EFFECT OF DIARRHEA INFECTION ON THE HEALTH OF CHILDREN BETWEEN 0-5 YEARS OF AGE

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

In developing nations such as Nigeria, elevated rates of mortality among young children are attributable to diarrhoea, notwithstanding global endeavours to enhance child health as a whole. Annually, an estimated five million children below the age of five perish from acute diarrhoea in developing nations across Asia, Africa, and Latin America. The first two years of life account for approximately 80% of these fatalities (Lucas & Gilles, 2019). One-third of infant and child deaths worldwide are attributed to diarrhoea, with dehydration accounting for approximately 70% of diarrhoea-related fatalities (Gupta & Mahajan, 2020). Dehydration is defined as the substantial loss of water and salts from the body, which is essential for the maintenance of blood volume and other fluid functions. Infant mortality rates in rural areas of Nigeria are twice as high as in urban areas, according to UNICEF (2002), because of inadequate hygiene and sanitation. Around 170,000 out of the 3 million infants born annually in Nigeria perish due to mortality, which is primarily attributable to inadequate knowledge and management practices regarding childhood diarrhoea. The extremely high morbidity and mortality rates associated with diarrhoea in children under the age of five are likely attributable to a number of factors, including poverty, illiteracy among females, inadequate water supply and sanitation, poor hygiene practices, and insufficient health services (Park, 2019). An additional well-documented risk factor for mortality in children afflicted with diarrhoea is malnutrition. This may be the result of insufficient case management. Hence, the primary approach to managing diarrhoea is to take measures to prevent dehydration. This can be accomplished through the use of Oral Rehydration Therapy (ORT) at home.A disruption of the gastrointestinal tract, diarrhoea is characterised by alterations in intestinal absorption and motility, which result in an expansion and alteration of the consistency of bowel movements (Ballabriga, Hilpert & Isliker, 2000). Diarrhoea is characterised by stool that is significantly more watery than regular stool and is often referred to as loose or watery stool. Dysentery refers to a specific type of diarrhoea in which they may contain blood (Obionu, 2021). Diarrhoea is defined as the passage of three or more watery stools in a 24-hour period (Tauxe, 2019). Constipation volume and consistency are the determining factors in the classification of diarrhoea. On the basis of its duration, the World Health Organisation – WHO (1993) categorised diarrhoea as acute or persistent. Acute diarrhoea is defined as an episode lasting less than two weeks; persistent diarrhoea is defined as an episode lasting more than two weeks. Morley (2022) further categorised diarrhoea based on its typological classification: There are three types of diarrhoea: exudative, osmotic, and secretary. Secretary diarrhoea is caused by the presence of a contaminant, chemical, or nutritional product that stimulates an active process in the intestinal epithelium of the lining. Osmotic diarrhoea is induced by the presence of osmotically active solutes in the intestinal lining, which are inadequately assimilated through the administration of laxatives containing magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is characterised by injury to the mucosal lining, which results in the secretion of various substances, including mucus, blood, and plasma protein. Nevertheless, it is critical to specify that the aetiology of diarrhoea remains unaffected by its classification.

Infections caused by a variety of bacterial, viral, and parasitic organisms, the majority of which are transmitted through contaminated water, manifest as diarrhoea. Viruses, bacteria, protozoa, or parasites, comprise the three main categories of microorganisms that cause diarrhoea in the majority of cases (Lucas & Gilles, 2019). Enteroviruses (such as rotavirus, escherichia coli, campylobacter spp., shigella, vibrio cholera, salmonella (non-typhoid), entamoeba histolytica, giardia lamblia, and cryptosporidium) are considered the primary causative agents of diarrhoea. These are additionally classified as follows: Bacteria (e.g., Shigella, Escherichia coli, Vibrio cholerae, Salmonella non-typhoid, campylobacter spp.); Viruses (e.g., Rota virus). Entamoeba histolytica, crytosporidium, and Giardia lamblia are examples of parasites. Viruses, particularly rotavirus, have been identified globally as the leading cause of acute diarrhoea in infants. In Nigeria, research has also revealed that bacteria account for a mere 3-20 percent of cases of diarrhoea, while viruses account for the majority of cases (60 percent). The majority of these pathogens are transmitted orally through the faeces. In the context of this research, "childhood diarrhoea" pertains to any form of lax, watery bowel movement that transpires with increased frequency in a child. The diverse etiological agents differ in accordance with the clinical manifestations of the illness. 

Frequent loose or watery stools, the risk of dehydration, intestinal injury (particularly in cases of bloody diarrhoea), and loss of appetite with or without vomiting are the primary complications of diarrhoea. On the contrary, according to Victoria, Bryce, Fountaine, and Monasch (2020), indications of dehydration become apparent only when there is an immediate reduction in body weight by around 4–5% of the total volume of fluid. Dehydration is characterised by the following manifestations: a diminished fontanelle, dry mouth and pharynx, a rapid and feeble pulse, skin elasticity loss, and decreased urine output. This tragic event results in the untimely demise of children under the age of five due to trauma. Werner (2021) observed that neonates and children below the age of five are most severely affected by dehydration. According to Longmach, Wilkinson, and Rajagopalan (2018), the indications and symptoms include frequent bowel movements characterised by loose, watery stools, abdominal cramps or pain, fever (especially in cases where an infectious cause is present), and haemorrhage. Frequently, parasites and bacteria can induce crimson diarrhoea. Furthermore, colorectal cancer, inflammatory bowel disease, and polyps can all contribute to the presence of blood and mucus in the faeces. Infection may also induce symptoms of nausea and vomiting. 

Dehydration and malnutrition are the primary hazards associated with diarrhoea (WHO, 1993). WHO defines dehydration as the most common cause of excessive sodium and water loss from the body. Malnutrition, on the other hand, can be brought about by an inadequate diet resulting from factors such as poverty, a scarcity of suitable foods, or erroneous beliefs regarding feeding. Frequent infections, including diarrhoea, are among the many causes of malnutrition. 

1.2 Statement of the problem 

The presence of loose or watery faeces on a minimum of three occasions daily, or more frequently than an individual's typical frequency, was classified as diarrhoea. While benign episodes of diarrhoea in children are uncommon, severe cases can cause substantial fluid loss and dehydration, potentially leading to fatal outcomes or other severe consequences if fluids are not promptly replaced upon the initial indication of diarrhoea. During the period from 2004 to 2009, approximately 2.5 million children under the age of five were afflicted with diarrheal disease in Nigeria, which resulted in 3191 deaths (CFR=0.12%). This equates to an annual average of 430,314 cases and 532 fatalities, with a period prevalence of 588 per 10,000 children under the age of five. (2019, Oria et al.).With a 12% outpatient prevalence, children under the age of five were among the top ten causes of inpatient and outpatient attendance. 68 Children who are malnourished, have compromised overall health, or are exposed to contaminated potable water are at a heightened risk of developing severe diarrhoea and dehydration in comparison to children who are in good health.Likelya Pashar et al. (2020). Children are more susceptible to life-threatening dehydration compared to adults due to the higher water content that comprises a greater proportion of their body weight. Young children, whose metabolic rates are higher than those of adults aged 65, consume more water daily, and their kidneys are less efficient at conserving water. The majority of pathogens that induce diarrhoea share a common mode of transmission, which is through the oral cavity of an infected individual. This is referred to as oral-fecal transmission. Research has demonstrated that implementing measures to enhance water quality at its source, including secure storage systems and treatment for household water, can effectively decrease the incidence of diarrhoea by up to 47%. In Nigeria, water, sanitation, and hygiene-related illnesses are responsible for a significant proportion of paediatric illnesses. As stated by Peter et al. (2018). 

Despite the significant issue of diarrhoea among children under the age of five in Nigeria, there is currently no research that examines the impact of diarrhoea infection on the health of this age group (as far as we are aware). Hence, this study was conducted to determine the effect of diarrhoea infection on the health of children between 0-5 years of age. 

1.3 Objective of the study

The general objective of this study is to examine the effect of diarrhea infection on the health of children between 0-5 years of age. The specific objective is as follows:

Ascertain mothers knowledge on the prevalence of diarrhea infection on the health of children between 0-5 years of age.

Assess mothers knowledge on the causes of diarrhea infection on the health of children between 0-5 years of age.

Assess mothers knowledge on the management of diarrhea infection among children between 0-5 years of age.

1.4  Research Questions

What is the prevalence of diarrhea infection on the health of children between 0-5 years of age?

What are the causes of diarrhea infection on the health of children between 0-5 years of age?

What are the management of diarrhea infection among children between 0-5 years of age?

1.5 Research Hypothesis 

Ho: Diarrhea infection has a positive effect on the health of children between 0-5 years of age

Ha: Diarrhea infection has a negative effect on the health of children between 0-5 years of age.

1.6 Significance of the Study

The study will ginger interest in the area of childhood health and disease in Nigeria. Mothers especially childbearing women will benefit from the result of the study as it will provide them with appropriate information on the concept, signs and symptoms, modes of transmission and the preventive measures of childhood diarrhoea. This will enable the women to make informed choices on the adoption of the management practices. Appropriate knowledge will influence them and enhance their practice. It will also help them in educating the public on the preventive measures of childhood diarrhoea. Low level of knowledge on the other hand will equally compel health policy makers to step up efforts in the area of education, seminars, workshops especially in rural areas with a view to raising the level of knowledge of the people regarding childhood diarrhoea and its management practices. The result on the management of childhood diarrhoea by mothers will be useful to mothers and caregivers. Appropriate practice will be encouraged and allow these mothers and caregivers to carry out these practices in the already established direction. On the other hand, inappropriate practice will call for adjustment and improvement and provide enlightenment efforts to achieve better results. Specifically, the data to be generated on the management practices of mothers may likely sensitize the mothers on the childhood diarrhoea in Ezeagu LGA to encourage identified sound practices while engineering changes in the unwholesome practices of mothers towards childhood diarrhoea.

The findings will be useful to the general public who may need appropriate information on childhood diarrhoea. Researchers will benefit from the study. They can build on the findings for further research is this area of knowledge. The data concerning this study may help to enrich the pool of data on the subject matter. Such data may also be beneficial to both Health and Education ministries, and may form the basis for future policy formulation and modification.

Finally, scholars and reading public will benefit from the theoretical significance of the study. It will contribute to the synthesis of the relevant theories in the field of study. It seeks to explain why people think, feel, and act the way they do. The study will add to the existing literature in the field of health education and child health in particular.

1.7 Scope Of The Study

The study focuses on the effect of diarrhea infection on the health of children between 0-5 years of age. Hence, the study will be delimited to Ezeagu LGA. of Enugu state.

1.8 Limitation Of The Study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing that it is a new discourse thus the researcher incurred more financial expenses and much time was required in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. Additionally, the researcher will simultaneously engage in this study with other academic work. Despite the constraint  encountered during the  research, all factors were downplayed in other to give the best and make the research successful.

1.9 Definition Of Terms

Diarrhoea: Refers as having loose or watery stools at least three times per day, or more frequently than normal for an individual.