IMPLEMENTATION STRATEGIES FOR THE GLOBAL ACTION PLAN FOR

DIARRHEA (GAPPD) AND DIARHEA REDUCTION AMONG CHILDREN BELOW

5YEARS IN UGANDA: A CASE OF WAKISO DISTRICT, UGANDA

PRESENTED BY

NANTEGE ROBINAH

FEBRUARY, 2024
 INTRODUCTION

Background of the Study

Despite all interventions, diarrheal diseases are still a public health problem leading to

childhood morbidity and mortality majorly in developing countries, mostly in South Asia and

sub-Saharan Africa (CDC, 2015). Diarrheal diseases account for 1.8 million deaths of children

below 5 years yearly globally, making it the second leading cause of death second to pneumonia

globally (WHO, 2017). According to Bui (2006), an estimated 2.5 million deaths occur each year

among children below 5years in developing countries and about 80% of these deaths occur due

to diarrhea in the first two years of life.

Globally, half of all deaths under 5 years of age took place in sub-Saharan Africa in 2017,

and another 30% in Southern Asia and in Sub-Saharan Africa, 1 in 13 (77 per 1000) children

died before their fifth birthday. In high-income countries, that number was 1 in 185 (5.4/1000)

(WHO, 2018). The number of deaths due to diarrhea is even higher than death due to diseases

like AIDS, malaria and measles. It is estimated that, three-quarters of diarrheal mortality are

concentrated in 15 high-burden countries, and among these 15 countries, 10 were from sub-

Saharan Africa; namely Angola, Burkina Faso, Democratic Republic of the Congo, Ethiopia,

Mali, Niger, Nigeria, Kenya Tanzania, and Uganda (Fischer et al., 2011).

The statistics on diarrhea prevalence and continued research triggered World Health

Organisation (WHO) and UNICEF to come up with global strategies to end preventable child

deaths from pneumonia and diarrhea by 2025. In 2013, the Integrated Global Action Plan for

Pneumonia and Diarrhea (GAPPD) was launched to reduce the massive burden of pneumonia

and diarrhea deaths among children. This was the first global framework to set national

pneumonia and diarrhea mortality targets ensuring that all countries have reduced child
pneumonia deaths to less than three for every 1,000 babies born and diarrhea deaths to less than

two for every 1,000 babies born by 2025.(WHO,2013). The global action plan was designed to

inform global and national programs and policies using a framework that targets to protect

children prevent disease and treat children who became sick. (WHO,2013)

As an implementation strategy for the GAPPD in Uganda, the government of Uganda

through the Ministry of health come out boldly in prioritizing disease prevention as opposed to

treatment of preventable diseases. Using GAPPD frame work to prevent and fight diarrhea in

children below 5years in Uganda, Ministry of health developed strategies like introduction of

Rotavirus on the immunization schedule, emphasizing breastfeeding, proper hygiene, good

nutrition in children, use of zinc and ORS in case of dehydration and increased awareness. This

was led by Uganda’s president who stressed that prevention is better than cure in all its health

campaigns (Nakibuuka/UNICEF, 2016).

In a study that was carried out by Every Breath Counts Coalition on GAPPD

implementation in 2019, it was revealed that in the eight years since the GAPPD was launched,

child pneumonia and diarrhea deaths have fallen by 27% to 1.2 million. Despite this progress,

pneumonia and diarrhea remain the largest killers of children beyond the neonatal period and

together are still responsible for 24% of all deaths among children under five (Greenslade.

L(2019). In Uganda, diarrhea remains among the five leading causes of under-five mortality,

contributing to more than 140,000 deaths every year. It accounts for 7.1% of under five children

mortality (UNICEF, 2018), indicating an increase in the trend from 1.84% to 7.1% in 2017.

According to the MDG report (2015), Uganda was ranked number 9 among these countries with

29,000 deaths due to diarrhea which confirmed the results from the demographic and Health

Survey (2011), conducted by Uganda Bureau of Statistics (UBOS) which indicated that 23% of
children under five years of age had diarrhea in Uganda. The prevalence was 20% in 2016

according UBOS. It’s due to this that the researcher intends to investigate why diarrhea

prevalence is still high in Uganda despite the implementation of the Global Action Plan for

Diarrhea among children below 5years in Uganda using Wakiso district as a case study.

Statement of the Problem

Diarrhea is the 2nd leading cause of death in children under 5 years after pneumonia

globally, leading to annual death of about 525,000 children. In developing countries, it’s

estimated that children under 5 years of age experience at least 3 episodes of diarrhea a year

leading to deprivation of necessary nutrients for growth, and a major cause for malnutrition

(Kumar & Borkar, 2018).

As a strategy of preventing and reducing child infant mortality due to diarrhea, the ministry of

health started the implementation of the Global action plan for the prevention and control of

diarrhea through the prevent, treat and protect strategy framework. Implementation has been

done through providing sanitation grant and support to NGOs for awareness creation,

breastfeeding campaigns, nutrition, Rotavirus immunization and hygiene and sanitation in the

community by the district and the town council,( District Health status report,2022). However,

the UNICEF report on implementation of GAPPD for 8years in Uganda still indicated that

diarrhea diseases still accounts for 6.4% of total deaths of children below five years (UNICEF,

2018) and the prevalence of diarrhea in Uganda has remained above 20% in the past 10 years

with 26% in 2006, 23% in 20ll and 20% in 2016 (UDHS 2016). This is also evident in the

Wakiso statistical report, (2020) which indicates that diarrhea is among the three killer diseases

in the district. It’s because of this that the researcher intends to carry out a study to find out why
Diarrheal diseases are still prevalent in the district despite the implementation of the Global

Action Plan for diarrhea in Uganda.

Research Questions

This research was guided by the following questions;

a) What’s the level of burden of diarrhea disease to children below 5years in Wakiso district

in Uganda?

b) What’s the status of the Global Action plan for diarrheal disease implementation in

Wakiso district in Uganda

c) What are the factors associated with the implementation of the Global Action Plan for

diarrhea in Wakiso District Uganda?

d) Is there an association between maternal social demographic factors, behavioral factors

and strategy level factors with the implementation of the Global action plan for diarrhea

among children below 5years in Wakiso district in Uganda?

Objective of the Study

General Objective of the Study

To carry out an analysis of the implementation of the Global Action Plan for diarrhea among

children below 5years in Wakiso district in Uganda.

Specific Objectives

e) To determine the level of burden of diarrhea to children below 5years in Wakiso district

in Uganda?
 f) To describe the status of the Global Action plan for diarrheal disease implementation in

in Wakiso district in Uganda

g) To describe the factors associated with the implementation of the Global Action Plan for

diarrhea in Wakiso District Uganda?

h) To establish whether there is an association between maternal social demographic factors,

behavioral factors and strategy level factors with the implementation of the Global action

plan for diarrhea among children below 5years in Wakiso district in Uganda?

Significance of the Study

Government/Ministry of Health

To identify gaps in the implementation of the Global action plan for diarrhea in the

district so as to guide the ministry in coming up with better policies that can reduce on the

burden of diarrhea disease among children.

To inform policy recommendations that can help lower diarrhea disease prevalence and

burden to children

Hospital Administration

To inform hospital administration about the prevalence of diarrhea disease among

children below 5years and the gaps in diarrhea prevention and management strategies so as to

reduce infant mortality due to diarrhea.

Scholars

To provide information to future researchers and academicians who want to pursue

research in the same area and also add to existing knowledge on diarrhea while stimulating new

areas of research through study findings and recommendation

Methodology

Study design

The study will use a descriptive cross-sectional study design employing the use of both

quantitative and qualitative study approaches.

Study population

The study will be conducted in, Wakiso district located in the central region of Uganda. It’s the

highest populated district of Uganda with a total of 3.5M people covering a total area of 2,807.75

square kilometers (UBOS, 2016). The district has two counties, , 1 municipality,6 town boards,

15sub-counties, 146 parishes and 704 villages.(Wakiso district profile,2022). The population is

engaged in various economic and social activities such as fishing, crop farming, animal

husbandry, petty trading, stone quarrying, brick making and sand mining. The other section of

the population is employed in schools, hospitals, factories, recreation centers, and hotel.

Sampling technique

The study will employ the use of random and purposive selection of participants to be included

in the sample size and in order to obtain the 95% confidence level; the sample size will be

calculated using the formula described by Cochran (Cochran, 1977) with a 5% level of precision.

No =Z2Pq

e2

Using the formulae, optimal sample size will be 384 people.

Data Collection Methods

Primary data will obtained directly from the mothers/ guardian of the children under 5 years in

Wakiso district using Questionnaire method for collection of quantitative data whereas key

informants’ interview will be used to collect qualitative data from respondents at the district,

town council, village level, village health teams and health personnel working within the district.

Data Analysis

Data collected will be sorted, edited, coded and entered on database using Statistical Package for

Social scientists (SPSS). The analysis of the data will be done at three levels, namely; Univariate

analysis, bivariate analysis and multivariate analysis.

Ethical Considerations

Research activities will be reviewed and approved by supervisors in Nkumba University after

getting approval from a Research Ethics Committee.

Each participant will be provided with a copy of a consent form. This will include all

implementers and caretakers of children below 5years.Verbal consent will also be sought from

illiterate caretakers.
References

WHO, UNICEF,(2013) End preventable deaths: Global Action plan for prevention and control of

Pneumonia and diarrhea

Bui Viet Hung.Most common causes and risk factors of children in northern Vietnam admitted in

Dong ann hospital Hanoi in northern Vietnam;2006

Entebbe statistical report;2014

Estimates generated by the WHO and maternal and child epidemiology estimation group

(MCEE);2018. Downloaded from http://data.unicef.org

Kumar, R., & Borkar, R. (2018). Magnitude and determinants of diarrhea among 0- 6 year ’ s

children : a cohort study from central India. International Journal of Community Medicine

and Public Health, 5(12), 5246–5252.

UNICEF.WHO, Worldbank, UN, DESA Population Division; Levels and trends in child

mortality report 2018. Estimates developed by the UN Inter-agency group for child

mortality estimation