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Caregiver Perception and the Role of Seasonality in Under-Five Childhood Diarrhea Incidence in Svay Rieng Province, Cambodia Brian S

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Caregiver Perception and the Role of Seasonality in Under-Five Childhood Diarrhea Incidence in Svay Rieng Province, Cambodia Brian S University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School June 2018 Caregiver Perception and the Role of Seasonality in Under-five Childhood Diarrhea Incidence in Svay Rieng Province, Cambodia Brian S. Wells University of South Florida, [email protected] Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the Environmental Engineering Commons Scholar Commons Citation Wells, Brian S., "Caregiver Perception and the Role of Seasonality in Under-five Childhood Diarrhea Incidence in Svay Rieng Province, Cambodia" (2018). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/7380 This Thesis is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Caregiver Perception and the Role of Seasonality in Under-five Childhood Diarrhea Incidence in Svay Rieng Province, Cambodia by Brian S. Wells A thesis submitted in partial fulfillment of requirements for the degree of Master of Science in Environmental Engineering Department of Civil and Environmental Engineering College of Engineering University of South Florida Major Professor: James Mihelcic, Ph.D. Mauricio Arias, Ph.D. Linda Whiteford, Ph.D. Date of Approval: June 6, 2018 Keywords: Weather Factors, Monthly Rainfall, Heavy Rainfall, Temperature, Caregiver Behavior, Rumdoul District Copyright © 2018, Brian S. Wells ACKNOWLEDGMENTS I would like to thank Dr. Mihelcic for giving me the opportunity to participate in the Master’s International program and for providing needed guidance during my time on-campus and abroad. I would also like to thank committee members Dr. Arias and Dr. Whiteford for the support and knowledge you have shared with me throughout this experience. Thank you to Dr. Wells, Kevin Orner, Christine Prouty, and my wonderful MI group for your helpful thoughts which were essential in shaping my work. I would also like to thank the supportive in-country staff and volunteers of Peace Corps Cambodia as well as Ung Prahors, Sok Chantary, and Chantha Oeurng for all the help you provided me throughout my service. A special thank you goes to my counterpart and friend Lach Phors who worked tirelessly by my side for the two years in Cambodia. I could not have done it without you. To my family, thank you as always. My mom especially, you were my inspiration for making the journey back to your home country. This experience has only brought us all closer together and is something I will cherish for the rest of my life. Finally, I would also like to take this opportunity to remember my closest friend, Chelsea Brown. You were the first on board to support this dream of mine. I will always have so much appreciation for you. And to her family, who have now become my family over the course of this experience. This material is based upon work supported by the National Science Foundation under Grant No. DUE-0965743. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation. TABLE OF CONTENTS LIST OF TABLES ........................................................................................................................ iii LIST OF FIGURES ...................................................................................................................... v ABSTRACT .................................................................................................................................. vi CHAPTER 1: INTRODUCTION ................................................................................................. 1 1.1 Research Motivation ................................................................................................... 1 1.2 Research Questions and Objectives ............................................................................ 4 CHAPTER 2: COUNTRY OVERVIEW..................................................................................... 7 2.1 Cambodia: Climate, Geography and Country Structure ............................................ 7 2.2 Peace Corps Service and Study Site .......................................................................... 10 CHAPTER 3: LITERATURE REVIEW ..................................................................................... 13 3.1 General Classification of Dehydration and Diarrhea ................................................. 13 3.2 Causes and Treatments of Diarrhea ........................................................................... 15 3.3 Weather Factors and Incidence of Diarrhea ............................................................... 17 3.3.1 Rainfall and Diarrheal Disease ................................................................... 18 3.3.2 Temperature and Diarrheal Disease ............................................................ 21 3.3.3 Rainfall, Temperature and Diarrhea in Cambodia ...................................... 25 3.4 Risk Factors for Diarrhea and Caregiver Perception ................................................. 26 3.4.1 Sanitation, Hygiene and Diarrhea ............................................................... 27 3.4.2 Caregiver Perception of Diarrhea and Care-Seeking Behavior .................. 30 3.4.3 Effects of Socioeconomic Factors: Education and Age .............................. 33 3.4.4 Sanitation, Hygiene and Caregiver Perception in Cambodia ...................... 34 CHAPTER 4: RESEARCH METHODS ..................................................................................... 37 4.1 Analysis of Weather Factors and Diarrhea Incidence ................................................ 37 4.1.1 Data Source and Collection ........................................................................ 38 4.1.2 Data Analysis: Weather Factors and Under-five Diarrhea ......................... 39 4.2 Research Methods: Surveys, Interviews and Household Observation ...................... 40 4.2.1 Inclusion/Exclusion Criteria ....................................................................... 41 4.2.2 Counterpart Involvement ............................................................................ 42 4.2.3 Sampling Method ........................................................................................ 42 4.2.4 Risk and Informed Consent ........................................................................ 44 4.2.5 Administration of Research Tools .............................................................. 45 4.2.6 Data Analysis: Research Tools ...................................................................49 i CHAPTER 5: RESULTS AND DISCUSSION ........................................................................... 50 5.1 Patterns in Rainfall, Temperature and Diarrhea in the Study Area ........................... 50 5.2 Associations between Weather Factors and Under-five Childhood Diarrhea ........... 55 5.2.1 Heavy Rainfall and Diarrhea from Previous Studies .................................. 59 5.2.2 Household Sanitation Characteristics in the Study Area ............................ 61 5.2.3 Heavy Rainfall and Diarrhea Incidence in the Study Area ......................... 62 5.2.4 Minimum Temperature and Diarrhea Incidence in the Study Area ............ 65 5.2.5 Monthly Rainfall/Maximum Temperature and Diarrhea Incidence ........... 67 5.3 Effect of Seasonality on Caregiving and Household Practice ................................... 69 5.3.1 Activities in the Wet and Dry Seasons ....................................................... 69 5.3.2 Division of Labor within the Household .................................................... 71 5.4 Caregiver Hygiene Practices ...................................................................................... 74 5.4.1 Scoring of Caregiver Knowledge and Practice ........................................... 75 5.4.2 Caregiver Hygiene Score and Demographics ............................................. 79 5.4.3 Caregiver Perception on Causes of Childhood Diarrhea ............................ 84 5.4.4 Care-Seeking Behavior of Childhood Diarrhea .......................................... 88 5.5 Additional Caregiver Perceptions of Diarrhea in the Study Area .............................. 91 CHAPTER 6: CONCLUSIONS AND RECOMMENDATIONS ............................................... 94 6.1 Major Findings ........................................................................................................... 94 6.2 Study Limitations ....................................................................................................... 98 6.3 Recommendations for Future Research ................................................................... 101 REFERENCES .......................................................................................................................... 104 APPENDIX A: RESEARCH APPROVALS............................................................................. 116 APPENDIX B: APPROVAL TO REPRODUCE ...................................................................... 123 APPENDIX C: RAW DATA .................................................................................................... 126 APPENDIX D: SURVEY, INTERVIEW, AND OBSERVATION GUIDES .......................... 128 APPENDIX E: BAR CHARTS OF STATISTICALLY SIGNIFICANT RESULTS ..............
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