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PREVALENCE AND DETERMINANTS OF DIARRHEA DISEASE AMONG UNDER-FIVE CHILDREN ATTENDING IMMUNIZATION CLINIC IN EDO STATE SPECIALIST HOSPITAL, BENIN CITY
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Diarrhea remains a significant public health concern globally, especially among under-five children in developing countries like Nigeria. According to the World Health Organization (WHO), diarrhea is one of the leading causes of morbidity and mortality in children under five years old. According to the World Health Organization (WHO), diarrhea is defined as the passage of three or more loose or watery stools in a 24-hour period (WHO 2024). It is typically a symptom of an infection in the gastrointestinal tract caused by a variety of bacterial, viral, and parasitic organisms. It can last several days and deprive the body of the water and salts required for survival (Ferede, 2020), resulting in severe dehydration and death or long-term consequences (Elias, 2019).
In Nigeria, the burden of diarrhea is particularly high, contributing significantly to childhood mortality rates. Understanding the prevalence and determinants of diarrhea among under-five children is crucial for designing effective interventions and policies to combat this health challenge.
The prevalence of diarrhea among under-five children in Nigeria is influenced by various factors, including socio-demographic characteristics and environmental conditions. Factors such as poor sanitation, inadequate access to clean water, and low socio-economic status contribute to the high prevalence of diarrhea in this age group. Additionally, the seasonality of diarrheal diseases, especially during the rainy season, exacerbates the problem. These factors underscore the complexity of addressing diarrhea among under-five children in Nigeria and similar settings.
Globally, diarrhea remains one of the major health problems [Black, Fontaine, Lamberti., Bhan, 2019]. In low- and middle-income countries (LMICs), diarrhea is still a leading cause of death and health loss among children under the age of five [Troeger, Forouzanfar, 2019]. Evidence from Asian countries [Nguyen, Binns, 2020, Rahmartani, Carson, 2020] showed that early formula feeding increases the risk of childhood diarrhea. Similar evidence from sub-Saharan African countries [Ogbo, 2019] has indicated that early introduction of complementary foods and bottle-feeding was associated with the onset of diarrhea among infants and young children. This could be due to the substitution of complementary foods for irreplaceable human milk, as well as contamination of the food and/or the bottle’s nipple [WHO, 2024].
Efforts to combat diarrhea in Nigeria have included vaccination programs, improved water and sanitation infrastructure, and health education campaigns. However, challenges such as vaccine coverage gaps, limited access to clean water and sanitation facilities in rural areas, and inadequate healthcare resources continue to hinder progress. Sustainable interventions that address these multifaceted challenges are essential to reducing the burden of diarrhea among under-five children in Nigeria.
The impact of diarrhea on child health goes beyond immediate morbidity and mortality. It can also lead to long-term consequences such as malnutrition Diarrhea prevents catch-up growth, and malnutrition, in turn, increases the frequency and duration of diarrhea episodes. This vicious cycle highlights the interconnectedness of diarrheal diseases with broader health and development outcomes among under-five children.
Addressing the prevalence and determinants of diarrhea among under-five children requires a holistic approach that integrates healthcare, water and sanitation infrastructure development, and community education. Maternal education plays a crucial role in preventing childhood diarrhea, emphasizing the importance of health literacy and empowerment. Additionally, interventions such as rotavirus vaccination have shown effectiveness in reducing diarrheal morbidity and mortality. These strategies, combined with improved access to healthcare services and socio-economic empowerment, can contribute to sustainable reductions in childhood diarrhea rates.
1.2 Statement of Problem
The prevalence of diarrhea among under-five children in Nigeria highlights significant gaps in the understanding that demand urgent attention. Despite ongoing efforts to address this issue, particularly in developing countries like Nigeria, the burden of diarrhea remains alarmingly high among young children (WHO, 2020). The specific prevalence rates of diarrhea among under-five children across different regions of Nigeria are inadequately documented, underscoring the need for more detailed data collection at the state and community levels (UNICEF, 2019). Such information is important for implementing targeted interventions and ensuring effective resource allocation.
There is a notable deficiency in the comprehensive exploration of socio-demographic factors contributing to the prevalence of diarrhea among under-five children. Variables such as income levels, parental education, and access to healthcare services significantly impact diarrhea rates but require further investigation to develop effective public health strategies (Adegboyega & Sekoni, 2019).
Research on the seasonality and environmental factors influencing diarrhea outbreaks among children in Nigeria is limited. Understanding the role of factors such as water contamination during the rainy season and local sanitation practices is vital for designing preventive measures that are responsive to regional conditions (Bello & Fadare, 2021). Although vaccination programs have been introduced, there remain substantial gaps in vaccine coverage and awareness among caregivers, which impede efforts to reduce diarrheal morbidity and mortality (Oluwaseun et al., 2018). Addressing these issues necessitates a deeper understanding of the barriers to vaccination and the development of innovative strategies to enhance coverage rates and caregiver education.
1.3 Aim of Study
The aim of the study is to assess the prevalence of diarrheal diseases among under-five children attending the immunization clinic at Edo State Specialist Hospital in Benin City, identify contributing factors, evaluate the health impact on affected children, inform public health interventions to reduce incidence, and raise awareness on prevention measures among healthcare providers and caregivers.
1.4 Specific Objectives of the Study
The specific objectives of this study include to:
- Determine the prevalence of diarrhea among under-five children attending the immunization clinic at Edo State Specialist Hospital, Benin City.
- Identify the determinants (such as socio-economic status, water and sanitation practices, breastfeeding practices, etc.) associated with diarrhea among under-five children in Edo state specialist Hospital, Benin City.
- Assess the knowledge, attitudes, and practices related to diarrhea prevention and management among caregivers of under-five children attending the immunization clinic at Edo state specialist Hospital, Benin City.
1.5 Research Questions
The following research questions were asked:
- What is the prevalence of diarrhea among under-five children attending the immunization clinic at Edo State Specialist Hospital, Benin City?
- What are the socio-economic and environmental determinants associated with diarrhea among under-five children in the same clinic?
- What are the knowledge, attitudes, and practices of caregivers related to diarrhea prevention and management?
1.6 Research Hypotheses
The following hypotheses were tested:
- There is no significant association between socio-economic status and the prevalence of diarrhea among under-five children attending the immunization clinic.
- There is no significant association between improved water and sanitation of diarrhea among under-five children attending the immunization clinic.
- There is no significant association between caregivers with better knowledge, positive attitudes, and good practices related to diarrhea prevention and management and thise who do not.
1.7 Significance of the Study
The findings of this study hold significant promise in advancing our understanding of diarrhea among under-five children, especially those engaging with immunization clinics. This contribution extends to the broader context of healthcare policies and interventions, particularly in regions like Edo State and similar settings grappling with high rates of diarrhea among young children. Through a nuanced comprehension of the determinants and prevalence of diarrhea, healthcare providers and policymakers stand to benefit immensely by implementing targeted strategies aimed at enhancing child health outcomes.
The impact of diarrhea on children’s health cannot be overstated, especially in resource-limited settings where access to quality healthcare and sanitation facilities may be constrained. By delving into the specific prevalence rates and factors influencing diarrhea among under-five children, this study adds valuable insights to the existing body of knowledge. These insights can serve as a roadmap for designing and implementing evidence-based interventions that directly address the root causes of diarrhea, leading to improved health outcomes for children in Edo State and similar contexts.
One of the primary advantages of understanding the determinants and prevalence of diarrhea is the ability to tailor interventions to specific populations and settings. Rather than adopting a one-size-fits-all approach, healthcare providers and policymakers can leverage this knowledge to develop targeted strategies that resonate with the local context. For instance, if the study identifies sanitation practices or water quality as significant contributors to diarrhea prevalence, interventions can focus on improving access to clean water sources and promoting hygienic practices within communities.
Furthermore, the findings of this study can inform policy formulation and resource allocation at both the state and national levels. By highlighting the burden of diarrhea among under-five children and elucidating the factors contributing to this burden, policymakers can prioritize investments in areas such as healthcare infrastructure, sanitation facilities, and health education programs. Such targeted investments have the potential to yield substantial returns in terms of reduced morbidity and mortality rates associated with diarrhea.
Moreover, the study’s insights can guide healthcare providers in implementing evidence-based practices within clinical settings. For example, understanding the prevalence of diarrhea-related risk factors among children attending immunization clinics can prompt healthcare providers to incorporate preventive measures and health education initiatives during routine immunization visits. This proactive approach not only addresses immediate health concerns but also contributes to building a foundation of lifelong health for children in the community.
In essence, the findings of this study serve as a catalyst for positive change in the realm of child health, particularly concerning diarrhea prevention and management. By bridging the gap between research and practice, this study contributes significantly to advancing child health outcomes in Edo State and similar regions, ultimately paving the way for healthier and thriving communities.