Background: Diarrhea is a major public health problem in Nepal. Recently, there was an outbreak of diarrheal diseases in different districts of mid and far western region of Nepal and the most affected district was Jajarkot. The objective of this study was to detect the causative organism and analyze the epidemic outbreak patterns of diarrhea in selected health institutions in Jajarkot district, Midwestern Region of Nepal, in terms of their demographic characteristics and laboratory findings of stool specimens. Methods: A descriptive study was conducted using secondary data from health institutions of two Village Development committees of Jajarkot. Stool samples were collected purposively to identify the agents of diarrheal diseases. Results: Out of the total 13 stool samples tested, 5 were diagnosed as harboring Vibrio cholerae. The Attack Rate and Case Fatality Ratio were calculated to be 8.2% and 1% respectively for the District. Age groups 15-44 were highly affected; male and female were approximately equally affected. Conclusions: Cholera appears to have been the most important cause for mortality in Jajarkot diarrhea outbreak. The diarrhea outbreak in any districts of Nepal should be closely monitored for the possibility of a Cholera epidemic in the future. Key words: cholera; diarrhea; epidemic; outbreak. DOI: 10.3126/jnhrc.v7i2.3008 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 66-68
The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, handwashing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.
Introduction: Diarrheal diseases are threat everywhere, but its frequency and impact are more severe in developing countries. Diarrhea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. In 2016, it was the eighth leading cause of mortality. Moreover, data from the World Health Organization indicated that diarrheal diseases are causes for an estimated 2 million deaths annually. Therefore, this study aimed to assess diarrheal diseases and associated behavioural factors. Method: An institution based cross-sectional study was conducted. A stratified random sampling method was employed to select 1050 study participants. Participants were interviewed using structured questionnaire. To analysis the data, binary logistic regression and multivariable logistic regression analysis was conducted. Results: The two weeks prevalence of diarrhea was found to be 3.4%. Further, 1.6%, 10.5%, 10.7% and 9% of the food handlers had acute watery diarrhea, cough, an infection of runny nose and incidence of any fever respectively. Regular hand washing after toilet (AOR = 0.13 with 95% CI: 0.024, 0.72), using toilet while wearing protective clothes/gown (AOR = 5.39 with 95% CI; 1.59, 18.32), habit of eating raw beef and raw vegetables (AOR = 6.27 with 95% CI: 1.89–20.78), type of toilet (AOR = 4.07 with 95% CI: 0.29–6.67 were associated significantly with diarrhea. Conclusion: This assessment proved to be an essential activity for reduction of community diarrheal diseases, as a significant number of food handlers had diarrhea. Good sanitation, hygiene practice and a healthy lifestyle behavior can prevent diarrhea. A strong political commitment with appropriate budgetary allocation is essential for the control of diarrheal diseases.
Abstract Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002–2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16–1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19–1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.
Diarrheal diseases are a collection of diseases caused by multiple viral, bacterial, and parasitic organisms that share common symptoms, and it's defined as the passage of three or more loose or liquid stool per day. This Descriptive community based cross sectional study was conducted in Shendi Town during the year2015To study Knowledge and Attitude towards diarrheal disease in children under five years. A system of simple random sampling allocation was followed to select the sample for coverage of diarrhea disease in Shendi town. The data was collected through instructed questionnaire according to SNAP standard Questionnaire which contains 20 closed ended questions with simple language that was been easily to understood by the respondents . The collected data was analyzed by entering it into computer and analyzed using both Microsoft Excel and Statistical Package for Social Sciences Program (spss). The results then presented in tables and figures, and then subjected to additional statistical analyses T test to find associations and statistical significance by finding P value. The most important conclusions revealed from the study is, Most of mothers (55%) seek medical treatment when their children got diarrhea. The most important recommendations emerged from this study, Government and Shendi local authorities must educate mothers on diarrheal disease prevention and rehydration, Sufficient programs and facilities should be made available for family planning, Give oriented task health education to health workers.
Human populations throughout the world can be found in diverse conditions. A proportion of the population of developing countries lives in deprived conditions characterized by ramshackle housing, lack of piped water and sanitation, and widespread fecal contamination of the environment. Enteric infections, particularly due to bacterial pathogenes, are readily transmitted under these circumstances. In contrast, the majority of inhabitants of industrialized countries live in a sanitary environment that generally discourages the transmission of enteric pathogenes, particularly bacteria. In both these ecologic niches, changes in human ecology and behavior are leading to the emergence of certain enteric infections. Relevant factors in developing areas include urbanization (leading to periurban slums), diminished breastfeeding, and political upheaval that results in population migrations. In industrialized areas, large-scale food production (e.g., enormous poultry farms), distribution, and retailing (e.g., fast-food chains) create opportunities where widespread and extensive outbreaks of food-borne enteric infection can ensue if a breakdown in food hygiene occurs.
The annual diarrhoea deaths of children under 5 years old in the world are at the striking level of 1 - 3 million. Together with pneumonia, diarrhoea is one of the primary killers of children and especially the poor, with countries in Africa and South East Asia (SEA) bearing most of its global burden. Vietnam is a country which, despite its official exit from poverty during the 1990s, has been facing an average of over 1.5 million annual documented cases of diarrhoea for the period between 2005 and 2011. This high incidence of the disease persists despite the existence of known preventions, and thus remains an ongoing development concern. By examining the case of diarrheal disease in the region of Vietnam's Mekong Delta, the study strives to understand the factors that govern this essentially preventable health risk. The goal of this study is particularly to answer how cultural, social and political environments define and shape the spread of diarrheal disease in Can Tho City in Vietnam's Mekong Delta. In order to achieve this goal, the study draws greatly from the theoretical current of Political Ecology. Tracing the roots of inequalities that come together with the use of natural resources, political ecologists usually seek to answer how knowledge around these risks is being constructed. Through this questioning of socio-environmental problems, power emerges as an element which determines if and how policy will be turned into practice and whom this process will benefit. Similarly, as this study aims at locating 'the political' in disease, it asks questions such as: what guides the spread of disease physically, what hinders its control institutionally and why people are disempowered from being able to be adequately protected from it. Engaging with questions of how the risk of disease is constructed, communicated and understood, this study, therefore, also calls for a better understanding of the agents who produce, receive and circulate that knowledge. The field of Critical Medical Anthropology proves extremely useful in exploring human health in this regard, laying bare issues of access to wealth and power, relating health patterns to socio-political aspects and to the cultural meanings that are ascribed to disease. In the case of Vietnam, it was shown how the projected image of a modernized and developed state which procures for its citizens highly contradicts the reality of a degrading and increasingly unhealthy environment, with significant parts of the population being vulnerable and suffering from a disease that can be controlled. This now obvious contradiction, however, remains blurred within the country. The constructed discourse marginalises the poor and normalises suffering, while at the same time legitimising the state's abdication of its responsibility to provide basic healthcare and clean water; instead the state transfers these responsibilities to the people. The Vietnamese state has subtly, but methodically, designed its institutions in a way that they obey bureaucratic order and present proof of their prescribed activities; even if in reality, much of the policy is hardly ever turned into meaningful practice. As this study shows, even though indicators of disease (incidence and mortality) provide a measurable and logical way to assess health risks, this type of assessment defines the risk of disease in a very narrow manner. It is for this reason that biomedical experts, public health practitioners and international think-tanks on health need to engage in a sincere dialogue with the humanities, including ethnographers, sociologists and political scientists. Although the methodologies and the epistemologies followed in these widely-defined fields might diverge immensely, they share a common interest of acting for the improvement of human health. If such a claim holds truth, then there is a lot to be gained from interdisciplinary thinking and sharing.
BACKGROUND: Enough evidence exists to attribute the occurrence of diarrheal disease outbreaks due to open defecation practice and unsafe sanitation methods. Open defecation enables pathogens such as virus, bacteria, and protozoa to infect humans by means of fecal–oral transmission methods through contaminated fluids, water, and fomites. To curb the malefic effects of open defecation, the Indian government had initiated pro sanitation program namely Swachh Bharat Mission (SBM) in 2014. SBM became the world's largest toilet-building initiative. More than 95 million toilets have been built across rural and urban India since the launch of this mission. This articulation summarizes the trend analysis of acute diarrheal disease (ADD) outbreaks over a 9-year period with emphasis on changes due to the building of toilets under the clean India campaign. METHODS: Weekly ADD outbreaks data from national-level Integrated Disease Surveillance Program between 2010 and 2018 were used for trend analysis along with the number of toilets constructed in rural areas under SBM from the year 2014. RESULTS: ADD outbreaks were analyzed from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season. CONCLUSION: The recent pattern of ADD outbreaks exhibits a declining rate.
Introduction: The incidence of diarrhea, a leading cause of morbidity and mortality in low-income countries such as Nepal, is temperature-sensitive, suggesting it could be associated with climate change. With climate change fueled increases in the mean and variability of temperature and precipitation, the incidence of water and food-borne diseases are increasing, particularly in sub-Saharan Africa and South Asia. This national-level ecological study was undertaken to provide evidence linking weather and climate with diarrhea incidence in Nepal. Method: We analyzed monthly diarrheal disease count and meteorological data from all districts, spanning 15 eco-development regions of Nepal. Meteorological data and monthly data on diarrheal disease were sourced, respectively, from the Department of Hydrology and Meteorology and Health Management Information System (HMIS) of the Government of Nepal for the period from 2002 to 2014. Time-series log-linear regression models assessed the relationship between maximum temperature, minimum temperature, rainfall, relative humidity, and diarrhea burden. Predictors with p-values < 0.25 were retained in the fitted models. Results: Overall, diarrheal disease incidence in Nepal significantly increased with 1 °C increase in mean temperature (4.4%; 95% CI: 3.95, 4.85) and 1 cm increase in rainfall (0.28%; 95% CI: 0.15, 0.41). Seasonal variation of diarrheal incidence was prominent at the national level (11.63% rise in diarrheal cases in summer (95% CI: 4.17, 19.61) and 14.5% decrease in spring (95% CI: −18.81, −10.02) compared to winter season). Moreover, the effects of temperature and rainfall were highest in the mountain region compared to other ecological regions of Nepal. Conclusion: Our study provides empirical evidence linking weather factors and diarrheal disease burden in Nepal. This evidence suggests that additional climate change could increase diarrheal disease incidence across the nation. Mountainous regions are more sensitive to climate variability and consequently the ...
Chalie Tadie Tsehay, Andualem Yalew Aschalew, Endalkachew Dellie, Tsegaye Gebremedhin Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Andualem Yalew AschalewUniversity of Gondar, P. O. Box: 196, Gondar, EthiopiaTel +251918151825Email yalewandualem@gmail.comPurpose: Diarrhea is a common childhood illness and one of the leading causes of death in young children globally. In Ethiopia, a significant number of deaths and hospitalizations in under-five children are related to diarrheal diseases. Inappropriate feeding during diarrhea leads to a double burden of diarrhea recurrence and malnutrition among children. However, empirical evidence is limited in Ethiopia. Thus, this study was aimed to assess feeding practices and associated factors during diarrheal disease among children aged less than five years in Ethiopia.Patients and Methods: The study used the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A two-stage stratified sampling technique was applied to identify 917 under five years children. Generalized linear mixed model analyses were computed, and a P value of less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify statistically significant factors with feeding practices.Results: The majority (92.5%) of mothers were married. Out of the participants, (54.1%) of children were male; 55.6% of them were in the age group of 6– 23 months. The appropriate feeding practices for children aged less than five years who had diarrhea was 15.4% (95% CI: 13.7%-18.2%). Mothers aged 25– 34 years (AOR: 0.6, 95% CI: 0.4– 0.9), agricultural occupation of mothers (AOR: 2.2, 95% CI: 1.3– 3.6), mothers attended four and more antenatal visit (AOR: 2.3, 95% CI: 1.3– 4.32) and mothers who had a postnatal checkup within two months of birth (AOR: 1.9, 95% CI: 1.1– 3.2) were factors statistically associated with child feeding practices during diarrhea.Conclusion: Less than one-fifth of under-five children practiced appropriate feeding during diarrheal disease. Working in agriculture and attending antenatal care and postnatal checkup within two months were positively influencing feeding practice. Therefore, the government of Ethiopia needs to strengthen the existing maternal and child health services.Keywords: feeding practices, diarrheal disease, under-five children, Ethiopia
