African Journal of Primary Health Care & Family Medicine

Abstract

Objectives:

Broad Objective - To determine the relationship between socio-economic status and the severity of dehydration at the time of presentation to Kijabe Hospital, in children between 2 months and five years of age who present with diarrhoea.

Specific Objectives - 1. To demonstrate a direct relationship between low socio-economic status and severe dehydration in children with diarrhoea aged between 2 months and five years at the time of presentation to AIC Kijabe Hospital. 2. To determine which social and economic factors have a stronger correlation to severity of dehydration at the time of presentation.

Design: This was a case control study.

Setting: The study was carried out at AIC Kijabe Hospital, (Kijabe, Kenya) paediatric ward, maternal and child health clinic, outpatient department and two of Kijabe Hospital’s satellite clinics. The two satellite clinics were Mariira and Mai Mahiu clinics.

Subjects: Consecutive children aged between two and sixty months who were seen at outpatient and inpatient departments of the Hospital who presented with diarrhoea meeting the inclusion criteria were recruited. Children were recruited until the required study sample size of 132 was achieved. Sixty-six children presenting with diarrhoea and severe dehydration were matched for age, sex and breast-feeding status with sixty-six children with diarrhoea without severe dehydration (controls).

Method: Two pre-tested questionnaires were used for each study subject. The clinician assessing the level of dehydration filled one questionnaire. The other questionnaire was administered to the child’s care taker by the nursing staff to asses the social and economic factors. The two investigators administering the questionnaire were blinded to each other’s findings to minimize bias. The data collected was analyzed using the Statistical Package for Social Sciences (SPSS) program for Windows.

Results: During the study period a total of 132 children with diarrhoea were sampled. Sixty-six of the children were considered severely dehydrated, and sixty-six controls were not severely dehydrated and were cross-matched for age, sex, and weight and breast-feeding status. The majority of the children were under one year old (59.2%), with the modal class being six months (12.6%). This contrasts sharply with findings in the developed world where typically admissions due to severe gastroenteritis peak around 11 months. There were more boys (76) with than girls (56) in the study, and this difference was statistically significant (Chi Square 8.04, p=.005). A total of 18 socio-economic factors were studied. Six if the factors showed significant association with severe dehydration. The risk factors for severe dehydration were mother’s age below 25 years (OR 2.369, LR 5.990, p=0.015), mother’s education eight years and below (OR 3.28, LR 9.928, p=0.002), father’s land size below three acres (OR 9.77, LR 17.33, p= and lesser than 0.001), father’s level of education eight years and below (OR 2.41, LR 5.156, p=0.024), family not owning any cattle (OR 2.486, LR 5.391, p= 0.21) and family owning poultry, (OR 0.45, LR 5.516, p= 0.024). No significant association was found for all the other 12 socio-economic factors studied.

Conclusions and recommendations: Low socioeconomic status of the child’s family was clearly a risk factor for severe dehydration in children with diarrhoea who are seen in Kijabe hospital. More studies need to be done to attempt to replicate the results of this study. Once adequate information has been obtained regarding the specific socioeconomic factors, national policies to control the impact of severe gastroenteritis can be addressed. From a medical and public health point of view, socio-economic factors like the size of land that the family owns, the level of education of the mother and father, and also the general economic status for the family are difficult to address. Campaigns for the education of the girl child may play a role in ensuring higher maternal literacy levels in the future. Land ownership is a sensitive issue. Primary health care providers may have an important role to play in working with the government to effect culturally and politically appropriate measures which affect health positively. Studies should be done to attempt to replicate with diarrhoea and find out the causal relationship.