CHAPTER ONE

INTRODUCTION

1.1 Background

Childhood diarrhea is defined as the passage of three or more loose or watery stools per 24 hours or an increase in stool frequency or liquidity that is considered abnormal by the mother (Tsinuel et al., 2003). Diarrheal disease is one of the most common problems affecting children across the world. Despite the remarkable progress in the reduction of under-five mortality, childhood diarrhea is still the leading cause of mortality and morbidity in this highly susceptible and vulnerable population (Bishop et al., 2011). Globally, diarrheal disease contributed to 15% of all under five deaths (approximately 2.5 million deaths each year), making diarrheal disease the second leading cause of death in the youngest members of the society (Bassani, 2010). Out of 1.5 million children killed by diarrhea by diarrhea disease, 80% were under two years old, experienced in average three episodes each year.

Developing countries or economically disadvantaged regions carried the highest burden of under-five mortality, with nearly four fifths of all under-five mortality occurring in sub-Saharan Africa and south Asia (WHO, 2017). In Africa, diarrhea due to infection is wide spread throughout the developing countries. In South East Asia and Africa, diarrhea is responsible for as much as 8.5% and 7.5% of all deaths respectively. In 1998, diarrhea was estimated to have killed 2.2 million people (WHO, 2000).

According to the World Health Organization (WHO) (2016), the under –five mortality rate in low-income countries was 73.1 deaths per 1000 live births, nearly 14 times the average rate in high-income countries (that is, 53 deaths per 1000 live births). In Ethiopia, diarrheal diseases are a major contributors to under-five mortality. According to the 2016 Ethiopia Demographic and Health Survey report, 12% of under-five children had a diarrheal episode in the 2 weeks before the survey.

More than half of under-five child deaths are attributed to diseases that are easily preventable and treatable through simple, cost effective, and affordable interventions. A study carried out in Yaoundé-Cameroon in 2002 by an interdisciplinary program shows that out of 3034 stool sample collected from children and examined at the epidemiology and Public laboratory of the Cameroon Pasteur Institute, about 60% were found to be infectious of pathogen virus, bacteria and parasites.

In Bolivia, diarrhea is the third leading cause of morbidity and mortality in children less than 5 years of age (Janya, 2003)). Diarrhea surveillance from national surveys for the country indicate an alarming rise in the diarrhea prevalence for this age group over time from 19.2% in 1998 to 31.3% in 2008.

Previous studies have identified risk factors for diarrhea such as younger age, (Boschi, 2005) male gender (Lomazzi, 2014), early weaning (Lawn, 2010), seasonal patterns (Liu, 2000), low maternal education ( Hogan et al., 2013), Lack of piped water supply (Kohl, 2011), Poor water storage practices (Bishop et al., 2011), younger maternal age (Pina, 2005), lack of hand washing with soap by caregiver (Pina, 2005), poor sanitation ( Hudson, 2011), visible feces in the yard (Boschi, 2005), indiscriminate disposal of child feces (Lawn, 2010), unsatisfactory garbage disposal (Black, 2010), shorter boiling time (Hudson, 2011), using water from cistern trunks (Hudson, 2011) and not treating water at home (Perin, 2000). In a recent multisite study it was found that the rotavirus was the most common cause of moderate to severe diarrhea in children aged 0-23 months of age, and shigellosis for the age group 24-59 months of age (Lawn, 2000).

Diarrheal can cause malnutrition, stunted growth and reduced well-being. It can affect the intellectual development, leading to significantly lower than average scores in intelligence tests in children aged less than 5 years and creates considerably demand for health services (Roy, 2011).

1.2 Statement of the problem

Diarrhea represents a significant burden on the health system, the house hold and nutritional status of children (Baharn, et al., 2001). Diarrhea is still a leading cause of deaths in children under five years old. It causes an annual mortality in 760 000 children (Gebru, 2014). Diarrhea has a short and long term effect on children, their families and the nation. It is a major cause of malnutrition, dehydration and even death in children under five years (Gebru, 2014). In addition diarrhea affects the physical and cognitive functioning of children under five years age (Guerral et al., 2000).

1.3 Rationale

This study will help to prevent, reduce the prevalence of diarrhea among children, as the population will be aware on the risk factors that leads to diarrhea in children. And it will also help to reduce the number of patients admitted in the hospital for diarrhea problems. It will also help the family members to reduce the cost they spent in treating their children and the indirect cost it causes from the mother’s absence of work and stay in the hospital for days caring for the sick child.

1.4 Research questions

• What is the prevalence of diarrhea in children less than 5 years of age?
• What are the factors that promotes diarrhea in children less than 5 years of age?

1.5 Objectives of the Study

1.5.1   General objective

The main objective of this study is to determine the prevalence and determinants of acute diarrhea among children under 5 years of age in Bokwoango community.

1.5.2 Specific objectives

1) To determine the prevalence of diarrhea in children less than 5 years of age.

2) To identify the factors that promotes diarrhea in children less than 5 years of age.