Gupta A1
1Dr Anil Gupta, Reader, Department of Physiology and Biochemistry,
Eklavya Dental College & Hospital, Kotputli, Rajasthan.
Address for
correspondence: Dr Anil Gupta, Email:
anilfzk2323@yahoo.com
Abstract
Introduction:
Diarrhea is the leading cause of malnutrition in children below the age
of five. Materials and
Methods: Present work consisted of total 440 children,
selected by random multi-stage sampling method, based on sample
selection criteria, executed in city, Fazilka, Punjab. Results and Discussion:
The study showed overall prevalence of (5.5%, 24/440 ) diarrhea in
whole study participants and high prevalence of (41%, 24/58)
diarrhea in children, who had acute malnutrition (wasting)
and it was accompanied by highly significant (p<0.001),
association between diarrhea and wasting in children. The prevalence of
diarrhoea was found to be associated with age (p<0.001), showed
high prevalence (12%) in lower age group (2y-3y) in comparison to its
low prevalence (2.7%) in higher age group (>3y-4y). Males
children had less prevalence (5.4%) of diarrhea as compared with female
children (5.5%), not statistically significant (p=0.5). Conclusion: Diarrhea
is invariably linked with age and acute malnutrition in children.
Key words:
Acute malnutrition, Diarrhoea, Wasting.
Manuscript received:
22nd Apr 2014, Reviewed:
25th Apr 2014
Author Corrected:
23rd May 2014, Accepted
for Publication: 23rd June 2014
Introduction
Chronic diarrhea is prevalent in developing countries. It persists for
more than two weeks and is also called persistant diarrhea. It is
common in children in two to three year age group. It results into
delayed healing of mucosa and decreased absorptive capability of
intestine [1]. According to WHO report, diarrhea is the second foremost
cause of death in children. Generally, diarrhea lasts for one week, but
its continuity beyond 14 days, has dire consequences on the body of
children. It drains water and minerals from body, resulting into
dehydration. Children, who are malnourished and have compromised body
immunity, are highly vulnerable to persistant diarrhea [2].
Lack of proper sanitization, unsafe drinking water and infections are
common causative factors for diarrhea in developing countries. In
chronic diarrhea, the children suffer from repeated attacks of watery
stools that deprive their body of necessary minerals and water content.
Therefore, diarrhoea is the principal cause of malnutrition, and
malnourished children are more vulnerable to diarrhoea. The aim of
present study was to describe the prevalence of diarrhea in children
below the age of five years and its association with factors like
wasting, age and gender in children in city, Fazilka in Punjab.
Materials
& Methods
1. Research Design
Observational, Descriptive and Cross-sectional research study was
undertaken.
2. Sampling Design
Study Area
Study was conducted in the city of Fazilka, Punjab. It is a city on
Indo-Pak border in Punjab. As per census report of 2001, Fazilka has a
population of 67,424, comprising 52% males and 48% females. In Fazilka,
13% of the population is under 6 years of age.
Sample Source and
Sampling Units
Children below the age of five years, residing in and around Fazilka,
Punjab, according to the inclusion and exclusion criteria, constituted
the sample source and sampling units.
3. Participant Selection
Criteria
Inclusion Criteria
1. Children between 2 years to below the age of five years.
2. All the children who were physically and mentally healthy.
Exclusion Criteria
1. Children who were critically ill.
2. The children who were crying and agitated, did not cooperate in
anthropometric measurement procedure.
4. Sampling Methods
Random, Multi-stage sampling technique was adopted.
In the first stage, the city was divided into three strata as:
Elementary schools, Anganwadi (child care centres), Slum Areas.
In the second stage, schools, anganwadi and slum areas were selected
randomly from the sample frame.
In the third stage, all the children between two years to below five
years of age, were selected as per the above stated selection criteria.
5. Data Collection
Instruments
Observation schedules and interview schedules were employed for
demographic and anthropometric parameters.
6. Data Collection Methods
1. Observation: This method was used to assess general behavior of
children.
2. Interview: This method was adopted to collect data about frequency
of stool passing and other additional information on physical symptoms
of children from the attendants.
3. Anthropometric parameters: The Weight and Height were measured by
Digital Weight measuring scale and two meters Tape.
7. Data Collection
Scales:
1. Data for the weight and height expressed in numerical values (n/N)
and percentage (n/N)%.
2.Two week time interval for diarrheal was considered. Those having had
an episode of diarrhoea, two weeks prior to time of interview
were labelled as (Y), otherwise (N).
8. Statistical Design
1. Weight and height of the participants were expressed in Z- score
classification, as recommended by WHO child growth standard, 2007.
2. The cut point of (-2SD), was used to compare the weight and height
of participants with that of median of reference population,
as follows:
Wasting as definied by WHO child growth standard
[3].
A. (WHZ), weight/height of participant below -2SD (moderate low wasting)
B. (WHZ), weight/height of participant below -3SD (severe low
wasting)
3. Bivariate analysis of categorical variables was done by
Fischer’s Exact Probability test.
4. p-value of ≤ 0.05 was implied as statistically significant.
Results
Table 1: Participants
distribution gender-wise and in different strata
|
Strata
|
Male
|
Female
|
Total participants
|
|
Frequency
|
(n%)
|
Frequency
|
(n%)
|
(n/N)
|
|
Schools
|
143/240
|
59%
|
97/240
|
41%
|
240/440
|
|
Anganwadi(child care centre)
|
78/127
|
61%
|
49/127
|
39%
|
127/440
|
|
Slum residents
|
39/73
|
53%
|
34/73
|
47%
|
73/440
|
Tables 1, showed overall distribution, 240/440, 127/440 and 73/440 of
study participants in different strata as in Schools,
Anganwadi and Slum areas and distribution of study
participants as males in schools, anganwadi and slum areas, 59%
(143/240), 61% (78/127) and 53% (39/73) respectively. The female
participants were 41% (97/240), 39% (49/127), 47% (34/73).
Table 2. Age-wise
distribution of participants
|
Age Group
|
Schools
|
Anganwadi(child care centre)
|
Slum residents
|
|
Frequency
|
(n%)
|
Frequency
|
(n%)
|
Frequency
|
(n%)
|
|
2Y to 3Y
|
88/240
|
37%
|
42/127
|
33%
|
39/73
|
53%
|
|
>3Y to 4Y
|
80/240
|
33%
|
42/127
|
33%
|
24/73
|
33%
|
|
>4Y to <5Y
|
72/240
|
30%
|
43/127
|
34%
|
10/73
|
14%
|
Table 2, showed the age-wise distribution of children in
schools as 37%, 33%, 30% and 33%, 33%, 34% in anganwadi and 53%, 33%,
14% in slum areas in the age groups of
Table 3. Prevalence of Wasting
and Diarrhoea in children under age of five years
|
Strata
|
Normal children
|
Wasting in children
|
Diarrhoea in children
|
|
(n/N)
|
(n)%
|
(n/N)
|
(n)%
|
(n/N)
|
(n)%
|
|
Schools
|
213/240
|
89%
|
27/240
|
11%
|
10/27
|
37%
|
|
Anganwadi
|
107/127
|
85%
|
20/127
|
15%
|
6/20
|
30%
|
|
Slum residents
|
62/73
|
85%
|
11/73
|
15%
|
8/11
|
72%
|
Further, analysis of table 3, confirmed prevalence of (41%,
24/58) as a whole and segmental prevalence of (37%), (30%) and (72%)
diarrhoea in children, accompanied by (11%), (15%) and (15%) of wasting
in children.
Table 4. Prevalence of
Diarrhoea in different age groups and in male & female children
under age of five
|
Variables
|
Diarrhoea
|
Normal children
|
|
(n/N)
|
(n/N)%
|
(n/N)
|
(n/N)%
|
|
Age
|
2y-3y
|
20/169
|
12%
|
149/169
|
88%
|
|
>3y-4y
|
4/146
|
2.7%
|
142/146
|
97.3%
|
|
Gender
|
Males
|
14/260
|
5.4%
|
246/260
|
94.6%
|
|
Females
|
10/180
|
5.5%
|
170/180
|
94.5%
|
Table 4, showed the prevalence of (12%) diarrhea in age group (2y-3y),
higher in comparison to prevalence of (2.7%) diarrhea in age group
(>3y-4y) in children under age of five. Further, it showed the
prevalence of diarrhea (5.4%) in male and (5.5%) in female children.
Table 5. Showing
Fischer’s Exact Probability test between Diarrhea and Wasting
in children
|
|
Diarrhoea
|
Non-diarrhoea
|
P value
|
|
|
Wasting
|
24
|
34
|
P< 0.001
|
|
|
Normal
|
0
|
382
|
Table 6.
Showing Fischer’s Exact Probability test between Diarrhea and
Age of children
|
|
Diarrhoea
|
Non-diarrhoea
|
P value
|
|
|
2y - 3y
|
20
|
149
|
P= 0.001
|
|
|
>3y – 4y
|
4
|
142
|
Table 7. Showing Fischer’s Exact Probability test between
Diarrhea and Gender of children
|
|
Diarrhoea
|
Non-diarrhoea
|
P value
|
|
|
Male
|
14
|
246
|
P= 0.5
|
|
|
Female
|
10
|
170
|
Fischer’s Exact Probability test was conducted between
different categorical parameters. Tables 5, 6,and 7 displayed
highly significant, (P< 0.001) and (P= 0.001) association
between variables (Diarrhoea-Wasting) and ( Diarrhoea-Age). Further,
non-significant (P= 0.5) association between (Diarrhoea-Gender) was
noticed.
Discussion
Diarrhea is multifactorial disorder and the leading cause of death in
children in both developed and developing countries. In the present
study, it is evident that diarrhea has high overall prevalence of (41%)
in children suffering from wasting under age of five years. These
findings are supported by still higher prevalence of diarrhea
(56.6%-58.6%) in children in a study conducted by Joshi et al, [4] in
Bahraich district, Uttar Pradesh, India. Although, the prevalence of
diarrhea differs in both, present and earlier studies, Owing to
disparity in food availability, socio-economic status, time of data
collection, literacy rate etc. However, past study authenticates the
presence of high rate of occurrence of diarrhea in children with
wasting ( acute malnutrition). Actually, diarrhea and malnutrition,
both interplay viciously and undermine the health of children. Diarrhea
is decidedly, associated with wasting (acute malnutrition), as
indicated by (p<0.001), in present study. It is supported by
work of Siddique et al, [5]. A study in India among hospitalized
children also reported a high association of diarrhea with severe
stunting by Sachdev et al., [6]. Present finding are similar with
earlier study by Njuguna & Muruka [7], both the studies
indicate highly significant (p<0.001) association between
diarrhea and malnutrition.
The under taken study, further, proves that diarrhea is more
prevalent(12%) in lower age group (2y-3y) in contrast to prevalence
(2.7%) in the upper age group( >3y- 4y). Additionally, the
present work proves that diarrhea is very much associated with the age
group of children (p=0.001). These findings in present study are
substantiated by earlier work of Teklemariam et al,
[8] in south west Ethiopia and another study by Bhatnagar
& Dosaih [9], in Delhi slum areas. Both, present and previous
studies, indisputably describes the reciprocate relation between
prevalence of diarrhea and age group of children. The study at present,
describes that prevalence of diarrhea is not affected by gender of
children and it has no significant, (p=0.5) association with gender of
children. This study is proved by another work by Swierczewskia et al,
[10] in Kenya.
Conclusion
Diarrhea is a fatal disease, liable for childhood mortality and
morbidity. It poses great challenge at the hands of physicians to treat
diarrhea in age group, below five years, owing to multiplicity of
causes for diarrhea in (0-5y) age. Acute malnutrition
(wasting) is detrimental to physical and mental health of children
especially in tender age of under five years. Wasting is associated
with diarrhea. Further, age is another factor that is covariate with
prevalence of diarrhea. A decline in age group always increases
occurrence of diarrhoea in children.
Funding: Nil, Conflict of interest:
Nil
Permission from IRB:
Yes
References
1. Gibbons T, Fuchs GJ. Chronic enteropathy: clinical aspects. Nestle
Nutr workshop Ser Pediatr Program. 2007;59: 89-101. [PubMed]
2. World Health Organisation. 2014. Availablr at:
http://www.who.int/mediacentre/factsheets/fs330/en/
3. World Health Organisation. The WHO Child Growth Standards. 2014.
Available at: http://www.who.int/childgrowth/en/.
4. Joshi PC, Kaushal S, Aribam BS, Khattri P, D'Aoust O,
Singh M.M, Marx M, Guha-Sapir D. Recurrent floods and prevalence of
diarrhea among under five children: observations from Bahraich
district, Uttar Pradesh, India. Glob Health Action. 2011;
4:10.3402/gha.v4i0.6355.
5. Siddique AK, Baqui AH, Eusof A, Zaman K. 1988
floods in Bangladesh: pattern of illness and causes of death. J
Diarrhoeal Dis Res. 1991 Dec;9(4):310-4. [PubMed]
6. Sachdev HPS, Kumar S, Singh KK, Satyanarayana L, Puri
RK. Risk factors for fatal diarrhea in hospitalized children
in India. J Pediatr Gastr Nutr. 1991;12(1):76–81. [PubMed]
7. Njuguna J, Muruka C. Diarrhoea and Malnutrition among children in
Kenyen district: A correlational study. J Rural Trop Public Health.
2011; 10: 35 ‐ 38.
8. Teklemariam S, Getaneh T, Bekele F. Environmental determinants of
diarrheal morbidity in under-five children, Keffa-Sheka zone, south
west Ethiopia. Ethiopia Med J. 2000; 38(1):27–34. [PubMed]
9. Bhatnagar S, Dosaih U. Diarrheal disease morbidity in
children below 5 years in urban slums of Delhi. Indian J Med Res. 1986;
84:53–8. [PubMed]
10. Swierczewskia BE, Odundo EA, Koech MC, Ndonye JN, Kirera RK,
Odhiambo CP, Cheruiyot EK, Shaffer DN, Ombogo AN, Oaks EV.
Surveillance for enteric pathogens in a case-control study of acute
diarrhoea in Western Kenya. 2012. Kenyatta University, Kenya. Kenyatta
University, School of Health Sciences.
How to cite this article?
Gupta A. Prevalence of Diarrhoea and its association with Wasting, Age,
and Gender in Children below Five years of age. Int J Med Res Rev
2014;2(4):291- 295.doi:10.17511/ijmrr.2014.i04.04