Risk factors, pre-presentation management and clinical state of children with diarrhoea presenting in a community cottage hospital

Abstract

Diarrhoael disease ranks second as the cause of under -five mortality worldwide and is particularly important in the developing world. Risk factors include water source, poor human and domestic waste disposal, poor hand washing and breastfeeding practices. Outcome depends on appropriate oral rehydration therapy, continued feeding and rational use of drugs. This work was designed to identify ongoing risk factors for diarrhoae presenting in a Cottage Hospital serving a well-defined catchment community in the Niger Delta region of Nigeria. It also aimed at identifying modalities of treatment before presentation at the hospital, clinical state at presentation and outcome of treatment on the children. A prospective study recruiting all children admitted for diarrhoae isease in the hospital between January and June 2016. Socio- demographic data, risk factors, place and modalities of pre- presentation management, clinical state on admission and outcome were recorded. Simple proportions, percentages and tables were used to analyze the data using stata 10 (stata corp. Texas). Fifty-four children representing 11.11% of 468 paediatric admissions to the hospital in the period were admitted into the study. The age range was 3 – 96months (median 11 months; 1QR 6 – 18 months). Identified risk factors were lack of Exclusive Breastfeeding (85.19%), use of feeding bottles (20.37%), questionable or poor sources of water (92.59%), poor hand washing practices with; 33.62% not washing hands always before feeding child and 35.91%, not always washing hands after cleaning infant/child’s faeces. Most of the children (35 or 64.82%) first presented at Patent Medicine Stores and 38 or 70.37%had some oral fluids. While 9 (16.67%) had dysentery 31(57.41) had anti-microbials and 18 (33.33%) had anti-emetics. Twelve (33.33%) of the children had severe dehydration and 2(3.70%) had extrapyramidal crisis from use of anti-emetics. None died, but one child developed cortical damage from hypoglycaemia. Diarrhoae is an important children problem in this catchment community. Major risk factors are lack of exclusive breastfeeding, unsatisfactory hand washing practices, questionable water sources and use of feeding bottles. These children are largely mismanaged at patent medicine stores before presentation at hospital. Provision of potable water should be a priority in this and similar communities. Good hygiene practices and Exclusive Breast Feeding(EBF) should be consistently taught in ante-natal clinics and immunization centres. Training and retraining of patent medicine dealers is essential.