Risk of Bidirectional Diarrhea-Malnutrition among Under-Five-Year-Old Children Admitted in Referral Hospitals in Western Kenya

Abstract

Background: Diarrhea leads to malnutrition while malnutrition aggravates the course of diarrhoea. In addition, it has been observed that children with moderate-severe diarrhoea cases are more likely to be malnourished compared to those with mild cases, and the bidirectional relationship of the conditions occurs in situations where either malnutrition or diarrhoea has become chronic. However, there is scanty information on the risks of bidirectional diarrhoeamalnutrition among under-fives from high-burden areas in the informal settlements of Western Kenya.

Materials And Methods: A cross-sectional design using a quantitative approach to collect primary and secondary data was applied to determine the occurrence of malnutrition, diarrhoea, and bidirectional diarrhoea malnutrition and further investigated the risk of bidirectional diarrhoea malnutrition among 105 under-fives admitted in two referral hospitals of Western Kenya between August 2020 to April 2021. The under-five children who met the inclusion criteria comprised those experiencing either acute or chronic malnutrition, as well as severe diarrhoea with dehydration or those at risk of dehydration due to malnutrition and diarrhoea, respectively. Primary and secondary data were collected using a semi-structured questionnaire and a data abstraction tool respectively.

Results: Out of 105 patients aged 0-59 months admitted to the hospital, 52 had malnutrition, and 53 had diarrhoea. The high occurrence of malnutrition and diarrhoea ranged between 71.7% and 78.85% in the age groups of 6-23 months whereas other age groups had 13.46- 18.87% < 6 and 7.69- 9.43% in 24-59 months. Of the 33 cases with bidirectional diarrhoeamalnutrition, n=28 (84.85%) cases were observed in the age group of 6-23 months, and the majority, 21 (63.64 %) had diarrhoea and then developed malnutrition. The findings showed that the risk for bidirectional diarrhoea-malnutrition among under-fives was untrimmed fingernails AOR= 2.73, 95% CI=0. 1.04-7.17, P-value=0.041 and having more than 3 underfives in a household (AOR=3.44, 95% CI= 1.15-24.65, P-value=0.032)

Conclusion: The study findings show a high occurrence of malnutrition, diarrhoea, and bidirectional diarrhoea malnutrition among children aged 6-23 months. Untrimmed fingernails and the number of under-fives in a household were associated with bidirectional diarrhoea-malnutrition. The study suggests that the occurrence of bidirectional diarrhoeamalnutrition can be reduced with the best household health practices.