Etiology, risk factors and management of infectious diarrhoea in children at Kenyatta National Hospital

Abstract

Background: Infectious diarrhea is a common cause of mortality and morbidity in developing countries. World Health Organization attributes 3.5 million deaths a year to diarrhea, with 80 percent of these deaths occurring in children under the age of five, and most occurring in children between six months and three years of age. The predisposing factors are mainly due to poor hygiene and most of the cases can be treated using drugs and supportive measures. Prevention is the main intervention strategy used to prevent this disease. Objective: The main objective was to assess the factors that predispose children to diarrhea. The specific factors assessed were prevalence of bacteria, protozoa, and helminthes, antimicrobial susceptibility of bacteria, risk factors and management of diarrhea. Methods: A cross section research design was used and target population was children suffering from diarrhea and accompanied by their guardians who visited KNH to seek treatment. Three hundred and eighty four children were selected for the study using simple random sampling. Data was collected using a questionnaire and stool specimens analyzed in microbiology and parasitology laboratories of Kenyatta National Hospital. The analysis of data was done using SPSS and data summarized in tables and charts. Both inferential and descriptive statistics were derived using chi square and confidence intervals. Results: Majority of the children were between 6-12 months of age and there were more males than females. The average duration of diarrhea was 4.55 days and majority had suffered from the disease before. Most of the parents had a certain level of formal education. The fathers had a source of income but most of the mothers were either self employed or not employed at all. Tap water and toilet facilities were available to most families and about half of the children had malnutrition. No organisms were found from the stools of 80.2% of the children. The pathogens isolated were Giardia lamblia, Entamoeba histolytica, Balantidium coli, Cryptosporidium petvum, Entamoeba coli, Blastocystis hominis, Endolimax nana, Chilomastix mesnili, Trichiuris trichiura, Salmonella typhi and Salmonella paratyphi. Bacteria isolated were sensitive to Ciprofioxacin and Levofioxacin but resisted most of the other drugs tested. xu The risks found to be associated with diarrhea were overcrowding, inadequate hand washing methods, mixed feeding, none or low level of education of the mother and administration of antibiotics. Majority of the children had concurrent illnesses and the most common were pneumonia, meningitis, malaria, rickets and malnutrition. Drugs were mainly prescribed to treat concurrent diseases. The most commonly prescribed drugs were Zinc Sulphate, Paracetamol, Benzyl penicillin G, Gentamicin, Metronidazole, Multivitamin, Coamoxiclav, Cefuroxime and Calcimax. ORS was most frequently used fluid and the intravenous ones included Ringers lactate, Darrows solution, 5% Detrose, Hartmans solution, normal saline and Rehydration salt for the malnourished. Conclusion Only a small proportion of diarrhea in children was caused by intestinal protozoa, helminthes or bacteria. Majority of the cases occurred during weaning and rehydration was the comerstone of diarrhea management Most of the drugs used were mainly for treating concurrent illnesses. Recommendation Mothers should be taught how to wean children especially on the type of food to use. They should also be educated on proper hygienic practices especially washing of hands. Bottle feeding should be discouraged and rational use of antibiotics encouraged.