Clinico - demographic factors associated with diarrhoeal disease outcome in under-five children: A Nigerian tertiary hospital experience

Abstract

Objectives: To determine the proportion of under-5 children presenting with diarrhoeal disease, and the clinicodemographic variables associated with the outcome at the emergency paediatric ward (CHER) of the Nnamdi Azikiwe University Teaching Hospital, Nnewi, South- East Nigeria.

Methods: Clinical and demographic details of patients with diarrhoeal disease as obtained from the Paediatrics emergency ward log book over an 18month period were analyzed using SPSS and Microsoft excel software packages. The clinical variables (non-parametric) were tested for degree of association with mortality using Spearman’s rank correlation. Chi square and Fischer exact test were used to determine presence of significant differences between certain variables. A p value <0.05 was deemed significant.

Results: One thousand, one hundred and sixty three out of 1,513 children admitted within the period were aged below 5 years. Acute diarrheal disease accounted for 32% and 38% respectively of morbidity and mortality in these under-five children, with a case fatality rate of 18.3%. The mean age at presentation was 11.96 months with a male to female ratio of 1.4:1. Presentation with fast breathing (Odds Ratio {OR} 2.6), convulsion (OR 2.5), loss of consciousness (OR 4.3), increased severity of dehydration, presence of one or more comorbidities (OR 4.68) and a co-diagnosis of sepsis (OR 3.23) significantly affected the outcome. (p< 0.05 in all these). Educational status of the mothers also significantly affected the outcome. (F=9.08, p=0.023)

Conclusion: Intensified effort should be made to sensitize the public about dangers of inappropriate therapy and late hospital presentation of children with diarrhoeal
disease. These will reduce mortality-heralding complications.

Keywords: diarrhoeal disease; mortality; sepsis