PREVALANCE OF DIARRHEAL DISEASE AND ITS ASSOCIATED FACTORS IN UNDER TWO CHILDREN IN YABU TOWN,MANA WOREDA ,JIMMA ZONE,OROMIA REGION,ETHIOPIA. PEREPERED BY: JEMAL ENDRIS(HO INTERN) A RESEARCH PAPER TO BE SUBMITED TO MEDICINE AND HEALTH OFFICER CORDINATING OFFICE,COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCE FOR PARTIAL FULFILMENT OF THE RUQUIREMENTS FOR THE BACHELOR OF SCIENCE DEGREE IN PUBLIC HEALTH SCIENCE. SEPTEMBER, 2016 JIMMA,ETHIOPIA PREVALANCE OF DIARHEAL DISEASE AND ITS ASSOCIATED FACTORS IN UNDER TWO CHILDREN IN YABU TOWN,MANA WOREDA, JIMMA TOWN, OROMIA REGION. PREPERED BY: JEMAL ENDRIS(HO INTERN) ADVISOR:Mr. NEGALIGN BIRHANU SEPTEMBER,2016 JIMMA,EHIOPIA ABSTRACT Background: Diarrhea is a leading cause of morbidity and mortality throughout the world. Global prevalence of diarrheal disease has shown that one billion episode and 3 million deaths occur each year among under 5 children, of which 80% were under 2 years of age. Objective: The main objective of this study is to assess prevalence of diarrheal disease and its associated factors among under 2 years old children in Yabbu town, Manna woreda, Jimma zone, Oromia region, Ethiopia. Methods and materials: Across sectional community based survey was conducted using systematic random sampling technique. 248 under two years old children are included. Data was collected by face to face interviews by using pre tested structured questionnaire. Result: data was collected from 248 households and The two weeks prevalence of diarrhea in under two years old children was 14.8%.High rate was seen in less than two years of age but no sex variation. Children’s of mothers age 20-30 years old had highest diarrheal occurrence(7.7%).Occurrence of diarrhea was highest in those who started breast feeding their children after 24 hours of delivery(7.7%) . Chi square test was done and shows strong association between occurrence of diarrhea and patterns of breast feeding, occurrence of diarrhea & time of initiation of breast feeding, occurrence of diarrhea and length of breast feeding ,occurrence of diarrhea and absence of latrine, occurrence of diarrhea &absence of hand washing facility after using toilet ,but no significant association between occurrence of diarrhea & age, ethnicity religion, occupational status, monthly in come of the family. Conclusion and recommendation:. It is concluded that as to this study the prevalence of diarrhea is high & the possible under line risk factors are suboptimal breast feeding and in proper sanitation. For the future further study and giving health education on risk factors of diarrhea by responsible body is recommended. I ACKNOWLEDGMENTS I would like to give My heartfelt gratitude to my advisor,Mr.Negalign Birhanu for his guidance, support and encouragement throughout the course of my proposal. I am also grateful for Jimma University health science librarian for helping me in searching important references. I would like to thanks team training program round two at Yabbu health center for providing me current information of the town. II TABLE OF CONTENTS PAGE ABSTRACT ..............................................................................................................................................................Ошиб ка! Закладка не определена. ACKNOWLEDGMENTS .............................................................................................................. II TABLE OF CONTENTS .............................................................................................................. III LIST OF FIGURE AND TABLE ...................................... IОшибка! Закладка не определена. LIST OF TABLE ................................................................ Ошибка! Закладка не определена. ACRONYMS AND ABRIVATION .................................. Ошибка! Закладка не определена. CHAPTER ONE:NTRODUCTION ................................... Ошибка! Закладка не определена. 1.1:Background ............................................................... Ошибка! Закладка не определена. 1.2 :Statement of The problems .................................................................................................. 2 CHAPTER TWO:LITERATURE REVIEW……….................................................................... .. 4 2.3 :Significance of the study……………………………………………………………………………………………………………….....7 CHAPTER THREE:OBJECTIVE ...................................... Ошибка! Закладка не определена. 3.1: General Objective..................................................... Ошибка! Закладка не определена. 3.2: Specific Objective .................................................... Ошибка! Закладка не определена. CHAPTER FOUR :METHOD AND MATHEWRIALS ... Ошибка! Закладка не определена. 4.1: Study Area................................................................ Ошибка! Закладка не определена. 4.2:Study period .............................................................. Ошибка! Закладка не определена. 4.3:Study Design ............................................................. Ошибка! Закладка не определена. 4.4: Population ................................................................ Ошибка! Закладка не определена. 4.4.1: Source population...............................................................................................................9 4.4.2:Study Population ................................................................................................................ 9 4.5.1:Inclusion Criteria ................................................................................................................ 9 4.5.2:Exclusion criteria ................................................... Ошибка! Закладка не определена. 4.6: Sample size determination and sampling Technique Ошибка! Закладка не определена. III 4.6.1:Sample size determination ..................................... Ошибка! Закладка не определена. 4.6.2:Sampling Technique..........................................................................................................10 III 4.7:Study variable.......................................................................................................................10 4.7.1 :Dependent variable...........................................................................................................10 4.7.2 :Independent variables.......................................................................................................10 4.8: Operational definition ........................................................................................................ 10 4.9: Data collection method and Instrument ............................................................................ 11 4.10: Data Quality assurance ..................................................................................................... 11 4.11: Data processing and analysis ............................................................................................11 4.12: Ethical consideration ........................................................................................................ 11 4.13:Dissemination of result ..................................................................................................... 12 CHAPTER FIVE: RESULT ..........................................................................................................13 CHAPTER SIX: DISCUSION. .....................................................................................................19 CONCLUSION...............................................................................,.............................................21 Recomendation..............................................................................................................................22 ANNEX......................................................................................................................................... 23 Annex 1:Refferences................................................................................................................................23 Annex 2:English Questionnaire ................................................................................................ 25 IV IV LISTS OF TABLE PAGE Table 1: socio demographic characteristics of mothers or care takers in Yabbu town..........……13 Table 2: distribution of diarrhea occurrence among socioeconomics and demographic features of mothers or care takers of children in Yabbu town...............................……………………..…15 Table 3:distribution of diarrhea occurrence among children of different breast feeding length, starting time and patterns of breast feeding in Yabbu town...................................…..............…16 Table4: Shows duration of diarrhea occurrence among under two children at Yabbu town, Jimma zone,Augest,2016.......................................................................................................…................17 Table5: shows distribution of households by their major sources of drinking water and presence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016...............18 Table6: shows distribution of households with the presence of latrine and presence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016..................................18 Table7: shows distribution of households with presence of hand washing facility after using toilet and prevalence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016...........................................................................................................................18 V V ACRONYMS AND ABRIVATION EBF-Exclusive Breast Feeding EDSHS-Ethiopian Demographic and Healthy Survey. EMJ-Ethiopian Medical Journal JU-SRP-Jimma University Student Research Program. SNNPR-South Nation Nationality and People Republic. WHO-World Health Organization. RIBS-Regional Integrated Basic Service. JIHS-Jimma Institution of Health Science. VI CHAPTER ONE:INTRODUCTION 1.BACKGROUND Diarrhea: is defined as the occurrence of three or more episode of water or loose stool within 24 hours. Main cause of death from acute diarrhea is dehydration which results from loss of body fluid in watery stool. Diarrheal disease can be acute watery diarrhea, that cannot last longer than two weeks or it can be persistent that can last longer than two weeks, also diarrhea can be watery, mucoid or bloody. This condition be directly related to causative agent(1). The causative agents of diarrhea disease are known to be viruses, bacteria and parasite. Rota viruses is the most frequent cause of severe life treating watery diarrhea in children under two years age. Worldwide, nearly all children have infection at this age. Common neurotoxin genius E.Coli is the most important cause of diarrhea in children and adult.Shigella is known cause of dysentery in about 60% of all episodes and mainly sever episode.Entaameba histoloticais the causative agent for an impudence mucoid diarrhea (1). Epidemiological y the infection that cause diarrhea are usually by feco oral route ,which includes ingestion of feco contaminated food or water and direct contact with infected faces(1). Among specific behaviors that promotes transmission of diarrheal disease are failure to breast feed, sub optimal breast feeding, using infant bottle feeding, storing food at room temperature and using contaminated water for drinking are the most important behavior for transmission of diarrhea.Many studies relating breast feeding on diarrhea disease suggest that breast milk offer substantial protection against diarrhea morbidity and mortality, more recently it was demonstrated that antibodies against enthropathogenic E.Coli to be presented in human colostrum(2). Despite such evident the incidence and duration of breast feeding is decreasing in many countries including Ethiopia. It is recommended that optimal breast feeding should be promoted as one important measure to control diarrhea(3). 1 1.2 STATEMENTS OF THE PROBLEM Diarrheal disease is a leading cause of child mortality and morbidity in worldwide around one billion people lack access to improved water and 2.5 billion have no access to basic sanitation. Every year there are about a billion cases of diarrheal disease worldwide(4). In 2004 diarrhea disease was the third leading cause of death in low economic countries causing 6.9 million death over all .In under five years old children diarrhea diseases is the second leading cause of death only preceded by pneumonia(4). Out of 1.5 million children killed by diarrheal disease in 2004,88% were under two years old. In developing countries children under three years old experience an average of three episode of diarrhea every year(4). Globally diarrhea is the third largest cause of morbidity and mortality among under five children and the six largest cause of mortality among population of all age groups. A then year review of the global problem of diarrhea disease has shown that there are one billion episode and 3 million death occur each year among under 5 children, of which 80% were under 2 years of age(5). Acute diarrheal disease in young children are dominant cause of excessive morbidity and mortality in developing communities of tropical countries. It is closely related to the socio economic and cultural conditions which impose up on these peoples a suboptimal nutrition ,marginal sanitation and limited medical services(6). In Africa a child experiences five episodes of diarrhea per year and 800,000 children die each year from diarrhea related dehydration(7). Diarrhea disease is among leading cause of morbidity and mortality among under children in Ethiopia when we see the prevalence of diarrhea in our country, it is more common among rural children (19%) than urban children(12%)(8). 1 It represents economic burden for developing countries. In many nations more than a third of hospital beds of children are occupied by patients with diarrhea. These patients are often treated with expensive intravenous fluid and in effective drugs(9). Diarrhea disease contribute a lot to the high prevalence of malnutrition one out of every twenty children born into developing countries die before reaching age of five from dehydration resulting from diarrhea. Acute watery diarrhea is the commonest form accounting 80 to 82% of the cases children 6 month to 11 months of age are the most commonly affected a time that coincide with initiation of complementary feeding. The highest mortality of diarrhea disease is encountered among infant(9). Handwashing is one of the most effective means of preventing diarrheal diseases, along with safe stool disposal and safe and adequate household water supply. This handbook focuses entirely on handwashing and advocates for stand-alonehandwashing-with-soap programs(10). Handwashing interrupts the transmission of disease agents and so can significantly reduce diarrhea and respiratoryinfections, as well as skin infections and trachoma. A recent review (Curtis and Cairncross 2003) suggests thathandwashing with soap, particularly after contact with feces (post-defecation and after handling a child’s stool), canreduce diarrheal incidence by 42-47 percente(10). Promotion of exclusive breast feeding in the first 4 to 6 months of life and reductions both in the incidence of diarrhea and related deaths are likely to be beneficial for infant survival in this population. Thisis consistent with earlier estimates of potential reductions in diarrhea mortality after increased breast feeding.6-8 Estimates indicate that infant mortality could be reduced by almost one third if the prevalence of exclusive breast feeding in the first four months of life could be raised to nearly 80%,with smaller gains with intermediate improvementsin breast feeding practices(11). The main reason of this study is to assess prevalence of diarrhea and its associated risk factors in under two children and this study will provide information on the issue that may help the health workers and policy makers to improve under two children mortality and morbidity rate by diarrhea in the town. 2 CHAPTER TWO LITERATURE REVIEW Different studies conducted in different countries on the morbidity analysis due to diarrhea among under five children which shows that the median incidence of the diarrhea was greatest for infants aged 6-11 months(five episodes per child per year) (12). The incidence of diarrheal disease among under five years old also varied according to regions and localities ,in particularly very high rate occurred among poor children living in Latin America, where under two children experienced 10 or more episode per year(12). A study done in Brazil also showed that the incidence varied directly with socioeconomic status such that poor rural children experienced five episode per year than urban children(12). In retrospective study conducted in Nigeria showed that the risk of diarrheal illness is significantly low in exclusively breast feed children which is 35% during the first 24 months of life compared with 76% of partially breast feed infant and 74% of the formula feed infant(13). According to a cross sectional study conducted in turkey out of 1278 children 458(35.8%) had diarrheas episode the risk for presenting diarrhea, statistically in male children (55.5%,p=(0.002)and infant of mothers with low educational level,59.3% where not exclusive breast feeding(14). Using a multi stage cluster sampling conducted a house hold survey of diarrhea among 4458 children under three years of age in Dakahlik Egypt from June 2002 to may 2003 to determine frequency of diarrhea and significantly higher among children in rural areas living in overcrowding areas and using non flush toilets(15). In Ethiopia many studies examined the diarrheal disease morbidity and mortality among under five children bases in 1983 health survey of Ethiopia examined child morbidity by age, sex,geographical region and sanitary facilities the conclusion of the survey was shows that morbidity level peak in second years of life without significant sex difference marked different in geographic region particularity with morbidity in western mountains and access to high quality 3 of drinking watery, latrine and garbage disposal are strongly related to reduce overall morbidity level(18). According to EDHS of 2011 diarrhea in under five children ,lowest in children living in Ad dis Ababa (12.2)while those living in Benishangulgumuz and Gambella has highest percentage (both 23%).13% of children under five years were reported to have had diarrhea and 3% had diarrhea with blood. The incidence of diarrhea is most common among children age 6-23 months(2325%).10.4% of children under 6 month were reported as they have diarrhea. Diarrhea prevalence is highest among children residing in house hold that drinks from un protected wells(18%). When comparing with toilet facility those children residing in house hold that has no toilet facility has high prevalence(13.7%).32% of children with diarrhea were taken for advice or treatment to health facility or provider(23). Infants breast feeding practice such as early exclusive breast feeding for the first six month of child is important determinant of nutritional status of the young children. Compared to selected sub Saharan African countries Ethiopian mothers are well in terms of breast feeding indicator.50% of Ethiopian children breast feed within one hour of births this rate is significantly lower than Mozambique(81%)and Malawi(71%).EBF in children less than 4 month old is as high as 62.3%.Timely complimentary feeding among 6-9 month old children is 77% which could also be improved to reach the rate seen in Kenya and Malawi(90%)(19). According to a community based cross sectional study done in Bale zone Goba woreda showed that the prevalence of timely initiation of breast feeding was 52.4%.Bivariety analysis showed that the attendance of formal education, being urban residents, institutional delivery, and post natal counseling on breast feeding where significantly associated with timely initiation of breast feeding practice(21) Different literature s showed that the magnitude of child hood diarrheal disease varies across the world from 3.58% in India,21.4% in Iraq and 19.6% in Egypt(26)to 32.7% in Tanzania(25).IN a similar fashion it has diverse figure in Ethiopia; EDHS determined it 13% nationally(7).Where as a study at ArbaMinch(south of Ethiopia),Nekemtie (Oromia region, Ethiopia),Mecha(North west Ethiopia) and Amhara region reported 30%(26),28.9(27),18%(10)13.7%(28) respectively. 4 Diarrhea disease is one of the leading cause of morbidity and mortality especially in developing countries despite it is both preventable and curable particularly breast feeding plays an important role to prevent diarrhea in children. Promotion and support of breast feeding can have significant impact to decrease and prevent the disease. According to study conducted in Yabbu town in 1998 E.C by Demisew Guluma no child were exclusively breast feed despite their respective age,97.3% were partially breast feed,2.7% were not breast at all.25% of prevalence of diarrhea was found in those not exclusively breast feed. The overall prevalence of diarrheal disease in Yabbu town is 27.4%(22). 5 SIGNIFICANCE OF THE STUDY The need of this study is to shows the evidence on the association between diarrhea ,breast feeding, educational status of the mother, income of the mother and occupational status of the mother, because there is no recent evidence about the problem in the town. The data obtained from this study will serve for further study and provide information on issue that may help health workers and policy makers to improve under two children mortality and morbidity rate by diarrhea. 6 CHAPTER THREE:OBJECTIVE 3.1: General Objective To assess the prevalence of diarrhea disease and associated factors among under two children in Yabbu town, Manna woreda, Jimma zone, Oromia Region, south west Ethiopia. 3.2: Specific Objective 1. To assess the prevalence of diarrhea disease among under two years old children. 2. To assess association between occurrence of diarrhea and patterns of breast feeding among under two years old children. 3. TO assess association between occurrence of diarrhea & time of initiation of breast feeding among under two years old children. 4. To assess association between occurrence of diarrhea & presence of latrine for house hold among under two children. 5. To assess association between occurrence of diarrhea & presence of hand washing facility after family use toilet among under two children. 7 CHAPTER FOUR :METHODS AND MATERIALS 4.1: Study Area The study was conducted in South western part of Ethiopia in Jimma zone, Manna woreda,yabbu town which is found 350km far away from Addis Ababa and 25km from Jimma town to the west. Climatic condition of the town is woinadega with estimated altitude of 1950-2550m above sea levels, the town has 2 health post, one health center,2 private clinic. The town has total population of 6812 among these 3339 are males and 3473 are females, from these under five children is 837 and under two children is 308.The total house hold of the town is 1125. 4.2:Study period:- The study was conducted from july10 - 15 ,2016. 4.3:source population:All under two years old children in yebbu town 4.4:Study population: A randomly selected under two years old children from the source population. Inclusion criteria : both sex Those children whose mothers/care takers are not deaf. Exclusion criteria: those children whose mothers are seriously ill or un able to respond. Those whose houses are closed after three times check. 4.6: Sample size determination and sampling Technique 4.6.1:Sample size determination Sample size will be determined by using single population proportion formula based on the following assumption the total number of under two years old children in Yabbu town is 308,total number of house hold is 1125 and sample size will be calculated as follows : p= prevalence of diarrhea of diarrhea Yabbu town which is 27.4%(22) d=margin error which is 5% z=confidence interval which is 1.96 n= (Zα/2)2p(1-P) 8 (d)2 n = (1.96)2 (0.274) (0.726) (0.05)2 n = 299.since the study is less than 10,000 corrective formula was applied nf=n/1+n/N 299/1+299/1125 +10% non response rate nf= 248 4.6.2:Sampling Technique A systematic random sampling technique used by determining "K" value k=N/n k=1125/236 k=5 which means, data will be collected by passing every five house having under two child. 4.7: Study variable 4.7.1 :Dependent variable Prevalence of diarrhea disease 4.7.2 :Independent variables Socio demographic characteristics: child’s age,sex, occupational and educational status mother/care giver. Environmental variables: Availability of latrine, source of water, hand washing facilities Behavioral variable: patterns of breast feeding, length of breast feeding, time of initiation of breast feeding. 4.8. Operational definition(23) Diarrhea: is passage of three or more loose or watery stool in 24 hours period. Acute diarrhea: Diarrhea beginning acutely and last for less than fourteen days. 9 Persistent diarrhea: Diarrhea beginning acutely and lasts for more than fourteen days. Dysentery: Diarrhea with visible blood in the faces. Exclusive breast feeding:Feeding infants only with breast milk for the first 6 month child except prescribed antibiotics and vitamins. Diarrheal episode: Provided that child facing watery,mucoid or bloody diarrhea three or more times within 24 hours or more after three days of first attack. 4.9: Data Collection method and Instrument A structured close and open ended questionnaire, which include all the relevant information to meet the objectives, originally developed in English. Then translated into Afan Oromo and back translated to English to check for consistency. The questionnairepre-tested before actual data collection. Data collectors also trained on the content of the questionnaire and process of data collection. The data was collected by face to face interview of the respondents. 4.10: Data Quality assurance Before the actual data collection commenced, pre test conducted in adjacent woreda health facility on 5% of respondents to ensure the validity of the survey tools and to standardize the questioner. The principal investigator will make frequent check on the data collection process to ensure the completeness and consistency of the gathered information. Any error that can found during the processcorrected immediately. 4.11: Data processing and analysis The collected data was cleaned, edited, complied, and organized by graphs, charts and tables and interpreted to give the necessary information. The data was analyzed manually by using scientific calculator based on the set of variables and objectives of the study. Finally chi-square test statics used to assess the presence of association between dependent and independent variable 10 4.12: Ethical consideration The research proposal submitted to Jimma University research and publication office for ethical consideration. Then official letter obtained from Jimma University college of public and medical science, health officers and medical science coordinating office. This official letter submitted to Yabbu town authorized body for their cooperation and permission. The purpose and objective of the study was explained to the participants before the starting of interview and informed consent was obtained from them. Participation in the study was on voluntary bases. Participants who would be unwilling to participate in the study and those who wish to quit from the study at any point in time was informed to do so without any restriction. 4.13:Dissemination of result The result of the study was disseminated to college of public health & medical science,CBE office& concerned body by presentation, written research report and to whom the information is needed as base line for further study. 11 CHAPTER FIVE: RESULT A total of 248 under two years old children were included in the study from sampled 248 yielding response rate of 100%.All respondents were mothers. The age of the respondents mothers ranges from (15-49).154(62.43%) respondents were in the age group of (20-39) year,230(92.9%) were oromo,236(95.1%) were muslim,123(49.18%) were illetrate,123(49.18%) were house wife and more than half of the mother ((51.4%) earn 301- 500 birr per month (Table 1) Table 1: Socio- demographic characteristics of study respondent in Yabbu Town ,Augest2016. Variable Frequency Percent (%) <20 47 28.11 20 – 39 154 62.43 40-49 46 18.14 >49 1 0.5 248 100 236 95.08 Orthodox 7 2.73 Protestant 5 2.18 T0tal 248 100 Oromo Amhara Others Total 23o 12 6 248 92.74 4.83 2.41 99.98 Age category in year Total Religion Muslim Ethnicity 12 Occupation House wife Gov’t employee Merchant Daily laborer Others T0tal Education status Illiterate Read and write Primary Secondary and above Total Monthly Income in Ethiopia Birr <100 100 – 300 301 – 500 501 – 700 701-1000 1000-1500 >1500 Total Age of children Below one year 1-2yaer Total 178 24 37 6 3 248 71.8 9.7 15.5 2.41 1.205 100 123 33 45 47 248 49.18 13.3 18.14 18.9 100 37 100 27 18 10 31 24 248 14.9 40.32 10.88 7.52 4 12.5 9.7 100 150 98 248 60.5 39.5 100 The two weeks prevalence of diarrhea was 14.8 %(n=36).Those children whose mothers were in the age group of 20-39 years had the highest rate of two weeks diarrheal prevalence (19)(52.7%).Children of mothers age less than 20 years and greater than 40 years had lowest prevalence rate of diarrhea11(4.4%)&7(2.5%) respectively. Those children whose mothers are illiterate had the highest two week prevalence of diarrhea24 (8.7)&those whose mothers are literate had lowest rate 14(6%).There was no significant association between the age of the mother and occurrence of diarrhea. Concerning occupation of the mothers children of house wife mothers had highest prevalence rate of 13 diarrhea24(8.7%).Concerning income of the mothers those children whose mothers get 100-300 birr had highest two week prevalence of diarrhea. Factors Associated with Occurrence of diarrhea By doing chi-square calculation it was found that there was no statistically significant association between occurrence of diarrhea and age,religion,occupational status ,monthly income of the mother, but there is statistical significant association between occurrence of diarrhea and patterns of breast feeding, time of initiation of breast feeding, length of breast feeding,precence of latrine, presence of hand washing facility for the family after using toilet (see table 2 , 3,6&7 below ). Table: 2, Distribution of diarrheal disease occurrence among socio economic and demographic feature of mothers of studied children in Yabbu town, Jimma zone, Augest, 2016. Feature Age Ethnicity Category <20 Yes Nom . 11 20-39 >40 Total Oromo Amhara Others Total Religion Muslim Christian Others Total Occupational House wife status Gov’t employs Merchant Daily laborer Others Total Income per <100 month 100-300 301-500 501-700 Diarrheal disease No % Nom. 4.4% 36 19 7.7% 136 6 36 2.4% 14.5 % 13.3 0.8 0.4 14.5 13.7 0.8 40 212 33 2 1 36 34 2 36 24 1 4 7 36 20 8 4 2 197 6 9 212 202 5 5 212 154 23 33 12 212 17 92 23 16 14.5 9.7 0.4 1.6 2.8 14.5 8.1 3.2 1.6 0.8 14 % 14.5 % 54.8 % 16.12 85.42 79.4 2.4 3.6 85.5 81.5 2.01 2.01 85.5 62.1 9.3 13.3 4.8 85.5 6.9 37.1 9.3 6.4 Tota X2 l 47 3.61 Pv 155 5.991 Df(2) 46 248 230 8 10 248 236 7 5 248 178 24 37 19 248 37 100 27 18 3.22 Df (2) 5.991 1.29 Df(2) 5.991 2.04 Df(4) 9.488 4 Df (6) 12.36 700-1000 1000-1500 >1500 Total 2 36 0.8 14.5 8 31 24 212 2.01 12.5 9.7 85.5 10 31 24 248 The highest rate of diarrheal occurrence 22 (8.7%) seen Among age groups of 6 months and above. Breast feeding status of the infants indicate that most of the mothers 164(66.1%) breast feed for greater than 6 months and few not breast fed at all 1(0.5%).The highest prevalence 22(8.7%) of diarrhea disease was observed in those who partially breast feed which is seconded by that in those who breast for greater than 6 months (Table 3). Occurrence of diarrheal disease as observed to be highest 19(7.7%) in those mothers who started to breast feed 24 hours after birth and breast feeding starting time has statistically significant association(p<0.05).(Table 3). Table: 3, Distribution of diarrheal occurrence among children of different breast feeding length starting time and pattern of breast feeding in Yabbu town, Jimma zone, June.2015. Breast feeding Length Diarrheal occurrence Num. Not at all < 4 month 4-6 month > 6 month Total Starting Soon after time birth 1-4 hrs after birth 24 hrs after birth I dont know Total Patterns of Exclusively breast breast feed feeding Partially breast feed Not breast feed at all Total Yes Numb. 1 4 9 22 % 0.4% 1.6 3.4 8.8% Numb. 3 22 45 142 36 5 14.7% 2.01% 212 163 85.5 65.7 248 168 100 67.7 62.3 <0.05 11 4.4% 38 15.3 49 19.7 Df(3) 19 7.7 9 3.6 28 11.3 7.815 1 36 14 0.4% 14.7% 5.6% 3 212 149 1.2 85.5 60.1 4 248 163 1.6 100 65.6 11.5 <0.05 22 8.5% 60 24.2 82 32.7 Df(2) 1 0.4% 4 1.6 5 2 5.991 36 14.5% 212 248 100 15 No % 1.2 8.9 19.8 57.3 Association Total Num. % X2 4 1.6 11.3 26 10.5 54 23.2 164 66.1 Pv <0.05 Df(3) 7.815 Types and duration of diarrheal occurrence also analyzed and 83.3%had watery diarrhea, 11.1 % was muciod &5.6% had bloody diarrhea. Concerning the duration of diarrhea 94.4% were acute cases while 5.6% were chronic. Figure 1: Shows types of diarrheal disease among under two children in Yabbu town ,Manna woreda,Jimmazone,June,2015. Table:4 ,Shows duration of diarrhea occurrence among under two children at Yabbu town, Jimma zone,Augest,2016. Duration of illness <14 days >14 days Total Occurrence of diarrhea 34 2 36 94.4 5.6 100 Major source of drinking water of the family were assessed and the majority 181(72.9%) were used pipe water and 37(14.9%) were used unprotected spring.(Table 5) 16 Table;5, shows distribution of households by their major sources of drinking water and presence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016. Source of drinking water Pipe water Protected spring Protected well Unprotected spring Unprotected well Total Occurrence of diarrhea Yes No Num. % Num. Total % Num . 1 4 26 % 0.4 1.6 10.4 181 2 30 11 72.5 0.8 1.2 4.4 182 2 7 37 72.9 0.8 2.8 14.8 5 36 2 14.8 17 212 6.8 85.2 22 248 8.8 100 According to this study 84 % the household has latrine, the highest prevalence of diarrhea occur among the house hold hadn’t latrine28(11.3%)&8(3.4%) occur among children of house hold who had latrine(Table 6) Table;6, shows distribution of households with the presence of latrine and presence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016. Presence of latrine Yes Occurrence of diarrhea Yes No 8 200 Total 208 Associa tion X2 Pv 11 P=3 7 .881 No 28 12 40 Total 36 212 248 According to this study only 8 house hold has hand washing facility after using toilet from the total of house hold 208 who had latrine.(Table 7). Table;7, shows distribution of households with presence of hand washing facility after using toilet and prevalence of diarrhea among their under two children in Yabbu town, Jimma zone,Augest,2016. Presence of hand washing facility Yes No Total Occurrence of diarrhea Yes No 2 6 8 190 10 200 17 Total 192 16 208 Association X2 Pv 60.83 Df =1 3.881 CHAPTER SIX DISCUSSION This study attempted to assess the prevalence of diarrheal disease among under two years old children’s and socio economic and demographic characteristics of the community which might have impact on diarrheal disease. The two week prevalence of Diarrheal disease in the study community was 14.8%,which is more than prevalence of diarrhea in under two children at national level (13.%)(7) when we compare with world 3.58% in India,21.4% in Iraq and 19.6% in Egypt(26)to 32.7% in Tanzania(25).In a similar fashion it has diverse figure in Ethiopia. as a study done at ArbaMinch(south of Ethiopia),Nekemtie (Oromia region, Ethiopia),Mecha (North west Ethiopia) and Amhara region reported 30%(26),28.9(27),18%(10)13.7%(28) respectively, closer to lower limit range probably because of the study design different sampling technique,differency between educational status of the studied community ,different sample size, different season of year in which the study conducted.. In this study different socio economic and demographic characteristics data showed that the majority 19(7.7%) of the cases were seen among mothers of 20-39 years of age age group similarly children’s of mothers who were illiterate had the high rate of 2 week prevalence of diarrhea 22(8.7%) than among mothers of children who were literate, which is similar to study conducted in Dakhali, Egypt and study conducted in southern Ethiopia communities. This implies low level of education increases risk of diarrhea (15.23) Children who were on breast feeding for greater than 6 months were (22) of which 8.7% had diarrhea. As to this study about 65.6% percent of mothers start breast feeding immediately after birth. Brest feeding starting time and diarrheal occurrence was analyzed using chi square test and shows statistically significant association. Which is similar to a study conducted in Bale zone, Goba Woreda(21) and 34.4% of mothers did not start immediately after birth, according to study conducted in sub Saharan countries Ethiopian mothers were in terms of breast feeding 50% initiate breast feeding with in 1 hour of birth ,in this study area 72.3% of them start breast feeding immediately after birth but it is relatively low when compared to other countries like 18 Mozambique 81.9%(20). Chi square test was done & showed that there is strong association between occurrence of diarrhea and time of initiation of breast feeding. . Diarrheal occurrence with patterns of breast feeding was analyzed and 22(8.7%) of partially breast feed, 14(5.4%) of exclusively breast feed and 1(0.5%) of not breast feed children had diarrhea. Chi square test was done shows that there is strong association between occurrence of diarrhea and patterns of breast feeding(p<0.05,df=2,chisquare calculated= 11.5).when compared to the study conducted at Chittagong Bangladesh 6.6% of exclusively breast feed and 19.2% partially breast children had diarrhea. As this study there is high prevalence of diarrhea among children’s of house hold who use un protected spring as source of drinking water26(10.5),which is similar with study done in Ethiopia at national level (11.3%) According to this study there is high prevalence of diarrhea among children’s of house hold who had no latrine(11.2%) ,which is similar with study done in Ethiopia at national level, those children residing in house hold that has no toilet facility has high prevalence (13.7%)(7). Chi square test was done& show that there is strong association between occurrence of diarrhea and absence of latrine. According to this study only 8 house hold has hand washing facility after using toilet from the total of house hold 208 who had latrine. There was high rate of diarrheal occurrence among those who had no hand washing facility,6 children out of 8 households who has latrine but no hand washing facility. Chi square test was done and shows strong association between occurrence of diarrhea and absence of hand washing facility after using toilet. As to this study majority of diarrhea was watery 83.3% and acute cases which is similar to study done in Kefasheka zone (23). 19 CONCLUSIONS According to this study all respondents were mothers and majority of them were in age group of between 20-39 years. Almost all study population was Muslim and Oromo. About half of study population was illiterate and most of them were house wife. Around half of the mothers got 100300 birr per month. The two weeks prevalence of diarrhea was (14.8) which is high even though, easily preventable. More than half of diarrhea occur in those children breast feed for more than six month and half of diarrhea occur in those children start breast feeding after 24 hours of birth. The majority of diarrheal prevalence occur in children whose family source of drinking water is un protected spring. Majority of mothers start breast feeding with in hour of birth and about 2/3 of them practice EBF which is appreciable. Majority of the house hold has latrine facility, but only few of them has hand washing facility after using toilet. Majority of the house hold use unprotected spring as source of drinking water. Chi square test was done there is strong association between occurrence of diarrhea and patterns of breast feeding, absence of latrine, absence of hand washing facility after using toilet. 20 RECCOMENDATION 1.To recommend those who going to conduct study in the future in this area and JU-CBE office because children’s of mothers age between 20-30 had highest diarrhea occurrence (7.7%) to dig out possible cause and intervention for this. 2. To recommend Yabbu health center to give sustainable and community based education on recommended breast feeding. 3. To recommend Yabbu town administrative office because about 23.7% of respondents use unprotected spring for drinking. 4.To recommend Yabbu town extension workers to give education on importance of washing hand after using toilet because 80.6% of the house hold who has latrine had no hand washing facility after using toilet. 5. To recommend Jimma zone health beauro to give health education on risk factors of diarrhea in collaboration with other centers. 21 REFERANCES 1.WHO-reading on diarrhea students manual Geneva 1992. 2.Sachdells H.P.S umber S.K.signh K.K Dase breast feeding intense mortality in children hospitalized with diarrhea journal of tropical pediatrics 1991,37(6). 3.AHRTAG.Preventing food born infection and hygiene, food safety and diarrhea, dialogue in diarrhea. The intense letter sue 1998(36)1-8). 4.WHO recent report diarrhea's disease Feb. 2013 (WWW WHO Int./medical center/ fact sheets) ts 330/en/index.Htme. 5.Disease of children in subtropics and tropics edited by D.bjellite and J.p Stanfield third edition 1978. 6.Dietary management of young children without diarrhea. A manual for managers of health programs(B.B.jellife and E.F.P jellize ) WHO 1990. 7.Demographic and health survey of Ethiopia A.A 2011.E.C. 8.Grime R.etal Environmental determinate of diarrhea among under five children Ethiopian Journal of health science vol 18 Nov 2.July 2008. 9.WHO persistent diarrhea in developing countries Buuetin of WHO 2006. 10.Tsinuel Girma .etal pediatrics wither note for health science student. 11.C.Bern ETAL.Magnitude of global problem of diarrhea disease Buuetin of WHO 2006. 12.Scott-Emuakpor MM oka for UA comparative study morbidity and mortality of breast feed and bottled migerianmteants East Africa med J1998;67(6).4J2J7. 13.Maimed DA,fealthem RG-HuttlySRA infants feeding and risk of severe diarrhea in Basranciry A case control study Bull WHO 1998:67(6)7016. 14.Mohammes S-E hlayes Abdwbaribener,Hatim M.Abdurahman:-protective effect of breast feeding on diarrhea among children in rapidly growing neully developedcomtry Turkish Journal of pediatrics. 15.Prevalance and determinant of diarrheal disease Egypt 2005(http//www empoustsoint) 16.Michrshahiert international breast feeding journal 2008(http//www internal/breast feeding journal com) 2001r.9.THE world July 2005 A-country status report on health and poverty. 17.Setting etal determinants of exclusive breast in Chittagong Bangladesh. 22 18.Determinant of exclusive breast feeding in Ethiopia Journal of Healthy and DEAV. 19.Lindtjen Bi ETAL, morbidity of infections disease Scandinavian journal 2003 20. Prevalence of diarrheal disease and risk factors in Bale Goba Zone. 21.A prevalence of diarrhea and its associated factors by Demise Guluma in Yabbu town 1998 E.C(un published) 22.EDHS,Centers statistical agency OMEDHS Addis Ababa,Ethiopia,2006. 23.Harrison principles of internal medicine 18th edition. 24.Assessment of determinant of diarrhea in keffa sheka woreda in southern Ethiopia. 25.Kumar SG,Subita L.diarrheal disease in developing cuontries.Jawaharlal Institute of post graduate medical education research,India,11(8);38.APR-JUNE 2012 26.Tilahun Delete Mossie etal:Childhood Diarrheal Disease among under Five children at Dejen District, North west, Ethiopia. 27.Eshete WB.A stepwise regression analysis on under five diarrheal morbidity prevalent in Nekemte town western Ethiopia, East Afr J Public Health.2008;5:193-8 28.Muluken D,Aberak.Predictors of under five childhood diarrhea: Mecha District, West GOjam,Ethiopia.EJHD.2011;25;(2):1 23 ANNEX -II: Questionnaire JIMMA UNIVERSITY COLLEGE OF OUBLIC HEALTH AND MEDICAL SCIENCE,MEDICINE AND HEALTH OFFICER COORDINATING OFFICE Questionnaire Introduction: This questionnaire is designed to collect data from resident of Yabbu town. The general objective of this questionnaire is to assess the prevalence of disease and its associated factors in under two children in Yabbu town, Jimma zone, South west Ethiopia. The questionnaire has two parts. Part one focuses on demographic characteristics of mothers or care takers and part two focuses on general information. This questionnaire will translated to Afan Oromo in order to get complete information from respondents. I .Identification Woreda _________________ ______________ Kebele _________________ House number Relation of the person interviewed to the child A. Mother B.Father C.Grand mother II.General information 1.Age of the mother/care taker………year. 2.Age or child months 3.Sex of the child male……female…….. 4. Ethnicity of the mother/care taker A. Oromo B.Amhara C. Tigre C.Gurage D.others specify 5. Religion of the mother/care taker. A. Muslim B.Orthodox C.Protestant D.others specify 6.Educational status of the mother o0r care taker 24 D.other specify A .Illiterate B. Read and write C. Primary D. Secondary and above. 7.Occupational status of the mother/care taker. A. House wife B.merchant C .govt employees D.dialey laborer E. other specify. 8.Monthly income of family……………………………………… birr. A.< 100 birr B.100-300 birr. c.301-500 birr D.501-700 birr E.700-1000 birr F.1000-1500 birr G.>1500 birr 9.Did your child have diarrhea in the last 2 weeks. A. Yes. B. No 10.If your answer to question number 9 is yes what type? A. Watery B. Mucoid C. Bloody. 11.Duration of the diarrhea A .< 14 days B.>or=14 days. 12.action taken for the illness. A. Treated at health facility B. Traditionally treated C. Home care is given D. Nothing done. 13.What changes was made on breast feeding when the child had diarrhea. A. Maintained B. Reduced C. Stopped 14.Did he/she recover now? A. Yes B.No 15.For how long do you feed your baby only breast milk? A. Not breast feed at all B.< 4 months C.4-6 months D.> 6 months 16.Do you have toilet? A.Yes B. No 17.Do you have hand washing facility after using toilet?A .Yes B. No 18.What is the major source of drinking water for the family?A. Pipe water C. Protected well D. Un protected well E. Unprotected spring. thank you very much for giving response! 25 B. Portal water 26