Prevalence of and factors associated with diarrhoeal disease in moderate to severely malnourished children aged 6 to 59 months at Mbagathi district hospital
Background: Diarrhoeal disease is one of the major causes of morbidity and mortality in developing countries particularly in children. Increasing evidence suggests that malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. The increased incidence and severity of diarrhoea in malnourished children is largely due to the deterioration of immune function; limited production and/or diminished functional capacity of all cellular components of the immune system. Objective: To determine the prevalence of diarrhoea among 6- 59 month old moderately to severely malnourished children and the factors associated with diarrhoea among these children. Study design: A three month hospital- based cross-sectional study. Study setting: The study took place in paediatric outpatient unit at Mbagathi District Hospital that has a monthly average outpatient attendance of approximately 2600 for children less than 5 years. The paediatric department is run by two paediatric consultants and 5 paediatric clinical officers. The main catchment area for the hospital is Dagorreti Division encompassing Kibera slum with an under five- year- old population of 4960 and a total population of 39061. The clientele however, comes from all over Nairobi since it is the main fully functional district hospital within Nairobi. Study population: This consisted of 6 to 59 month old moderately to severely malnourished children seeking treatment at Mbagathi District Hospital. Methodology: Moderately to severely malnourished children were enrolled in the study after informed written consent was obtained from the guardian. The guardian’s social- economic and demographic data, child’s clinical history pertaining possible risk factors and physical examination findings were taken. The patient’s HIV status was ascertained by PCR for those aged below 18 months and by ELISA for those aged above 18 months. Immunization status was ascertained by looking at the child- mother health booklet and by recall for those who didn’t have the booklet. All findings were recorded then analyzed using STATA. Logistic regression was used determine independent factors. Results The average age (SD) of children in the study was 20.9 months (SD = 13). Infants were (36%) while above 1 year old were 98 children (64%). The mean anthropometric values were – 2.73 for WHZ and 11.7 cm for MUAC. Severe wasting (WHZ - 3) was present in 56.4% (89/ 160) of children. Mean age for mothers was 27.1 years while the most commonly reported levels of formal education were primary (45.6%) and secondary (45%) level of education with less than 3% being illiterate. Out of the 160 malnourished children, 75 had diarrhoea yielding a prevalence of 46.9%. Dysentery was 6.7% while persistent diarrhoea was 18.7%. After adjustments were made for confounding variables, diarrhoea was approximately 5.3 times higher (95% CI 1.53-9.00) among children of single mothers compared to children of married mothers (p = 0.004). The odds ratio of diarrhoea declined from 1.00 in the lowest income group earning below Kenya Shillings (KShs) 5000 monthly to an odds ratio of 0.03 in household with incomes of KShs 15000 and above. Malnourished children who were not bottle fed had significantly lower risk of developing diarrhoeal disease compared to bottle fed children (OR = 0.27, 95% CI 0.08-0.92, p =0.037). Similarly, guardians who did not wash hands with soap were 16 times more at risk of having children with diarrhoea than those who practiced hand washing with soap (OR = 16.33, 95% CI 4.29-62.23, p < 0.001). Children who drank unboiled or untreated water had higher risk of developing diarrhoea than those who treated or boiled first (OR=4.98, 95% CI 1.50-16.56, P = 0.009). There was no significant statistical association between breastfeeding and age at onset of complementary feeds and odds of diarrhoea (OR 2.0; CI 0.96-4.22; P= 0.06). Conclusion The prevalence of diarrhoea among moderate to severely malnourished children was 46.9%. Dysentery was 6.7% while persistent diarrhoea was 18.7%. The factors that were found to be associated with diarrhoea in these children include reduced household income, maternal single marital status, use of bottle feeding, lack of proper hand washing practices and drinking unsafe water. Intensification of health education on these factors in the hospital is recommended and policy makers should create measures to combat poverty, improve literacy levels and encourage fully functional families.