Diarrhoeal disease remains one of the principal causes of morbidity and mortality in children. Globally, children aged less than five years experience, on average, 3.2 episodes of diarrhoea every year (1), and consequently 1.87 million children will die from dehydration associated with diarrhoeal disease (2). The child mortality rate in Ethiopia in 2007 was 199 per 1,000 births (3), and approximately one of every five deaths every year in Ethiopia is due to diarrhoeal disease (2).
Epidemiological studies have been conducted to identify the risk factors that contribute to the incidence of diarrhoeal disease in developing countries; however, to our knowledge, this is the first study in Ethiopia that investigated the environmental and maternal caretaking variables of acute diarrhoea and the management of the illness. Both environmental and maternal caretaking variables are key implementation priorities that are likely to contribute to reduction of mortality due to diarrhoeal disease (3).
Furthermore, managing acute diarrhoea appropriately is critical in preventing dehydration and deaths of children (4). The use of oral rehydration therapy (ORT), ongoing fluid replacement, and age-appropriate nutritional support represent the foundation for the management of acute diarrhoeal illnesses among children (5). The introduction of ORT in the early 1980s dramatically reduced mortality associated with diarrhoeal disease worldwide (6). Nonetheless, the low use-rates of ORT and inadequate knowledge of the preparation of oral rehydration solution (ORS) represent areas of concern regarding the management of acute diarrhoea, particularly in Ethiopia.
The aim of this study was to identify the risk factors and to understand the case management of acute diarrhoeal disease at the University of Gondar Re ferral and Teaching Hospital, which would help develop effective interventions to reduce morbidity and mortality associated with diarrhoeal disease.
MATERIALS AND METHODS
Study site and design
A prospective, matched, case-control study was conducted at the University of Gondar Referral and Teaching Hospital in the North Gondar Zone, Ethiopia, where the population is more than 2.9 million. Gondar is located approximately 700 km from Addis Ababa in the northwestern part of Ethiopia called the Amhara region. The average household has five members, often living in one room; many households have domestic animals; over 60% of the population has access to improved sources of drinking-water; and almost 40% of the population has access to a toilet or a latrine (7). In the Amhara region, 25% of females and 54% of males are literate (7). Three-fourths of health problems faced by children are due to communicable diseases, and at least half of all children aged less than five years experience symptoms of acute respiratory infections, malaria, and diarrhoea at any given point (7). Often, caretakers first take sick children to health posts or to health centres, and the district and zonal hospitals often are the last places where caregivers seek care for sick children. The University of Gondar Referral and Teaching Hospital provides care to approximately 10,000 children every year; 50 of the 350 beds in the hospital are allocated for children.
The sample-size of 220 matched subjects was determined, using a confidence level of 95% and a power of 80% to detect a 50% difference between cases and controls (8). Four hundred and forty cases and controls were enrolled during July 2007-January 2008. Interviews with the mothers of children were completed after verbal informed consent was obtained.
All children, aged less than five years, who came to the hospital for general treatment, were eligible for the study. Upon presentation, children were assessed at the outpatient department (OPD). If they did not have dehydration or complications, they were given prescriptions for medications and/or ORS and discharged. …