Risk Factors for Diarrhoea and Upper Respiratory Tract Infections among Children in a Rural Area of Uganda
Mbonye, Anthony K., Journal of Health Population and Nutrition
Diarrhoea and upper respiratory tract infections (URTIs) account for 7.5 million deaths of children aged less than five years annually in developing countries. Most deaths occur in sub-Saharan Africa; for example, 36% of 10.5 million children who died in 2000 were from this region (1).
A number of risk factors for diarrhoea among children in Africa have been documented. Food bought from street vendors has been associated with prolonged diarrhoea among children in Nigeria (2), while age of a child, quality of water, environmental sanitation, parental education, household size, and birth interval have been identified as risk factors for children in a rural area of Zaire (3). A study, in Burkina Faso, West Africa, has shown that faecal disposal is associated with diarrhoea or dysentery among children (4).
In southwestern Ethiopia and in West Africa, the high prevalence of diarrhoea has been associated with socioeconomic, demographic and environmental factors and the immunization status of a child (5-7).
It is now widely recognized that, to decrease high mortality and morbidity among children in sub-Saharan Africa, there is a need to pursue WHO recommendations of implementing standard diagnostic and treatment procedures, strengthening immunization against the six killer diseases, ensuring adequate nutrition, and improving water supply and sanitation as important preventive measures (1).
In Uganda, children aged less than five years constitute 17% of the total population, and mortality of children aged less than five years is currently estimated at 152 per 1,000 livebirths (8). Malaria, diarrhoea, and acute respiratory tract infections (ARTIs) are the leading causes of mortality. The prevalence of diarrhoea among children in Uganda is estimated to be 20% and URTIs to be 23% (9).
In addition to high morbidity among children in Uganda, immunization coverage has stagnated at lower levels for the last 12 years. In 1995, immunization coverage was 47%, which declined to 37.6% in 2000. At the same time, the prevalence of diarrhoea and URTIs among children has been high over the same period (9).
Initiatives to address morbidity and mortality among children in Uganda have been implemented at national and district levels under a decentralized health system. These strategies include implementation of the integrated management of childhood illness (IMCI), home management of malaria, improved case management and proper diagnosis of childhood diseases at health units, training and support supervision of health workers. These initiatives have involved partnership among the government, the private sector, and non-governmental organizations (9). Despite this endeavour, immunization and childcare programmes are implemented as vertical programmes. It is, therefore, necessary to obtain data that show that integration of these programmes is one of the cost-effective ways to reduce morbidity and mortality among children.
Identifying factors associated with morbidity and mortality among children in Uganda is of public-health importance for two main reasons. First, morbidity and mortality among children are quite high, thus, creating a strong national drive to reduce morbidity. Therefore, there is a need to identify information necessary for designing appropriate strategies for child-survival programmes. Second, there is a need to obtain data necessary for use in advocacy among policy-makers so that adequate resources are allocated for child-health programmes and issues, such as integration of programmes, are well-addressed.
This paper presents results of a knowledge, attitude, and practice study carried out in 2001 in Sembabule district, a remote area in southern Uganda. The aim of the study was to assess the impact of a child-survival project, which supported immunization of children, proper nutrition, and improved healthcare-seeking for children. The specific objectives were: to assess the prevalence of diarrhoea, URTIs, and immunization coverage among children aged less than two years, and to identify risk factors associated with high prevalence of diseases among children. …