Epidemiological investigation and management of bloody diarrhea among children in India

English version

Autoři: Rahul Bawankule ^aff001; Sadanand Shetye ^aff002; Ashish Singh ^aff003; Abhishek Singh ^aff001; Kaushalendra Kumar ^aff001
Působiště autorů: International Institute for Population Sciences, Mumbai, India ^aff001; B. K. L. Walawalkar Hospital and Rural Medical College, Kasarwadi-Sawarde, India ^aff002; SJM School of Management, Indian Institute of Technology Bombay, Powai, Mumbai, India ^aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222208

Souhrn

Background

The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines—the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context.

Methods

We used data from the National Family Health Survey (NFHS)—4 conducted in 2015–16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years.

Findings

The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children’s socioeconomic and demographic characteristics.

Conclusion

The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children’s stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Klíčová slova:

Social sciences – Sociology – Communications – People and places – Population groupings – Geographical locations – Medicine and health sciences – Pathology and laboratory medicine – Health care – Diagnostic medicine – Signs and symptoms – Public and occupational health – Gastroenterology and hepatology – Age groups – Children – Families – Ecology and environmental sciences – Natural resources – Water resources – Mothers – Mass media – Asia – India – Environmental health – Sanitation – Diarrhea – Anthropology – Cultural anthropology – Religion

Zdroje

1. UNICEF, WHO. Diarrhoea: Why children are still dying and what can be done New York: The United Nations Children’s Fund (UNICEF) and World Health Organization (WHO), 2009.

2. International Vaccine Access Center (IVAC), Health JHBSoP. Pneumonia and Diarrhea Progress Report 2018. 2018.

3. UNICEF. One is too many: Ending child deaths from pneumonia and diarrhoea. New York: UNICEF, 2016.

4. WHO. The Treatment of diarrhoea: a manual for physicians and other senior health workers. Geneva, Switzerland: Department of Child and Adolescent Health and Development, World Health Organization, 2005.

5. WHO. The Management of bloody diarrhoea in young children. Geneva Switzerland: WHO, 1994.

6. Keusch Gerald T. F O, Bhargava Alok, Boschi-Pinto Cynthia, Bhutta Zulfiqar A., Gotuzzo Eduardo, Rivera Juan, Chow Jeffrey, Shahid-Salles Sonbol, and Laxminarayan Ramanan. Chapter 19, Diarrheal Diseases In: Jamison Dean T B JG, Measham Anthony R, Alleyne George, Claeson Mariam, Evans David B, Jha Prabhat, Mills Anne, and Musgrove Philip, editor. Disease Control Priorities in Developing Countries. 2 ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank, Oxford University Press, New York; 2006. p. 371–88.

7. Al-Kubaisy W, Al Badre A, Al-Naggar RA, Shamsidah N.I N. Epidemiological study of bloody diarrhoea among children in Baghdad, Iraq. International Archives of Medicine. 2015;8. doi: 10.3823/1603

8. Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, Kirkwood B, et al. Childhood diarrhoeal deaths in seven low- and middle-income countries. Bulletin of the World Health Organization. 2014;92(9):664–71. Epub 06/23. doi: 10.2471/BLT.13.134809 25378757

9. Hale TL, Keusch GT. Chapter 22, Shigella. In: Baron S, editor. Medical Microbiology. 4 ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.

10. Perez-Perez GI, Blaser MJ. Chapter 23, Campylobacter and helicobacter. In: Baron S, editor. Medical Microbiology. 4 ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996.

11. Giannella R. Chapter 21, Salmonella. In: Baron S, editor. Medical Microbiology. 4 ed. Galveston (TX): The University of Texas Medical Branch at Galveston; 1996.

12. Evans DJ Jr, Evans DG. Chapter 25, Escherichia coli in diarrheal disease. In: Baron S, editor. Medical Microbiology. 4 ed. Galveston: The University of Texas Medical Branch at Galveston; 1996.

13. Kuskonmaz B, Yurdakok K, Yalcin SS, Ozmert E. Comparison of acute bloody and watery diarrhea: a case control study. Turk J Pediatr. 2009;51(2):133–40. Epub 2009/06/02. 19480324.

14. Njuguna C, Njeru I, Mgamb E, Langat D, Makokha A, Ongore D, et al. Enteric pathogens and factors associated with acute bloody diarrhoea, Kenya. BMC infectious diseases. 2016;16:477. Epub 2016/09/08. doi: 10.1186/s12879-016-1814-6 27600526

15. Brooks JT, Shapiro RL, Kumar L, Wells JG, Phillips-Howard PA, Shi YP, et al. Epidemiology of sporadic bloody diarrhea in rural Western Kenya. The American journal of tropical medicine and hygiene. 2003;68(6):671–7. Epub 2003/08/02. 12892051.

16. Holtz LR, Neill MA, Tarr PI. Acute bloody diarrhea: a medical emergency for patients of all ages. Gastroenterology. 2009;136(6):1887–98. Epub 2009/05/22. doi: 10.1053/j.gastro.2009.02.059 19457417.

17. Murphy MS. Management of bloody diarrhoea in children in primary care. BMJ: British Medical Journal. 2008;336(7651):1010–5. doi: 10.1136/bmj.39542.440417.BE 18456632

18. WHO UNICEF. Intergrated Management of Childhood Illness. Geneva: World Health Organisation, 2008.

19. Nasrin D, Wu Y, Blackwelder WC, Farag TH, Saha D, Sow SO, et al. Health care seeking for Childhood Diarrhea in Developing Countries: Evidence from Seven Sites in Africa and Asia. The American journal of tropical medicine and hygiene. 2013;89(1 Suppl):3–12. doi: 10.4269/ajtmh.12-0749 23629939

20. Perez-Cuevas R, Guiscafre H, Romero G, Rodriguez L, Gutierrez G. Mothers’ health-seeking behaviour in acute diarrhoea in Tlaxcala, Mexico. Journal of diarrhoeal diseases research. 1996;14(4):260–8. Epub 1996/12/01. 9203789.

21. Fissehaye T, Damte A, Fantahun A, Gebrekirstos K. Health care seeking behaviour of mothers towards diarrheal disease of children less than 5 years in Mekelle city, North Ethiopia. BMC research notes. 2018;11(1):749-. doi: 10.1186/s13104-018-3850-3 30348211.

22. Ahmed F, Clemens JD, Rao MR, Ansaruzzaman M, Haque E. Epidemiology of shigellosis among children exposed to cases of Shigella dysentery: a multivariate assessment. The American journal of tropical medicine and hygiene. 1997;56(3):258–64. Epub 1997/03/01. doi: 10.4269/ajtmh.1997.56.258 9129527.

23. Bawankule R, Singh A, Kumar K, Pedgaonkar S. Disposal of children’s stools and its association with childhood diarrhea in India. BMC Public Health. 2017;17:12. doi: 10.1186/s12889-016-3948-2 28056888

24. Sarker AR, Sultana M, Mahumud RA, Sheikh N, Van Der Meer R, Morton A. Prevalence and Health Care–Seeking Behavior for Childhood Diarrheal Disease in Bangladesh. Global Pediatric Health. 2016;3:2333794X16680901. doi: 10.1177/2333794X16680901 28229092

25. International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-4), 2015–16: India. IIPS Mumbai, 2017.

26. WHO, UNICEF. Core Questions on Drinking-Water and Sanitation for Household Surveys. Geneva, Switzerland: World Health Organisation and UNICEF, 2006.

27. Hajeebhoy N, Nguyen PH, Mannava P, Nguyen TT, Mai LT. Suboptimal breastfeeding practices are associated with infant illness in Vietnam. International Breastfeeding Journal. 2014;9(1):12. doi: 10.1186/1746-4358-9-12 25097662

28. Bawankule R, Singh A, Kumar K, Shetye S. Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study? PloS one. 2017;12(1):e0169713. doi: 10.1371/journal.pone.0169713 28076428

29. Aziz FAA, Ahmad NA, Razak MAA, Omar M, Kasim NM, Yusof M, et al. Prevalence of and factors associated with diarrhoeal diseases among children under five in Malaysia: a cross-sectional study 2016. BMC public health. 2018;18(1):1363-. doi: 10.1186/s12889-018-6266-z 30537956.

30. Degefa G, Gebreslassie M, Meles KG, Jackson R. Determinants of delay in timely treatment seeking for diarrheal diseases among mothers with under-five children in central Ethiopia: A case control study. PloS one. 2018;13(3):e0193035–e. doi: 10.1371/journal.pone.0193035 29584727.

31. Wilson SE, Ouédraogo CT, Prince L, Ouédraogo A, Hess SY, Rouamba N, et al. Caregiver recognition of childhood diarrhea, care seeking behaviors and home treatment practices in rural Burkina Faso: a cross-sectional survey. PloS one. 2012;7(3):e33273–e. doi: 10.1371/journal.pone.0033273 22428006.

32. Lam F, Pro G, Agrawal S, Shastri VD, Wentworth L, Stanley M, et al. Effect of enhanced detailing and mass media on community use of oral rehydration salts and zinc during a scale-up program in Gujarat and Uttar Pradesh. Journal of global health. 2019;9(1):010501-. Epub 12/10. doi: 10.7189/jogh.09.010501 30546870.

33. Bedford KJA, Sharkey AB. Local barriers and solutions to improve care-seeking for childhood pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger: a qualitative study. PloS one. 2014;9(6):e100038–e. doi: 10.1371/journal.pone.0100038 24971642.

34. Hong TK, Dibley MJ, Tuan T. Factors affecting utilization of health care services by mothers of children ill with diarrhea in rural Vietnam. The Southeast Asian journal of tropical medicine and public health. 2003;34(1):187–98. Epub 2003/09/16. 12971534.

35. Malhotra N, Upadhyay RP. Why are there delays in seeking treatment for childhood diarrhoea in India? Acta paediatrica (Oslo, Norway: 1992). 2013;102(9):e413–8. Epub 2013/05/31. doi: 10.1111/apa.12304 23718747.

36. Anteneh ZA, Andargie K, Tarekegn M. Prevalence and determinants of acute diarrhea among children younger than five years old in Jabithennan District, Northwest Ethiopia, 2014. BMC public health. 2017;17(1):99-. doi: 10.1186/s12889-017-4021-5 28103908.

37. Gao W, Liu X, Yan H. Prevalence of diarrhea among children less than 36 months of age in rural western China in 2001 and 2005. The American journal of tropical medicine and hygiene. 2014;91(6):1197–202. doi: 10.4269/ajtmh.14-0179 25223941.

38. Bado AR, Susuman AS, Nebie EI. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990–2013): assessing the neighborhood inequalities. Global health action. 2016;9:30166-. doi: 10.3402/gha.v9.30166 27174860.

39. Bruce N, Pope D, Arana B, Shiels C, Romero C, Klein R, et al. Determinants of care seeking for children with pneumonia and diarrhea in Guatemala: implications for intervention strategies. American journal of public health. 2014;104(4):647–57. Epub 04/. doi: 10.2105/AJPH.2013.301658 24524510.

40. Gebretsadik A, Worku A, Berhane Y. Less Than One-Third of Caretakers Sought Formal Health Care Facilities for Common Childhood Illnesses in Ethiopia: Evidence from the 2011 Ethiopian Demographic Health Survey. International Journal of Family Medicine. 2015;2015:6. doi: 10.1155/2015/516532 26273479

41. Ayalneh AA, Fetene DM, Lee TJ. Inequalities in health care utilization for common childhood illnesses in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey. International Journal for Equity in Health. 2017;16(1):67. doi: 10.1186/s12939-017-0561-7 28431502

42. Sarker AR, Sultana M, Mahumud RA, Sheikh N, Van Der Meer R, Morton A. Prevalence and Health Care-Seeking Behavior for Childhood Diarrheal Disease in Bangladesh. Global pediatric health. 2016;3:2333794X16680901–2333794X. doi: 10.1177/2333794X16680901 28229092.

43. Ministry of Drinking Water and Sanitation (Govt. of India). Swachh Bharat Mission and NRDWP: 3 Years of Good Goverenance. New Delhi: Ministry of Drinking Water and Sanitation, 2017.

44. Ministry of Panchayati Raj. Handbook on Gram Panchayat and Sanitation New Delhi: Ministry of Panchayati Raj; 2014 [cited 2016 20 July].

45. Freeman MC, Majorin F, Boisson S, Routray P, Torondel B, Clasen T. The impact of a rural sanitation programme on safe disposal of child faeces: a cluster randomised trial in Odisha, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2016;110(7):386–92. doi: 10.1093/trstmh/trw043 27496512

46. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious diseases. 2003;3(5):275–81. doi: 10.1016/S1473-3099(03)00606-6 12726975.

47. Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical medicine & international health: TM & IH. 2006;11(3):258–67. doi: 10.1111/j.1365-3156.2006.01568.x 16553905.

48. UNICEF India. Handwashing With Soaps in Schools Before Midday Meal: UNICEF; 2015 [cited 2018 4 Feb].

49. WHO. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses: World Health Organization; 2013.

50. Casburn-Jones AC, Farthing MJG. Management of infectious diarrhoea. Gut. 2004;53(2):296–305. doi: 10.1136/gut.2003.022103 14724167

51. Ministry of Housing and Urban Affairs (Govt. of India). Guidelines for Swachh Bharat Mission—Urban. New Delhi: Ministry of Urban Development, 2017.

52. Boerma JT, Weinstein KI, Rutstein SO, Sommerfelt AE. Data on birth weight in developing countries: can surveys help? Bulletin of the World Health Organization. 1996;74(2):209–16. Epub 1996/01/01. 8706237.

53. Islam MM. Can maternal recalled birth size be used as a proxy measure of birth weight? An evaluation based on a population health survey in Oman. Matern Child Health J. 2014;18(6):1462–70. Epub 2013/10/30. doi: 10.1007/s10995-013-1386-7 24166140.

54. Lule SA, Webb EL, Ndibazza J, Nampijja M, Muhangi L, Akello F, et al. Maternal recall of birthweight and birth size in Entebbe, Uganda. Tropical medicine & international health: TM & IH. 2012;17(12):1465–9. Epub 2012/09/22. doi: 10.1111/j.1365-3156.2012.03091.x 22994260

55. Barakat M, El-Kady Z, Mostafa M, Ibrahim N, Ghazaly H. Antibiotic-associated bloody diarrhea in infants: clinical, endoscopic, and histopathologic profiles. J Pediatr Gastroenterol Nutr. 2011;52(1):60–4. Epub 2010/07/20. doi: 10.1097/MPG.0b013e3181da215b 20639777.

56. Yilmaz M, Bilir YA, Aygun G, Erzin Y, Ozturk R, Celik AF. Prospective observational study on antibiotic-associated bloody diarrhea: report of 21 cases with a long-term follow-up from Turkey. European journal of gastroenterology & hepatology. 2012;24(6):688–94. Epub 2012/03/22. doi: 10.1097/MEG.0b013e328352721a 22433794.