HYGIENE FACTORS IN OCCURANCE OF DIARRHEA DISEASE AMONG 0-5 YEARS CHILDREN
Objectives: To identify the determinants and describe the extent of diarrhoeal diseases among under-five children in urban Ethiopia.
Design: Community based, cross-sectional study.
Setting: Jimma, a town in south western Ethiopia, is an urban area with multi-ethnic population. The town is divided into 20 kebelles. Each kebelle has a population of about 5000 people
Subjects: Six hundred and five children under the age of five years were selected by random sampling. There were 142 children with diarrhoeal diseases in selected households. All those without diarrhoea were taken as controls.
Results: The incidence at diarrhoeal diseases was 5.48 episodes per child per year. The incidence of persistent diarrhoea was 7.75%. About 24.5% of the acute diarrhoeal diseases (ADD) culminated to persistent diarrhoea. Well source of water, lack of complete immunization, attack of measles and acute respiratory infections (ARI) in the previous two weeks were found to be significantly associated with occurrence of diarrhoeal disease; however, only ARI and well water were retained in the logistic regression analysis.
Conclusion: The incidence of diarrhoeal diseases and the progression to persistent diarrhoea are very high. Many of the socio-environmental factors did not appear as significant determinants independently. The implication of this is that in a homogenous and economically deprived society improvement in a single factor does not reduce the problem of diarrhoeal diseases. Hence, an inter-sectoral approach is recommended to control diarrhoeal diseases.
Diarrhea disease is a major public health problem in developing countries. It is a communicable infected disease, which has a large number of cases and high morbidity rate. The epidemiological office the Ministry of Public Health reported that diarrhea disease in Thailand has a higher incidence rate than other communicable infectious diseases (Department of Communicable Disease Control, 2000). In addition, when the epidemic pattern of diarrhea disease was studied over past 10 years, it was found that the number of cases was highest in 1999. This happened because of the drastic change in the economy and community (Vathanophas et al, 1986). A large number of people moved from the countryside to towns. As a result, the populations of the towns increased drastically and public facilities were insufficient. Water supplies were not enough to drink and use, sanitation was not good, rubbish and wastes increased, sewage and wastewater were not hygienically treated, resulting in the accumulation of germs and disease carriers (Churat, 1987; Satienchok, 1988; Satyawisis, 1990).
Epidemic patterns of diarrhea disease in Thailand had been studied by the Office of the Permanent Secretary for the public health in during 1995-1999 period. The results show that the incidence rate due to diarrhea for children was four times higher than that for adults. The Epidemiological Office also studied the incidence rate of diarrhea in 1999. It was observed that there were 981,072 cases of diarrhea disease, and the incidence rate for children was 7117.3 per 100,000 population. In 1999, there were 397 deaths from diarrhea. The disease can be found in every age group from January to December (The Office of the Permanent Secretary, 2000).
The epidemic pattern of diarrhea disease in Pattani Province, located in the south of Thailand, has been studied since 1995. The numbers of cases had increased over the 1995-1999 period. The incidence rates for each year from 1995 to 1999 were 1502.2, 1682.8, 1853.1, 1720.9, and 2783.7 per 100,000 population, respectively (Pattani Public Health Province Office Report, 1999). In 1999 the number of cases of diarrhea disease in children under 5 years old was 5,103 out of 17,265 per 100,000 population (38.56 %). It was observed that although the number of people who had diarrhea increased drastically, the mortality rate decreased. This tendency is similar to that for rural areas (Pattani Public Health Province Office Report, 1999). However the incidence rate in Pattani Province was higher than the benchmark for the control of diarrhea disease set up by the Ministry of Public Health. In developing National Public Health plan No.8 (1997-2001), a program for the control of diarrhea disease has been set up. The aim of this program is to decrease the incidence rate and mortality rate of diarrhea disease. The program states that the incidence rate of diarrhea disease in children under 5 years old should be less than 3,000 per 100,000 population, whereas that in other groups of age is less than 1,000 per 100,000 population (Ministry of Public Health, 1997). From the above information it is of interest to investigate “why diarrhea disease occurs in Pattani Province every year” and “what factors affect on acute diarrhea disease in children age under 5 years in Pattani Province”.
The main objective of this study is to investigate the risk factors related to acute diarrhea disease in children under 5 years old using mother and child carers in Pattani Province as subjects. A future objective is to develop a model to forecast the risk factors related to acute diarrhea disease in children under 5 years old.
1.2 RESEARCH HYPOTHESES
Socio-demographic factors, environmental factors, knowledge factors about diarrhea disease and behaviour factors for prevention of diarrhea disease are related to acute diarrhea disease in children aged under 5 years in Pattani Province.
1.3 DEFINITION OF TERMS
Diarrhea disease: excrement is fluid or water more than 3 times during 24 hours, or excrement is blood once a day.
Factors: components of activity in association with behaviour for prevention and treatment diarrhea disease. They can be measured by the percentage and the mean.
Risk factors: factors affecting diarrhea disease in children under 5 years old in Pattani Province caused by socio-demographic characteristics, environment, knowledge and behaviour of mother and child carer.
Socio-demographic factors: carers, age, sex, marital status, religion, occupation, income and education of carers.
Environmental factors: water, child play area, domestic animal, garbage disposal and defecation pattern.
Knowledge factors: causes of diarrhea disease, symptoms, prevention, treatment and danger sign.
Behaviour factors: personal hygiene, food and milk.
ORS: oral rehydration salt, consisting of water with salt and mineral salt.
Behaviour for prevention to the diarrhea disease : conduct for prevention of diarrhea disease of mother and child carer having children aged under 5 years.
Children aged under 5 years: age groups of children under 5 years staying in the village of Panarehk District in Pattani Province.
Knowledge about diarrhea disease : ability to remember and can answer about text of knowledge with cause, symptoms, preventions, treatment and factors related to acute diarrhea disease by answering the questionnaire.
Experience about diarrhea disease: number of times when the children aged under 5 years had diarrhea sickness during 1 year ( 1 January – 31 December 1999)
Danger signs of diarrhea disease: the symptoms of the patient were heavy sickness with diarrhea disease including heavy defecation, heavy vomiting, heavy weakness and excrement of blood or the patient not eating and drinking.
Armitage P, Berry G. 1987. Statistical Methods in Medical Research. Second Edition, Blackwell Scientific Publications:109-112.
APHA Technical Report: Criteria for the Development of Health Promotion and Education Programs. 1987. American Journal of Public Health;77(1):89-92.
Bateman OM, Smith S. 1991. A Comparison of the Health Effects of Water Supply and Sanitation in Urban and Rural Guatemala. Arlington (VA): Water and Sanitation for Health (WASH) Project; WASH Field Report Number 352.
Bateman, OM. 1992. Diarrhea Transmission and Hygiene Behavior: Personal and Domestic Hygiene. Paper presented at an Informal Consultation on Interventions to Improve Hygiene Behaviors, WHO, Geneva, May 18-20, 1992.
Bateman OM, Smith S, Roark P. 1993a. A Comparison on the Health Effects of Water Supply and Sanitation in Urban and Rural Areas of Five African Countries. Arlington (VA): Water and Sanitation for Health (WASH) Project; WASH Field Report Number 398.
Bateman OM, Zeitlyn S, Jahan RA, Brahman S. 1994. Latrine Coverage Statistics: What the Numbers Mean for Health. paper presented at “Environmental Health and Policy Perspectives,” Third Annual Scientific Conference, ICDDR,B, Dhaka, Bangladesh. Abstract number 17.