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Determinants of Acute Bloody Diarrhea Among Adult Outpatient Visits in Bibugn District, Northern Ethiopia

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Determinants of Acute Bloody Diarrhea Among Adult Outpatient Visits in Bibugn District, Northern Ethiopia Quality in Primary Care (2018) 26 (1): 13-19 2018 Insight Medical Publishing Group Research Article DeterminantsResearch Article of Acute Bloody Diarrhea amongOpen Access Adult Outpatient Visits in Bibugn District, Northern Ethiopia Among Belay Department of Epidemiology, Jimma University, Ethiopia Lemessa Dube Department of Epidemiology, Jimma University, Ethiopia Solomon Berhanu Department of Epidemiology, Jimma University, Ethiopia ABSTRACT Background: Acute bloody diarrhea (dysentery) is a and analysis respectively. Bivariate analysis was done and all medical emergency that warrants serious medical investigation covariates with p-value <0.25 were entered into multivariable for patients of all ages. It is also among weekly reportable logistic regression analysis. AOR with 95% CI were calculated disease in Ethiopia. However, studies related to its determinants to identify independent variables which were significantly have been limited. associated with acute bloody diarrhea, p-value <0.05 were considered as determinants of acute bloody diarrhea. Objective: To identify determinants of acute bloody diarrhea among adult outpatient visits in Bibugn district, Results: Storage of drinking water not separate from water northern Ethiopia. for others uses (AOR=3.00 (1.39-6.48)), dipping use to draw drinking water from the storage container (AOR=2.49 (1.21- Methods: We conducted a case-control study with 222 5.14)), refuse disposal in open fields (AOR=2.71 (1.37-5.38)) participants (56 cases and 166 controls) in Bibugn district and using less than 20 L daily water consumption per capita governmental health facilities. A case was defined as a person (AOR=2.89 (1.28-6.49)) were independently associated with of age ≥ 18 years, who attends adult outpatient department in acute bloody diarrhea. selected governmental health facilities of Bibugn district with acute diarrhea containing visible blood in the stool between Conclusion: Daily water consumption per capita use of <20 February and April, 2017. A control was defined as, non- L, storage of drinking water not separate from water for others diarrheal outpatient visitors of age ≥ 18 years who attends uses, dipping use to draw water from storage container and adult outpatient departments in the selected governmental open field refuse disposal practice were found to be associated health facilities of the district. Face to face interview with with an increased riskof adult acute bloody diarrheal diseases. consecutive sampling method was used to collect data. Epi Keywords: Acute bloody diarrhea; Adult outpatient visits; Data version 3.1 and SPSS version 22 were used for data entry Bibugn district Introduction dysentery especially in older children and adults living in rural areas [2]. Diarrhea is defined as having loose or watery stools at least Transmission is fecal-oralroute including direct person-to- three times per day, or more frequently than normal for an person contact. Two features of the disease facilitate person-to- individual. According to their clinical pattern, diarrheal diseases person transmission: the infective dose is low (as few as 100 can be classified in to three as acute watery diarrhea (diarrhea viable organisms), so minor hygiene omissions allow fecal- without blood lasting less than 14 days), acute bloody diarrhea oral spread, and many persons have only a mild illness, so (diarrhea with blood lasting less than 14 days) or persistent they remain in contact with and can transmit the infection to diarrhea (diarrhea with or without blood that lasts at least 14 others [3,4]. Proper hygiene and sanitization interventions are days). All of which are potentially life-threatening and require critical to prevent shigellosis. This includes appropriate hand- different treatment courses [1]. washing after using the toilet, hand-washing before preparing Acute bloody diarrhea (dysentery) is defined as an acute or handling food, and properly sanitizing food contact [1]. bout of diarrhea lasting less than 14 days in which subjects are Dysenteric diarrhea is associated with prolonged illness and passing grossly bloody stools. Strains of Shigella, Salmonella complicated disease and can be associated with fatalities in and Campylobacter are important causes of dysentery in all children in the developing world and in the elderly or infirm regions of the world. In developing tropical and semitropical living in the industrialized regions [2]. regions, Entamoeba histolytica is an important cause of In Ethiopia, bloodydiarrhea reported weekly as part of priority 14 Lemessa Dube diseases under Integrated Disease Surveillance and Response outpatient department in governmental health facilities with System (IDSR) in the Ministry of Health. Acute bloody diarrhea acute diarrhea containing visible blood in the stool within the outbreaks have been reported during different times in Ethiopia study period. A clinician diagnosed acute bloody diarrhea based however; information about risk factors associated with acute on history of visible blood in stool for less than 14 days as bloody diarrhea was limited in the country [5,6]. recommended in WHO Surveillance standards [12]. We used cases that were already diagnosed by health professionals at Though mortality rates among older children, adolescents outpatient departments in selected governmental health facilities and adults are lower than those observed in children under of the district. five, diarrhea still poses a substantial burden accounting for approximately 2.8 billion diarrhea episodes among older Control was a non-diarrheal outpatient visitor of age ≥ 18 children, adolescents and adults [7]. For patients of all ages years who attends adult outpatient departments in governmental acute bloody diarrhea (dysentery) is a medical emergency that health facilities within the study period.Controls were also warrants serious medical investigation [8]. identified by health professionals at outpatient departments in the selected governmental health facilities of the district as non- Dysentery continued to be one of the major outbreaks in diarrhea outpatient visitor. Africa with over half million cases reported in 2006. The most common isolate confirmed was Shigella dysenteriae type I, Inclusion and exclusion criteria resistant to cotrimoxazole [6]. The emergence of antibiotic resistant Shigella and Salmonellais serious problems in All adult outpatient visitors who have lived in the district antimicrobial therapy globally and the incidence varies with for more than six months were eligible for the study.Controls the area of isolation of these strains. The progressive increase that had a history of diarrhea within the past two weeks and in antibiotics resistance among these pathogens in developing cases with concomitant known causes of blood in the stool like countries is becoming a critical area of concern [9]. A study hemorrhoid, trauma and other local anorectal bleeding were conducted in Gondar town health institutions, Ethiopia revealed excluded from the study. Cases and controls were selected only that isolates of Shigella and Salmonella showed high rate of once as study participants (repeated visitors were excluded). drug resistance to the commonly used antibiotics (Ampicillin, Sample size determination and sampling technique Amoxicillin and Tetracycline) [10]. Sample size was calculated by Kelsey formula using Ethiopia 2015/2016 annual performance report showed that Epi Info Version 7.0.8.3 software, considering one variable a total of 267,489 dysentery cases and 229 deaths were reported assumed to bring difference in the two groups. So th0at sample from all regions of the country. Majority of cases were reported size calculation was based on the following assumptions: from Oromia and Amhara Regions (83,980 (31.4%) and Two-sided confidence level (CI)=95%, Power=80%, Ratio 60,877 (22.8%), respectively. The incidence rate was highest in of cases to controls=1:3 and from a similar study conducted Benishangul Gumuz Region (1,751/100,000 population) [11]. in Kenya; separate storage of drinking water from water for There was an epidemic of dysentery in Jimma city of Ethiopia others uses were taken as main predictor of the outcome (acute from December 12 to 22, 2008 due to Shigella flexnneri, with bloody diarrhea). In this study the percent of controls exposed a total of 566 cases and the majority of cases (52.8%) were (proportion of non-diseased with storage of drinking water students from Jimma University [5]. Therefore, the objective of separate from water for others uses) was 57.9% with Odds ratio this study was to identify determinants of acute bloody diarrhea (OR) of 0.412 [12]. Thus, the total sample size was 222 (56 among adult outpatient department visitors of governmental Cases and 166 Controls). health facilities in Bibugn district, northern Ethiopia. (Z++ Z )2 pq (r 1) Materials and Methods n = αβ1− and n= rn 1 rp()− p 2 21 Study setting, design and population 12 Where, The study was conducted in Bibugn district, which is found n =Number of cases in East Gojjam Zone, Amhara national regional state, Ethiopia. 1 It is located at 381 km North of Addis Ababa and the total n2=Number of controls projected population of the district for 2016/2017 is 94,566; Z =Standard normal deviate for two-tailed test based on male accounts 49.0% of the total populations. The district has α/2 alpha level (relates to the confidence interval level) three urban and 15 rural Kebeles (the smallest administrative unit in Ethiopia). Four health centers, 18 health posts,
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