Determinants Of diarrhoea among under-five children in Umzingwane District, Zimbabwe: a case-control study

Abstract

Diarrhoeal disease remains a leading cause of mortality and morbidity among children less than five years old in the developing world. The average annual incidence rate of diarrhoea in children less than five years of age (under-fives) is estimated to be 2.6 episodes in developing countries. It is also estimated that there are 100 million episodes and 3.3 million deaths occurring each year among under-fives globally. In Africa, a child typically experiences five episodes of diarrhoea per year, and 800,000 children die each year from diarrhoea and dehydration. In Zimbabwe diarrhoea is the fourth highest cause of death for children under five and is the reason for 12% of child hospital admission (Zimbabwe Maternal and Child Health Integrated Programme, 2014). According to World Bank Collection of Development Indicators, 2014 the prevalence of diarrhoea in under-fives in Zimbabwe was 16%. Umzingwane District recorded a high number of diarrhoea cases in underfives in 2016. The total number of diarrhoea cases from under- fives was 1 018 andconstituted 40% of the total number of diarrhoea cases in the district. The figure constitutes an overrepresentation of morbidity among this age group since the underfives make up 13.7% of the total population. The cause for the upsurge of diarrhoea cases was not documented by epidemiological studies or the literature. The aim of this study was to examine or discover context-specific conditions in Umzingwane district that may have led to an uptick in diarrhoea cases among under-fives in 2016. The study was a 1:1 unmatched case-control study. The research surveyed 200 cases and 200 controls. The cases were under-fives in Umzingwane District who had diarrhoea in 2016. The researcher used the standard case definition for diarrhoea as cited in the literature. The controls were under-fives who did not have diarrhoea in 2016 and came from the same neighbourhood as cases. A pre-tested, interviewer-administered questionnaire, was used to collect data from caregivers of cases and controls and under-fives. The questionnaire was filled by trained research assistants. Sanitary inspections were conducted through visual assessment of the infrastructures and the sanitary state surrounding the household water supply, water-holding containers, household sanitary conditions, food storage, personal hygiene, kitchen hygiene and vaccination status of the children as these factors have a potential risk to health and wellbeing of the child. Water samples were collected from boreholes and shallow unprotected wells to check for Escherichia Coli (E. coli) contamination and turbidity Data were analyzed using Epi Info 7.2.1.0 version. Odds ratios and Chi-square tests at 5% significant levels and 95% confidence intervals were generated using the software. Forward stepwise logistic regression analysis was used to control for confounding and effect modification. The adjusted odds ratios were calculated toquantify the strength of association between risk factors and outcome and factors with a p-value less than 0.05 were considered significant. Out of 35 borehole water samples tested, 33(94.29%) were below the threshold limit for contamination with Escherichia coli and 2 of the 35 (5.71%) borehole water samples tested were above the threshold for contamination with Escherichia coli. Out of 50 unprotected shallow wells water samples tested 9(18%) were below the threshold limit for contamination with Escherichia coli and 41(82%) unprotected shallow wells water samples tested were above the threshold for contamination with Escherichia coli. Independent risk factors for contracting diarrhoea were: source of water [OR=2.2457, CI=1.0924-4.6164, p-value=0.0278], disposal of solid waste [OR=4.62, CI=1.9380-11.0330, p-value=0.0006], sanitary state of the kitchen [OR=2.2307, CI=1.0185-4.8854, p-value=0.0449]. Independent protective factors for contracting diarrhoea were: household income [OR=0.2273, CI= 0.1180-0.4378, pvalue=0.0000], caregiver knowledge on diarrhoea prevention and control [OR=0.2940, CI=0.1316-0.6566, p-value=0.0028], washing hands by caregivers at all critical times [OR=0.0461, CI=0.0227-0.0937, p-value=0.0000] The study has highlighted the disaggregated household level risk factors for diarrhoea in under-fives in Umzingwane District. The environmental risk factors were drinking water from contaminated sources, indiscriminate disposal of waste around the home and unsanitary status of the kitchen where food is prepared. This clearly indicates the importance of environmental health as a determinant of child health. Therefore, there is a need for effective measures to enhance universal access to safe water, improved food hygiene practices and appropriate waste management strategies at the household level. The socioeconomic protective factors were knowledge of diarrhoea prevention and economic stability of the caregivers. The behavioural protective factor was washing of hands at all critical times by caregivers. This implies that hygiene promotion interventions should prioritise protective factors such as increasing caregiver knowledge of diarrhoea prevention, establishment and use of hygienic hand washing facilities and improving socioeconomic status of households.