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Risk factors for diarrheal duration
N M Mirza1, L E Caulfield, R E Black
1University of Nairobi, Kenya.
Insights
Uncovered water containers and diluted cow's milk prolonged diarrhea in Kenyan children. Continued feeding with oral rehydration solutions (ORS) and sugar salt solutions (SSS) improved recovery, highlighting hygiene and feeding practices for child health.
Area of Science:
- Public Health
- Pediatrics
- Infectious Disease Epidemiology
Background:
- Prolonged diarrheal illness is a significant cause of child morbidity and mortality, particularly in resource-limited settings.
- Understanding risk factors related to child feeding and household hygiene is crucial for effective intervention strategies.
Purpose of the Study:
- To identify specific child feeding behaviors and household hygiene practices associated with prolonged diarrheal illness in young children.
- To determine factors influencing the duration of diarrheal episodes in an urban slum population.
Main Methods:
- A longitudinal community study involving 920 children aged 3-37 months in Nairobi, Kenya, over 14 months.
- Morbidity surveillance through regular home visits and in-home observations of maternal and child practices.
- Cox regression analysis to assess the impact of behavioral covariates on diarrheal recovery time.
Main Results:
- Uncovered water containers were associated with a reduced risk of prolonged diarrhea (RR=0.77).
- Giving no fluids (compared to oral rehydration solutions/sugar salt solutions) significantly increased recovery time (RR=1.42).
- Administering diluted cow's milk in the initial days of diarrhea also prolonged illness duration (RR=1.23).
Conclusions:
- Household water storage practices and appropriate fluid management are critical for reducing diarrheal duration.
- Continued feeding, particularly with nutrient-rich options like cereal-milk mix, is recommended during diarrheal episodes.
- Interventions should focus on improving water hygiene and promoting optimal feeding practices to mitigate prolonged diarrhea in children.
Abstract:
To identify child feeding behavior and household hygiene practices that are risk factors for prolonged diarrheal illness, a longitudinal community study was conducted over a 14-month period among 920 children aged 3-37 months who lived in an urban slum settlement in Nairobi, Kenya. Morbidity surveillance was done by home visits every third day in the absence of diarrhea and daily during diarrheal illness until termination of the episode. In-home observations were made to characterize maternal hygiene, cooking, and child feeding practices. Overall, 1,496 episodes of diarrhea were detected. The average diarrheal incidence was 3.5 episodes/child-year, and the incidence of diarrhea > 14 days was 3 episodes/100 child-years. Cox regression was used to examine the independent effects of covariates on time to recovery from a diarrheal episode. Adjusted behavioral factors that were observed to influence recovery from diarrhea included: uncovered water containers (rate ratio (RR) = 0.77, 95% confidence interval (CI) 0.64-0.94); giving no fluids (as opposed to oral rehydration solutions (ORS)/sugar salt solutions (SSS)) (RR = 1.42, 95% CI 1.14-1.77); and administration of diluted cow's milk during the first 3 days of an episode (RR = 1.23, 95% CI 1.00-1.52). These associations remained significant after adjusting for diarrheal severity. The authors recommend, among other measures, improvement of water storage and promotion of continued feeding with cereal-milk mix during diarrhea.