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ORIGINAL ARTICLE
Year : 2017  |  Volume : 11  |  Issue : 1  |  Page : 6-10

Assessment of the incidence of diarrhea in children under 5 years at the Institute of Child Health, Banzazzau, Zaria


1 Department of Biochemistry, Faculty of Science, Ahmadu Bello University, Zaria, Nigeria
2 Department of Biochemistry, Kogi State University, Anyigba, Kogi State, Nigeria

Date of Web Publication15-Feb-2018

Correspondence Address:
Ifeoma Bernadette Ucheh
Department of Biochemistry, Faculty of Science, Ahmadu Bello University, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/anm.anm_22_16

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   Abstract 


Introduction: This study was carried out to assess the incidence of diarrhoea in children under five years at the catchment community of Institute of Child Health (ICH), Banzazzau, Zaria, affiliated to Ahmadu Bello University Teaching Hospital Zaria.
Aims: The study aim was to assess the incidence of diarrhoea amongst children under five years at the Institute of child health Banzazzau between January 2013 and December 2014.
Settings and Design: The study was a retrospective study of the incidence of diarrhoea amongst children under five years at the Institute.
Materials and Methods: The materials used for this survey include medical records, questionnaires, weighing scale and a metre rule. Hospital records of children presented with diarrhoea were reviewed to assess the occurrence of diarrhoea among under five. A total of 2,400 hospital records of children under 5 years over a period of 24 months (January 2013- December 2014) who attended the clinic were reviewed.
Statistical Analysis Used: Data was analysed using SPSS, version 20.0 and anthropometric data was analysed using the WHO Anthro Software Package 2011.
Results: The socio-demography of children seen in the hospital records showed a preponderance of male children over females that presented with diarrhoea (55.4%) and children within the aged 12-23 months had the most diarrhoeal cases (36.8%).
Conclusions: Diarrheal disease assessed in under five years in the study area occurred more in male children who are between the ages of 12 to 23 months..

Keywords: Diarrhoea, Children, Under five


How to cite this article:
Ucheh IB, Eleojo AA, Tyoalumun K, Nanpen DM. Assessment of the incidence of diarrhea in children under 5 years at the Institute of Child Health, Banzazzau, Zaria. Ann Nigerian Med 2017;11:6-10

How to cite this URL:
Ucheh IB, Eleojo AA, Tyoalumun K, Nanpen DM. Assessment of the incidence of diarrhea in children under 5 years at the Institute of Child Health, Banzazzau, Zaria. Ann Nigerian Med [serial online] 2017 [cited 2018 Dec 13];11:6-10. Available from: http://www.anmjournal.com/text.asp?2017/11/1/6/225609




   Introduction Top


Diarrhea is a disease of the gastrointestinal tract, characterized by abnormal fluidity and frequency of fecal evacuation, three or more, or at least one bloody stool in a 24 h period. It is not unusual to also find mucus in the stool.[1] In developing countries like Nigeria, majority of diarrheal infection is caused by viruses, few by bacteria and other parasites. The symptoms in children include having 3 or more loose stools in 24 h, watery or unusual bowel movements exceeding child's normal stool, with or without vomiting.[2] There could also be changes in stool characteristics such as color, volume, and frequency. Other signs include abdominal cramps, dehydration, weight loss, perianal erythema, and malnutrition. Transmission of diarrheal agents is usually through the feco-oral route resulting from intake of contaminated food or water. Some predisposing factors such as unhygienic environment, poor nutritional status, and inadequate breastfeeding were observed in the community which necessitated the need for the study. Research findings show that acute diarrhea is one of the principal causes of morbidity and mortality among children in low-income countries. The cornerstone of treatment is oral rehydration therapy and dietary management. Many children in developing countries die from acute diarrhea directly or through such complications such as shock, electrolyte imbalance, and sepsis.[3] The aim of the study was to assess the incidence of diarrhea among children under 5 years at the Institute of Child Health (ICH), Banzazzau, between January 2013 and December 2014 [Figure 1] and [Figure 2].
Figure 1: Modes of delivering complementary food to children under 5 years by care givers attending the Institute of Child Health, Banzazzau, Zaria from January to June 2015

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Figure 2: Care giving practices of caregivers of children under 5 years at the Institute of Child Health, Banzazzau, Zaria from January to June 2015

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   Subjects and Methods Top


The study was a retrospective and cross-sectional survey of the prevalence of diarrhea among children under 5 years at the ICH, Banzazzau, between January 2013 and December 2014. The ICH is located in Zaria local government with 13 different wards. Kwarbai A, Kwarbai B, and Gyallesu are the wards with the highest number of under 5 children visiting the clinic. The population for the study was drawn from the hospital records of children under 5 years who were presented with diarrhea at ICH between January 2013 and December 2014 and caregivers of children under 5 years of age who brought their children to the clinic for the management of diarrhea from surrounding communities. Simple systematic sampling technique was used for the study. This was based on a review of the number of diarrheal cases that were seen on a monthly basis at the clinic. The method chosen for calculating sample size was that cited by Charan and Biswas.[4]





SS = 158.70.

Where, P = Prevalence rate of diarrhea in Kaduna State which is 13.5% (NDHS 2013), Z = degree of confidence 95% or 1.96, C = degree of freedom 5% or 0.05, and SS = sample size. The retrospective study was done using the simple systematic sampling method, for every 3 cases of diarrheal disease in children under 5 years; one case was picked amounting to 100 cases/month from January 2013 to December 2014. The cross-sectional study involved a multistage sampling methodology, which was used to select the wards, communities, and households. The three wards – Gyallesu, Kwarbai A, and Kwarbai B having the highest number of under 5 children visiting ICH for diarrhea were selected from the 13 wards in Zaria LGA as shown below: communities within the wards were listed alphabetically, using probability proportional to size, 12 communities were randomly selected within the selected wards. In the selected communities, household listings were carried out and thirty households whose members visited the ICH because of diarrhea within the last 12 months were systematically selected and enlisted in the study before caregivers were interviewed. The communities included Jushi, UngwarKatuka, Amaru, Babban Dodo, Lemu (Kwarbai A), Angwar Alkali, Danmadami, RiminTsiwa, KofarDoka, Madaka (Kwarbai B), Kongo, and Fage (Gyallesu). In each of the households, caregivers who took their under 5-year-old children with diarrheal disease to ICH, Banzazzau, were identified. The caregivers were interviewed and data were entered into semistructured questionnaires. The data collected included the caregivers' sociodemography, breastfeeding, and caregiving practices. Ethical clearance was obtained from the Health Ethics Research Committee of the Ahmadu Bello University Teaching Hospital, Zaria, before commencement of work. Data were analyzed using the IBM Corporation. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corporation). The Sociodemographic data were expressed as frequencies, percentages, and charts. The anthropometry was analyzed using the WHO Anthro Software Package 2011.


   Results Top


[Table 1] shows the sociodemographic characteristics of children under 5 years of age presented with diarrhea at the ICH, Banzazzau, Zaria. Exactly 55.4% of the children under 5 years of age were males while 41.5% were females. Only 36.8% of the children were within the age of 12–23 months, 35.0% were within the 0–11 months of age, and the age group (36–47 months) had the least percentage (6.4%). [Table 2] also indicated that 90% of the caregivers were mothers while 3.1% were grandmothers. The age group of caregivers shows that 55.0% of them were between 20 and 29 years of age. Precisely, 83.4% of the caregivers were married, 54.1% were fulltime homemakers, and 28.4% had <# 5000 as estimated monthly income. Only 31.2% of the caregivers had no formal education, 24.3% had completed senior secondary school education, and 1.6% had postgraduate education. [Table 3] shows the incidence rate of diarrhea and sick children under the age of five between January 2013 and December 2014. Within the period of review, total of 30,572 children were presented to ICH, Banzazzau, for various ailments. Exactly 56.3% were children under the age of 5 years. Children under 5 years presented with diarrheal disease accounted for 29.1% of the total number of children that sought for care during the period under review and 51.8% of children under the age of 5 years. Therefore, the incidence of diarrheal disease in children under 5 years was 51.8%.
Table 1: Sociodemographic characteristics of under-five children presented with diarrhea at Institute of Child Health, Banzazzau, between 2013 and 2014


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Table 2: Sociodemographic characteristics of caregivers who accessed care at the Institute of Child Health, Banzazzau, Zaria, from January 2013 to December 2014 (n=320)


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Table 3: Incidence rate of diarrhea and sick children under 5 years


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   Discussion Top


The incidence rate of diarrhea at the clinic was 51.8%, making it about half the population of all children who attended clinic; likewise, research by Siziya et al.[5] showed an equal incidence of diarrhea in both gender of children. The highest prevalence by age group was 12–23 months (36.8%) while older children in the group <48 months of age had the least prevalence (6.4%). This pattern was reported by NDHS though with lower values for age group of 12–23 months (16.7%) and older children 48–59 months (5%). Yilgwan and Okolo [6] also reported higher male to female ratio of 5:4. A total of 62.5% of caregivers were below 30 years of age as compared to the National Demographic and Health Survey [7] which showed 54% of caregivers to be below 30 years of age. The marital status of caregivers obtained from the study reflects the Nigerian Population Commission [8] data which showed that Nigerians show a universal approach to marriage to ensure social and economic security, as 83.4% of them were married while 8.5% were single, widowed, separated, or divorced. This sometimes translates to better caregiving attitudes toward children nutrition and overall health. Treatment of diarrhea involves the application of the WHO “4 home rules” which include continuous fluid administration in the form of oral rehydration solution (ORS) or recommended home fluid (RHF), zinc supplementation of 10 mg for children under 6 months and 20 mg for children above 6 months for 10–14 days, continuous feeding baby as often as baby wants, and referral to health facility for professional care if diarrhea persists. Care is one of the major needs for optimum well-being of all children, especially those under 5 years who are sick.[9] Almost half of all the children of caregivers were sick a month before research was carried out. “Diarrhea infection only” was the fifth leading cause of illness in children at about 8.8%, while the WHO put diarrhea as the second leading cause of child deaths in children globally.[10]

Majority (55%) of the nursing mothers are within the age of 20–29 years; this could be a major reason since most young women know little about child care and adequate hygiene which are factors that prevent the infection. More so, a good number of the mothers (24.4%) were traders; selling in a dirty environment of the market square is a potential threat to such infections. The research shows that only few households earn monthly income above 25 thousand naira. Under 5 cases of diarrhea in both years studied showed that the incidence rate of infection was high at the beginning of rainy season (March, April, May) and at the peak of dry season (November and December). This is similar to other findings which show that the incidence of the disease varies greatly with the seasons and a child's age.[3],[5],[11] The data generated from this research can serve as a useful baseline for future interventions and for comparison studies for children under 5 years. Active handwashing and breastfeeding should be exclusive for the first 6 months of a child's life, followed by complementary feeding up till 2 years of age. Preparation of ORS and RHFs such as rice water, coconut water, watery soups and increased water intake should be properly demonstrated to caregivers to enhance infant and young child feeding practices in the country.


   Conclusion Top


Diarrheal disease assessed in under five years in the study area occurred more in male children who are between the ages of 12 to 23 months.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Nancy Roper. Churchill Livingstone Pocket Medical Dictionary. 14th edition, London, Madrid, Melbourne and New York; 995.p. 322.   Back to cited text no. 1
    
2.
Catherine AC, Zahra A. Gastroenteritis in children: Part II. Prevention and management. Afr Med Fam Physician. 2012;85:1066-70.  Back to cited text no. 2
    
3.
Korie FC, Ikefuna AN, Ibe BC. Bacterial agents associated with acute diarrhoea in under 5 children in Enugu Nigeria. J Dent Med Sci 2012;2:40-5.  Back to cited text no. 3
    
4.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35:121-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Siziya S, Muula AS, Rudatsikira E. Correlates of diarrhoea among children below the age of 5 years in Sudan. Afr Health Sci 2013;13:376-83.  Back to cited text no. 5
[PUBMED]    
6.
Yilgwan CS, Okolo SN. Prevalence of Diarrhea disease and risk factors in Jos university teaching hospital, Nigeria. Ann Afr Med 2012;11:217-21.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
National Population Commission (NPC) [Nigeria] and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014. p. 165-88.  Back to cited text no. 7
    
8.
National Population Commission, Nigeria. Population Census of the Federal Republic of Nigeria: Analytical Report at the National level Abuja, Nigeria; 1998.  Back to cited text no. 8
    
9.
Singh J, Gowriswari D, Chavan BR, Patiat RA, Debnath AC, Jain DC, et al. Effect of maternal literacy on nutritional status of children under the age of 5 years in the Babban Dodo community Zaria City North West Nigeria. Ann Niger Med 2012;6:61-4.  Back to cited text no. 9
    
10.
World Health Organization. Integrated Management of Childhood illness (IMC). World Health Organization; 2012. p. 17-8.  Back to cited text no. 10
    
11.
Azad A, Nourjah N, Shahbazi F. Relationship Of intestinal parasitic infections to malnutrition among schoolchildren near Tehran, Iran. Southeast Asian J Trop Med Public Health 2004;35:116-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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