Association between Attitude towards Wife Beating and Childhood Diarrhea: A Demographic and Health Survey-Based Study in 25 Sub-Saharan African Countries.

BACKGROUND: Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children. METHODS: We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI). RESULTS: The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54-0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women's age (35-39 years-aOR = 0.48, 95% CI; 0.31-0.74, 40-44 years-aOR = 0.57, 95% CI; 0.35-0.93, 45-49 years-aOR = 0.35, 95% CI; 0.16-0.79) was negatively associated with childhood diarrhea, while husband's education (primary school-aOR = 1.36, 95% CI; 1.05-1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09-1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14-2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44-8.83) were positively associated with diarrhea among under-five children. CONCLUSIONS: The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea.

The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families.

BACKGROUND: Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. METHODS: From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (<5 years of age) seeking treatment for diarrhea in sentinel hospitals participating in Bolivia's diarrheal surveillance program across three main geographic regions. Data collected included demographics, clinical symptoms, direct costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). RESULTS: Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (p<0.05) when stratified on appointment type. Direct, indirect, and total costs to families were significantly higher for inpatients as compared to outpatients of urban (p<0.001) and rural (p<0.05) residence. Consult fees and indirect costs made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. CONCLUSIONS: This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

Impact of socio-cultural practice of infant/young child gum lancing during teething.

BACKGROUND: Fever and diarrhea are among the common morbidities that do occur during infancy and are sometimes wrongly associated with teething by the community. Some societies practice gum lancing, ordinarily referred to as gum cutting, as a remedy for the "teething diarrhoea". These myths have a potential of giving false security with the belief that these symptoms are part of the teething process, and so medical attention may not be sought when necessary. There are few studies focusing on the outcome of such practices despite their known potential dangers. OBJECTIVE: To describe various methods of gum lancing and clinical presentation, management and outcome of gum lancing among the Akamba people as seen in Kangundo District Hospital. METHOD: One hundred and fifteen infants/children who were brought to the hospital with a positive history of gum lancing. RESULTS: The common presenting complaints were persistent diarrhoea (74.0%), fever (44.3%), difficulty in breathing (27.8%) and refusal to feed (20.9%). 58.3% cases warranted admission and these included severe dehydration and shock (47.8%), severe and very severe pneumonia (40.3%), meningitis (26.9%) and generalized sepsis (17.9%). There were a total of 7 mortalities (6.1%), 3 on arrival and 4 within the pediatric ward. Invasive gum lancing procedures and delayed seeking of medical attention were associated with severe disease and poorer outcomes. CONCLUSION: The impact of gum lancing is of both a public health and economic significance. It is associated with unfavorable outcome if prompt measures are not put in place. There is need to conduct community sensitization and educate caregivers on the truths of teething and dangers of gum lancing as well as seeking health services for fever and diarrhoea. Use of broad-spectrum antibiotics and adequate rehydration are necessary in management of the victims.

[Survey about the perception of the gastroenteritis and the infection due to rotavirus by the mothers in France]. / Enquête sur la perception de la gastro-entérite et de l'infection à Rotavirus par les mères en France.

AIM: To describe the perception of the acute gastroenteritis (AGE) and the interest for the vaccination of the AGE due to Rotavirus. MATERIAL AND METHODS: Observational investigation realized by phone by the IPSOS institute, with 1002 French women of 18 years and more, constituting a representative national sample, having at least a child below 2 years, between 7 and January 31st, 2008. RESULTS: AGE is mainly considered by the mothers questioned as a grave pathology (43.1%) or very grave (51.3%) for the children below 2 years. This perception is bound to the symptoms and to the complications known for the disease. For the questioned mothers, the AGE comes along very often or often with diarrheas (97.2%), vomits (94.3%) or dehydration (94%). Hospitalizations are also perceived as frequent. The quasi-totality of the questioned women (98.3%) considers finally that it is about a very contagious disease (75.4%) or rather contagious (22.8%). The AGE at the child below 2 years provoke very frequently a medical consultation (91.8%), during which some solutions of oral rehydration are prescribed in six cases on 10 (62%). The questioned mothers are for the greater part favorable (86.3%) to a drinkable vaccine to prevent the AGE due to Rotavirus, and 88.1% say that they would intend to protect their child with this vaccine. CONCLUSION: The questioned mothers know the potential gravity of the AGE and a very wide majority of them (86.3%) declare themselves favorable to the prevention of the AGE at Rotavirus by the vaccination.

Impact of postnatal depression on infants' growth in Nigeria.

BACKGROUND: The contribution of maternal postnatal depression to infant growth and under-nutrition in Africa has not been well studied. This study aims to examine the impact of postnatal depression (PND) on infants' physical growth in the first 9 months of life in Nigeria. METHODS: A longitudinal case controlled study in which 242 women (consisting of 120 depressed and 122 matched non-depressed postpartum women) had their infants' weight and length measured at the 6th week, 3rd month, 6th month and 9th month after delivery. Discontinuation with breastfeeding and illnesses like diarrhoea, persistent vomiting, fever and cough were also recorded at these periods. RESULTS: Infants of depressed mothers had statistically significant poorer growth than infants of non-depressed mothers at the 3rd month (weight OR 3.41, 95% CI 1.30-8.52; length OR 3.28, 95% CI 1.03-10.47) and the 6th month postpartum (weight OR 4.21, 95% CI 1.36-13.20; length OR 3.34, 95% CI 1.18-9.52). Depressed mothers were more likely to stop breastfeeding earlier and their infants more likely to have episodes of diarrhoea and other infectious illnesses. LIMITATIONS: Psychiatric interview was conducted only once (at 6 weeks postpartum), our sample size was moderate and we did not account for mothers who had been depressed in pregnancy. CONCLUSION: Prevention of postnatal depression and close monitoring of the growth of infants of depressed mothers should be integrated into maternal and child health policies in this region.

[Assessment of workload in pediatric emergency units due to acute gastroenteritis during the epidemic season in France]. / Evaluation de la charge de travail induite aux urgences pédiatriques par les gastroentérites aiguës en période épidémique.

OBJECTIVE: The aim of this study was to assess the burden of medical and paramedical activities related to the management of acute gastroenteritis (AGE) cases in France. METHODS: An observational, multicenter study was carried out in 23 French pediatric emergency units. Each unit was requested to include the first 25 children less than five years of age, consulting for AGE during the epidemic season. RESULTS: A total of 443 children was included between January and April 2007. The median age was 13 months. Symptoms had been persisting for an average of 2.7 days, and 60.7% of patients had already consulted. In 62.6% of cases, oral rehydration solution (ORS) had been prescribed. The median waiting time in the EU was 15 minutes. The median time spent by a health care professional with a child was 55 minutes (30 minutes for paramedical care and 25 minutes for medical care). The length of these visits increased significantly (p<0.0001) if children presented with signs of dehydration or behavioral changes. The child's age had no significant impact. Rehydration in the EU was 70% oral rehydration, 16% parenteral rehydration (8% were combined). Among the children, 37% were discharged after consultation in the EU, 39% after observation, and 24% were hospitalized. 90% of the children who were given a prescription on discharge were prescribed at least one ORS (n=333). CONCLUSION: The time spent by a health care professional with a child presenting with acute gastroenteritis could cause organizational problems during an epidemic outbreak.

Teething myths among community health officers.

Many symptoms are attributed to teething in infants as a result of myths and opinions of people in the community. These myths have given false security with the belief that these symptoms are part of the teething process. The purpose of the study was to investigate the beliefs and practices of Community health Officers about teething. 60% of the respondents whose responses were analyzed believed that children have systemic problems during teething periods. Fever and diarrhea were the most frequent symptoms associated with teething. As health care providers at the community level, there is a need for this cadre of health care providers to separate cultural beliefs from scientific and proven medical practices. This can be achieved by their attendance at regular refresher courses organized for them after their graduation.

The World Health Organization oral rehydration solution in US pediatric practice: a randomized trial to evaluate parent satisfaction.

BACKGROUND: The World Health Organization's effective, inexpensive oral rehydration solution (WHO-ORS) is used worldwide, but rarely by US practitioners because, in part, of concerns about parent satisfaction. OBJECTIVE: To compare caretaker satisfaction with the WHO-ORS, a packet-based solution requiring preparation, with satisfaction with a commercially prepared oral rehydration solution (C-ORS), (Pedialyte; Ross Nutritionals, Columbus, Ohio). DESIGN AND METHODS: Randomized controlled trial in an urban pediatric clinic and a suburban family medicine clinic. Children aged 3 to 47 months treated as outpatients for diarrhea were randomized to receive either WHO-ORS or C-ORS. After 48 hours of use, caretakers completed a telephone interview measuring satisfaction with aspects of the solution. RESULTS: Of 97 families enrolled, 91 (94%) were available for follow-up interviews. The WHO-ORS and C-ORS groups were comparable at baseline in all respects, except that slightly more caretakers in the latter group had used the C-ORS for the current illness before study enrollment (P= .06). Caretakers in the WHO-ORS group had higher overall satisfaction, satisfaction with cost, willingness to purchase in the future, and to recommend use (P<.001 for all). Differences remained significant after controlling for prior use of the C-ORS. There was no difference in satisfaction with ease of administration (P=.90), appearance (P=.20), and effectiveness (P=.80). No adverse effects attributable to either study solution occurred. CONCLUSIONS: Caretakers who prepared and used the WHO-ORS were more satisfied with their solution than a comparable group who administered C-ORS. Fear of parental dissatisfaction need not be a barrier to use of the WHO-ORS in the United States.

Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil.

To determine potential, long-term deficits associated with early childhood diarrhea and parasitic infections, we studied the physical fitness (by the Harvard Step Test) and cognitive function (by standardized tests noted below) of 26 children who had complete surveillance for diarrhea in their first 2 years of life and who had continued surveillance until 6-9 years of age in a poor urban community (favela) in Fortaleza in northeast Brazil. Early childhood diarrhea at 0-2 years of age correlated with reduced fitness by the Harvard Step Test at 6-9 years of age (P = 0.03) even after controlling for anthropometric and muscle area effects, anemia, intestinal helminths, Giardia infections, respiratory illnesses, and socioeconomic variables. Early childhood cryptosporidial infections (6 with diarrhea and 3 without diarrhea) were also associated with reduced fitness at 6-9 year of age, even when controlling for current nutritional status. Early diarrhea did not correlate with activity scores (P = 0.697), and early diarrhea remained significantly correlated with fitness scores (P = 0.035) after controlling for activity scores. Early diarrhea burdens also correlated in pilot studies with impaired cognitive function using a McCarthy Draw-A-Design (P = 0.01; P = 0.017 when controlling for early helminth infections), Wechsler Intelligence Scale for Children coding tasks (P = 0.031), and backward digit span tests (P = 0.045). These findings document for the first time a potentially substantial impact of early childhood diarrhea and cryptosporidial infections on subsequent functional status. If confirmed, these findings have major implications for calculations of global disability adjusted life years and for the importance and potential cost effectiveness of targeted interventions for early childhood diarrhea.

From aralu to ORS: Sinhalese perceptions of digestion, diarrhea, and dehydration.

This paper explores popular Sinhalese perceptions of diarrheal diseases and related health care behavior. Also addressed are cultural interpretations of dehydration and perceptions of oral rehydration solution (ORS). The social marketing of ORS is considered. It is suggested that the marketing of ORS be more closely linked to education programs which promote appropriate conceptualization of dehydration. The need to more closely integrate nutrition education and diarrheal management programs is discussed.

Symptoms and perceived severity of illness as predictive of treatment for diarrhea in six Asian and African sites.

This paper examines associations between symptoms, judgement of severity and treatments given for episodes of childhood diarrhea. Using data from ten large sample surveys conducted in six research sites in Asia and Africa, the paper addresses three main questions. One, to what extent are judgments of severity of diarrhea among young children a function of the symptoms observed during an episode of diarrhea? Two, what is the relative importance of symptoms observed vs judgments of severity in the treatments given for diarrhea? And three, what do the results imply for programs promoting the use of ORT for diarrhea? The study found that mothers, perception of severity of illness is linked most closely to three symptoms: vomiting, fever and lassitude. These symptoms are associated with (a) treating the child at all and (b) taking the child to a health facility. These conclusions take on particular significance since they are based on a comparison of ten data sets from six sites differing widely in population density, ecology, access to medical services, educational level and financial resources.

Mystification of a simple solution: oral rehydration therapy in northeast Brazil.

Problems in the control of access to and administration of oral rehydration therapy (ORT) in Northeast Brazil are described and discussed. Administration of ORT is controlled by the medical establishment, which is in general opposed to the use of home made and home administered ORT. Reasons for this resistance are discussed in terms of anthropological theories on ritual, mystification, and the social construction of reality; the medical establishment is described as using ORT as a symbol and guarantor of social status and power. Finally, an innovative program to circumvent the medical establishment by teaching ORT to traditional healers is described; the healers' integration of ORT into religious healing ceremonies is analyzed.

'A bothersome death'--narrative accounts of infant mortality in Cape Town, South Africa.

Traditional measures of health status such as mortality rates and cause-of-death information give limited insight into the role of caregivers and health care providers in infant illness and death. To the extent that the behaviours of these parties can be accurately mapped, they may reveal important sites for effective community interventions and the improvement of medical care. This possibility is explored in relation to infant mortality in Cape Town, South Africa, by analysing verbal histories provided by the caregivers of 70 infants in the course of obtaining police death certification. From these verbal histories it appears that acute respiratory infection and diarrhoeal disease caused the majority of deaths. Infants with a respiratory condition were likely to have been taken for medical attention prior to death. By contrast, the parents of infants with diarrhoeal disease, while more active towards these infants, were less likely to seek medical care--these infants typically being found dead in bed or dying en route to the hospital or clinic. A story of infant death at home following recent medical care was obtained in over half the cases. This study demonstrates a simple method for the examination of the content and structure of lay accounts of illness and death. The implications for health care of such accounts are discussed in terms of the behavioural antecedents of infant mortality due to acute respiratory infections and diarrhoeal disease.

Mothers' concepts of childhood diarrhea in rural Pakistan: what ORT program planners should know.

Diarrhea is the leading cause of infant and child death in Pakistan. Appropriately, the development of oral rehydration therapy (ORT) programs has become a major priority of the Pakistan Ministry of Health and of international funding agencies. Paradoxically, however, there is virtually no published anthropological literature on diarrhea-related traditional health beliefs and practices among the rural and illiterate people who make up 90% of the nation's population. The study reported on here focuses on these matters and suggests important implications for the multimillion-dollar ORT programs currently being launched. Mothers' ethnomedical models of diarrheal disease and concepts of appropriate treatment are discussed, as are practical problems relating to the effective implementation of ORT in such a setting. The results underline the need for anthropological studies as an adjunct to health interventions involving behavioral modification.

Sociocultural factors and the promotion of exclusive breastfeeding in rural Yoruba communities of Osun State, Nigeria.

Child survival strategies include prolonged and intensive breastfeeding, together with its early initiation, and breastmilk only for the first six months of life. This paper reports on local knowledge and attitudes of breastfeeding and the sociocultural factors that shape its practice in poor rural Yoruba communities of Southwestern Nigeria. The study has conducted 10 focus group discussions among homogeneous groups of grandmothers, pregnant women, lactating mothers, husbands, and community health workers, and a questionnaire survey of 256 third trimester pregnant women. All women in these communities breastfeed their infants on demand, and for up to two years, because breastmilk is universally accepted as the best food for babies, and breastfeeding spaces births. Prelacteal feedings of water herbal infusions and ritual fluids are the norm, and breastmilk is supplemented, from birth, with water and teas. Exclusive breastfeeding is considered dangerous to the infant: the baby has an obligatory requirement for supplementary water to quench its thirst and promote its normal development, and for herbal teas which serve as food and medicine. Colostrum is discarded because it is dirty, "like pus", and therefore potentially harmful to the infant, although 24% of the survey sample would give it to their babies. Expressed breastmilk is suspect as it can get contaminated, poisoned or bewitched. Complementary foods are introduced as early as two months because of perceived lactation insufficiency. The commonest supplement is a watery maize porridge of low nutrient density. Breastfeeding can also be dangerous, as toxins and contaminants can be passed to the infant through breastmilk. The most serious conflict with the WHO/UNICEF recommendations is the lack of local credibility of exclusive breastfeeding. According to local knowledge, the early introduction of water, herbal teas, and of complementary foods is designed to enhance child survival, while these are supposed to do the exact opposite by the WHO/UNICEF rationale, by exposing the infant to contaminants early, thereby increasing diarrheal morbidity and mortality. Child survival interventions need to address this conflict.

An atypical eating disorder in a 2-year-old female.

The case of a 21-month-old girl with an atypical eating disorder helps illustrate the impact that a serious illness and subsequent hospitalization may have on a young child's psychosexual development. The consultant emphasizes how assessing the interaction between the child's development and her environment can help treaters understand the child's self-experience during the hospitalization that led her to develop an eating disorder. Participants in the presentation discuss implications for intervention in a pediatric-liaison setting.

[Food allergy and psychosomatic medicine. New frontiers]. / Trofoallergia e psicosomatica. Nuove frontiere.

Within the area of psychosomatic and behaviour disorders in childhood, a few problems worthy of clinical investigation in order to investigate the hypothetical role of trophoallergy: colics, hyporexia, and sleep disorders within the first year of life; toddler diarrhoea and irritable bowel syndrome; hyperactivity, learning disabilities, migraine and tension fatigue syndrome in later years. Personal data and literature strongly supporting a causative role of food allergy in a significant percentage of such a kind of cases are presented. The possible pathways, and the guide-lines for a clinical approach are presented.

Attitude, beliefs and practices of some Nigerian nurses toward teething in infants.

The objective of this study was to assess the perceptions of some Nigerian nurses on the various societal beliefs about teething. A cross sectional survey was conducted among 542 nurses in the teaching, general and Local Government hospitals and clinics in Ibadan, a city in south western Nigeria. The outcome of the study revealed that the majority of the nurses believed that loss of appetite, crying, increased salivation and general irritability were a necessary part of the teething process. Furthermore, 82,1%, 61,4% and 27,9 % of them implicated fever, diarrhoea and boils respectively as signs of teething. The older and more experienced nurses and males seemed to ascribe symptoms more with the teething process. From this study, it is clearly evident that there are erroneous beliefs concerning teething persistent among Nigerian nurses. Since the societal beliefs may be harmful to the health of the children, there is a desperate need to address them. In doing this, a health education programme should be formulated to educate these misconceptions among the general public and especially target older and more experienced nurses as well as the males. Nursing and expectant mothers should also be

Health Care Utilization and Attitudes Survey: understanding diarrheal disease in rural Gambia.

Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0-11, 12-23, and 24-59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1-9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1-23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population.

Health care-seeking behavior during childhood diarrheal illness: results of health care utilization and attitudes surveys of caretakers in western Kenya, 2007-2010.

We interviewed caretakers of 1,043 children < 5 years old in a baseline cross-sectional survey (April to May 2007) and > 20,000 children on five separate subsequent occasions (May of 2009 to December 31, 2010) to assess healthcare seeking patterns for diarrhea. Diarrhea prevalence during the preceding 2 weeks ranged from 26% at baseline to 4-11% during 2009-2010. Caretakers were less likely to seek healthcare outside the home for infants (versus older children) with diarrhea (adjusted odds ratio [aOR] = 0.33, confidence interval [CI] = 0.12-0.87). Caretakers of children with reduced food intake (aOR = 3.42, CI = 1.37-8.53) and sunken eyes during their diarrheal episode were more likely to seek care outside home (aOR = 4.76, CI = 1.13-8.89). Caretakers with formal education were more likely to provide oral rehydration solution (aOR = 3.01, CI = 1.41-6.42) and visit a healthcare facility (aOR = 3.32, CI = 1.56-7.07). Studies calculating diarrheal incidence and healthcare seeking should account for seasonal trends. Improving caretakers' knowledge of home management could prevent severe diarrhea.