DIARREAL DESEASE AMONG UNDER FIVE CHILDREN AND ITS

DISTAL AND PROXIMAL DETERMINANTS IN CASE OF RUMAYTO

KEBELE AYSAITA AFAR ETHIOPIA

DEPARTMENT OF PUBLIC HEALTH MPH IN NUTRITION FUNDAMENTAL INDIVIDUAL

ASSIGNMENT

BY:-
EBRAHIM
 DIARREAL DESEASE AMONG UNDER FIVE CHILDREN AND ITS
DISTAL AND PROXIMAL DETERMINANTS IN CASE OF RUMAYTO
KEBELE AYSAITA AFAR ETHIOPIA

By

Ebrahim Ahmed, January 2020

Submited to Etsey……. (MPH)

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Table of Contents
INTRODUCTION.................................................................................................................................................3
Genetic and Biological factors...........................................................................................................................4
Behavioral and attitudinal Factors....................................................................................................................4
Physical factor...................................................................................................................................................5
Social determinant............................................................................................................................................5
Health Service Factors.......................................................................................................................................5
REFERENCES......................................................................................................................................................7

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INTRODUCTION
It is over 150 years since John Snow closed the Broad Street pump after a cholera outbreak and
thereby initiated the debate on diarrheal disease risk factors and their elimination. Diarrhea is a
major health problem. Diarrheal diseases are food and water borne illnesses of the gastrointestinal
(GI) tract caused by harmful bacteria, parasites, viruses, or chemicals with common symptoms such
as vomiting, diarrhea, abdominal pain, fever, and chills (NIH, 2012). In fact the diseases are
characterized by intestinal disorder with abnormal fluidity and frequency of fecal evacuations
(Afroza et al., 2013).The infectious agents associated with diarrheal diseases are transmitted chiefly
through the fecal- oral route (Shivali et al., 2015). Diarrheal infection spreads through
contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. There
are three clinical types of diarrhea: acute watery diarrhea – lasts several hours or days, and includes
cholera; acute bloody diarrhea – also called dysentery; and persistent diarrhea that – lasts 14 days or
longer. According to the World Health Organization (WHO, 2010), there were about two billion
cases of diarrheal disease worldwide , every year, of which 1.9 million children younger than 5
years of age die from the infection. This amounts to 18% of all the deaths of children under the age
of five and means that more than 5000 children are dying every day which is the second leading
cause of death of the age group. According to Farthing (2012), 78% of child death occurs in African
and South-East Asian regions (Farthing, 2012).
Diarrheal disease is a serious public health problem among children in Ethiopia. In Ethiopia, during
2011,
About 13% of children less than five years of age had diarrhea [4]. In the country, 24–30% of all
infant deaths were due to diarrhea [5]. A multiregional baseline household health status survey
indicated that the two week prevalence of any diarrhea among children aged 0–23 months was
reported to be 22% [6]. As a part of the country, Afar region is one of the poorest, least developed
and under-serviced regions of Ethiopia where the highest child mortality rate is reported. Rural
communities of the region are suffering from shortage of water, hygiene and sanitation facilities.
The main sources of water for the community are rivers, streams, ponds, and wells. During 2015,
safe water and sanitation coverage of the district was 35% and 12%, respectively [7].

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Genetic and Biological factors
Several host factors are associated with increased incidence, severity, or duration of diarrhea. They
include
• Malnutrition: the severity and duration is increased in under nourished children, especially those
with severe malnutrition.
• Failure to get children immunized for measles: - diarrhea and dysentery are most frequent or
severe in children with measles or who have had measles
In the previous four weeks. This presumably results from immunological
Impairment caused by measles. Its association with diarrhea accounted for one third
Or more of diarrhea related deaths in young children. Measles predisposes to diarrhea by:
a. Direct effect of the virus on the intestinal epithelium
b. Inducing immune suppression
• Immunodeficiency or immune suppression: - This may be temporary, due to certain viral
infections (e.g. measles) or it may be prolonged, as in persons with the acquired Immunodeficiency
syndrome (AIDS). When immunosuppression is severe, diarrhea can be caused by unusual
pathogens and may also be prolonged.
• AGE - Most diarrheal episodes occur during the first two years of life. Incidence is highest in the
age group 6-11 months, when weaning often occurs. This Pattern reflects the combined effects of
declining levels of antibodies Acquired from the mother, lack of active immunity in the infant,
introduction of Food that may be contaminated with fecal bacteria and direct contact with 26 human
or animal feces when the infant starts to crawl.
Most enteric pathogens Stimulate at least partial immunity against repeated infection or illness,
which Helps to explain the declining incidence of disease in older children and adults.

Behavioral and attitudinal Factors

Individual behavior also plays a role in diarrheal disease. A number of specific behavior help
enteric pathogens to spread and thus increase the risk of diarrhea. Poor weaning practice (abrupt
and/or early weaning with dilute and dirty formula)
• Storing cooked food at room temperature and using them without heating adequately. When food
is cooked and then stored to be used later, it may be easily contaminated, for example, by contact

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with contaminated surface, or Container if not covered, or when a contaminated hand comes in to
contact with water being used for drinking or food preparation in the kitchen.
• Failing to wash hands after defecation, after handling feces or before handling food.

Physical factor
Lack of safe and clean water for human consumption, poor road infrastructure and inaccessibility
and remote areas coupled with the mobility nature of the pastoral community may increase to
infection. Diarrhea is caused by different germs that get in to our body through food or drink that is
not hygienically handled. Unhygienic practices like not hand washing before eating and after
visiting a toilet, not keeping food hygiene, not collecting, storing and using drinking water
hygienically, not disposing human waste including that of children's properly and not keeping
environmental hygiene.

Social determinant
Many disease causing organisms arise from the human environment. The immediate human
environment his house and its surrounding. Over 85% of the Ethiopian Population lives in the rural
areas. Most of the rural people are farmers. By and large the society has animals or chicken that they
raise and live with. Such animals produce Waste matters, which may contribute to human
infections. Waste materials such as animal dung, animal’s urine, solid waste, open defecation in the
compound are causes of the propagation of diarrhea and other infectious diseases. Poverty and poor
living conditions Overcrowding (internally displaced people, refuge, camps, population gathering)
also play risk factor of diarrheal disease.

Health Service Factors

Health service has also play a role for the spread of diarrheal disease, some of them are listed

 Lack of isolate cases from other cases and severe cases from non-severe cases. Contain all
excreta (feces and vomit).

 Shortage of caretaker per patient is allowed.

 Inappropriately Wash hands with soap and water.

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  Unable to disinfect when leaving the center.

 Unable to disinfect clothes of infected people before leaving the center.

 Poor hygienic and with private toilets and bathing areas for patients and caretakers.

 If patients arrive by public transport, the vehicle should not be disinfected.

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REFERENCES
1. Salami LI. Factors influencing breastfeeding practices in Edo state, Nigeria.Afr J Food Agric
Nutr Dev. 2006; 6(2):1–12.
2. Quinn VJ, Guyon AB, Schubert JW, Stone-Jiménez M, Hainsworth MD, Martin LH. Improving
breastfeeding practices on a broad scale at the community level: success stories from Africa and
Latin America. J Hum Lact. 2005; 21(3): 345–54.
3. Liu L, Johnson HL, Cousens S, Perini J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li
M. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010
with time trends since 2000. Lancet. 2012; 379(9832):2151–61.
4 Ghwass MMA, Ahmed D. Prevalence and predictors of 6-month exclusive breastfeeding in a rural
area in Egypt. Breastfeed Med. 2011; 6(4):191–6.
5 Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, Kirkwood B, Mohan SB, Mazumder S,
Bhutta Z, Raza F. Childhood diarrhoeal deaths in seven low-and middle-income countries. Bull
World Health Organ. 2014; 92(9):664–71.
6 Egata G, Berhane Y, Worku A. Predictors of non-exclusive breastfeeding at 6 months among rural
mothers in east Ethiopia: a community-based analytical cross-sectional study. Int Breastfeed J.
2013; 8:8.
7Sonko A, Worku A. Prevalence and predictors of exclusive breastfeeding for the first six months
of life among women in Halaba special woreda, Southern Nations, Nationalities and Peoples’
Region/SNNPR/, Ethiopia: a community based cross-sectional study. Arch Public Health. 2015;
73(1):53–64.