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10 11648 J SJPH 20130102 12
10 11648 J SJPH 20130102 12
Dept. of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
Dept. of Biochemistry and Molecular Biology, Jahangirnogor University, Savar, Dhaka, Bangladesh
Email address:
[email protected] (Sk. S. Rahman)
Abstract: Children under 5 years old are most vulnerable and high risk group who need special health care services. Because infectious diseases, diarrhea, malnutrition etc are very common in this group. This study was carried out among the
total of 400 children in Kushtia from January 2008 to December 2008 and observed the prevalence of diarrhoea among
them. A cross sectional survey was carried out to determine nutritional status of under-5years children by anthropometric
measurement, MUAC measurement and bio-chemical assessment. Anthropometric measurements were performed by standard methods National Centre for Health Statistics (NCHS) of the United States. Amongst all the children higher proportion
of children 47% were found to be malnourished (under weight) using W/A as indicator in the age range of 0-60 months.
Amongst all the subjects prevalence of wasting and stunting was 51% and 49% respectively. Age group 0-12 months
shows the highest prevalence of wasting, under weight and stunting. The prevalence of diarrhoea was found 44.5%. The
maximum prevalence (48.86%) and frequency (1.7) of diarrhoea was present in 12-24 months of age. Factors that influence
malnutrition and frequency of diarrhea were limited access to sanitation facilities, unhygienic water drinking and handling,
mothers education, misconception about food, infectious diseases and weaning practices. These results suggested that improving nutritional status of urban poor requires direct, focused and integrated strategies that are preferably community
based and involve the behavior modification by education in addition to providing comprehensive preventive and curative
health and nutritional services.
1. Introduction
Diarrhoea is one of the major factors that contribute significantly to high child morbidity and mortality in many
developing countries.[1] Among children under 5 years old,
about 17% of all deaths occur due to Diarrhoea.[2] Annually,
at least 1,500 million episodes of diarrhoea occur in this
group and about 4 million childrens death occur due to
diarrhoea.[3] Among the causative agents, the following
bacteria have been reported: enterotoxigenic Escherichia
coli (ETEC), Shigella, Salmonella, and Campylobacter.[4,5]
Among the viruses, rotavirus seems to be the most common.[6] In developing countries, diarrhoeal infections under
5 years child are generally associated with rotavirus often at
the time of weaning.[7] The infectious agents associated with
diarrhoeal disease are transmitted chiefly through the faecal-oral route.[8,2] Food contamination is one major route for
the transmission of enteropathogens, especially under the
hygienic conditions prevailing in a rural setting. Various
studies have reported that the source of enteropathogens was
either water or food.[9,10] For most people in developing
countries, the major source of food is cereals, and dairy
products are limited to a very small segment of affluent
groups. Presumably, the reports of food as the origin of
diarrhoea refer to cereal- based diets, since all the cases cited
came from developing countries.[11,12] Diarrhoea is an intestinal disorder characterized by abnormal fluidity and frequency of fecal evacuations, generally the result of increased
motility in the colon; may be an important symptom of such
underlying disorders as dysenteric diseases, lactose intolerance GI tumors and inflammatory bowel disease. Yet
17
16
% of children
14
12
10.5
10
11.75
10.25
9.75
8.75
9.25
8.75
8
6
6
4
2
0
0-12
13-24
25-36
37-48
49-60
Age in year
60
53 52 53
48 50
50
46
47 46
43 45 42
41
40
30
20
10
0
0-12
13-24
25-36
37-48
Age (m onth)
Stunted
Wasted
Underw eight
% of paremts
57
45
40
35
30
25
20
15
10
5
0
44
39.75
16.25
Primary
Level of education
Figure 3. Percent distribution of parents by educational status.
58
Afroza Khatun et al.: A cross sectional study on prevalence of diarrhoeal disease and nutritional
status among children under 5-years of age in Kushtia, Bangladesh
58.75
1.8
60
% of parent
Frequency
36
40
30
20
1.2
1.23
1
0.8
0.6
0.2
0
0
Sanitary
Kacha
0-12
others
51.75
48.25
50
38.25
30
20
10
0
Yes
25-36
37-48
49-60
3. Results
61.75
60
40
13-24
% of parent
1.3
1.17
0.4
5.25
10
No
Yes
Washing of hands
before cooking
No
Personal hygienity
74
80
1.46
1.4
50
70
1.7
1.6
70
This study was carried out among the total of 400 rural
and urban children (boys 209, girls 191) under five years old
in Kushtia district from January 2008 to December 2008 and
observed the prevalence of diarrhoea among them with
special reference to the socioeconomic status of parents.
Distribution of children by age, sex, family size, family
income, educational qualification of parents, and types of
house are being depicted in this phase.
Table 1 showed the distribution of children according to
age and sex, Childrens age was in a range of 0-60 months
with a mean of 31.12 months. Amongst 400 children, 52.25%
were male and 47.75% were female, highest number 27.50%
of children were in the age group 0-12 months. Percentage
of children in age group of 13-24, 25-36, 37-48 and 49-60
months were 22%, 18.50%, 18% and 14% respectively.
% of family
60
50
40
26
30
Total
Number
Age (month) Number
of male (%) of female (%) number
20
10
0
Tub w ell
Supply w ater
Others
48.86
% of children
48
68 (17.00)
42(10.50)
110(27.50)
13-24
47(11.75)
41(10.25)
88(22.00)
25-36
35(8.75)
39(9.75)
74(18.50)
37-48
35(8.75)
37(9.25)
72(18.00)
49-60
24(6.00)
32(8.00)
56(14.00)
Total
209(52.25)
191(47.75)
400(100.00)
31.12
45.94
46
44
0-12
Mean age
(month)
42.72
42
41.07
40
38
36
0-12
13-24
25-36
37-48
49-60
Wasted
Underweight
Age (months)
(-2SD
or below)
(-2SD
or below)
(-2SD or
below)
0-12
53
52
53
13-24
48
50
46
25-36
47
46
41
37-48
43
45
42
49-60
47
43
49
Total
49
51
47
No of parent
% of
Primary
176
44.00
Below S.S.C
159
39.75
Up to S.S.C
65
16.25
parent
No of parent
% of parent
Sanitary
235
58.75
Kacha
144
36.00
others
21
5.25
% of family
Tub well
296
74
Supply water
104
26
Others
Age
0-12
13-24
25-36
37-48
49-60
Total
No. of Children
Prevalence (%)
47
43
34
31
23
178
42.72
48.86
45.94
43.05
41.07
44.50
Table shows the distribution of parents by the type of latrines used. Most of the study subjects used the sanitary
latrines. That is 36.00% of had kaccha and 58.75% had
sanitary latrines.5.25% used others. Type of latrine Proportion stunted is in households using sanitary latrines. Chronic
malnourishment appears to be even higher in households
with no access to toilet facilities.
Table 5. Distribution of Mothers Based on Personal Hygienity
Personal hygienity
400
No of parent
Total
Number
of mothers
59
Yes
No
Yes
No
247
(61.75%)
153
(38.25%)
207
(51.75%)
193
(48.25%)
From the above table, it has been shown that most of the
mothers (61.75%) wash their hands before cooking and use
soap (51.75%) after coming from latrine. It has been also
shown that few mothers (38.25%) are not wash their hands
before cooking and use soap (48.25%) after coming from
latrine.
Age (months)
Frequency
0-12
1.17
13-24
1.70
25-36
1.46
37-48
1.30
49-60
1.23
4. Discussion
Mortality and morbidity are high under five years children.
About 12.5-15% of world population are in this age group.
In developing countries, 25-30% of mortality occurs in this
group.[19-24] Among the major life threatening infectious
diseases diarrhoea is one of the major preventable gastrointestinal health problem. Risk factors for diarrhoea
include malnutrition, poor gastrointestinal absorption, poor
personal hygiene, environmental sanitation problems, unhygienic food preparation, improper sewage disposal and
improper use of latrines, early discontinuation of breastfeeding, and unhygienic bottle-feeding.[25,26] Prevalence of
diarrhoea is quite alarming amongst our children who belong to low socioeconomic status. According to UNICEF
and the World Health Organization (WHO), diarrhoea kills
more children than any other illness more than AIDS,
60
Afroza Khatun et al.: A cross sectional study on prevalence of diarrhoeal disease and nutritional
status among children under 5-years of age in Kushtia, Bangladesh
5. Conclusions
In our study, the high prevalence of diarrhoea are suspected and reported in Kushtia district. So, the authors
recommend frequent nutritional survays and targeting persons are displaced to better understand the causes of diarrhea.
In addition to poverty alleviation, action must be addressed
to the underlying factors of food security, food safety, social
status, gender discrimination, womens education, housing,
adequate healthcare practice, supply of portable water and
sanitation.
Acknowledgement
The authors are thankful to the Dept. of Applied Nutrition
and Food Technology and to the participants of this study at
Kushtia who shared their valuable time to fill their oral
questionnaire and various types of anthropometric measurement.
References
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[4]
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[8]
K. E. Byers, R. L. Guerrant, B. M. Farr, Fecal-oral transmission, In: Thomas JC, Webber DJ editor(s). Epidemiologic
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