A REVIEW OF RESEARCH
ON CHILDHOOD
Gimono
Wamai
Technical Advisor: Tom Barton
Child Health and Development Centre
P.O. Box 6717 Kampala, Uganda.
A Project of UNICEF, and Child Health and
CDD Programme, Development Centre,
Ministry of Health Makerere University
JULY 1992
ABSTRACT
BACKGROUND:
The Control of Diarrhoeal Diseases (CDD) Programme was initiated in 1984. Since that time a number of studies have been conducted addressing different aspects of childhood diarrhoea including: incidence, cause, morbidity, mortality, treatment, use of oral rehydration salts (ORS) and other home fluids, health unit and home management of diarrhoea. These studies have been conducted both at local and national levels and have employed various methods of data collection. Despite the range of these studies, there is no central organized catalogue of the CDD studies and their findings. As a result of lacking an organized data base, there has been reduplication of some activities while other aspects have hardly been studied.
Following a joint meeting between the CDD Programme and the CHDC in March 1992, it was decided that a study be conducted to review completed research on childhood diarrhoea, make an annotated bibliography and recommend research in aspects of childhood diarrhoea found lacking.
The emerging recommendations will act as a guideline to the CDD programme, the CHDC, UNICEF, other policy makers, NGOs and research institutions interested in childhood diarrhoea.
OBJECTIVES:
The objectives of the present study were to:
1. Review completed research on Control of Diarrhoeal Diseases.
2. Make an annotated bibliography of the studies reviewed.
3. Make recommendations for follow up research on aspects of Control of Diarrhoeal Diseases found lacking.
METHODOLOGY:
The study was a retrospective review of CDD-related research in Uganda over the last nine years. Data collection was done by reviewing reports of completed studies conducted in Uganda. Sources of these records included: the UNICEF Library, CDD Library, CHDC Library, Albert Cook Library, the Institute of Public Health Library and Dr. Barton's personal library.
RESULTS:
Based on recall of recent episodes, a two week incidence between 8.6% and 19.5% was reported. Diarrhoea was most frequently reported in the less than two years age group; this group accounted for between 50% to 80% of diarrhoea cases.
Childhood diarrhoea was attributed to numerous causes. Factors like 'false teeth', 'millet disease', developmental milestone stages and spiritual misfortunes were regarded as important causes of diarrhoea by mothers and traditional healers. Most mothers and traditional healers did not recognise poor sanitation as an important contribution of diarrhoea. The relationship between improper excreta disposal and diarrhoea was not well known. The perception of health workers on causes of diarrhoea were not documented.
When a child gets diarrhoea the treatment given has depended on the presumed cause. Actions have ranged from doing nothing at all to giving herbs, tablets, avoiding certain foods, consulting a traditional healer or visiting a health unit. Decision-making procedures and rationale for the decisions taken were not determined.
Although food was not deliberately withheld, the child's condition usually dictated that it took more liquids than solids during diarrhoea. There was no single home-based fluid used during diarrhoea in all the regions studied. Those commonly mentioned included: tea, fruit juices, maize porridge, cassava and rice water and wheat flour. Some fluids were avoided during diarrhoea because they were believed to worsen the illness, including: milk, millet porridge and sweet foods/fluids.
Health units (e.g., health centres and dispensaries) were the commonest source of treatment sought outside the home. A large majority (80%) of rural health workers were Dressers and Nursing Aides. Constraints affecting health units included lack of facilities for preparing and administering the ORS solution in the health unit.
Health inspectors were engaged in health education on prevention and home management of diarrhoea including use of ORT. Traditional healers were a frequent source of treatment for diarrhoea. Healers claimed that diarrhoea was the commonest childhood illness they treated.
Oral rehydration salts (ORS) and their use in diarrhoea have been investigated by a number of researchers. The studies showed an awareness about the ORS sachet of up to 90% among mothers, and between 90% and 100% for health workers and inspectors. Most rural residents (70%) used unprotected water sources. Water was not routinely boiled for drinking. Hand-washing after defecation was practiced more by adults than children.
CONCLUSION:
Most research has been done in large town and hence a need for research in small towns as well. There is still a gap in reports documenting diarrhoeal disease mortality. There are no interventional studies to assess the impact of programmes like EPI, nutrition etc. Factors like 'false teeth', 'millet disease', developmental stages and spiritual factors were considered important causes of diarrhoea by mothers and traditional healers.
Management of diarrhoea by private practitioners and shop owners has hardly been studied. Different home available fluids were recommended as suitable for a child suffering from diarrhoea in different ethnic areas. Dangerous practices like 'false teeth' extraction are practiced by some traditional healers as treatment for diarrhoea. Most of the rural and slum dwellers have no access to safe and adequater water and sanitary facilities.
KEYWORDS[ diarrhoea, evaluation ]