Academic journal article Journal of Health Population and Nutrition

Household Management of Childhood Diarrhoea: A Population-Based Study in Nicaragua

Academic journal article Journal of Health Population and Nutrition

Household Management of Childhood Diarrhoea: A Population-Based Study in Nicaragua

Article excerpt


Diarrhoeal diseases are the second leading cause of childhood mortality worldwide (1) and can contribute to malnutrition and developmental delays (2,3). The great majority of diarrhoeal episodes are treated at home (4). Optimizing the management of diarrhoea in the household setting may lessen the severity and sequelae of diarrhoeal episodes (5).

To this end, the World Health Organization (WHO) has provided recommendations on the management of childhood diarrhoea by families and in communities (6). These recommendations include early initiation of oral rehydration therapy (ORT); continuation of breastfeeding; continuation of high-energy, micronutrient-rich diet; zinc supplementation; and the need to seek medical care as appropriate. While the recommendations are clear, little is known about adherence to these recommended practices to inform health education efforts. Data on the use of ORT are provided for many countries by Demographic and Health Surveys (DHS) (7) but less is known about dietary restrictions and appropriate use of zinc and antibiotics for children with diarrhoea.

In Nicaragua, a low/middle-income country in Central America, diarrhoea remains among the most common causes of child mortality and morbidity (8-10). Prior studies on the household management of diarrhoea in the region are limited. DHS from Nicaragua show that more than one-half (54%) of caretakers had provided ORT to their children with diarrhoea; however, 52% had provided the child with less food, and 25% had provided the child with less fluids during the diarrhoeal episode. A study on the household management of diarrhoea in the Dominican Republic reported high rates of dietary restrictions (11); another study from peri-urban Mexico found that self-medication with antibiotics for diarrhoea management was common (12).

As the majority of diarrhoea cases are treated at home and appropriate household management of diarrhoea can lessen the severity of diarrhoeal episodes, the objective of this study was to examine the household management of childhood diarrhoea in Nicaragua. To examine the diarrhoea management in this setting, we surveyed parents or caretakers of a population-based sample of children below five years of age.



The study was conducted in Leon, Nicaragua's second largest city, having an estimated population of 193,123 in 2011. During the time the study was conducted, the population of Leon received a municipal water supply (chlorinated groundwater).

Primary healthcare in Leon is provided at (i) government-administered (public) primary-care centres and health posts, which provide services free of charge; (ii) fee-for-service private physicians' offices; and (iii) Clinicas previsionales, a tier of private clinics providing care for insured government workers and others with health insurance.

Sample selection, design, and data collection

The Health and Demographic Surveillance Site-Leon (HDSS-Leon) maintains demographic surveillance for 10,994 households in the municipality of Leon (13). A simple random sample of 531 households was selected from HDSS-Leon as part of a larger study on childhood diarrhoea incidence (14). Of the 864 children below five years of age, who resided in selected households over the course of the one-year study, parents of 826 children consented for participation in the study. The study followed an 'open cohort' design; new children and newborns moving into selected households were enrolled while children who passed their fifth birthday or moved out of selected households no longer contributed to data.

Field workers visited households to collect baseline characteristics and weight of children and returned every two weeks over a one-year study period (25 January 2010 to 24 January 2011) to record information on diarrhoeal episodes (14). During the final two months of the year-long study, 618 children remained under surveillance (neither had passed their fifth birthday nor moved out of a selected household). …

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