A Case-Control Study of Caregiver’s Feeding Knowledge and Practices, in Relation to Etiology of Diarrhea Among Children Aged 0-23 Months in Gokwe North District, Zimbabwe

Abstract

Diarrhea prevalence among children under-five in Gokwe North district was estimated at 16.5% in 2018, surpassing the national average of 10% in the same period. The World Health Organization confirms that 54% of deaths due to diarrhea and other causes in under-fives have malnutrition as an underlying factor. The current study sought to investigate the possible relationship between the high diarrhea burden and Nutrition by examining the knowledge and practices of primary caregivers in the feeding of infants. The research followed a matched case-control study design. A Case was defined as the mother of a child who had had one or more episodes of diarrhea two weeks before the interview date. The selection of seven clinic catchment areas, 149 cases, and 149 controls was done through multi-stage sampling. Chi-Square tests for association and a binomial logistic regression model were conducted using SPSS version 16. Controls tended to be more knowledgeable than cases on the recommended IYCF practices. In the 0 to 5-month age group, practices that were significantly associated with diarrhea were mixed feeding (p=0.001), exclusively breastfeeding (p=0.000), and IYCF knowledge (p=0.001). For the 6 to 23 months age group significant associations were noted with the number of handwashing times (p=0.035), access to improved pit latrine (p=0.022), source of water for household use (p=0.007), type of container used (p=0.040), Mid Upper Arm Circumference (p=0.000) and IYCF Knowledge (p=0.001). Significant predictors of diarrhea in children of 0-5 months of age were IYCF knowledge [AOR 1.15, (CI 1.06; 1.24) P = 0.001], water source [AOR 20.9, (CI 1.77; 28.4) P = 0.016]. as well as the use of a nipple bottle [AOR 0.057, (CI 0.01, 0.48) P = 0.009]. For the 6 to 23-month age group significant predictors were IYCF Knowledge [AOR 1.034, (CI 1.01; 1.06) P = 0.001] and meal frequency [AOR 0.254, (CI 0.09; 0.71) P = 0.010]. Both IYCF and WASH practices were found to be having an association with diarrhea incidence in under-five children, particularly the 0-23-month age group. IYCF practices mostly affected the 0-5 months age range whereas as the child grows further into the 6-23 months range WASH-related factors have the greater influence in determining diarrhea.