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Nurudeen QO, Yusuf ZM, Salimon SS, Falana MB, Ayinla A, Asinmi MR, Oweh OT, Dikwa MA. Hydroethanolic extract of Piliostigma thonningii leaves extenuates the severity of diarrhoea in female Wistar rats. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2024; 21:26-37. [PMID: 38180845 DOI: 10.1515/jcim-2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Nigeria ranks second in the global prevalence of diarrhoea with most cases concentrated in the Northern-region of the country. This research explored the antidiarrhoeal efficacy of the hydroethanolic extract of Piliostigma thonningii leaves (HEPTL), locally used to manage diarrhoeal conditions in Kebbi State, Nigeria. METHODS P. thonningii leaves were screened for their secondary metabolites and mineral constituents. Using 3 standard-diarrhoea models, female Wistar rats completely-randomised into six-groups of six animals each were utilised for probing the antidiarrhoeal activity of HEPTL. Animals in groups I and II served as the negative and positive controls, whereas the rats in groups III, IV and V respectively received 50, 100, and 200 mg/kg body weight-(bw) of HEPTL. RESULTS Six secondary metabolites and eight minerals were found in the extract, with flavonoids and calcium being the most abundant while steroids and zinc were the least prevalent, respectively. High performance liquid chromatographic analysis revealed the presence of 19 bioactive substances. Furthermore, there was a significant (p<0.05) and dose-related reduction in diarrhoea onset, water content, and wet faeces count. Similarly, the amount of intestinal fluid and average distance traversed by the charcoal-meal were decreased dose-dependently by the HEPTL with a commensurate rise in the suppression of intestinal fluid accrual and peristalsis. Acetylcholinesterase, Na+/K+-ATPase, reduced glutathione, intestinal-alkaline phosphatase and protein levels increased significantly (p<0.05) whereas superoxide-dismutase, catalase, intestinal-nitric oxide and malondialdehyde levels all fell significantly (p<0.05). However, the level of intestinal glucose was not significantly altered. CONCLUSIONS Overall, the HEPTL exhibited a profound effect in the alleviation of the severity of diarrhoea, notably at 200 mg/kg bw.
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Affiliation(s)
- Quadri Olaide Nurudeen
- Biochemistry Unit, Department of Biological Sciences, Al-Hikmah University, Ilorin, Nigeria
| | | | - Saoban Sunkanmi Salimon
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | | | - Abdul'aziz Ayinla
- Biology Unit, Department of Biological Sciences, Al-Hikmah University, Ilorin, Nigeria
| | - Muhammed Robiu Asinmi
- Biochemistry Unit, Department of Biological Sciences, Al-Hikmah University, Ilorin, Nigeria
| | | | - Muhammad Ali Dikwa
- Department of Microbiology and Biotechnology, Federal University Dutse, Dutse, Nigeria
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de Souza Goncalves L, Chu T, Master R, Chhetri PD, Gao Q, Cil O. Mg2+ supplementation treats secretory diarrhea in mice by activating calcium-sensing receptor in intestinal epithelial cells. J Clin Invest 2024; 134:e171249. [PMID: 37962961 PMCID: PMC10786700 DOI: 10.1172/jci171249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Cholera is a global health problem with no targeted therapies. The Ca2+-sensing receptor (CaSR) is a regulator of intestinal ion transport and a therapeutic target for diarrhea, and Ca2+ is considered its main agonist. We found that increasing extracellular Ca2+ had a minimal effect on forskolin-induced Cl- secretion in human intestinal epithelial T84 cells. However, extracellular Mg2+, an often-neglected CaSR agonist, suppressed forskolin-induced Cl- secretion in T84 cells by 65% at physiological levels seen in stool (10 mM). The effect of Mg2+ occurred via the CaSR/Gq signaling that led to cAMP hydrolysis. Mg2+ (10 mM) also suppressed Cl- secretion induced by cholera toxin, heat-stable E. coli enterotoxin, and vasoactive intestinal peptide by 50%. In mouse intestinal closed loops, luminal Mg2+ treatment (20 mM) inhibited cholera toxin-induced fluid accumulation by 40%. In a mouse intestinal perfusion model of cholera, addition of 10 mM Mg2+ to the perfusate reversed net fluid transport from secretion to absorption. These results suggest that Mg2+ is the key CaSR activator in mouse and human intestinal epithelia at physiological levels in stool. Since stool Mg2+ concentrations in patients with cholera are essentially zero, oral Mg2+ supplementation, alone or in an oral rehydration solution, could be a potential therapy for cholera and other cyclic nucleotide-mediated secretory diarrheas.
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Dessale M, Mengistu G, Mengist HM. Prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under five diarrheic children attending public health facilities in Debre Markos town, Northwest Ethiopia. Front Public Health 2023; 11:1114223. [PMID: 36815155 PMCID: PMC9939529 DOI: 10.3389/fpubh.2023.1114223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
Background Under five children are at risk of diarrhea-associated morbidity and mortality. Salmonella and Shigella are major causes of diarrhea in under-five children, especially in developing countries. This study aimed to assess the prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under-five diarrheic children in Debre Markos town public health facilities. Methods A cross-sectional study was conducted at public health facilities in Debre Markos town using a consecutive convenient sampling technique. Data on socio-demographic and associated factors were collected using a structured questionnaire. Salmonella serovars and Shigella species were identified using MacConkey, Xylose Lysine Deoxycholate, Salmonella Shigella agar, and biochemical tests. The antimicrobial resistance pattern was determined by using the modified Kirby-Bauer disk diffusion technique. Results The overall prevalence of Salmonella and Shigella was 11.7% (26/222; 95% CI = 7.2-17.5%). Isolated Salmonella serovars showed a higher rate of resistance (85.7%, 6/7) for both Ampicillin and Amoxicillin/Clavulanic acid while Shigella isolates showed a higher resistance rate to Amoxicillin/Clavulanic acid (78.9%, 15/19) and Ampicillin (73.7%, 14/19). The overall multidrug resistance (MDR) rate of Salmonella and Shigella isolates was 88.5% (23/26). Parent/guardian educational status ≤ elementary school (AOR = 3.783; 95% CI = 1.28-11.19; P = 0.016), presence of two or more under-five children in the family (AOR = 8.999; 95% CI = 2.93-27.69; P < 0.001), unimproved source of drinking water (AOR = 5.010; 95% CI = 1.56-16.10; P = 0.007), the habit of storing cooked foods for later use (AOR = 3.199; 95% CI = 1.07-9.54; P = 0.037), attendance of the child at social gatherings (AOR = 5.387; 95% CI = 1.78-16.35; P = 0.003), and infrequent child fingernail trimming (every ≥ 2 weeks; AOR = 4.693; 95% CI = 1.47-14.94; P = 0.009) showed statistically significant association with the prevalence of culture-confirmed Salmonella and Shigella isolates. Conclusion The prevalence of culture-confirmed Salmonella and Shigella isolates was significantly high in the study area. Salmonella and Shigella isolates exhibited a high rate of MDR pattern. Parent/guardian education level below the elementary school, the presence of two or more under-five children in the family, using unimproved water source, a habit of storing cooked food, and infrequent fingernail trimming were independent predictors of culture-confirmed Salmonella and Shigella. Therefore, besides public health measures, regular surveillance of the prevalence and antimicrobial resistance pattern of Salmonella and Shigella should be routinely practiced in the study setting.
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Affiliation(s)
- Mesfin Dessale
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia,Gidan Health Center, Gidan Woreda Health Office, Gidan, Ethiopia
| | - Getachew Mengistu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia,*Correspondence: Hylemariam Mihiretie Mengist ✉
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Bolarinwa OA, Tadesse Tessema Z, Frimpong JB, Seidu AA, Opoku Ahinkorah B. Multi-Level Analysis and Spatial Interpolation of Distributions and Predictors of Childhood Diarrhea in Nigeria. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211045286. [PMID: 34690501 PMCID: PMC8529312 DOI: 10.1177/11786302211045286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diarrhea is one of the health problems contributing to Nigeria's under-5 mortality rate, ranked as the eighth highest globally. As our search is concerned, there is limited evidence on the spatial distribution of childhood diarrhea in Nigeria. Therefore, this study aimed to examine the spatial distribution and predictors of diarrhea among under-5 children in Nigeria. MATERIALS AND METHODS Using data from the child's recode file of the 2018 Nigeria Demographic and Health Survey, a sample of 28 583 children of women of reproductive age was considered as the sample size for this study. The outcome variable used in this study was childhood diarrhea. We employed both multilevel and spatial analyses to ascertain the factors associated with childhood diarrhea as well as its spatial clustering. RESULTS The regional distribution of the prevalence of diarrhea among children in Nigeria ranged from 0% to 62%. The hotspots for childhood diarrhea were in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. The likelihood of a child having diarrhea in Nigeria was higher among women whose partners have secondary education and above [aOR = 1.18; 95%CI = 1.05-1.33], women currently working [aOR = 1.24; 95%CI = 1.13-1.35], women practicing Islam [aOR = 1.24; 95%CI = 1.04-1.46], and women who were exposed to mass media [aOR = 1.29; 95%CI = 1.18-1.42], compared to women whose partners had no formal education, women not currently working, women practicing Christianity, and those who were not exposed to mass media. Children born to mothers who reside in North East [aOR = 2.55; 95%CI = 2.10-3.10], and communities with medium socioeconomic status [aOR = 1.44; 95%CI = 1.09-1.91] were more likely to experience diarrhea compared to those born to mothers residing in the North Central and in communities with low socioeconomic status. CONCLUSION High proportions of childhood diarrhea among under-5 children in Nigeria were located in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. Policies and interventions that seek to reduce or eliminate diarrhea diseases among under-5 children in Nigeria should take a keen interest in the factors identified as predictors of childhood diarrhea in this study as this will help in achieving the aims of WASH, ORT corners, and SDG 3 by the year 2030.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine,
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South
Africa
- Obaxlove Consult, Lagos, Nigeria
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and
Biostatistics, Institute of Public Health, College of Medicine and Health Sciences,
University of Gondar, Gondar, Ethiopia
| | - James Boadu Frimpong
- Department of Health, Physical
Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health,
University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and
Veterinary Services, James Cook University, Townsville, QLD, Australia
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Ezezika O, Ragunathan A, El-Bakri Y, Barrett K. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLoS One 2021; 16:e0249638. [PMID: 33886584 PMCID: PMC8062013 DOI: 10.1371/journal.pone.0249638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. METHODS A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. RESULTS The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. CONCLUSION A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. REGISTRATION A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).
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Affiliation(s)
- Obidimma Ezezika
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Apira Ragunathan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Yasmine El-Bakri
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
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Abolurin OO, Olaleye AO, Adekoya AO. Addressing the Sub-Optimal Use of Oral Rehydration Solution for Childhood Diarrhoea in the Tropics: Findings From a Rural Setting in Nigeria. J Trop Pediatr 2021; 67:5948851. [PMID: 33130901 DOI: 10.1093/tropej/fmaa071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. AIM To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels. METHODS A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®. RESULTS Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. CONCLUSION There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged. Lay summaryOral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.
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Affiliation(s)
- Olufunmilola O Abolurin
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Atinuke O Olaleye
- Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
| | - Adesola O Adekoya
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria
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Andrus A, Cohen R, Carvajal-Aguirre L, El Arifeen S, Weiss W. Strong community-based health systems and national governance predict improvement in coverage of oral rehydration solution (ORS): a multilevel longitudinal model. J Glob Health 2020; 10:010503. [PMID: 32257158 PMCID: PMC7103061 DOI: 10.7189/jogh.10.010503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Diarrheal disease remains a leading cause of child death globally, especially in low and middle-income countries. Use of oral rehydration solution (ORS) for treatment of diarrhea in children, a very cost-effective intervention, remains below 50% in many countries. Here we use a multi-level longitudinal model to reveal important predictors of ORS use at the national level. The findings suggest that increasing government effectiveness along with increased implementation and affordability of community-based health programs can lead to substantial increases in ORS use. Key informant interviews with national health leaders in countries that significantly improved ORS coverage support these quantitative findings.
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Affiliation(s)
- Althea Andrus
- Alutiiq, US Department of State contractor, Washington, DC, USA
| | - Robert Cohen
- CAMRIS International, Inc., USAID contractor, Bethesda, Maryland, USA
| | | | | | - William Weiss
- Department of International Health, John Hopkins University, Baltimore, Maryland, USA.,Sustaining Technical and Analytic Resources (STAR) Project, Public Health Institute, USAID Contractor, Washington, DC, USA
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Ugboko HU, Nwinyi OC, Oranusi SU, Oyewale JO. Childhood diarrhoeal diseases in developing countries. Heliyon 2020; 6:e03690. [PMID: 32322707 PMCID: PMC7160433 DOI: 10.1016/j.heliyon.2020.e03690] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 12/27/2022] Open
Abstract
Diarrhoeal diseases collectively constitute a serious public health challenge globally, especially as the leading cause of death in children (after respiratory diseases). Childhood diarrhoea affecting children under the age of five accounts for approximately 63% of the global burden. Accurate and timely detection of the aetiology of these diseases is very crucial; but conventional methods, apart from being laborious and time-consuming, often fail to identify difficult-to-culture pathogens. The aetiological agent of an average of up to 40% of cases of diarrhoea cannot be identified. This review gives an overview of the recent trends in the epidemiology and treatment of diarrhoea and aims at highlighting the potentials of metagenomics technique as a diagnostic method for enteric infections.
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Affiliation(s)
- Harriet U Ugboko
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Obinna C Nwinyi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Solomon U Oranusi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - John O Oyewale
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
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Mothers' Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061816. [PMID: 32168801 PMCID: PMC7143144 DOI: 10.3390/ijerph17061816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/20/2022]
Abstract
This study was designed to simultaneously examine if mothers’ personal healthcare autonomy within the household, and the level of their maternal-healthcare utilization, translates into better preventive (complete immunization) and curative (treatments for diarrhoea, fever and acute respiratory infection) efforts on morbidities in child healthcare. We analysed data pooled from three consecutive waves of the Nigeria Demographic and Health Survey: the surveys of 2008, 2013 and 2018. Using a multilevel logistic regression, we estimated the odds ratio for each of the outcome variables while adjusting for covariates. Findings revealed that mothers’ health autonomy is positively associated with child immunization and treatment of morbidities (except diarrhoea), a relationship moderated by the frequency of mothers’ exposure to media. Additionally, mothers’ healthcare utilization is positively associated with complete immunization, and all forms of morbidity treatment (except diarrhoea). Although the relationship between mothers’ healthcare-utilization and child immunization is not dependent on family wealth, however, the relationship between mothers’ healthcare utilization and treatment of morbidity is dependent. Policy effort should be geared towards stimulating mothers to seek appropriate and timely child healthcare and future studies could consider looking into the mediating role of paternal support in this relationship.
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Abolurin OO, Oyelami OA, Oseni SB. A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria. Afr Health Sci 2020; 20:406-412. [PMID: 33402929 PMCID: PMC7750047 DOI: 10.4314/ahs.v20i1.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Zinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea. Objective The objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea. Methods The study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria. Results The diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 – 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013). Conclusion Zinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured.
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Affiliation(s)
- Olufunmilola O Abolurin
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria
| | - Oyeku A Oyelami
- Department of Paediatrics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Saheed B Oseni
- Department of Paediatrics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Mulatya DM, Ochieng C. Disease burden and risk factors of diarrhoea in children under five years: Evidence from Kenya's demographic health survey 2014. Int J Infect Dis 2020; 93:359-366. [PMID: 32061860 DOI: 10.1016/j.ijid.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed at examining the socio-demographic, environmental and behavioural determinants of diarrhoea in children under five years in Kenya. METHODS The study entailed an analysis of secondary data from the Kenya Demographic Health Survey (DHS) 2014 using STATA Corp 2010. A total of 19,889 children <5 years were in the study, out of whom 2,906 had diarrhoea in the last two weeks prior to the survey. Descriptive analysis of independent variables and logistic regression model was used to analyse risk factors associated with diarrhoea in children <5 years. RESULTS The most significant risk factors (p < 0.05) associated with diarrhoea morbidity in children <5 years were child age (AOR 2.26 95% CI 1.64, 3.11), low level of caregiver's education (AOR 1.45 95% CI 1.11, 1.90) and unsafe disposal of children's faeces (AOR 1.29 95% CI 1.03, 1.61). Wealthier households (AOR 0.83 95% CI 0.68, 1) were protective for diarrhoea in children <5 years. CONCLUSION Increasing caregiver education, wealthier households and promoting hygienic behaviours in poor households were associated with reducing diarrhoea. Programmes aimed at reducing diarrhoea may achieve better results in targeting caregivers with children in high risk age cohorts of 6-23 months.
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Affiliation(s)
- Diana Mutuku Mulatya
- Development Alternatives Incorporation, (DAI), P.O Box 30153-00200, Nairobi, Kenya.
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Kauna R, Sobi K, Pameh W, Vince JD, Duke T. Oral Rehydration in Children with Acute Diarrhoea and Moderate Dehydration-Effectiveness of an ORS Tolerance Test. J Trop Pediatr 2019; 65:583-591. [PMID: 31330028 DOI: 10.1093/tropej/fmz017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children's Emergency Department (CED) over a period of 2-4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1-23.0) ml/kg ORS (p < 0.001).
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Affiliation(s)
- Rhondi Kauna
- Department of Paediatrics, Port Moresby General Hospital, NCD, Papua New Guinea
| | - Kone Sobi
- Department of Paediatrics, Port Moresby General Hospital, NCD, Papua New Guinea
| | - Wendy Pameh
- School of Medicine and Health Sciences, Tarauma Campus, Port Moresby, NCD, Papua New Guinea
| | - John D Vince
- School of Medicine and Health Sciences, Tarauma Campus, Port Moresby, NCD, Papua New Guinea
| | - Trevor Duke
- School of Medicine and Health Sciences, Tarauma Campus, Port Moresby, NCD, Papua New Guinea.,Centre for International Child Health, University of Melbourne and MCRI, Royal Children's Hospital, Parkville, Victoria, Australia
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Lam F, Wentworth L, Cherutich P, Migiro S, Abdala K, Musyoka M, Ogolla S, Obudho M, Mwangi Z, Kihoto R, Cheruiyot C, Wariari B, Battu A, Schroder K. An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016. J Glob Health 2019; 9:010505. [PMID: 31293782 PMCID: PMC6608604 DOI: 10.7189/jogh.09.010505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016. Methods In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc. Results The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI) = 38%, 47%) and zinc coverage was 18% (95% CI = 15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI = 12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds = 2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage. Conclusions Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.
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Affiliation(s)
- Felix Lam
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | - Peter Cherutich
- Department of Preventive and Promotive Health, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Santau Migiro
- Newborn, Child, and Adolescent Health Unit, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Khadija Abdala
- Newborn, Child, and Adolescent Health Unit, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | | | | | | | | | | | | | | | - Audrey Battu
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Kate Schroder
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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Lee HY, Van Huy N, Choi S. Determinants of early childhood morbidity and proper treatment responses in Vietnam: results from the Multiple Indicator Cluster Surveys, 2000-2011. Glob Health Action 2016; 9:29304. [PMID: 26950559 PMCID: PMC4780114 DOI: 10.3402/gha.v9.29304] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022] Open
Abstract
Background Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. Objective This study examines the determinants of diarrhea and ‘illness with a cough’ and treatments for each of the conditions among young children in Vietnam, and describes trends over time. Design Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. Results Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37–0.53, p<0.001), male (OR: 1.21, 95% CI: 0.64–2.37, p<0.05), living in rural areas (OR: 1.28, 95% CI: 1.00–1.64, p<0.05), or of Kinh ethnicity (OR: 0.70, 95% CI: 0.56–0.87, p<0.01) were more likely to suffer from diarrhea. Ethnic differences and higher household wealth were factors significantly associated with having illness with a cough. In particular, the effect of level of wealth on illness with a cough varied in each wave. Mothers with higher levels of education had higher odds of seeking ORT compared with mothers with the lowest level of education. Seeking formal treatment for children who have illness with a cough was associated with being in a household in the richest wealth quintile (OR: 0.56, 95% CI: 0.34–0.91, p<0.05). Conclusions This study demonstrates the importance of identifying different risk factors for these two illnesses and also factors associated with healthcare-seeking behaviors in order to reduce the burden of childhood morbidity in Vietnam. Policies aimed at tackling childhood morbidities should include comprehensive strategies that impact on socioeconomic and environmental factors.
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Affiliation(s)
- Hwa-Young Lee
- JW Lee Center for Global Medicine, Seoul National University, College of Medicine, Seoul, Korea; ;
| | - Nguyen Van Huy
- Department of Health Management, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; ;
| | - Sugy Choi
- JW Lee Center for Global Medicine, Seoul National University, College of Medicine, Seoul, Korea
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