost i1portant ca,ses of
1or-idity and 1ortality in developing co,ntries, especially in .frican
co,ntries! C"D %iarrhea is defined as an a-nor1al increase in daily
stool fl,idity, fre9,ency, and vol,1e fro1 what is considered
nor1al for an individ,al! C&D %iarrhea kills an esti1ated &!; 1illion
people each year, with a-o,t ='+*'> of the1 -eing children ,nder
five years of age! C7D,C#D The disease is responsi-le for over a
9,arter of the deaths of children in the world today! C;D 5ost of
these deaths occ,r in developing co,ntries where an esti1ated &;>
of ,nder+five 1ortality is directly attri-,ted to diarrhea disease! C7D,
C#D,C;D
%espite the widespread ,se of oral rehydration therapy $O<T(, the
incidence of ac,te diarrheal diseases has not decline 1,ch, tho,gh
a s,-stantial red,ction in ann,al diarrheal deaths fro1 #!; 1illion in
the "84's to the present level of a-o,t & 1illion children is
attri-,ta-le to the pro1otion of O<T! C7D This is -eca,se 1ost
pop,lations of the world, especially developing co,ntries, lack
access to pota-le water and are still afflicted -y poverty, poor
sanitation, and lack of hygiene! O<T is an i1portant tool in the
prevention of dehydration res,lting fro1 diarrhea! 5others all over
the world, especially in developing co,ntries, have -een ta,ght the
types, ,se, and i1portance of this all i1portant tool with regard to
diarrhea and its attendant se9,elae in antenatal clinics and child
welfare! 5oreover, even print and electronic 1edia are other ways
of giving health ed,cation! C=D,C*D .lso, -asic hygiene, ho,sehold
sanitation and ade9,ate appropriate feeds are e1phasi0ed in
different health clinics and well child visits! .ltho,gh these efforts
have -een shown to decrease the severity of ac,te diarrheal
episodes and sharply red,ce the n,1-er of s,-se9,ent death, C7D,
C*D a large n,1-er of children are still afflicted with diarrhea that
has a negative i1pact on their growth and develop1ent!
5any cases of ac,te diarrhea 1ay -e treated at ho1e or 1ay
recover witho,t any treat1ent, -,t a few children 1ay develop
severe dehydration and so will necessitate e1ergency roo1 care
with intraveno,s fl,ids!
t,dies have -een cond,cted in the past to esta-lish risk factors
diarrhea! An :thiopia, Yohannes and his colleag,es C4D fo,nd the
incidence of diarrhea to -e higher in the second half of the infant@s
life when in-orn i11,nity is weak and e6pos,re to conta1inated
weaning foods increases! They also showed that children living in
ho,seholds with so1e kind of toilet facility are less likely to -e sick
than children in ho,seholds that do not have toilet facilities! Eack of
access to a toilet facility is associated with a high incidence of
diarrhoea! C8D The greatest red,ctions in diarrhoea are associated
with fl,sh toilets co1pared with pit latrines! C"'D P,-lic latrines are
generally ,nhygienic and ,nhealthy for children d,e to the presence
of flies and dirty floors, which pro1ote infections s,ch as cholera,
shigella, sal1onella, and rotavir,s, all of which have -een shown to
-e 1a2or ca,ses of diarrhea in children! C8D,C"'D The sa1e st,dy
indicates that the prevalence of diarrhea varies according to
ed,cation of 1other, -eing significantly lower a1ong children of
1ore ed,cated 1others than a1ong children of 1others with no
ed,cation! This is pro-a-ly -eca,se ed,cation provides the
knowledge of the r,les of hygiene, feeding and weaning practices,
and the interpretation of sy1pto1s which enhances ti1ely action
on childhood illness! C"'D
The ai1 of the present st,dy was to assess the prevalence of
diarrhea a1ong children aged =+=' 1onths presenting to the
diarrhea training ,nit $%TU( of the Jos University Teaching Hospital
$JUTH( -y collecting c,rrent and relia-le infor1ation on the
incidence and so1e deter1inants of ac,te diarrheal diseases, with a
view of adding to the e6isting -ody of knowledge as well as help in
policy change that will i1prove childcare in Nigeria!
5aterials and 5ethods
. total of 7;' children were st,died -etween Jan,ary &''4 and
%ece1-er &''8! %ata were collected -y interviewing 1others and
prepared 9,estionnaires were co1pleted -y the researchers and
residents in the %TU! The infor1ation o-tained were as folllows)
parents@ age, literacy level and occ,pation, n,1-er of children aged
=+=' 1onths in the fa1ily, gender, n,1-er of passage of loose
stools per day, and d,ration of ac,te diarrhea! Binally, the
prevalence of ac,te diarrhea d,ring the past &# 1onths was
calc,lated a1ong children aged =+=' 1onths and its association
with sociode1ographic, environ1ental, and do1estic factors was
eval,ated!
An this st,dy, ac,te diarrhea was defined as the passage of three or
1ore loose or watery stools per day, lasting less than "# days! %ata
were analy0ed ,sing :pi info version 7!;!" statistical software and
Chi+s9,are and t test were ,sed to co1pare proportions and 1eans,
respectively!
<es,lts
Feneral characteristics
%,ring the st,dy period spanning & years, a total of &7,4*= children
were seen in o,r e1ergency pediatric ,nit, of which 7;' presented
with diarrhea, giving a diarrhea prevalence of "!;>! .1ong the
children seen with diarrhea "4; $;#>( were 1ale and "=4 $#'>(
fe1ale! The 1ean age was "" ?+ 4!; 1onths! The 1ean d,ration of
diarrhea was fo,nd to -e #?+7!= days! 5ost children were aged =
1onths $infants, =8>; toddlers, &4>@ and pre+schoolers, 7>(
CTa-le "D! . total of "#7 $#'!8>( children were e6cl,sively
-reastfed while &'* $;8!">( were not! Of the n,1-er of children
not e6cl,sively -reastfed, "; were HAG e6posed neonates on -reast
1ilk s,-stit,te!HTa-le "I
. total of "48 $;#>( 1others had recevied at least pri1ary
ed,cation, while "=" $#=>( had no for1al ed,cation CBig,re "D!
There is a trend towards -eing ,nderweight as the age increases in
-oth se6es as depicted -y the weight for age 0 scores CBig,re &D!
i1ilarly, fro1 the age of &' 1onths onwards, the children are
st,nted CBig,re 7D!HBig,re "IHBig,re &IHBig,re 7I
%,ration of %iarrhea Gs o1e <isk Bactors
CTa-le "D shows the res,lts of testing the association of five factors
fo,nd to infl,ence diarrhea in previo,s st,dies! The d,ration of
diarrhea has -ivariate associations with 1other@s ed,cational stat,s,
se6 of child, -reastfeeding, fa1ily type, diarrhea in other si-lings
and place of residence! Only three varia-les reached the statistical
significance level $P J '!';( in the logistic regression 1,ltivaria-le
1odel predicting d,ration of diarrhea! 5other@s ed,cational stat,s
$odds ratio CO<D K '!'*=8, 8;> confidence interval CCAD K '!'"+
"!#*(, -reastfeeding $O< K '!*7, 8;> CA K '!#"+"!&*(, and
diarrhea in other si-lings $O< K '!*7, 8;> CA K '!#'+"!"8(!
%isc,ssion
The present st,dy e6a1ined children presenting to the diarrhea
training ,nit of JUTH and fo,nd a prevalence of &!=>! This val,e is
lower than that reported -y Lolahi et al!C""D in Aran, reporting a
prevalence of "'!7>! This is also lower than the prevalence
reported -y hah C"&D et al! in Andia! However, hah st,died
children aged less than 7 years, in who1 we know even in the
present st,dy to have a high risk of diarrhea! The low prevalence of
diarrhea recorded in the present st,dy 1ay not -e ,nconnected
with the s,ccess of the child s,rvival strategies instit,ted in the past
decades, which ai1ed at enlightening and ed,cating 1others on
co11on childhood ail1ents, i11,ni0ation, -reastfeeding, and
n,trition, all of which have -een shown to red,ce the incidence of
diarrhea! The diarrhea training ,nit in JUTH, apart fro1 1anaging
cases of diarrhea, provides ed,cation on diarrhea prevention and
ho1e 1anage1ent to 1others presenting to o,r facility! This
enlighten1ent 1ight have s,cceeded in e1powering the 1others
with skills for ho1e 1anage1ent of diarrhea, and th,s red,cing the
n,1-er of children necessitating hospital care for the sa1e! C"7D,
C"#D,C";D
This st,dy also fo,nd 1ore -oys than girls presenting with diarrhea!
This is in contrast with the higher n,1-er of girls reported -y Lolahi
et al! in Aran C""D hah et al! in Pakistan, C"&D and Fascon C"=D in
Tan0ania! The reason for o,r finding is not known -,t 1ay -e
connected with the c,lt,ral practices in o,r co,ntry where there is
preference for -oys over girls, which co,ld also affect care giving!
Anfants for1 the largest gro,p with diarrhea, especially those
aro,nd = 1onths of age, which is si1ilar to what other researchers
have reported! C7D,C;D,C""D,C"&D,C"7D,C"=D,C"*D .lso, a large
proportion of these cases of diarrhea seen in this age gro,p were
a1ong those not e6cl,sively -reastfed, and th,s conferring higher
odds of having diarrhea CTa-le &D! :6cl,sive -reastfeeding in
infancy is known to protect against diarrhea with 1aternally
ac9,ired anti-odies helping to fight infective agents responsi-le for
the disease! However, at this stage, there is a general decline in
these anti-odies and 1ore so in those not e6cl,sively -reastfed,
and hence the high risk of developing diarrhea! /esides,
co1ple1entary feeds are ,s,ally introd,ced at this stage with an
attendant increase risk of conta1ination, especially in the
developing world like o,rs where safe water and -asic sanitation is
lacking! At was also noticed that "; of these infants were neonates
on -reast 1ilk s,-stit,te! These are HAG+e6posed neonates residing
in r,ral areas where safe water and -asic hygiene are ,navaila-le!
:arly Antrod,ction of co1ple1entary feeds has -een shown to
increase the risk of diarrhea d,e to possi-le conta1ination of the
feeds! C"=D HTa-le &I
5ost children were wasted, with their weight for age scores -elow
the 1ean for age! %iarrhea has 1a2or effects on the n,trition of the
child, with loss of n,trients as the 1ain pathopysiologic 1echanis1!
C"7D .lso, 1ost 1others tend to withhold feeds d,ring episodes of
diarrhea thinking that will red,ce the stool -,lk, and hence stop the
disease! /esides, the diarrhea episode, which ,s,ally res,lts fro1
infection places a 1eta-olic de1and on the child and if it is
rec,rrent, it will affect the growth and develop1ent of the child with
conse9,ent 1aln,trition setting in, which th,s -rings in a cascade
of vicio,s cycle! C"4D
The risk of having diarrhea was also fo,nd to -e higher in children
whose 1others had no for1al ed,cation! This is si1ilar to reports
-y %ikassa et al! C"#D in Congo and :kane1 et al! C=D in Eagos,
Nigeria! /oth st,dies were case control and de1onstrated a strong
association -etween the risk of having diarrhea and low or no
ed,cation in 1others! :d,cation is a vital tool in enlightening
1others and also changing their healthcare seeking -ehavior and
practice! C"'D,C""D,C"&D,C"=D,C"*D This knowledge is said to affect
their -ehavior, especially as it relates to child rearing practices and
healthcare! Bor e6a1ple, .h1ed et al! C";D in ,dan fo,nd that
illiterate 1others in r,ral areas were 1ore likely to stop
-reastfeeding their child who developed diarrhea and resort to
traditional re1edies s,ch as g,1 ca,tery in an atte1pt to stop
teething! However, Ok,nri-ido and his colleag,es C"8D fo,nd a
slightly different scenario in their st,dy of c,lt,ral perceptions of
diarrhea 1anage1ent a1ong Yor,-a wo1en, where they reported
a high likelihood of co1-ination of western and traditional
re1edies, even tho,gh a few were inclined towards western
re1edies alone!
Concl,sion
This st,dy indicates that 1aternal ed,cation -ears a significant
i1pact on 1or-idity ca,sed -y diarrhea! :d,cated 1others are
1ore e6posed to the i1portance of hygiene, -etter childcare and
feeding practices, and are 1ore aware of disease ca,sation factors
and preventive 1eas,res! The present st,dy indicates that there is
an ,rgent need for effective intervention 1eas,res to c,rtail the
incidence of diarrhea a1ong children! .lso, health intervention
progra1s, incl,ding e6cl,sive -reast feeding, which enhance
children@s physiological resistance against diseases, and 1aternal
hygiene ed,cation sho,ld -e strengthened in order to red,ce the
incidence of diarrhea! At is hoped that the res,lts of the st,dy will
provide g,idance for policy 1akers in for1,lating strategies to
i1prove child health in Nigeria!
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AuthorAffiliation
Christopher Yilgwan) %epart1ent of Paediatrics, Jos University
Teaching Hospital, P5/ &'*=, Jos
Okolo) %epart1ent of Paediatrics, Jos University Teaching
Hospital, P5/ &'*=, Jos
3ord co,nt) 2400
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/ody Height, /ody 3eight, /reast Beeding, Child, Preschool,
%iarrhea ++ co1plications, Be1ale, Hospitals, Teaching, H,1ans,
Anfant, Anterviews as Topic, 5ale, 5or-idity, 5others ++ psychology,
Nigeria ++ epide1iology, Prevalence, P,estionnaires, <isk Bactors ,
e6 %istri-,tion, ocioecono1ic Bactors , Ti1e Bactors , %iarrhea ++
epide1iology $1a2or(, Health Lnowledge, .ttit,des, Practice
$1a2or(, 5others ++ ed,cation $1a2or(
Title
Prevalence of diarrhea disease and risk factors in Jos University
Teaching Hospital, Nigeria
Author
Yilgwan, Christopher; Okolo,
"ublication title
.nnals of .frican 5edicine
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$"( Yilgwan C, Okolo ! Prevalence of diarrhea disease and risk
factors in Jos University Teaching Hospital, Nigeria! .nnals of
.frican 5edicine &'"& "&;""$#()&"*+&"