Association between women’s empowerment and diarrhoea in children under five years: evidence from the 2017/18 Benin Demographic and Health Survey

Globally, diarrhoea is the third leading cause of death for under five-children. Women’s empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women’s empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57–0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65–0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women’s age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women’s empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women’s empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women’s education and decision-making power and enhancing awareness of women’s human and democratic rights.

KNOWLEDGE, ATTIUTDE AND PRACTICES OF HEALTH CARE PROFESSIONALS ON USING ZINC TO TREAT CHILDHOOD DIARRHOEA

To assess knowledge, attitude and practice (KAP) related to zinc use by healthcare professionals (HCPs) for diarrhoea in children. (2) To check the availability/non availability of zinc formulations in community pharmacies. Childhood diarrhoea is one of the leading cause of morbidity and deaths globally. Excessive nutrients loss occurs as an aftermath of the diarrhoea. Zinc supplementation to children aid in replenishing lost micronutrients and improves overall health during episodes of diarrhoea. A pre-tested, self-administered questionnaire was developed and distributed among 100 practitioners that included general physicians and paediatricians and 50 community pharmacists in different localities of Delhi. A presentation containing therapeutic role of zinc in childhood diarrhoea was administered to non-prescribers of zinc. Majority of prescribers reported already using zinc as an adjunct to ORS yet believed ORS alone can meet the demand of lost nutrition from the body. Non-prescribers disagreed that ORS alone meets the demand of lost nutrition yet believed zinc is safe for managing childhood diarrhoea. Their practice rely on prescribing anti-diarrhoeals and antibiotics to treat diarrhoea in infants. Community pharmacists believed that zinc is safe and beneficial for children under 5 years of age however, the rate of dispensing zinc formulations from pharmacies is low. The study displayed a gap of knowledge among HCPs and recommends conduction of educational programs to ensure adequate consumption of zinc supplements among children.

Impact of universal home visits on child health in Bauchi State, Nigeria: a stepped wedge cluster randomised controlled trial

Background Nigeria is the second biggest contributor to global child mortality. Infectious diseases continue to be major killers. In Bauchi State, Nigeria, a stepped wedge cluster randomised controlled trial tested the health impacts of universal home visits to pregnant women and their spouses. We present here the findings related to early child health. Methods The home visits took place in eight wards in Toro Local Government Authority, randomly allocated into four waves with a delay of 1 year between waves. Female and male home visitors visited all pregnant women and their spouses every 2 months during pregnancy, with a follow up visit 12–18 months after the birth. They presented and discussed evidence about household prevention and management of diarrhoea and immunisation. We compared outcomes among children 12–18 months old born to mothers visited during the first year of intervention in each wave (intervention group) with those among children 12–18 months old pre-intervention in subsequent waves (control group). Primary outcomes included prevalence and management of childhood diarrhoea and immunisation status, with intermediate outcomes of household knowledge and actions. Generalised Estimating Equations (GEE), with an exchangeable correlation matrix and ward as cluster, tested the significance of differences in outcomes. Results The analysis included 1796 intervention and 5109 control children. In GEE models including other characteristics of the children, intervention children were less likely to have suffered diarrhoea in the last 15 days (Odds Ratio (OR) 0.40, 95% confidence interval (CI) 0.30–0.53) and more likely to have received increased fluids and continued feeding in their last episode of diarrhoea (OR 6.06, 95% CI 2.58–14.20). Mothers of intervention children were more likely to identify lack of hygiene as a cause of diarrhoea (OR 2.24, 95% CI 1.27–3.95) and their households had better observed hygiene (OR 3.29, 95% CI 1.45–7.45). Intervention children were only slightly more likely to be fully immunised (OR 1.67, 95% CI 0.78–3.57). Conclusions Evidence-based home visits to both parents stimulated household actions that improved prevention and management of childhood diarrhoea. Such visits could help to improve child health even in settings with poor access to quality health services. Trial registration ISRCTN82954580. Date: 11/08/2017. Retrospectively registered.

Diarrhoea and Associated Clinical Features in Different Pathotypes of Diarrheagenic E. coliIsolated in Children: A Case-Control Study in a Tertiary Care Hospital

Background: Acute gastroenteritis remains to be a major health problem in children causing high morbidity and mortalityIn India, diarrhoea is the third most common cause of death in children younger than 5 years of age, with an estimation of 300,000 deaths each year. Diarrheagenic Escherichia coli (DEC) being one of the important bacterial agents, the present hospital-based study was done to enlighten on the occurrence of different pathotypes and clinical features associated with DEC related diarrhoea. Methods:The case-control study was carried out in SCB Medical College, Odisha from October 2014 to September 2016 on the childhood diarrhoea cases (≤ 14 years of age). Stool samples were collected and processed to isolate the causative bacterial agent by standard biochemical test, serotyping and multiplex PCR. Results: 350 cases and 100 controls were included in the study. The different pathotypes of DEC were isolated significantly more in cases than control group (P value = 0.0205) with an isolation rate of 7.4% in cases. 12 (46.2%) of DEC were in 0-1 year age group followed by 1-5 year of age group i.e. 11 (42.3%) and least in 5-14 years of age group i.e. 3 (11.5%). The most common pathotype was Enterotoxigenic E. coli (ETEC) followed by Enteropathogenic E.coli (EPEC). Fever is the most common symptom associated with DEC diarrhoea; the other two common symptoms were watery diarrhoea and vomiting. Exclusive breastfeeding was the protective factor. Seasonal variation of DEC was found more among the cases in the rainy season. Conclusion: Different pathotypes of DEC being associated commonly with childhood diarrhoea, the correct identification of various types of DEC along with the clinical knowledge is important to reduce the morbidity and mortality caused by it.

Knowledge and Barriers to Use of Low-Osmolarity Oral Rehydration Solution and Zinc Supplementation in the Management of Childhood Diarrhea Among Primary Health Care Providers in Imo State, Nigeria

Low-Osmolarity Oral Rehydration Solution (L-ORS) and zinc supplementation remain the recommended gold standard for the management of childhood diarrhoea. However, since 2005, there has been little or no progress in increasing the use of L-ORS and zinc supplementation in the management of children under 5 years with diarrhoea. The study, therefore, assessed the knowledge and barriers to the use of low osmolarity ORS and zinc supplementation among primary healthcare providers. The study was a descriptive cross-sectional design carried out among health care providers working in government-owned primary health centres across the 27 LGAs of Imo State Nigeria. A pre-tested structured questionnaire was used to collect data from randomly selected 340 health care providers. Data was analysed using descriptive statistics and a chi-square test. Out of the 340 healthcare providers who participated in the study, a higher proportion of respondents demonstrated a moderate level of knowledge (75.86%), which was reflected in their moderate extent of use of L-ORS and zinc supplementation in the management of childhood diarrhoea. Major barriers contributing to the suboptimal use of L-ORS and zinc included poor availability of L-ORS and zinc supplementation (85.9%), limited training and re-training of health care workers (60.9%) and poor communication of current public trends among health providers (81.5%). Findings from the study also indicated that the level of knowledge on the use of L-ORS - zinc and cadre of the health providers were significantly associated with the use of L-ORS and zinc: p-value 0.01, p-value < 0.01 respectively. Despite the moderate level of knowledge on the use of L-ORS and zinc, there still remained identifiable knowledge gaps on key factors underlying the use of the recommended L-ORS and zinc, hence there is a need for continuous training and re-training programs for health care workers to improve their knowledge and skillsets towards promoting sustainable use of Low ORS and Zinc supplementation in the management of childhood diarrhoea.

Knowledge and Health-Belief as Predictor of Prevention and Management of Childhood Diarrhoea at Federal Medical Centre, Owo

Childhood diarrhoea is found to be the second main cause of under-five mortality the world over, in the developing countries. Therefore, the study examines the health beliefs of mothers as predictors of prevention and management of childhood diarrhoea in Federal Medical Centre, Owo, Ondo State. The study employs a descriptive cross-sectional survey research, a consecutive sampling technique to select 166 mothers of under-five children at the Children Outpatient Clinic of FMC, Owo. A mixed method analysis of quantitative and in-depth interviews was utilized to retrieve information from mothers of under-five children in FMC, Owo. The demographic information and research question was analysed using descriptive statistics while the research hypothesis was analysed using Pearson Product Moment Correlation and Linear regression. The results revealed that, more than half of the mothers have average knowledge of childhood diarrhoea. Across all the factors, there was a moderate level of health belief in the prevention of childhood diarrhoea among the nursing mothers of under-five children. 66.5% Average level of management of childhood diarrhoea. The first hypothesis indicated a significant relationship of socio-demographic characteristics and prevention of childhood diarrhoea among nursing mothers in under-five children in FMC, Owo Marital Status, 0.625, Occupation, 0.788, income of mother, 0.911, ethnicity, 0.771 and level of education, 0.604) and the prevention of childhood diarrhoea, this was significant 0.05 level of significance. However, religion was not significantly related with the prevention of childhood diarrhoea and prevention of childhood diarrhoea among nursing mothers of under-five children in FMC, Owo (p > 0.05). There was a significant relationship between knowledge and management of childhood diarrhoea among nursing mothers of under-five children in FMC, Owo (r=0.779, df=165, p<0.05). The study recommends that there is a need for public health physicians, social workers to provide nutritional educational programs about diarrhoea should be implemented for mothers in different community health services. Government should enforce good sanitation and improvement of housing conditions, especially water resources in rural areas.

Do breastfeeding practices correlate with childhood diarrhoea? Multiple data analyses using national surveys in Ghana

Background: Breastfeeding is a natural intervention that tends to have a protective effect on the occurrence of diarrhoea in children. In environments where breastfeeding is suboptimal coupled with the early introduction of complementary foods, children are at a higher risk of experiencing diarrhoea. This study examined whether breastfeeding practices are associated with childhood diarrhoea in Ghana using multiple secondary datasets. Methods: The study used Ghana Demographic and Health Survey (GDHS) 2003, 2008 and 2014 datasets. These datasets contain data on women and issues related to children who were two years of age (0-23 months). An appended weighted sample of 4,675 mother-child pairs was used for the analyses. Logistic regression analyses were performed to assess the association between breastfeeding practices (including other explanatory variables) and childhood diarrhoea.Results: Children who were not exclusively breastfed had higher odds of experiencing diarrhoea. These categories of children most likely to be exposed to diarrhoea included those who were not breastfeeding (OR = 3.382, 95% CI = 2.019, 4.820), predominantly breastfeeding (OR = 1.824, 95% CI = 1.198, 2.777), and partially breastfeeding (OR = 2.795, 95% CI = 1.931, 4.047).Conclusions: Findings for this study further affirms to the protective effect breastfeeding has against childhood diarrhoea. Exclusive breastfeeding and at times predominant breastfeeding could prevent or minimize diarrhoea compare to non-practice of breastfeeding or partial breastfeeding.

Effectiveness of solar disinfection water treatment method for reducing childhood diarrhoea: a systematic review and meta-analysis

ObjectiveThis study aimed to pool out the available evidence on the effectiveness of the solar disinfection water treatment method for reducing childhood diarrhoea.DesignSystematic review and meta-analysis.SettingGlobal.MethodsSearches were conducted in Medline/PubMed, Scopus, Google Scholar, Cochrane Library databases and references to other studies. The review included all children living anywhere in the world regardless of sex, ethnicity and socioeconomic status published in English until December 2019. Studies that compared the diarrhoea incidence between the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The outcome of interest was the change in observed diarrhoea incidence and the risk from baseline to postintervention. Two independent reviewers critically appraised the selected studies. Effect sizes were expressed as risk ratios, and their 95% CIs were calculated for analysis.ResultsWe identified 10 eligible studies conducted in Africa, Latin America and Asia that included 5795 children aged from 1 to 15 years. In all identified studies, solar disinfection reduced the risk of diarrhoea in children, and the effect was statistically significant in eight of the studies. The estimated pooled risk ratio of childhood diarrhoea among participants that used the solar disinfection water treatment method was 0.62 (95% CI 0.53 to 0.72). The overall pooled results indicated that the intervention of solar disinfection water treatment had reduced the risk of childhood diarrhoea by 38%.ConclusionsThe intervention of solar disinfection water treatment significantly reduced the risk of childhood diarrhoea. However, the risk of bias and marked heterogeneity of the included studies precluded definitive conclusions. Further high-quality studies are needed to determine whether solar disinfection water treatment is an important method to reduce childhood diarrhoea.PROSPERO registration numberCRD42020159243