DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20184798

Magnitude and determinants of diarrhea among 0-6 year’s children: a cohort study from central India

Rakesh Kumar, Rajnish Borkar

Abstract


Background: Inspite of efforts of all the stakeholders, diarrhea still remains a cause of significant morbidity and mortality in developing country like India.

Methods: A follow up study was done among 305 children of 0-6 year’s age to estimate the incidence and risk factors of diarrhea. Diarrhea was defined as more than 3 stools in one day that were more liquid than usual. At each monthly follow up enquiry was made about the occurrence of diarrhea, health seeking, infant feeding practices and dietary history etc. Cumulative incidence, attack rates and risk ratio was used to estimate the burden and risk factors of diarrhea.

Results: The number of diarrhea episodes per child per year was 0.65 (95% CI=0.62-0.67). The cumulative incidence of diarrhea among 0-6 years children was 485.7 per 1000 children per year (95% CI=430.8–540.9). In terms of attack rate, the diarrhea among 0-6 years children was 63.5 percent (95% CI=58.1–68.7). Age of child, birth weight, total duration of breastfeeding, anaemia and season were found to be significant risk factors of diarrhea.

Conclusions: Further substantial changes in diarrhea incidence will require action on multiple factors like improvement of birth weight of child by better maternal and child health (MCH) care, continued breastfeeding of child till two year of age, correction of anaemia and provision of safe water supply and sanitation during summer and raining season. 


Keywords


Diarrhea, Incidence, Risk factors, Cohort study

Full Text:

PDF

References


World Health Organization. (2018). Diarrheal disease. Available at: http://www.who.int/news-room/fact-sheets/detail/diarrheal-disease. Accessed 11 September 2018.

National Family Health Survey (NFHS 4), (2015-16). Available at: http://rchiips.org/NFHS/factsheet _NFHS-4.shtml Accessed on 11 September 2018.

GBD Diarrheal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrheal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17:909–48.

Garg BS, Nayar S. Doctors for the rural poor. World Health Forum. 1996;17:268-70.

Schmidt MK, Muslimatun S, West CE, Schultink W, Gross R, Hautvast JG. Nutritional status and linear growth of Indonesian infants in west java are determined more by prenatal environment than by postnatal factors. J Nutr. 2002;132(8):2202-7.

Park K. Park’s textbook of preventive and social medicine.24th ed. Jabalpur (India): Banarasidas bahnot; 2017.

Indian council of medical research. Nutrient requirement and recommended dietary allowances for Indians- A report of the expert group of the Indian Council Med Res: 2009.

World Health Organisation. Iron deficiency anaemia: Assessment, prevention and control A guide for programme managers. Geneva (Switzerland): World Health Organisation; 2001.

Jelliffe DB. The assessment of the nutritional status of the community. Geneva: World Health Organisation Monograph series, 1966.

WHO Anthro [computer program]. Version 3.01. Geneva (Switzerland): World Health Organization.

WHO AnthroPlus [computer program]. Version 1.0.3. Geneva (Switzerland): World Health Organization.

Venkateswarlu C, Reddy KK, Rao AP. Assessment of diarrhea among pre-school children. Anthropol 2004;6(2):97-100.

Jayalakshmy R, Roy G, Premarajan KC. Incidence and risk factors of acute diarrheal disease among under-five children in urban slums in Pondicherry z— One year follow-up study. Indian J Matern Child Health. 2011;13:1–11.

Gupta S, Gupta SK, Jamwal DS, Kumar D. Incidence of diarrhea among under-five children in a rural area of Jammu– A longitudinal study, Indian J Matern Child Health. 2011;13(2):1–6.

Reddaiah VP, Kapoor SK. Epidemiology of Diarrhea and its Implication for Providing Services. Indian J Pediatr. 1991;58:205-8.

Sengupta PG, Sircar BK, Mondal S, Gupta DN, Ghose S, De SP. Epidemiological profile of acute Diarrheal diseases of a cohort of rural under five children: A three years longitudiual observation. Indian J Public Health. 1997;41(3):79-81.

Anand K, Sundaram KR, Lobo J, Kapoor SK. Are diarrheal incidence and malnutrition related in under-five children? A longitudinal study in an area of poor sanitary conditions. Indian Pediatr. 1994;31(8):943-8.

Mihrete TM, Alemie GA, Teferra AS. Determinants of childhood diarrhea among underfive children in Benishangul Gumuz Regional State, North West Ethiopia. BMC Pediatr. 2014;14:102.

Walker F. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012;12:220.

Causes and Consequences of Intrauterine Growth Retardation, Proceedings of an IDECG Workshop, November 1996, Baton Rouge, USA, Supplement of the Eur J Clin Nutr. 1996: 100.

Lamberti L M, Walker C L F, Moiman A, Victora C and Black R E. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011;11(3):15.

Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr. 1997;66:464–77.

Macintosh N, Helm PJ, Smyth RL. Forfar & Arneil’s Textbook of Pediatrics. 6th ed. Edinburgh: Churchill Livingstone; 2003.

Isenbarger DW, Hien BT, Ha HT, Ha TT, Bodhidatta L, Pang LW, et al. Prospective study of the incidence of diarrhea and prevalence of bacterial pathogens in a cohort of Vietnamese children along the Red River. Epidemiol Infect. 2001;127:229-36.