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
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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