Prevalance and Risk Factors Associated with Diarrhoeal Disease in Peadiatric Patients at Masindi Hospital

PREVALANCE AND RISK FACTORS ASSOCIATED WITH DIARRHOEAL DISEASE IN PEADIATRIC PATIENTS AT MASINDI HOSPITAL

KADIIMA LEONARD

BMS/0042/61/DU

A RESEARCH REPORT SUBMITED TO THE FACULTY OF CLINICAL MEDECINE AND DENTISTRY IN PARTIAL FULFILMENT OF THE REQUIRMNET OF AWARD OF BACHELOR OF MEDECINE AND BACHELOR OF SURGERY OF KAMAPALA INTERNATIONAL UNIVERSITY

SUPERVISOR: MR MANIGA JOSEPHAT

OCTOBER 2014

Decelerations

I KADIIMA LEONARD hereby declare that this research report is my original work and has not been submitted to any university or institution of higher learning for any academic award.

Sign ……………………… Date…………………………………

Approval

This is to certify that this research report has been prepared under my supervision and has never been presented anywhere for other purpose and is now ready for submission to Faculty of Clinical Medicine and Dentistry

Sign...... Date …………………………

MR. MANIGA JOSEPHAT

Acknowledgement

I wish to extend my sincere gratitude to my beloved wife MRS PHOEBE KADIIMA for her immeasurable spiritual ,social ,psychological support that has enabled me to complete this dissertation .

Other people of distinguished efforts and influence include Mr. OKOT JIMMY, PETER KUNGU, PETER KIVUMBI, KYAMBADDE ROBERT, KUSINGURA MESEARCH AND OTHERS.

Special thank goes to my supervisor who overwhelmingly offered in his time and academic support

iii

DEDICATION

Because excellence is not granted to a man but given as a reward of labour ,this dedication is in the memory of my late father Mr . Adolf Kitumwa Mulinda ,and my mother Molly

Burindima Mulinda who unreservedly toiled toward my upbringing and academic carrier

,sincerely they will continue to excel through whatever achievement I get

List of Acronyms e.g. exaplia gratia – for example edn(s) Edition(s) et al. et alii- and others ibid ibidem- in the same quotations op cit. opera citato- in the work already quoted sup. Supplement ver(s) version

MoH Ministry of Health

CDC Center for Disease Control and Prevention

Table of Contents DECELERATIONS ...... I

APPROVAL ...... II

ACKNOWLEDGEMENT ...... III

LIST OF ACRONYMS ...... V

TABLE OF CONTENTS ...... VI

LIST OF TABLES ...... VIII

LIST OF FIGURES ...... VIII

LIST OF EQUATIONS ...... VIII

ABSTRACT ...... IX

CHAPTER ONE ...... 1

INTRODUCTIONS ...... 1

1. BACKGROUND ...... 1

1.2PROBLEM STATEMENT ...... 2

1.3STUDY JUSTIFICATIONS ...... 2

1.4STUDY OBJECTIVES ...... 3

1.4.1 BROAD OBJECTIVE ...... 3

1.4.2 SPECIFIC OBJECTIVES ...... 3

1.5RESEARCH QUESTIONS ...... 3

1.6SCOPE OF THE STUDY ...... 4

1.6.1 TIME SCOPE ...... 4

1.6.2 GEOGRAPHICAL SCOPE ...... 4

1.6.3 CONTENT SCOPE...... 4

CHAPTER TWO ...... 5

LITERATURE REVIEW ...... 5

2.1. BACKGROUND ...... 5

2.2 PREVALENCE OF DIARRHOEA ...... 5

2.3 SOCIO DEMOGRAPHIC DETERMINANTS ...... 6

2.4 ENVIRONMENTAL RISK FACTORS ...... 7

CHAPTER THREE ...... 9

STUDY METHODOLOGY ...... 9

2.0 GENERAL INTRODUCTIONS ...... 9

2.1 STUDY AREA ...... 9

2.2STUDY DESIGN ...... 9

3.3 STUDY POPULATION ...... 9

3.4 SAMPLE SIZE DETERMINATION ...... 9

3.5.2 SAMPLING METHOD ...... 10

3.4.2 INCLUSION CRITERIA ...... 10

3.5.3 EXCLUSION CRITERIA...... 10

3.6 RESEARCH INSTRUMENTS ...... 11

3.7 DATA COLLECTION PROCEDURE ...... 11

3.7.1 DATA MANAGEMENT ...... 11

3.7.2 DATA ANALYSIS AND PRESENTATION PLAN ...... 11

3.8 ETHICAL CONSIDERATIONS ...... 11

CHAPTER FOUR ...... 12

STUDY RESULTS ...... 12

4.1 CHARACTERISTICS OF THE SUBJECTS ...... 12

4.1 PREVALENCE OF DIARRHOEA ...... 12

4.2 SOCIO-ECONOMIC STATUS ...... 14

CHAPTER FIVE ...... 17

DISCUSSIONS ...... 17

5.2 CONCLUSION ...... 19

5.3 RECOMMENDATIONS ...... 19

REFERENCES ...... 20

APPENDICES ...... 23

APPENDIX I: DATA COLLECTION TOOL ...... 23

APPENDIX II: WORK PLAN ...... 27 vii

APPENDIX III: RESEARCH BUDGET ...... 28

APPENDIX IV: MAP OF MASINDI DISTRICT …………………………………………………………30 APPENDIX V: MAP OF UGANDA ……...... ……………...…..……………………………………….31

List of Tables

Table 1: Age distribution of Respondents ...... 13

Table 2: Employment Status of Mothers ...... 13

Table 3: Marital Status of Respondents ...... 13

Table 4: Educational Levels of Mothers ...... 14

List of Figures Figure 1: Prevalence of Diarrhoea ...... 12

Figure 2: Presence of other siblings under 5 ...... 15

Figure 3: Presence of Pit Latrine at Home ...... 15

Figure 4: Treatment Options ...... 16

List of Equations Equation 1: Fisher's Formula ...... 10

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ABSTRACT. Introduction

Diarrhea is the most important public health problem connected to water and sanitation and can be both “waterborne” and “water-washed”. In recent decades, a consensus developed that the key factors for the prevention of diarrhea are sanitation, personal hygiene, availability of water and good quality drinking water; and that the quantity of water that people have available for hygiene is of equal or greater importance for the prevention of diarrhea as the bacteriological water quality(Jensen PK, 2004) Methodology: A cross sectional was conducted among mothers attending the OPD services at Masindi general hospital to determine the prevalence of diarrhoea within the last two weeks among mothers with children under five. The study used self-administered questionnaires and the response rate of 97.4 %( 74) and default of 2(2.6 %%) was recorded as the mothers did not return the completed questionnaires. Results: The results from this study showed that the prevalence of diarrhoea was 22.37%; the mothers whose children had diarrhoea were mostly between the age groups of 37 and above, unemployed married or staying together and those who stopped at primary levels of education. Most of the children who had brothers or sisters at home developed the diarrhoea 17(out of 29) and most of them had no latrine at home, the most common treatment options for children were deworming 10(33.33%), and ORS 9(30.00%) Conclusion: the study concluded that diarrhoea prevalence was high among the children under five within Masindi district. With most of the risk factors being low level of maternal education, married and high numbers of children the absence of a pit latrine at home.

Recommendation The community health department should survey and determine the families without pit latrines and encourage them to build pit latrines at their homes, the health facilities should conducted maternal education to reduce the usage of Antibiotics and traditional herbs in the treatment of childhood diarrhoea among mothers in children under five in Masindi. And community leaders should identify families with high risk of diarrhoea and refer them to VHTs for health education and follow up.

CHAPTER ONE

INTRODUCTIONS

1.1 Background

It is over 150 years since John Snow closed the Broad Street pump after a cholera outbreak and thereby initiated the debate on diarrheal disease risk factors and their elimination. Today diarrhea remains a major public health problem. In developing countries, diarrhea is among the leading causes of childhood morbidity and mortality. An estimated one billion episodes and 2.5 million deaths occur each year among children under five years of age. About 80% of deaths due to diarrhea occur in the first two years of life(Urio EM, 2001)

Infectious or noninfectious causes may be responsible for acute diarrhea and, in selected patients, both can occur simultaneously. Noninfectious causes of diarrhea include drugs, food allergies, primary gastrointestinal diseases such as inflammatory bowel disease, and other disease states such as thyrotoxicosis and the carcinoid syndrome (Mayer HB, 1994).

A variety of infectious diseases cause acute diarrhea. It is useful to categorize infectious diarrheal diseases by the portion of the intestine that they are prone to infect since the presenting symptoms vary by region of the intestine involved in disease (Wanke, 1996)

1.2 Problem Statement

Diarrhea remains the leading cause of morbidity and mortality in children under 5 years old worldwide(Black, 2013).The burden is disproportionately high among children in low- and middle-income countries(Fisher Walker, 2012).Young children are especially vulnerable to diarrheal disease and a high proportion of the deaths occur in the first 2 years of life (UNICEF/WHO, 2009). Worldwide, the majority of deaths related to diarrhea take place in Africa and South Asia. Nearly half of deaths from diarrhea among young children occur in Africa where diarrhea is the largest cause of death among children under 5 years old and a major cause of childhood illness(WHO, 2007).

Epidemiological studies show that factors determining the occurrence of diarrhea in children are complex and the relative contribution of each factor varies as a function of interaction between socio-economic, environmental and behavioral variables (Desalegn, 2011).

In Uganda, the control of diarrheal disease (CDD), including promotion of breast-feeding, oral rehydration therapy and specific health education is a part of national strategies aiming to improve the quality of life and reduce the burdens caused by diseases. Despite this fact, diarrheal disease is still the second leading cause of infectious morbidity and mortality in children as well as in adults in Uganda.

In Masindi no published information has so far become available to explain the major risk factors among children under five. It is inline with this that this study has been proposed to determine the major risk factors for developing diarrhea in Masindi especially among mothetrs attendng care at Masisindi hospital.

1.3 Study Justifications

This study provided additional resources and reference for future researchers in the same areas of interest, and, the study results will be subjected to further evaluations to improve understandings about the prevalence and risk factors associated with diarrheal disease among children under five

in Masindi district and finally, study results would be helpful in planning and implementation of prevention strategies at the community level

1.4 Study Objectives

1.4.1 Broad Objective

The broad objective of this study is to determine the prevalence and risk factors associated with diarrhea among children under-five admitted to Masindi Hospital in 2013.

1.4.2 Specific Objectives

1. To determine the prevalence of diarrhoea from June 2014 to December 2013 at Masindi Hospital. 2. To determine the socio-economic determinants of diarrhea among children under five in Masindi Hospital. 3. To determine the environmental exposure risk factors associated with development of diarrhea among children under five admitted to Masindi Hospital.

1.5 Research Questions

This study answered the following questions

1. What is the prevalence of diarrhoea infections at Masindi general hospital between January 2013 to December 2013? 2. What are the socio-economic characteristics of children admitted with diarrhea at Masindi general hospital? 3. What environmental exposure risks are associated with the development of diarrhea among children admitted at Masinidi general hospital?

1.6 Scope of the Study

1.6.1 Time Scope

This study was conducted between June 2014 and October 2014.

1.6.2 Geographical Scope

The study was conducted at Masindi Hospital, Masindi district, the study participants were mothers from within Masinidi district. Masindi District is a district in Western Uganda. Like many other Ugandan districts, it is named after its 'chief town' of Masindi, the location of the district headquarters. Masindi District is bordered by Nwoya District to the north, Kiryandongo District to the east, Nakasongola District and Nakaseke District to the southeast, Kyankwanzi District to the south, Hoima District to the southwest and Bulisa District to the northwest

1.6.3 Content Scope.

The study mostly described the distribution of diarrhoea among the children under five years of age who are attended to Masinidi Hospital, the environmental risk factors and socio-economic nature of the children. This included the maternal (social class).

CHAPTER TWO

LITERATURE REVIEW

2.1. Background

Almost everyone has become ill of, or will be affected by diarrhea at some point in their lives. Diarrhea can occur as a symptom of many different illnesses, as a side effect of some drugs or may be due to anxiety among other things. Diarrhea results from an imbalance in the absorption and secretion properties of the intestinal tract; if absorption decreases or secretion increases beyond normal, diarrhea results. It can range in severity from an acute, self-limited annoyance to a severe, life-threatening illness.

The definition of diarrhea depends on what is normal for the individual. For some, diarrhea can be as little as one loose stool per day. Others may have three daily bowel movements normally and not be having what they consider diarrhea. According to K. Armon, diarrhea is defined as a change in bowel habit for the individual child resulting in substantially more frequent and/or looser stools

2.2 Prevalence of Diarrhoea

Worldwide diarrheal disease is the second leading cause of death in under-five year children. It is responsible for 1.7 million morbidity and 760, 000 mortality of children every year

The overall burden of acute infectious diarrhea in the United States and other developed countries has not been well-studied in contrast to this entity in the developing world. Most series have focused on specific groups of patients or specific pathogens. The incidence of acute diarrhea in the general population is probably best estimated by prospective studies that incorporated active surveillance in well-defined cohorts. Only a few such studies have been published (Christine A Wanke, 2011)

Morbidity and mortality due to acute diarrhea is significant even in the United States where diarrhea is more often than not a "nuisance disease" in the normally healthy individual. Most

cases of acute diarrhea are self-limited, whether the cause is an infection, including viruses, or non-infectious (Ho MS, 1988(ML, 1988 #4)).

It was suggested early in this century and later confirmed in several studies that breast feeding was beneficial to the health of infants and that it had a protective effect against diarrhea in infancy. The health impact of human milk in young children above 1 year of age, however, is controversial (Jelliffe DB, 1978).

Seasonal patterns to childhood diarrhea have been noted in many tropical locations, where there are two definite seasonal peaks: the summer one, associated with bacterial infections, and the winter one, related to viruses. In some studies diarrhea prevalence was found to be higher in the rainy season than in the dry season. During the dry seasons when rainwater and borehole water are less available, disinfecting drinking water from available surface sources may substantially reduce illness. In some studies contamination was more prominent during the rainy season(Adkins HJ, 1897)

According to A. Teshima et al, the number of diarrhea patients in the first peak in April is sensitively correlated to climate elements in pre-monsoon. Climate in pre-monsoon influences the total number of diarrhea patients through the spring peak (April-May) and the climate in August through October influences the autumn peak of patients. Meteorological elements play reverse role on the peak of spring and autumn diarrhea patient. There are also some researches reporting that a distinct increase of diarrhea takes place in the years of El Nino(Pascual M, 2000).

2.3 Socio Demographic Determinants

In studies from Bangladesh breast feeding was associated with lower mortality up to the age of 3 years in malnourished children and a lower prevalence and severity of bloody and chronic diarrhoea.6, 8 By contrast, several studies have associated prolonged breast feeding with reduced food intake and malnutrition (Briend A, 1988).

Because of the association between low state of nutrition and prolonged breast feeding it has been suggested that breast feeding after 18 months of age may be detrimental (Brakohiapa LA, 1988)

Many studies have established that the diarrhea prevalence is higher in younger children 13, 17, 18,

19, 20, 21, 22. The prevalence is highest for children 6- 11 months of age, remain at a high level among the one year old children, and decrease in the third and fourth years of life(Molbak, 2000(Woldemicael, 2001 #13). Higher rate of diarrhea has been observed in boys than girls (Jinadu MK, 1991). Other demographic factors, like mothers’ younger age (Molbak, 2000), low level of mother's education (Etiler N, 2004), high number of siblings (Molbak, 2000), birth order, were significantly associated with more diarrhea occurrence in children less than five.

Some studies have shown that the association between socio-economic factors, such as poor housing, crowded conditions(Etiler N, 2004), low income(Woldemicael, 2001); and higher rate of diarrhea was statistically significant.

2.4 Environmental Risk Factors

As diarrhea is acquired via contaminated water and foods, water-related factors are very important determinants of diarrhea occurrence. Increasing distance from water sources, poor storage of drinking water (Ghosh S, 1997) (e.g. obtaining water from storage containers by dipping, no drinking water storage facility), use of unsafe water sources (such as rivers, pools, dams, lakes, streams, wells and other surface water sources), water storage in wide mouthed containers, low per capita water used (BS, 1994), have been found to be risk factors for more diarrhea occurrence among children less than five

Sanitation obviously plays a key role in reducing diarrhea morbidity. Some sanitation factors, like indiscriminate or improper disposal of children's stool and household garbage, no existence of latrine or unhygienic toilet, sharing latrine, house without sewage system, increased the risk for diarrhea in children (Brooks, 2003).

Some studies have revealed that children not washing hand before meals or after defecation, mothers not washing hands before feeding children or preparing foods, children eating with their hands rather than with spoons, eating of cold leftovers, dirty feeding bottles and utensils unhygienic domestic places (kitchen, living room, yard), unsafe food storage, presence of animals inside the house presence of flies inside the house, were associated with risk of diarrhea morbidity in children(Curtis V, 2000).

The literature on feeding practices and risk of diarrhea is extensive. In general, the morbidity of diarrhea is lowest in exclusively breast-fed children; it is higher in partially breast-fed children, and highest in fully-weaned-children. In addition, a particular risk of diarrhea is associated with bottle-feeding. Many studies have shown the strong protective effect of breast feeding. A high concentration of specific antibodies, cells, and other mediators in breast milk reduces the risk of diarrhea following colonization with entero-pathogens (VanDerslice J, 2004).

The association between diarrhea and malnutrition is so common in low income societies that the concept of a vicious circle is appealing, with diarrhea leading to malnutrition and malnutrition predisposing to diarrhea. Children whose immune systems have been weakened by malnutrition are the most vulnerable to diarrhea. Diarrhea, especially persistent and chronic diarrhea, undermines nutritional status, resulting in malabsorption of nutrients or the inability to use nutrients properly to maintain health. A number of studies have reported higher incidence of diarrhea in malnourished children. A tendency of increased incidence of diarrhea was also Found in children with low weight-for-age, or, in particular, in stunted children (KH, 2013)

Immunodeficiency is not only a cause of persistent or chronic diarrhea (chronic diarrhea is the major cause of morbidity and death among adults with Human immunodeficiency virus - HIV), but also a risk factor for diarrhea. Due to innate or acquired immunodeficiency, patients are vulnerable to pathogens that cause infectious diseases including diarrhea. Diarrhea is reported in up to 60% of patients with AIDS. One of the many consequences of the HIV/AIDS pandemic may be to halt the impressive decline in childhood diarrheal mortality seen over the past four decades. Diarrheal incidence, duration, severity and mortality are higher in children with HIV/AIDS than in others(Kosek M, 2013, Diseases, 1994 #23)).

CHAPTER THREE

STUDY METHODOLOGY

2.0 General Introductions

In this chapter a description of the method and procedure that was employed in conducting this study. The chapter includes; the study design, area of study population, sample size determination, sampling procedure, data collection procedure, management and analysis, instruments, inclusion criteria, ethical considerations, limitations to the study and dissemination of results.

2.1 Study Area

This study was a cross sectional study to determine the risk factors among children under five at Masindi general Hospital, Masindi district. This design enabled the researcher to review the risk associated with the patients attending to the clinic with the help of key self-reported risk in the form of a study questionnaire.

2.2 Study Design

This study was carried out in Masindi Hospital, Masindi district located along Kampala-Gulu highway, only approximately 190Kms from Kampala. The area was selected because of the availability of a large number of patients available at the hospital.

3.3 Study population

The study population consisted of all children who were attending to the young child clinic and general OPD. These generations described the environmental risk factors associated with the development of diarrheal disease.

3.4 Sample Size Determination The sample size was determined by fisher’s formula (1962)

Equation 1: Fisher's Formula Where: z = confidence interval

P= proportion of staff involved in child care (treating pneumonia) estimated at the standard i.e.

0.5 q= 1-p d= degree of error = 12% (0.12)

So when substituted in the above formula

n= 76

3.5.2 Sampling method

Respondents were selected by simple random sampling where by the researcher sought informed consent from the mothers/care takers consent.

3.4.2 Inclusion criteria

For mothers to be included in this study, he/she had to be attending OPD or young child clinic with a child.

3.5.3 Exclusion criteria.

All patients who declined to participate in the study.

3.6 Research instruments

Data collection tool with structured questionnaire were used to collect data from the respondents at the clinic. The questionnaire were printed in English but were interpreted for mothers during the process of data collection.

3.7 Data collection procedure

Data was collected by conducting in-depth interview with the mothers available at the unit during the time of data collection. Data was collected between 10:00am and 2:00pm, every day from Monday to Tuesday only for two weeks.

3.7.1 Data management

Data obtained was kept in safe custody and treated with respected and confidentiality and then analysis was done at the end of every working day to ensure adequacy, competence, and correctness of information collected.

3.7.2 Data analysis and presentation plan

Data was analyzed electronically using Statistical Product for Social Scientists (SPSS) version 21 In SPSS and excel 2010. The major risk factors were determined by comparing the groups among mothers whose children developed diarrhoea within the last 2 weeks.

Editing involved manual checking for errors and omission in the filled tools to ensure consistency, completeness, validity, relevancy and accuracy of data collected. The analyzed information were presented as frequency distribution tables, graphs, and pie-charts.

3.8 Ethical considerations

A letter of introduction was sought from the dean of faculty of clinical medicine and dentistry, after submitting the research report to the faculty. The researcher then introduced himself to the in-charge and other staffs of the unit.

All the records collected were treated with confidentiality through coding to avoid revealing of personal individual information. 11

CHAPTER FOUR

STUDY RESULTS

4.1 Characteristics of the subjects A total of seventy six mothers whose children had developed diarrhoea were included in this study hundred from June to October 2014 to determine the prevalence and risk of diarrhoea diseases at Masindi general hospital

4.1 Prevalence of Diarrhoea

Figure 1: Prevalence of Diarrhoea Figure 1 above shows that the number of children who had diarrhoea in this study were 17 out of the 76 mothers who were interviewed. Therefore, the prevalence of diarrhoea according to this study was 22.37%.

Table 1: Age distribution of Respondents

Variable N=76 Diarrhoea

Yes No Total

Age of mothers (years)

15-24 6 19 25

28-37 3 10 13

Above 37 8 30 38

Table one shows that the mothers whose children had diarrhoea were mostly between the ages of 37 and above (8), while 15-24 were 6 and 28-37 were 3.

Table 2: Employment Status of Mothers

Variable N=76 Diarrhoea

Yes No Total

Maternal occupation

Employed 11 19 30

Unemployed 16 30 46

Table 2 above showed that diarrhoea was common among children of months who were unemployed, (16) followed by those who were employed (11)

Table 3: Marital Status of Respondents

Variable N=76 Diarrhoea

Marital Status Yes No Total

Married /cohabiting 20 37 57

Single/divorced /widowed 7 13 20

Table 3 showed that 20 of the children whose mothers were married or staying together had developed diarrhoea while 7 of the children whose mothers were single had developed diarrhoea

Table 4: Educational Levels of Mothers

Variable N=76 Diarrhoea

Education Level of Mothers Yes No Total

None 2 4 6

Primary 12 15 27

Secondary 9 17 26

Post-Secondary 7 11 18

According to table 4 above, most of the children with diarrhoea had mothers who stopped in primary levels of education, 12, followed by secondary, 9, and post-secondary 7 and the least number were 2 among mothers who had no education at all.

4.2 Socio-economic Status

Figure 2: Presence of other siblings under 5

Figure 2 above showed that most of the children who had brothers or sisters at home developed the diarrhoea 17(out of 29) and those who had no other siblings less than 5 years were 10(out of 47).

Figure 3: Presence of Pit Latrine at Home

Figure 2 showed that of the children who developed diarrhoea, most of them had no latrine at home, 19 and followed by those who had latrine at home 8.

Figure 4: Treatment Options

Figure 4 above showed that most of the children were dewormed 10(33.33%), followed by those who received ORS 9(30.00%), and antibiotics 8(26.67%) and the least were children who were given other treatment 3(10%)

CHAPTER FIVE

DISCUSSIONS

This study investigated the prevalence and socioeconomic and environmental risk factors and treatment option of diarrhea in children <5 years old in Masindi district. The two-week prevalence of diarrhea among the children was 22.3%.

The occurrence of diarrhea was associated with maternal age of above 37, unemployed mothers and being married or staying together and maternal education with highest cases being more common among the mothers who stopped at primary school levels.

The two-week period of diarrhea occurrence used as a criterion in this study is comparable with studies conducted in Western Ethiopia (Desalegn, 2011) Egypt and India.

Such high rate of childhood diarrhea, despite considerable improvements in water sources and sanitation facilities, indicates the need for more attention. A number of studies have already recommended this. However, the prevalence of diarrhoea still continues to be high in rural areas. According to the report of the Ministry of Health 2011, 63.2% of children in rural areas are still suffering from diarrhoea in rural areas.

Children’s whose mothers cannot read and write or had limited literacy (primary level and no education) reported more diarrhoea among their children than the literate mothers the findings were similar to those of Telekim in 2012 who showed mother who had no skills to read and write had their children four times most like to concede to diarrhoea. This could be explained by the fact that maternal literacy increases the mothers’ opportunity to access care and treatment and aloes improves the practices of the mother to take their children for immunization and other preventive services. The study findings implies that maternal skills is one the most critical determinant in child health and should be emphasized at all aspects in order to improve not only diarrhoea but also the general health of the children. 17

A recent ministry of Health reported that maternal literacy was associated with child mortality. According to the report, pneumonia and malaria were more common among children whose mothers were ill trained.

This study also showed that mothers who were married and/or staying together were had more children with diarrhoea than other mothers who were single. Though this study did not reveal exactly why, the study postulated that married mothers were having a large number of children than their single counterparts. This in part affected the quality of sanitation and also the levels of access preventive services by mothers.

The study also highlight that there may be an associated relationship between diarrhoea and poverty especially the relationship among mothers poverty levels (income levels) and diarrhoea.

Most of the children were dewormed 10(33.33%), followed by those who received ORS 9(30.00%), and antibiotics 8(26.67%) and the least were children who were given other treatment 3(10%). The study showed that there were cases of wrong treatment of diarrhoea by mothers whose children developed diarrhoea within Masindi. Although there is adequate treatment of children with Diarrhoea with ORS and deworming drugs, the study showed that there is still a wide proportion of mothers who are using Antibiotics in the treatment of diarrhoea which is outside the treatment options within the community. Esone et al., 2010 showed that there were treatment of non-infectious diarrhoea with Antibacterial.

The cause of these is that there is a high prevalence of wrong information related to the treatment of diarrhoea within the communities. Traditionally, there has been a very poor method of treatment of diarrhoea within the communities. Many mothers used ciprofloxacin and Imodium according to Rose 2009. This study could relate the practice with mothers knowledge but the researcher observed that most of the mothers were comfortable with the notion that Antibacterial were quite safe in the treatment of diarrhoea

5.2 Conclusion

The study concluded that diarrhoea prevalence was high among the children under five within Masindi district. With most of the risk factors being low level of maternal education, married and high numbers of children the absence of a pit latrine at home.

5.3 Recommendations

Basing on these findings, the study recommended that:

1. The community health department should survey and determine the families without pit latrines and encourage them to build pit latrines at their homes

2. The health facilities should conducted maternal education to reduce the usage of Antibiotics and traditional herbs in the treatment of childhood diarrhoea among mothers in children under five in Masindi

3. The community leaders should identify families with high risk of diarrhoea and refer them to VHTs for health education and follow up

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APPENDICES

APPENDIX I: DATA COLLECTION TOOL

RESEARCH TOPIC: PREVALANCE AND RISK FACTORS ASSOCIATED WITH DIARRHOEAL DISEASE IN PEADIATRIC PATIENTS AT MASINDI HOSPITAL

SELF ADMNISTERED QUESTIONAIRE

Date:………………………………………………Place of Interview……………………………………………………..

Introduction

Name of Researcher: Leonard Kadiima

Purpose of the questionnaire: This questionnaire is developed as a data collection tool to be filed in by selected respondents. The data obtained from which shall be used only for research purposes in partial fulfillment of the award of Bachelor of Medicine and Bachelor of Surgery of Kampala International University. The investigator requests your voluntary participation in this study. You are free to withdraw from this study at any stage or decline to give information if you feel uncomfortable

This data will be treated with the utmost confidentiality it deserves and will not be released to anyone/organization except for an academic purpose.

Section A: Socio-Economic determinants of gastroenteritis among pediatric patients attending Masindi Hospital

1. Mothers Age a) 18-27 b) 28-37 c) 38-47 d) 47 and above

3. Mothers Education

a) Primary b) Secondary c) Tertiary /University d) None

4. Mother Occupation a) Employed b) Unemployed c) Peasant d) Business

5. Fathers occupation a) Employed b) Unemployed c) Peasant d) Business Man

6. Maritial Status of the mother e) Married f) Single mother

7. Does the child’s father drink alcohol a) Yes b) No

Section B: Environmental exposure risk factors associated with development of gastroenteritis among children under five admitted to Masindi Hospital

1. Is the baby having other brothers and sisters? a) Yes b) No

2. Do you have a latrine at home? a) Yes b) No

3. How often do you clean the latrine in a week? a) None b) Once c) Twice d) >more than 2 times a week

4. How far is your latrine away from the kitchen a) 10 – 20 meters b) 21 – 30 meters c) 30 Meters and above

5. Do you have a separate kitchen at home? a) Yes b) No 6. If yes, how many times do you clean your kitchen in a day? a) Once b) Twice c) Three d) More than three times

7. How do you store food for your baby at home? ...... 8. How do you store food for your baby at home? e) Once f) Twice g) Three h) More than three times

9. How frequently do you clean your water container in a week?

i) Once j) Twice k) Three l) More than three times

Thanks for your time and participation

APPENDIX II: WORK PLAN

Activity  Time  June July Aug Sept Oct Nov 2014 2014 2014 2014 2014 2014

Report Writing X X Approval X X Data Collection X Analysis X

Draft Report X Submission of Final Report X

APPENDIX III: RESEARCH BUDGET

ITEM COST PER NUMBER OF AMOUNT UNIT UNITS

Data Collection and 200,000/= 1 200,000/= analysis Printing report and 20,000/= 4 copies 80,000/= reports Binding 5000/= 4 20,000/=

Research assistants 20,000/= 4 80,000/= TOTAL COST 380,000/=

APPENDIX IV: MAP OF MASINDI DISTRICT

APPENDIX V: MAP OF UGANDA SHOWING MAJOR DISTRISCTS