Factors associated with diarrheal morbidity among under-five children in Jigjiga town, Somali Regional State, eastern Ethiopia: A cross-sectional study

listen audio

Study Justification:
– The prevalence of under-five diarrhea in Somali Regional State, Ethiopia is one of the highest in the country.
– Understanding the factors associated with under-five diarrhea can help inform interventions and policies to reduce its prevalence.
– This study aimed to examine the multiple factors associated with under-five diarrhea in Jigjiga town, Somali Regional State, Ethiopia.
Highlights:
– The two-week prevalence of under-five diarrhea in Jigjiga town was 14.6%.
– Maternal educational level of primary school and above was found to be protective against childhood diarrhea.
– Unavailability of water and lack of hand washing facility were associated with diarrhea.
– Poor water supply, lack of hand washing facilities, and lack of formal maternal education were identified as factors contributing to under-five diarrhea in the study area.
– Improved access to water supply and environmental health intervention programs promoting good hygiene behavior could help alleviate the burden of childhood diarrhea.
Recommendations:
– Improve access to water supply in Jigjiga town.
– Implement environmental health intervention programs to promote good hygiene behavior.
– Focus on increasing maternal education, particularly at the primary school level and above.
Key Role Players:
– Local government authorities
– Health department officials
– Community leaders
– Non-governmental organizations (NGOs) working in the area
– Health professionals and educators
Cost Items for Planning Recommendations:
– Water infrastructure development and maintenance
– Hygiene promotion campaigns and materials
– Education programs for mothers and caregivers
– Training for health professionals and educators
– Monitoring and evaluation activities

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which allows for the examination of multiple factors associated with under-five diarrhea. The sample size was calculated based on a formula and a multistage sampling technique was used. The study also obtained ethical clearance and conducted face-to-face interviews. However, the study is limited by its cross-sectional design, which only provides a snapshot of the data at a specific point in time. To improve the strength of the evidence, a longitudinal study design could be considered to establish causal relationships between the factors and under-five diarrhea. Additionally, including a control group and conducting a randomized controlled trial could further strengthen the evidence.

Background: The prevalence of underfive diarrhea in Somali Regional State, Ethiopia is one of the highest in the country. This study attempted to examine the multiple factors associated with underfive diarrhea and how they might influence its prevalence in Jigjiga, Somali regional state, Ethiopia. Methods: A community based cross-sectional study was conducted from February 15 to 28, 2015. Multistage sampling technique was used to collect data from 492 mothers via household survey. A pre-tested, structured questionnaire was used to collect data through face-to-face interview. Ethical clearance was obtained before data collection. Stepwise multivariable logistic regression was used to calculate adjusted odds ratios. Results: The two weeks prevalence of under five diarrhea in Jigjiga town was 14.6%. Up on multivariable analysis, maternal educational level of primary school and above was found to be protective against childhood diarrhea [AOR: 0.227(0.100-0.517)] whereas, unavailability of water [AOR: 2.124(1.231-3.664)] and lack of hand washing facility [AOR: 1.846(1.013-3.362)] were associated with diarrhea. Conclusion: Poor water supply, lack of hand washing facilities and lack of formal maternal education were associated with underfive diarrhea in the study area. Improved access to water supply along with environmental health intervention programs designed to promote good hygiene behavior could be of paramount importance to alleviate burden of childhood diarrhea.

This study was a community based cross-sectional study conducted from February 15–28, 2015. Jigjiga is the capital town of Somali Regional State located in the eastern part of Ethiopia. The population of the town is estimated to be 159,300. The population is mainly of Somali extraction and most residents are Muslim. There is one referral and one zonal hospital, and two health centers in town. Sample size was computed based on single population proportion formula assuming 95% confidence interval, 5% margin of error, prevalence (P) of 19.5% (two weeks prevalence of diarrhea among children under age five in Somali Regional State, Ethiopia) [10], a design effect of 2 (since multistage cluster sampling was used) and a non-response rate of 10% which gave a final sample size of 530. A multistage sampling technique was used including Kebeles (administrative sub divisions of town) as first-stage units, and Ketenas (non-administrative sub divisions of kebeles) as second-stage units, and households as third-stage units. First, of the total 10 kebeles in the town, 5 kebeles were selected by lottery method. Then, ketenas were chosen from each of the 5 kebeles. The number of ketenas included was proportionally allocated to the size of the kebeles. Since the number of underfive children residing in the selected ketenas was not available, a census was conducted in all the selected ketenas to have a sampling frame. Based on this sampling frame obtained from the census, the final sample size of 530 was proportionally allocated among the ketenas. Systematic random sampling was used within each ketenas to select households for interview. In households with more than one under five index children or more than one mother or caregiver, lottery method was used to choose one. Two revisits to a household were made for respondents unavailable at the time of data collection. Inclusion criteria for the study participants were being an index underfive child, and a mother or care giver who is permanent resident of the town. The outcome variable was diarrhea and independent variables were composed of socio demographic variables, household and environmental, hygiene behavior and child feeding practices. A questionnaire adapted from World Health Organization (Core questions on drinking water and sanitation for household surveys) [14] composed of closed-ended questions was used in preparation of the instrument. The final questionnaire was translated to Somali language and back to English language to check for consistency. The questionnaire was pretested on 5% of the total sample size, i.e. 27 mothers of underfive children who resided in a Kebele outside the study area. Finally a pretested, structured questionnaire was used to conduct face-to-face interviews Additional file 1. Data collectors proficient in the local Somali language were trained by the researchers. On-field supervision of data collectors was carried out. Data was entered, cleaned and analyzed using Statistical Package for Social Sciences. Descriptive statistics was used to present results. Crude and adjusted odds ratio with 95% confidence interval were also calculated in univariate and multivariable logistic regressions. In order to identify independent factors associated with the outcome, variables significantly associated on univariate analysis at a cut off point p value 0.3 were put in to multivariable model for further analysis. Backward stepwise regression was implemented to identify final adjusted odds ratios of independent factors associated with diarrhea at a cut-off point p-value 0.05. All caregivers underwent informed consent for participation in the study. Ethical clearance was obtained from the Institutional Review Board of Jigjiga University, Directorate of Research, Publication and Technology Transfer.

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that travel to remote areas, including Jigjiga town, to provide maternal health services such as prenatal care, vaccinations, and education.

2. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and support to mothers and caregivers in their own communities.

3. Telemedicine: Introducing telemedicine services that allow mothers and caregivers in Jigjiga town to consult with healthcare professionals remotely, reducing the need for travel and improving access to medical advice and support.

4. Water and sanitation infrastructure: Investing in improved water supply systems and sanitation facilities in Jigjiga town to ensure clean water and proper hygiene practices, which can help prevent diarrheal diseases and improve overall maternal and child health.

5. Maternal education programs: Implementing programs that focus on improving maternal education levels, particularly targeting primary school education and above, to empower mothers with knowledge and skills to better care for themselves and their children.

6. Health promotion campaigns: Conducting targeted health promotion campaigns in Jigjiga town to raise awareness about the importance of maternal health, hygiene practices, and the availability of healthcare services.

These innovations can help address the factors identified in the study, such as poor water supply, lack of hand washing facilities, and lack of formal maternal education, and ultimately improve access to maternal health in Jigjiga town.
AI Innovations Description
Based on the study, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Improve maternal education: The study found that maternal educational level of primary school and above was protective against childhood diarrhea. Therefore, implementing programs that focus on improving maternal education can help reduce the prevalence of under-five diarrhea.

2. Enhance water supply: The study identified poor water supply as a risk factor for under-five diarrhea. To address this, innovative solutions can be developed to improve access to clean and safe water in the study area. This can include implementing water purification systems, promoting rainwater harvesting, or establishing water treatment facilities.

3. Promote hand washing facilities: Lack of hand washing facilities was also associated with diarrhea in the study. Innovative approaches can be implemented to promote the availability and use of hand washing facilities in households, schools, healthcare facilities, and other public places. This can include designing low-cost, easy-to-use hand washing stations or implementing behavior change campaigns to promote hand hygiene.

4. Implement environmental health interventions: The study suggests that environmental health intervention programs designed to promote good hygiene behavior could be important in reducing the burden of childhood diarrhea. Innovative interventions can be developed to address environmental factors that contribute to diarrhea, such as improving sanitation infrastructure, waste management systems, and overall hygiene practices in the community.

5. Strengthen healthcare infrastructure: The study mentioned the presence of one referral and one zonal hospital, and two health centers in the town. To improve access to maternal health, innovative solutions can be developed to strengthen the healthcare infrastructure in the study area. This can include expanding healthcare facilities, improving the quality of services provided, and ensuring the availability of skilled healthcare professionals.

Overall, the recommendations from the study highlight the importance of education, water supply, hygiene practices, environmental health interventions, and healthcare infrastructure in improving access to maternal health. By developing innovative solutions in these areas, it is possible to make significant progress in reducing the burden of under-five diarrhea and improving maternal and child health outcomes.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase maternal education: Promote and provide opportunities for formal education for women, particularly at the primary school level and above. This can help empower women to make informed decisions about their health and the health of their children.

2. Improve water supply: Enhance access to clean and safe water by implementing infrastructure projects that ensure a reliable supply of water to households and communities. This can help reduce the risk of diarrheal diseases and improve overall hygiene practices.

3. Promote handwashing facilities: Implement programs and initiatives that encourage the availability and use of handwashing facilities, such as handwashing stations with soap and water. This can help prevent the spread of infectious diseases, including diarrhea.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the prevalence of under-five diarrhea, maternal educational level, availability of water supply, and access to handwashing facilities.

2. Collect baseline data: Conduct a survey or data collection process to gather baseline information on the indicators mentioned above. This can involve interviewing mothers and caregivers, observing the availability of water and handwashing facilities, and collecting relevant demographic data.

3. Implement interventions: Implement the recommended interventions, such as providing education programs for women, improving water supply infrastructure, and promoting handwashing facilities. Ensure that these interventions are implemented in a controlled and systematic manner.

4. Monitor and evaluate: Continuously monitor and evaluate the impact of the interventions on the identified indicators. This can involve conducting follow-up surveys or data collection processes to assess changes in the prevalence of under-five diarrhea, maternal educational level, availability of water supply, and access to handwashing facilities.

5. Analyze and interpret data: Analyze the collected data using statistical methods to determine the impact of the interventions. This can involve calculating adjusted odds ratios, conducting multivariable regression analysis, and comparing the data before and after the interventions.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the interventions in improving access to maternal health. Make recommendations for further improvements or adjustments to the interventions based on the findings.

7. Communicate findings: Share the findings of the impact assessment with relevant stakeholders, such as policymakers, healthcare providers, and community members. This can help inform decision-making and guide future efforts to improve access to maternal health.

Yabelana ngalokhu:
Facebook
Twitter
LinkedIn
WhatsApp
Email