Abstract

Diarrhea remains the second leading cause of death among children below five years, it kills more children than AIDs, malaria and measles combined. In Cameroon, the burden diarrhea is very high especially with recurrent outbreaks of cholera in some parts of the country, especially in the south west region. The WHO has underlined the need for epidemiological surveys of infantile diarrhea in all areas.

The objective of this study was to determine the community and hospital prevalence of diarrhea and its associated risk factors in in Fako Division. This study was a cross sectional study in which questionnaires were administered to households in communities of the Buea, Tiko and Limbe HDs to determine the community prevalence of diarreha and risk factors of diarrhea in children 5 years and below. A retrospective study was also conducted by review of hospital records to identify the hospital prevalence of childhood diarrhea.

Chi square was used to test association of diarrhea and risk factors under study, and both univariate and bivariate analysis was used to determine the significance of association of determinants. The community prevalence of diarrhea in children 5 years and below was 20.91% and the hospital prevalence was 19.28%. Children living in houses where there are four or more children in the house were 3.4 times more likely to develop diarrhea than children in homes with just one child.

Additionally children who had not received the rotavirus vaccine and cholera vaccine were approximately two times more likely to develop diarrhea and respectively. Children whose parents did not wash their hands before feeding them or clean their nipples were 1.3 times and 1.6 times more likely to develop diarrhea and Diarrhea is still a public health problem in the Fako Division, and there is a need for more effective sensitization and education of the population for appropriate preventive measures to further reduce the prevalence.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diarrhea is defined as the passage of three or more loose or liquid stools per day or more frequent passage of loose stools than is normal for the individual (WHO, 2017). Though most episodes of childhood diarrhea are not always severe, acute cases can lead to significant fluid loss and dehydration (Winfred et al., 2021). In endemic areas diarrhea can be caused by a wide variety of bacteria, viruses and protozoa (Vila et al., 2000).

Diarrheal diseases are the most important causes of child morbidity and mortality in low income countries. Diarrhea remains the second leading cause of death among children under five years globally (Manuetu et al., 2021). Nearly one in five child deaths, 1.5 million each year, are due to diarrhea. Diarrhea kills more young children than AIDs, malaria and measles combined (Tambe et al., 2015).

Diarrhea is one of the top 10 diseases that contribute to global DALYs even in recent years. It is found to be one of the most common diseases among children under 5 years (Behera and Mishra, 2022). Diarrhea exposes children to several other infections by predisposing them to malnutrition. It also accounts for 16% of hospital admissions malnutrition (Workie et al., 2019). Diarrhea globally remains one of the main public health problems, although recent findings show that deaths due to diarrhea among children less than 5 years decreased by 34.5% between 2005 and 2015 (Troeger et al., 2020).

Children may become infected through contaminated water, beverages, food or through person-to-person contact (NIH, 2017). A significant proportion of diarrhea can be prevented through safe drinking water and adequate hygiene and sanitation (WHO, 2017). Several factors affect the occurrence of diarrhea; these include child’s age, maternal education, household income, hygiene of feeding practices, breastfeeding status, malnutrition, personal hygiene, environmental sanitation, water availability and quality, and latrine utilization (Workie et al., 2019).

In another report by George et al (2014), risk factors identified for diarrhea such as younger age, male gender, early weaning, seasonal patterns, low maternal education, lack of pipe borne water supply, poor water-storage practices, younger maternal age, lack of hand washing with soap by caregiver, poor sanitation, visible feces in the yard, indiscriminate disposal of child feces, unsatisfactory garbage disposal, using water from cistern trucks, and not treating water in the home (George et al., 2014).

Common causes of diarrhea in children include: infections (from viruses, bacteria, or parasites), functional gastrointestinal disorders (like irritable bowel syndrome and toddler`s diarrhea), food allergies and intolerances (Ciliac disease), inflammatory bowel disease (Ulcerative colitis) (NIH, 2014). In a multisite study by Kotloff et al (2013) rotavirus was found to be most common cause of moderate to severe diarrhea in children 0–23 months of age, and shigellosis for the age group 24–59 months of age.

Risk factors for childhood diarrhea vary by population with some factors being more important than others in particular settings. Therefore, it is important to identify the distinct risk factors for diarrhea in children ≤5 years so disease control programs can be implemented that are tailored to target these risk factors (George et al, 2014).

Cameroon is a sub Saharan Africa country with the highest mortality from diarrheal diseases (Dadonaite et al, 2018). No comprehensive data on the prevalence of diarrhea in children ≤5 years exist in Fako, thus necessitating the need for a study on the prevalence and associated risk factors of diarrhea in children ≤5 years in Fako Division, to propose measures of prevention.

1.2 Statement of the problem

Diarrheal diseases are the 2nd leading cause of death in children 5 years and below in developing countries (Levine et al., 2020). Very little data is available in Cameroon on diarrhea morbidity in children 5 years and below though epidemiological studies in some parts of the country have revealed a high prevalence of diarrhea and diarrhea causing pathogens (Tambe et al., 2018).

The WHO has accordingly underlined the need for epidemiological surveys of infantile diarrhea in all areas (Nkrumah et al., 2011). These surveys help to understand the burden and etiology of infant diarrhea. Understanding the epidemiology of diarrhea in children 5 years and below across the country is critical for defining and prioritizing interventions that can accelerate the reduction of morbidity, mortality of infantile diarrhea (Chissaque et al., 2018), thus the need for this study in Fako Division.

1.3 Research Questions

1. What is the prevalence of diarrhea in children 5 years and below in Fako?
2. What risk factors are associated with diarrhea in children 5 years and below in Fako?

Check out: Microbiology Project Topics with Materials