AN ASSESSMENT OF THE ASSOCIATION BETWEEN DOMESTIC HYGIENE, DIARRHOEA - - PowerPoint PPT Presentation

AN ASSESSMENT OF THE ASSOCIATION BETWEEN DOMESTIC HYGIENE, DIARRHOEA AND NUTRITIONAL STATUS IN CHILDREN UNDER TWO YEARS IN KHAYELITSHA HREC 104/2012

Manyeleti Sambo MPhil Thesis University of Cape Town School of Child and Adolescent Health Supervisors: Prof. Michael Hendricks

• Prof. Lesley Bourne

BACKGROUND

BACKGROUND

BACKGROUND

Diarrhoea Deaths in Cape Town 2009

Neonatal 35% Diarrhoea 16% Pneumonia 13%

Causes of death in children under 5 years, Western Cape 2009. Groenewald, et al. 2012

Diarrhoea cases in Khayelitsha

Source: De Azevedo, 2011. The Diarrhoeal Disease Season Plan in Cape Town

Objectives

 To determine the anthropometric status of children <2

years who had not experienced diarrhoea the previous month before the study

 To observe hygiene practices of mothers/caregivers in

the home environment

 To explore the relationship between socio-

demographic factors, domestic hygiene and diarrhoea

Case Control design Case Diarrhoea (age <2yrs) No diarrhoea episode (1 month before study) HIV negative status Control No diarrhoea (age <2yrs) No diarrhoea episode (1 month before study) HIV negative status

Methodology

METHODOLOGY

 Stratified sampling method

• The sample size of 200 was proportionally allocated to

each clinic, based on the number of diarrhoea cases seen per day

City Health/Provincial clinics Cases Controls Nolungile clinic 52 52 Matthew Goniwe clinic 4 4 Town Two clinic 8 8 Zakhele clinic 1 1 Khayelitsha site B CHC 35 35 Total 100 100

Data Collection for Anthropometry

Data Collection

Study population (200) Cases (100) Controls (100) 100 Questionnaires 100 Anthropometry 46 Household observations 100 Questionnaires 100 Anthropometry 46 Household observations

Analysis

 Descriptive analyses were performed using frequencies

and percentages (%)

 Logistic regression was used to identify possible

predictors of diarrhoea for each variable.

Anthropometry Results

WAZ > 2 SD HAZ WHZ

• 2 to +2 SD

< - 2 SD

Multiple logistic results

Variables OR 95% CI p-values Child care by family/relative/day-care 2.79 1.25-6.21 0.012* Wash dishes in container 0.39 0.19-0.84 0.015* Grandmother preparing food for child 0.38 0.91-0.98 0.046* Rats in the house 2.01 0.93-4.33 0.074 Toilet problems 2.21 0.91-5.40 0.081 Kitchen not separate from other rooms 1.72 0.91-3.27 0.096 Maternal/caregiver < 25 years 1.73 0.93-3.22 0.083

LIMITATIONS

 HIV status could not be confirmed in most of the cases

and controls

 Not all households were located for hygiene

• bservations.

 Not all variables on the checklist were observed  Data was collected in both summer and winter seasons

STRENGTHS OF STUDY

 The case-control study assessed multiple risk factors  It obtained findings quickly  Required minimal funding and limited resources  Logistic regression was used to control for mediating

and confounding factors

Conclusion

 Mothers provide a protective effect for children from

diarrhoea

 Grandmothers have a protective effect for diarrhoea

when they prepare food for the child

 Kitchen sink does not have a protective effect from

diarrhoea

Fig 2: Fecal-oral transmission

Recommendations

Recommendations

Health Care facilities, Day Care facilities and community health promotion, education and interventions

Breastfeeding Safe food preparations Hygiene (water and sanitation) Maintenance and proper use of private and public

toilets

Waste management and pest (rats & flies) control

Acknowledgements

 Prof. Michael Hendricks  Prof. Lesley Bourne  Participants  Mrs Jawaya Shea  Dr Christiaan van Woerden