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A Case Control Study on Determinants of Diarrheal Morbidity Among Under-Five Children in Wolaita Soddo Town, Southern Ethiopia

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A Case Control Study on Determinants of Diarrheal Morbidity Among Under-Five Children in Wolaita Soddo Town, Southern Ethiopia Original article A case control study on determinants of diarrheal morbidity among under-five children in Wolaita Soddo Town, Southern Ethiopia Mulat Tarekegn1, Fikre Enquselassie1 Abstract Background: Diarrheal disease is the most common cause of illness and the second leading cause of child death in the world. The disease accounts for 4.3% of the total global disease burden; the burden being greatest in the developing world including Ethiopia. Objective: The aim was to assess potential determinant factors associated with diarrheal morbidity among under-five children in Wolaita Soddo Town, South Ethiopia. Methods: A community-based case control study on 198 cases and 396 controls was conducted in Southern Ethiopia; cases were under-five children with diarrhea in the last 15 days of recall period. Three kebeles (one kebele from each sub-city) were first selected by a lottery method. Then a house to house survey was conducted to enumerate under-five children in the selected kebeles. During the enumeration identification number was given for the households with name and age of the child which was used as a sampling frame for the selecting cases and controls. .For each case, two controls were selected randomly. Odds ratios with 95% confidence intervals were calculated to show the strength of association. Results: The odds of developing diarrheal morbidity was 2.6 times higher among children with fathers having no formal education compared to those with fathers educational status of high school completed (Adj OR=2.56, 95% CI:1.25, 5.25). Cases were about 4 times higher among families perceived that were to be economically very poor compared to families perceived rich or medium (Adj OR=.3.84, 95% CI:1.25, 11.82). Children in households with no latrine were about 13.5 times (Adj OR=13.45, 95% CI:3.58, 50.49) more likely to develop diarrhea compared to children with households with latrines. Treatment of drinking water showed a significant odds (Adj OR=2.34, 95% CI:1.33, 4.14) of developing diarrhea. Similarly, diarrheal diseases were higher among children whose mothers have poor knowledge of transmission methods and those who washed hands less frequently compared to those who did. Conclusion: Poor housing, poor sanitation conditions, poor personal hygiene, and lack of relevant knowledge are strongly associated with the occurrence of diarrheal disease among children of under-five years of age. Health education should be given to the public especially to mothers and caretakers on personal hygiene. [Ethiop. J. Health Dev. 2012;26(2):78-85] Introduction safe and adequate water supply. Age of the child, lower Diarrhea remains one of the most common illnesses of maternal education, bigger family size and lower socio children and one of the major causes of infant and economic status are also reported to have an impact on childhood mortality in developing countries (1-3). the incidence of diarrhea in children, (13-18). Estimated worldwide episodes of acute diarrhea were 1.5 billion per year in 2008. Of these episodes 1.5–2 million Almost all of the above studies conducted in Ethiopia deaths occur in children aged under-five (4, 5). The being cross-sectional surveys, they may not have burden is greatest in the developing world where access adequate power to ascertain the association of diarrheal to safe water, sanitation, and medical care are often disease with socio-demographic and environmental limited. More than 70%, of which 90% being children, of conditions. Thus, this study was undertaken in Wolaita annual global deaths from diarrheal disease are accounted Soddo Town with the aim of assessing determinant for by eleven countries (6). Diarrhea continues to be one factors of diarrheal morbidity using a case-control study of the most common causes of morbidity and mortality approach. among infants and children in Ethiopia. According to the Ethiopian Demographic and Health Survey 2005 (7), the Methods two week period prevalence of diarrhea among under- The study was conducted in Wolaita Soddo Town, capital five children was estimated to be 18%. Other estimates of Wolaita Zone from December, 2009 to June, 2010. indicate that the two-week period prevalence in rural Wolaita is one of the 13 zones in Southern Nations areas vary from 17% to about 37% in Ethiopia (8-12). Nationalitis and Peoples Region. It is centrally located in the region, bordered by Kambata and Tembaro and The prevalence varied across regions; the highest (25%) Hadiya Zone in the north, Gamogofa Zone in the south, being in Southern Nations, Nationalities and Peoples Dawro Zone in the west, Sidama Zone and Oromiya Region (SNNPR) (12). Previous studies have also Region in the east. Malaria, tuberculosis, malnutrition indicated that the occurrence of diarrhea is associated and HIV/AIDS complicated by overcrowding are the with poor housing and sanitary conditions and a lack of main health problems of the zone (19). The study area, 1School of Public Health, Addis Ababa University; E-mail [email protected]. A case control study on determinants of diarrheal morbidity among under-five children 79 Wolaita Soddo Town, is 385 km south of Addis Ababa Data collectors were given the identification numbers of and 160 km west of the regional capital, Hawassa. The households, name and age of the child, but did not know total population of the town is estimated to be 76,780, the diarrheal status of study subjects. A structured with male to female ratio of 1.12:1. Based on the 2007 questionnaire was used to interview the mother or Ethiopian census, in SNNPR urban areas the average caretaker of the child. The collected data was checked by family size of 4.2, the total number of households in the the principal investigator on a daily basis for any town was 18,281 (20). The town is structured in three incompleteness and/or consistency. If any sub-cities (kifle ketema) and eleven kebeles. There are incompleteness and/or inconsistency appeared, one government and one NGO hospitals, one government corrections were made by going back to the specific health center, ten clinics, two pharmacies, one drug household. distribution store, three drug stores and eight drug vendors in the town. Data were entered into Epi-Info 3.3.2 for windows and exported to SPSS 15.0 for windows for analysis. The A community-based case control study was conducted to strength of association between dependent variable and determine factors of diarrheal morbidity among under- independent variables (covariates) was expressed in odds five children in Wolaita Soddo. Cases were children who ratio (OR) with 95% confidence interval. A stepwise experienced diarrhea within the last two weeks of recall multiple logistic regression technique was used to period before the survey. evaluate the independent effect of determinant factors on the outcome variable by controlling the effect of others. The sample size was calculated using the following All the explanatory variables that showed significant double proportion formula: association during the crude analysis were included in the logistic regression model used to calculate adjusted ratios. n1= Ethical clearance was obtained from the institutional n2=n1r, where review board (IRB) of the Medical Faculty, Addis Ababa n1 = Number of cases, n2 = Number of controls University. Permission was also obtained from Wolaita p1= Proportion of exposure in cases, Town Administration before the study was undertaken. p2 = Proportion of exposure in controls An information sheet was prepared and read to the p = (p1+p2)/2 eligible participants to obtain verbal consent. r = Case to control ratio Z = Coefficient at level of power Results =coefficient at level of significance As shown in Table 1, the mean (+SD) age of cases and controls were 29.8 (+14.7) and 30.6(+14.1) months, respectively. One hundred eighty two (91.9%) of the Taking the proportion of 0.32 for cases and 0.21 for cases and 359 (90.70%) of the controls were born to controls of feeces seen in the compound, as one of the mothers of age 18-35 years; 11(5.6%) of the cases and 24 determinant factors of diarrheal morbidity, from previous (6.1%) of the controls were born to mothers of age 35 study (14), with 95% confidence interval and 80% years and above. One hundred eighty one (91.4%) of the power, the required sample size was 198 cases and 396 cases and 366 (92.4%) of the controls had their mothers controls. as caretakers, while 17(8.6%) of the cases and 30 (7.6%) the controls had caretakers other than the mothers. Three kebeles (one kebele from each sub-city) were first selected by a lottery method. Then a house to house Regarding maternal/caretaker educational status, 50 survey was conducted to enumerate under-five children (25.3%) of the cases and 111 (28.0%) of the controls in the selected kebeles by five nurses recruited for the were high school graduates, 40 (20.2%) of the cases and study. During the enumeration identification number was 109 (27.5%) of the controls had completed elementary given for the households with name and age of the child school and 108(54.5%) of the cases and 172(44.5%) of which was used as a sampling frame for selecting cases the controls had no formal education. and controls. The mother or a caretaker was asked if the child had diarrhea with a recall period of 15 days before Concerning religion, 130 (65.7%) of the cases and 240 the date of enumeration. Diarrhea was defined as the (60.6%) of the controls were followers of the protestant passing of three or more loose or watery stools or one religion; and 65(32.8%) of the cases and 140 (35.4%) of stool with blood or mucus in a 24 hour period.
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