Prevalence and Factors Associated with Diarrhoea among Children between 6 and 59 Months of Age in Mwanza City Tanzania

Prevalence and Factors Associated with Diarrhoea among Children between 6 and 59 Months of Age in... Abstract Background Childhood diarrhoea is a global public health problem especially in unplanned settlements of low- and middle-income countries. Different studies have associated household settlement and childhood diarrhoea, but the prevalence and risk factors associated with childhood diarrhoea at the community level are not clearly known. Method A community-based cross-sectional study was performed to determine the prevalence and risk factors associated with diarrhoea in among 480 children between 6 and 59 months of age in Mwanza city from June to August 2016. Risk factors associated with childhood diarrhoea in Mwanza city were determined using univariate, bivariate and multivariate analysis. Results The study showed a prevalence of diarrhoea of 20.4% and an association between type of settlement and childhood diarrhoea (p < 0.001) in a chi-square analysis. During bivariate analysis, and logistic regression, after controlling for other factors, unplanned settlement was significantly associated with childhood diarrhoea (odds ratio=3.475, p < 0.001 and AOR=3.469, p < 0.001). Other factors associated with childhood diarrhoea were behaviour of mother washing hands before preparing food (AOR = 0, 193, p < 0.001), mother washing hands after changing child’s napkins (AOR = 0.544, p < 0.036) and the behaviour of the child washing hands after toilet (AOR = 0.447, p < 0.006). Conclusion Risk factors associated with childhood diarrhoea in Mwanza city are unplanned settlement and behaviour of mother and child washing hands during critical time; hence, continuous community health promotion insisting on washing hands with soap and water during critically time is the best method for fighting childhood diarrhoea in Mwanza city. settlement, childhood diarrhoea, cross-sectional study BACKGROUND Diarrhoea is defined as the passage of three or more motions of loose or watery stool in 24 h [1]. Despite the reported 68% global reduction in number of deaths because of diarrhoea between 1990 and 2013 [2], diarrhoea has remained among the common causes of morbidity and mortality [3] in children in developing countries. Approximately 78% of all deaths occur in Africa and south-east Asia [4]. With regard to type settlements, studies have associated higher prevalence of childhood diarrhoea with unplanned settlements [5]. Globally, the use of unsafe domestic water is associated with diarrhoea [1], and studies have associated household sanitation and hygienic behaviours with diarrhoea in children worldwide [6, 7]. However, prevalence and factors associated with diarrhoea among children between 6 and 59 months of age in Mwanza city are not clearly known. This study intended to determine the prevalence and risk factors associated with diarrhoea among children between the ages of 6 and 59 months of age in Mwanza city, Tanzania. METHODOLOGY Study location This study was conducted within Mwanza city, Tanzania. The choice of Mwanza city was based on the fact that 70% of the settlements were unplanned [8] and was declared the cleanest city in Tanzania for 9 consecutive years. Research design The research used cross-sectional case control study and was preferred because it describes the distribution of variables and examines association among variables in a population-based sample [9]. Study population The targeted population was 80 945 children between 6 and 59 months of age resided within Mwanza city, Tanzania. Inclusion criteria Only children between 6 and 59 months of age who stayed in selected households for at least 6 months before the study were included. Exclusion criteria Severely ill children and children whom their parents refused to consent for the study were excluded. Sample size estimation and sampling procedure A sample size of 398 participants was obtained by using the following formula [10]. n =N1+N(e)2. To increase the validity of the study as well as the ratio of 1:3, 82 participants were added making 480. A ratio of 1:3 was used because nearly 75% of Mwanza city population stays in unplanned settlements [8]. Sampling method and procedure A purposive sampling method was used to identify wards with unplanned and planned settlements. In total, 10 of 21 wards composing Mwanza city were purposively selected. Purposive sampling method was preferred because it allows the collection of focussed information [11]; therefore, it enabled the researcher to select wards with unplanned and planned settlements. The desired sample size (480 subjects) was proportionately divided to the selected wards. Thereafter, a modified systematic sampling technique was used to sample households in the selected wards. The modified systematic sampling method is a method in which the targeted population is divided by estimated sample size to achieve the sampling fraction, and in this study, a sampling fraction of 168 was obtained. The sampling fraction was used as an interval between one household and another during data collection process. Guided by sample fraction, wards were visited and households selected. Caregivers were asked similar questions on behalf of children until the required number of subjects per ward was obtained. If selected household had no an eligible child, the next was picked, and if had more than one eligible child, the youngest were picked. Data collection tools and techniques The study used closed-ended questionnaire. The selection of this tool was guided by the nature of data to be collected, availability of resources and objectives of the study. The overall objective of the study was to determine the prevalence and risk factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city. Variable and measurements Independent variables The household location was classified as unplanned or planned settlement. Intermediate variables Caregivers were asked if they had risk behaviours as well as presence of environmental risk factors, which contribute to diarrhoea in children like temporary or permanent house floor. Risk behaviours included washing hands with soap and water during critical time (i.e mother before preparing food, feeding the child, after toilet and the child washing hands with soap and water after toilet and before taking food). Temporary floor was an earthen floor, while permanent floor was a floor made of permanent floor materials like cement or tiles. Respondents were inquired if they boiled or used chemical (chlorine) to treat their drinking water before consumption as one way of rendering it free from diarrhoea causing organisms. Outcome variable The outcome variable was the presence of diarrhoea among children 6–59 months of age within 14 days before the study. This was evaluated by asking parent or guardian if the child involved in this study had suffered from diarrhoea within 14 days before the study. Data processing and analysis Two different people entered data into a computer using SPSS 21.0 version. The two entries were compared and disparities corrected. SPSS 21.0 version window software was used for all analysis. Descriptive statistics of social demographic characteristics was conducted. Pearson chi-square test was done for testing association between variables at p-values < 0.05. Then, stratification was done to evaluate potential confounders and interacting variables. Finally, multivariate analysis using a multiple logistic regression was performed to adjust for potential confounders, and a p-value of 0.05 was used for statistical significance. Ethical consideration An approval and informed consent forms were obtained from University of Dodoma on May 2016. An ethical clearance certificate was obtained from University of Dodoma on June 2016. Permission to enter the community was obtained from Mwanza regional commissioner and Mwanza city Director Offices. Before the survey, explanation of the study was made to respondents. The researcher guaranteed respondents confidentiality of information they provided. Verbal and written consents were obtained freely from respondents. Individual’s identification and information remained confidential throughout the study as well as in report writing. RESULTS Characteristics of sample The study sample comprised 480 (100%) children between 6 and 59 months of age, with the mean age of 2.88 ± 1.431. Majority (110; 22.9%) had an age between 6 and 11 months, while ages >24 months had 18.5% each as shown in Table 1. In total, 120 000 (25%) and 360 (75%) children resided in unplanned and planned settlement, respectively. Of 480 subjects, 254 (52.9%) were females and 226 (47.1%) were males. Table 1 General characteristics of the study population (N = 480) Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Table 1 General characteristics of the study population (N = 480) Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Prevalence of diarrhoea among children between 6 and 59 months of age in Mwanza city The overall prevalence of diarrhoea among children between 6 and 59 months of age in Mwanza city was 20.4%, being higher among females (56.1%) against 43.9% among males. Up to 29.5% of diarrhoea cases passed mucoid stool, 28.5% rice water stool, 19.3% of cases had stool with a normal colour, 18.3% greenish colour and 2.3% passed bloody stool. Nearly 10.6% of diarrhoea cases reported abdominal pain, and 16.3% of all cases had fever. Straining on defaecation and anal itching were reported by 4 and 4.4% cases, respectively. Analysis of factor contributing to diarrhoea among children 6–59 months of age in Mwanza city Table 2 showed the socio-demographic factors associated to childhood diarrhoea: unplanned settlement (p = 0.001), number of rooms (p = 0.01), temporary house floor (p = 0.006) and monthly income (p = 0.001). Chi-square test results in Table 3 also showed the behavioural factors significantly related with prevalence of diarrhoea in children between 6 and 59 months of age. This included clean surrounding (p = 0.017), hand wash before food preparation (p = 0.001), child’s hand wash before eating (p = 0.014), child’s hand wash with soap and water before eating (p = 0.001), hand wash before feeding her child (p = 0.0001), mother’s hand wash with soap and water after toilet visit (p = 0.004), child’s hand wash with soap and water after toilet visit (p = 0.016) and hand wash with soap and water after changing napkin, only cups for taking drinking water from its container (p = 0.008). Table 2 Socio-demographic factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Table 2 Socio-demographic factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Table 3 Behavioural factors related with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Table 3 Behavioural factors related with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Table 4 showed the results of multivariate logistic regression analysis, after controlling all the covariates. Unplanned settlement increases the odds of childhood diarrhoea. Hand wash before food preparation, mother’s hand wash with soap after toilet, child’s hand wash with soap after toilet and hand wash with soap after napkin change were found to decrease the odds of childhood diarrhoea. Table 4 Logistic regression of factors associated with childhood diarrhoea in Mwanza city, Tanzania Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Note: AOR: Adjusted Odds Ratio. Table 4 Logistic regression of factors associated with childhood diarrhoea in Mwanza city, Tanzania Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Note: AOR: Adjusted Odds Ratio. DISCUSSION The prevalence of diarrhoea in children between 6 and 59 months of age (20.4%) in Mwanza city supports the study done in India that reported a prevalence of diarrhoea among children aged <5 years of 21.7% [12]. However, the result of the current study is 8.4% higher than the national average [13]. Higher prevalence of diarrhoea in children in the current study may be because of the difference in study location of which all sample subjects (100%) were living urban area as compared with 64% in 2015 Demographic and Health Survey (DHS). Secondly, the difference may be because the current study excluded children between 0 and 5 months of age, which was included in 2015 DHS survey. Studies have reported the low incidence of diarrhoea among children 0 and 5 months age [14, 15]. Nevertheless, the current prevalence of childhood diarrhoea is lower than that which was reported in Mwanza hospital-based [16, 17]. This may be because of the reporting of only rotavirus-caused diarrhoea. With respect to the type of house floor, the chi-squire test results revealed an association between childhood diarrhoea in houses with the temporary floor. This supports a study that associated temporary house floors with a higher prevalence of diarrhoea in children [18]. High chance of childhood diarrhoea in houses with few rooms in Mwanza city which may be caused by overcrowding and this is in line with a study which associated overcrowding with a high prevalence of childhood diarrhoea [19]. Overcrowding is associated with poor environmental sanitation, which increases the possibility of contaminating water and food leading to diarrhoea. Higher prevalence of childhood diarrhoea in poor families concurs with a study that reported a higher prevalence of childhood diarrhoea in poor families living in developing countries [20]. In Mwanza city, poor families stays in unplanned settlement with shortage of essential infrastructure including improved sanitation facilities, which increase the risk of diarrhoea in children. Higher prevalence of diarrhoea in children between 6 and 35 months of age in the current study is in line with a study, which reported the odd of diarrhoea to be between 1.5 and 3.7 times higher among children between 7 and 36 months of age as compared with younger children in [18]. This may be because of the nutritional shift from breastfeed to other newly introduced baby feed introduced between 6 and 12 months old for many infants. Low prevalence of childhood diarrhoea among children whose household surroundings were clean is in line with a study done in Rwanda that associated higher prevalence of childhood with unclean household surroundings [21]. The low prevalence of childhood diarrhoea among children whose mothers washed hands before preparing food, feeding their children, after toilet as well as children who washed hands after eating is in line with other studies [22, 23]. Higher childhood diarrhoea in unplanned settlement is in line with a study done in Ethiopia [5]. Unplanned settlements are associated with poor sanitation and hygienic infrastructures like toilet facilities and shortage of water, and therefore, increase the chance of diarrhoea in children. Low prevalence of diarrhoea among children whose mothers washed hands during critical time, children who received recommended vaccination regularly as well as children who washed hands during critical time is in line with other studies that associated washing hands during critical time and under-five vaccinations with reduction of childhood diarrhoea [23]. The current study results ascertained that drinking raw water was protective against childhood diarrhoea in Mwanza city. This concurs with the June and July 2016 water test report of Mwanza Urban Water and Sewage. This is contrary to other studies that associated the use of raw water with higher prevalence of diarrhoea in children [24, 25]. Limitation of the study As city by-law punishes people with poor household sanitation, some families refused to consent for the study fearing punishment. Moreover, some families felt difficult to estimate their monthly average income. Recommendation for the future study Authors recommend that there is a need to compare Escherichia coli count between domestic water and main sources of water within Mwanza city. CONCLUSION Risk factors associated with childhood diarrhoea in Mwanza city are unplanned settlement and behaviour of mother and child washing hands during critical time. Therefore, continuous community health education and promotion insisting on washing hands with soap and water during critically time is the best method for fighting childhood diarrhoea in Mwanza city. FUNDING This work was supported by Northern Tanzania Union Conference of Seventh Day Adventist Church. REFERENCES 1 WHO ( 2017 ). Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ (July 2017, date last accessed). 2 Naghavi M , Wang H , Lozano R , et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 . Lancet 2015 ; 385 : 117 – 71 . http://dx.doi.org/10.1016/S0140-6736(14)61682-2 Google Scholar CrossRef Search ADS PubMed 3 Tate JE , Burton AH , Boschi-Pinto C , et al. Global, regional, and national estimates of rotavirus mortality in children< 5 years of age, 2000–2013 . Clin Infect Dis 2016 ; 62(Suppl 2) : S96 – 105 . 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Breastfeeding and the risk for diarrhea morbidity and mortality . BMC Public Health 2011 ; 11 : S15 . Google Scholar CrossRef Search ADS PubMed 15 Sizya S , Muula AS , Rudatsikira E. Correlates of diarrhoea among children below the age of 5 years in Sudan . Afr Health Sci 2013 ; 13 : 376 – 83 . Google Scholar PubMed 16 Hokororo A , Kidenya BR , Seni J , et al. Predominance of rotavirus G1 [P8] genotype among under-five children with gastroenteritis in Mwanza, Tanzania . J Trop Paediatr 2014 ; 60 : 393 – 6 . http://dx.doi.org/10.1093/tropej/fmu028 Google Scholar CrossRef Search ADS 17 Temu A , Kamugisha E , Mwizamholya DL , et al. Prevalence and factors associated with group a Rotavirus infection among children with acute diarrhoea in Mwanza, Tanzania . J Infect Dev Ctries 2011 ; 6 : 508 – 15 . 18 Bado AR , Susuman AS , Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990–2013): assessing the neighbourhood inequalities . 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BMC Public Health 2014 ; 14 : 395 . http://dx.doi.org/10.1186/1471-2458-14-395 Google Scholar CrossRef Search ADS PubMed 23 Khan MMH , Zanuzdana A , Burkart K , et al. Determinants of diarrhoea in ‘Urban’slums of dhaka and adjacent rural areas: a household‐level analysis . Popul Space Place 2014 ; 20 : 498 – 511 . Google Scholar CrossRef Search ADS 24 Shrestha S , Aihara Y , Yoden K , et al. Access to improved water and its relationship with diarrhoea in Kathmandu Valley, Nepal: a cross-sectional study . BMJ Open 2013 ; 3 : e002264 . Google Scholar CrossRef Search ADS PubMed 25 Tubatsi G , Bonyongo MC , Gondwe M. Water use practices, water quality, and households’ diarrheal encounters in communities along the Boro-Thamalakane-Boteti river system, Northern Botswana . J Health Popul Nutr 2015 ; 33 : 21 . Google Scholar CrossRef Search ADS PubMed © The Author(s) [2018]. Published by Oxford University Press. All rights reserved. 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Prevalence and Factors Associated with Diarrhoea among Children between 6 and 59 Months of Age in Mwanza City Tanzania

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Abstract

Abstract Background Childhood diarrhoea is a global public health problem especially in unplanned settlements of low- and middle-income countries. Different studies have associated household settlement and childhood diarrhoea, but the prevalence and risk factors associated with childhood diarrhoea at the community level are not clearly known. Method A community-based cross-sectional study was performed to determine the prevalence and risk factors associated with diarrhoea in among 480 children between 6 and 59 months of age in Mwanza city from June to August 2016. Risk factors associated with childhood diarrhoea in Mwanza city were determined using univariate, bivariate and multivariate analysis. Results The study showed a prevalence of diarrhoea of 20.4% and an association between type of settlement and childhood diarrhoea (p < 0.001) in a chi-square analysis. During bivariate analysis, and logistic regression, after controlling for other factors, unplanned settlement was significantly associated with childhood diarrhoea (odds ratio=3.475, p < 0.001 and AOR=3.469, p < 0.001). Other factors associated with childhood diarrhoea were behaviour of mother washing hands before preparing food (AOR = 0, 193, p < 0.001), mother washing hands after changing child’s napkins (AOR = 0.544, p < 0.036) and the behaviour of the child washing hands after toilet (AOR = 0.447, p < 0.006). Conclusion Risk factors associated with childhood diarrhoea in Mwanza city are unplanned settlement and behaviour of mother and child washing hands during critical time; hence, continuous community health promotion insisting on washing hands with soap and water during critically time is the best method for fighting childhood diarrhoea in Mwanza city. settlement, childhood diarrhoea, cross-sectional study BACKGROUND Diarrhoea is defined as the passage of three or more motions of loose or watery stool in 24 h [1]. Despite the reported 68% global reduction in number of deaths because of diarrhoea between 1990 and 2013 [2], diarrhoea has remained among the common causes of morbidity and mortality [3] in children in developing countries. Approximately 78% of all deaths occur in Africa and south-east Asia [4]. With regard to type settlements, studies have associated higher prevalence of childhood diarrhoea with unplanned settlements [5]. Globally, the use of unsafe domestic water is associated with diarrhoea [1], and studies have associated household sanitation and hygienic behaviours with diarrhoea in children worldwide [6, 7]. However, prevalence and factors associated with diarrhoea among children between 6 and 59 months of age in Mwanza city are not clearly known. This study intended to determine the prevalence and risk factors associated with diarrhoea among children between the ages of 6 and 59 months of age in Mwanza city, Tanzania. METHODOLOGY Study location This study was conducted within Mwanza city, Tanzania. The choice of Mwanza city was based on the fact that 70% of the settlements were unplanned [8] and was declared the cleanest city in Tanzania for 9 consecutive years. Research design The research used cross-sectional case control study and was preferred because it describes the distribution of variables and examines association among variables in a population-based sample [9]. Study population The targeted population was 80 945 children between 6 and 59 months of age resided within Mwanza city, Tanzania. Inclusion criteria Only children between 6 and 59 months of age who stayed in selected households for at least 6 months before the study were included. Exclusion criteria Severely ill children and children whom their parents refused to consent for the study were excluded. Sample size estimation and sampling procedure A sample size of 398 participants was obtained by using the following formula [10]. n =N1+N(e)2. To increase the validity of the study as well as the ratio of 1:3, 82 participants were added making 480. A ratio of 1:3 was used because nearly 75% of Mwanza city population stays in unplanned settlements [8]. Sampling method and procedure A purposive sampling method was used to identify wards with unplanned and planned settlements. In total, 10 of 21 wards composing Mwanza city were purposively selected. Purposive sampling method was preferred because it allows the collection of focussed information [11]; therefore, it enabled the researcher to select wards with unplanned and planned settlements. The desired sample size (480 subjects) was proportionately divided to the selected wards. Thereafter, a modified systematic sampling technique was used to sample households in the selected wards. The modified systematic sampling method is a method in which the targeted population is divided by estimated sample size to achieve the sampling fraction, and in this study, a sampling fraction of 168 was obtained. The sampling fraction was used as an interval between one household and another during data collection process. Guided by sample fraction, wards were visited and households selected. Caregivers were asked similar questions on behalf of children until the required number of subjects per ward was obtained. If selected household had no an eligible child, the next was picked, and if had more than one eligible child, the youngest were picked. Data collection tools and techniques The study used closed-ended questionnaire. The selection of this tool was guided by the nature of data to be collected, availability of resources and objectives of the study. The overall objective of the study was to determine the prevalence and risk factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city. Variable and measurements Independent variables The household location was classified as unplanned or planned settlement. Intermediate variables Caregivers were asked if they had risk behaviours as well as presence of environmental risk factors, which contribute to diarrhoea in children like temporary or permanent house floor. Risk behaviours included washing hands with soap and water during critical time (i.e mother before preparing food, feeding the child, after toilet and the child washing hands with soap and water after toilet and before taking food). Temporary floor was an earthen floor, while permanent floor was a floor made of permanent floor materials like cement or tiles. Respondents were inquired if they boiled or used chemical (chlorine) to treat their drinking water before consumption as one way of rendering it free from diarrhoea causing organisms. Outcome variable The outcome variable was the presence of diarrhoea among children 6–59 months of age within 14 days before the study. This was evaluated by asking parent or guardian if the child involved in this study had suffered from diarrhoea within 14 days before the study. Data processing and analysis Two different people entered data into a computer using SPSS 21.0 version. The two entries were compared and disparities corrected. SPSS 21.0 version window software was used for all analysis. Descriptive statistics of social demographic characteristics was conducted. Pearson chi-square test was done for testing association between variables at p-values < 0.05. Then, stratification was done to evaluate potential confounders and interacting variables. Finally, multivariate analysis using a multiple logistic regression was performed to adjust for potential confounders, and a p-value of 0.05 was used for statistical significance. Ethical consideration An approval and informed consent forms were obtained from University of Dodoma on May 2016. An ethical clearance certificate was obtained from University of Dodoma on June 2016. Permission to enter the community was obtained from Mwanza regional commissioner and Mwanza city Director Offices. Before the survey, explanation of the study was made to respondents. The researcher guaranteed respondents confidentiality of information they provided. Verbal and written consents were obtained freely from respondents. Individual’s identification and information remained confidential throughout the study as well as in report writing. RESULTS Characteristics of sample The study sample comprised 480 (100%) children between 6 and 59 months of age, with the mean age of 2.88 ± 1.431. Majority (110; 22.9%) had an age between 6 and 11 months, while ages >24 months had 18.5% each as shown in Table 1. In total, 120 000 (25%) and 360 (75%) children resided in unplanned and planned settlement, respectively. Of 480 subjects, 254 (52.9%) were females and 226 (47.1%) were males. Table 1 General characteristics of the study population (N = 480) Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Table 1 General characteristics of the study population (N = 480) Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Variable Category N % Child age (months) 6–11 110 22.9 12–23 103 21.5 24–35 89 18.9 36–47 89 18.9 48–59 89 18.9 Child sex Female 254 52.9 Male 226 47.1 Child’s residence type Unplanned settlement 360 75 Planned settlement 120 25 Regular under-five vaccination Yes 367 76 No 113 24 Prevalence of diarrhoea among children between 6 and 59 months of age in Mwanza city The overall prevalence of diarrhoea among children between 6 and 59 months of age in Mwanza city was 20.4%, being higher among females (56.1%) against 43.9% among males. Up to 29.5% of diarrhoea cases passed mucoid stool, 28.5% rice water stool, 19.3% of cases had stool with a normal colour, 18.3% greenish colour and 2.3% passed bloody stool. Nearly 10.6% of diarrhoea cases reported abdominal pain, and 16.3% of all cases had fever. Straining on defaecation and anal itching were reported by 4 and 4.4% cases, respectively. Analysis of factor contributing to diarrhoea among children 6–59 months of age in Mwanza city Table 2 showed the socio-demographic factors associated to childhood diarrhoea: unplanned settlement (p = 0.001), number of rooms (p = 0.01), temporary house floor (p = 0.006) and monthly income (p = 0.001). Chi-square test results in Table 3 also showed the behavioural factors significantly related with prevalence of diarrhoea in children between 6 and 59 months of age. This included clean surrounding (p = 0.017), hand wash before food preparation (p = 0.001), child’s hand wash before eating (p = 0.014), child’s hand wash with soap and water before eating (p = 0.001), hand wash before feeding her child (p = 0.0001), mother’s hand wash with soap and water after toilet visit (p = 0.004), child’s hand wash with soap and water after toilet visit (p = 0.016) and hand wash with soap and water after changing napkin, only cups for taking drinking water from its container (p = 0.008). Table 2 Socio-demographic factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Table 2 Socio-demographic factors associated with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Unplanned settlement 28.73 0.001 Yes 45 37.5 75 62.5 No 53 14.7 307 85.3 ≤3 rooms 6.71 0.010 Yes 80 23.5 261 76.5 No 18 12.9 121 87.1 Temporary house floor 7.63 0.006 Yes 61 25.5 178 74.5 No 37 15.5 204 84.6 Monthly income <TSh 171 000 (77USD) 12.59 0.001 Yes 58 27.9 150 72.1 No 40 14.7 232 85.3 Table 3 Behavioural factors related with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Table 3 Behavioural factors related with diarrhoea in children between 6 and 59 months of age in Mwanza city, Tanzania (χ2)/N = 480 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Variables Category Diarrhoea cases Yes Diarrhoea cases No χ2 p-value N % N % Clean surroundings 5.71 0.017 Yes 84 19.1 356 80.9 No 14 35 26 65 Washing hands before preparing food 45.38 0.001 Yes 73 16.6 366 83.4 No 25 61 16 39 Child washing hands before eating food 6.09 0.014 Yes 72 23.9 229 76.1 No 26 14.5 153 85.5 Child washing hands with soap and water before eating 10.14 0.001 Yes 22 12.6 152 87.4 No 76 24.8 230 75.2 Washing hands with soap and water before feeding her child 20.46 0.001 Yes 26 11.6 199 88.4 No 72 28.2 183 71.8 Mother washing hands with soap and water after toilet 8.20 0.004 Yes 70 17.9 321 82.1 No 28 31.5 61 68.5 Child washing hands with soap and water after toilet 5.83 0.016 Yes 27 14.8 156 85.2 No 71 23.9 226 71.6 Wash hands with soap and water after changing child’s napkins 7.50 0.006 Yes 26 14.1 159 85.9 No 72 24.4 223 75.6 Only cups for taking drinking water from its container 6.98 0.008 Yes 71 18.1 321 81.9 No 27 30.7 61 69.3 Table 4 showed the results of multivariate logistic regression analysis, after controlling all the covariates. Unplanned settlement increases the odds of childhood diarrhoea. Hand wash before food preparation, mother’s hand wash with soap after toilet, child’s hand wash with soap after toilet and hand wash with soap after napkin change were found to decrease the odds of childhood diarrhoea. Table 4 Logistic regression of factors associated with childhood diarrhoea in Mwanza city, Tanzania Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Note: AOR: Adjusted Odds Ratio. Table 4 Logistic regression of factors associated with childhood diarrhoea in Mwanza city, Tanzania Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Variable Category OR 95% confidence interval (CI) for OR p-value AOR 95% CI for AOR p-value Lower Upper Lower Upper Unplanned settlement Yes 3.475 2.171 5.565 0.001 3.467 2.032 5.922 0.001 No reference Temporary house floor Yes 0.529 0.336 0.834 0.006 0.644 0.384 1.082 0.096 No reference Monthly income ≤170, 000(77USD) Yes 0.446 0.284 0.701 0.001 0.629 0.370 1.068 0.086 No reference Clean house surroundings Yes 0.438 0.219 0.875 0.019 0.951 0.410 2.202 0.907 No reference Age between 24 and 35 months Yes 0.590 0.353 0.986 0.044 0.757 0.415 1.381 0.364 No reference Washing hands before preparation of food Yes 0.128 0.065 0.25age1 0.001 0.193 0.090 0.413 0.001 No reference Washing hands with soap before eating Yes 0.438 0.261 0.734 0.002 0.637 0.342 1.186 0.155 No reference Mother wash hands with soap after toilet Yes 0.475 0.283 0.796 0.005 0.544 0.308 0.960 0.036 No reference Child washing hands with soap after toilet Yes 0.551 0.338 0.897 0.017 0.419 0.232 0.758 0.004 No reference Washing hands with soap after changing napkins Yes 0.506 0.310 0.289 0.007 0.447 0.253 0.791 0.006 No reference Only one cup Yes 0.500 0.297 0.841 0.009 0.963 0.509 1.821 0.908 No reference Regular vaccination Yes 0.271 0.163 0.451 0.001 0.271 0.163 0.451 0.001 No reference Note: AOR: Adjusted Odds Ratio. DISCUSSION The prevalence of diarrhoea in children between 6 and 59 months of age (20.4%) in Mwanza city supports the study done in India that reported a prevalence of diarrhoea among children aged <5 years of 21.7% [12]. However, the result of the current study is 8.4% higher than the national average [13]. Higher prevalence of diarrhoea in children in the current study may be because of the difference in study location of which all sample subjects (100%) were living urban area as compared with 64% in 2015 Demographic and Health Survey (DHS). Secondly, the difference may be because the current study excluded children between 0 and 5 months of age, which was included in 2015 DHS survey. Studies have reported the low incidence of diarrhoea among children 0 and 5 months age [14, 15]. Nevertheless, the current prevalence of childhood diarrhoea is lower than that which was reported in Mwanza hospital-based [16, 17]. This may be because of the reporting of only rotavirus-caused diarrhoea. With respect to the type of house floor, the chi-squire test results revealed an association between childhood diarrhoea in houses with the temporary floor. This supports a study that associated temporary house floors with a higher prevalence of diarrhoea in children [18]. High chance of childhood diarrhoea in houses with few rooms in Mwanza city which may be caused by overcrowding and this is in line with a study which associated overcrowding with a high prevalence of childhood diarrhoea [19]. Overcrowding is associated with poor environmental sanitation, which increases the possibility of contaminating water and food leading to diarrhoea. Higher prevalence of childhood diarrhoea in poor families concurs with a study that reported a higher prevalence of childhood diarrhoea in poor families living in developing countries [20]. In Mwanza city, poor families stays in unplanned settlement with shortage of essential infrastructure including improved sanitation facilities, which increase the risk of diarrhoea in children. Higher prevalence of diarrhoea in children between 6 and 35 months of age in the current study is in line with a study, which reported the odd of diarrhoea to be between 1.5 and 3.7 times higher among children between 7 and 36 months of age as compared with younger children in [18]. This may be because of the nutritional shift from breastfeed to other newly introduced baby feed introduced between 6 and 12 months old for many infants. Low prevalence of childhood diarrhoea among children whose household surroundings were clean is in line with a study done in Rwanda that associated higher prevalence of childhood with unclean household surroundings [21]. The low prevalence of childhood diarrhoea among children whose mothers washed hands before preparing food, feeding their children, after toilet as well as children who washed hands after eating is in line with other studies [22, 23]. Higher childhood diarrhoea in unplanned settlement is in line with a study done in Ethiopia [5]. Unplanned settlements are associated with poor sanitation and hygienic infrastructures like toilet facilities and shortage of water, and therefore, increase the chance of diarrhoea in children. Low prevalence of diarrhoea among children whose mothers washed hands during critical time, children who received recommended vaccination regularly as well as children who washed hands during critical time is in line with other studies that associated washing hands during critical time and under-five vaccinations with reduction of childhood diarrhoea [23]. The current study results ascertained that drinking raw water was protective against childhood diarrhoea in Mwanza city. This concurs with the June and July 2016 water test report of Mwanza Urban Water and Sewage. This is contrary to other studies that associated the use of raw water with higher prevalence of diarrhoea in children [24, 25]. Limitation of the study As city by-law punishes people with poor household sanitation, some families refused to consent for the study fearing punishment. Moreover, some families felt difficult to estimate their monthly average income. Recommendation for the future study Authors recommend that there is a need to compare Escherichia coli count between domestic water and main sources of water within Mwanza city. CONCLUSION Risk factors associated with childhood diarrhoea in Mwanza city are unplanned settlement and behaviour of mother and child washing hands during critical time. Therefore, continuous community health education and promotion insisting on washing hands with soap and water during critically time is the best method for fighting childhood diarrhoea in Mwanza city. FUNDING This work was supported by Northern Tanzania Union Conference of Seventh Day Adventist Church. REFERENCES 1 WHO ( 2017 ). Diarrhoeal Disease. http://www.who.int/mediacentre/factsheets/fs330/en/ (July 2017, date last accessed). 2 Naghavi M , Wang H , Lozano R , et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 . Lancet 2015 ; 385 : 117 – 71 . http://dx.doi.org/10.1016/S0140-6736(14)61682-2 Google Scholar CrossRef Search ADS PubMed 3 Tate JE , Burton AH , Boschi-Pinto C , et al. Global, regional, and national estimates of rotavirus mortality in children< 5 years of age, 2000–2013 . Clin Infect Dis 2016 ; 62(Suppl 2) : S96 – 105 . 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Journal of Tropical PediatricsOxford University Press

Published: Jan 12, 2018

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