Academic journal article Journal of Health Population and Nutrition

Reducing the Burden of Diarrhea among Children under Five Years Old: Lessons Learned from Oral Rehydration Therapy Corner Program Implementation in Northern Nigeria

Academic journal article Journal of Health Population and Nutrition

Reducing the Burden of Diarrhea among Children under Five Years Old: Lessons Learned from Oral Rehydration Therapy Corner Program Implementation in Northern Nigeria

Article excerpt

Background

Recent mortality estimates among children under five years old show that just five countries account for 50 percent of global mortalities. Of those five, Nigeria accounts for 11 percent of all deaths [1]. Diarrheal disease is the third leading cause of infant and child mortality in developing countries; it is responsible for 11 percent of all under-five deaths worldwide [2] and claims the lives of 1.8 million children per year worldwide [3]. Despite a decrease in childhood diarrheal diseases from 4.6 million to 0.8 million over the last three decades, the number of diarrheal deaths remains unacceptably high [2,4,5]. In Nigeria, the prevalence of childhood diarrhea is 10 percent, with 26 percent of cases treated with oral rehydration salts (ORS) solution [6,7]. Diarrhea also accounts for more than 16 percent of deaths, estimated at 150,000 annually, among children under five years old [8,9].

For Nigeria to meet the Millennium Development Goal 4 (MDG4), the country must attain a two-thirds reduction in the under-five mortality rate from 230 deaths per 1000 live births in 1990 to 76 in 2015. The 2013 Nigeria Demographic and Health Survey [8] reported an under-five mortality rate of 128 deaths per 1000 live births which means an additional annual 20 percent reduction is needed by 2015 to meet the target. Healthy home practices and community-based care could save over 90,000 children a year in Nigeria [10].

The impact of diarrheal morbidity on disability-adjusted life years is likely to remain substantial even as diarrheal mortality diminishes following current trends [11-13]. Nutritional deficits caused by diarrhea can affect a child's growth, fitness, cognition, and performance at school [11,13]. It is estimated that each diarrheal episode a child experiences in the months preceding the child's second birthday increases the risk of being stunted by 5 percent [14]. Moreover, diarrheal illness in early childhood is associated with long-term adverse cognitive effects and decreased work productivity later in life [11].

Key measures to treat diarrhea in children include rehydration with intravenous fluids in case of severe dehydration, oral rehydration salt (ORS) solution for moderate or no dehydration, and zinc supplements to reduce the duration of a diarrhea episode and stool volume [15]. Reduction in diarrheal mortality in the past decades has been attributed largely to scaling up oral rehydration therapy (ORT), which consists of the oral administration of ORS and/or recommended home fluids including salt-sugar solution (SSS). ORT is judged to be the "most important medical advance of the 20th century" [16]. Research demonstrated that the therapy cures dehydration and prevents deaths [17-21]. ORT is a simple, highly effective, inexpensive, and technologically appropriate methodology [22]. However, currently only 39 percent of children with diarrhea in developing countries receive the recommended treatment [23].

Numerous studies and diarrheal prevention programs have identified health facility-based ORT corners as a cost-effective strategy to promote case management of diarrheal diseases in many developing countries [21,22]. Further, evidence shows that ORT corners reduce the number of diarrheal referrals and admissions in a hospital [24]. Research has also demonstrated that most children treated in ORT corners recover quickly after initial treatment with ORS solution and can be discharged and sent home thereafter [21].

We conducted an operations research study to examine the effect of facility-based ORT corners on caregivers' knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers' and service providers' perceived facilitators and barriers to utilization and delivering of ORT corner services in Northern Nigeria. The study was part of an ongoing strategy for setting up ORT corners in Bauchi and Sokoto states in northern Nigeria.

Methods

Study context, population and sites

In view of the high burden of diarrhea among children under five years old in Nigeria, the Targeted States High Impact Project introduced 225 ORT corners between March 2010 and August 2011 in Bauchi (n? …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.