Associated risk factors of gastroenteritis in infancy

doi:10.21203/rs.3.rs-3793853/v1

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Associated risk factors of gastroenteritis in infancy

https://doi.org/10.21203/rs.3.rs-3793853/v1

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Introduction

Gastroenteritis is a condition characterized by inflammation of the gastrointestinal tract, resulting in a variety of symptoms like cramps, nausea, vomiting, diarrhoea, abdominal discomfort and dehydration. This ailment can manifest in two forms: acute or chronic. Acute gastroenteritis typically resolves within two weeks, while chronic gastroenteritis may persist for a period ranging from 14 to 30 days. Significantly, gastroenteritis can affect individuals of all age groups and poses a significant health risk, particularly in children. Chronic gastroenteritis stands as a leading cause of childhood mortality, and diarrhea remains a widespread illness among children worldwide.

Patients and Methods

A study was conducted involving 200 children, comprising a hundred cases and a hundred controls, to investigate the issues linked to gastroenteritis in children within their first years of life. The cases included children diagnosed with gastroenteritis, while controls comprised healthy children. To ensure the study's accuracy, children admitted to the Intensive Care Unit (ICU) or severely ill due to conditions other than gastroenteritis were excluded from the cases. Similarly, the control group consisted of children without any underlying diseases.

Results

A notable disparity emerged in various factors, including patient age, gender, maternal education, family structure, socioeconomic status and household income. These findings suggest that less education at home, unfavorable socioeconomic status, and restricted family income are potential risk factors associated with the development of gastroenteritis. Furthermore, the study also revealed significant distinctions in aspects related to child health, such as feeding patterns, the daily intake of meals, maternal responses to a child's diarrhea, consumption of boiled water, the child's penchant for consuming unpreserved food items, and the practice of sterilizing feeding equipment.

Gastroenteritis is a condition characterized by inflammation of the gastrointestinal tract, which manifests with symptoms such as cramps, nausea, vomiting, diarrhoea, and dehydration in addition to abdominal pain [1]. It can take two forms: acute and chronic, with acute episodes typically resolving in less than 14 days, while chronic cases can persist for 14 to 30 days [1]. Gastroenteritis poses a significant health concern affecting individuals across all age groups, but it is particularly noteworthy as a primary cause of death in children [3]. One of the most common childhood ailments in the world today is diarrhoea. Although viruses are the main cause of gastroenteritis, other pathogens such as bacteria, helminths, and protozoa can also cause the illness, especially in developing countries [4]. Approximately 87% of instances of acute gastroenteritis in affluent nations are caused by viruses, with rotavirus being the most prevalent. Globally, rotavirus is responsible for 40% of cases of infant diarrhea, resulting in approximately 145,000 deaths annually in Asia, with India, Pakistan, and Indonesia reporting the highest mortality rates. Breastfeeding is recognized as a protective measure against gastrointestinal infections [5], and the supplementation of zinc, along with oral rehydration solution (ORS), has proven to be quite effective in treating acute gastroenteritis [6, 7].

Serious repercussions can arise from acute diarrhoea, mainly from high fluid and electrolyte losses. These implications can include dehydration, acidosis, and even death. However, timely intervention through fluid replacement and electrolyte restoration can prevent many deaths. In developing countries, gastroenteritis in children also leads to other direct adverse outcomes, including malnutrition, stunted growth, and impaired cognitive development [8].

In developed nations, acute gastroenteritis remains a significant source of illness. Malnutrition exacerbates the incidence and severity of diarrhea and other infections [9]. Diarrhea-related malnutrition often occurs due to reduced appetite, dietary restrictions, and malabsorption syndromes [10].

Numerous critical risk factors are linked to gastroenteritis, harming kids in low- and middle-income nations in particular [11]. These risk variables include low maternal education, low socioeconomic position, and malnutrition in children [12, 13]. The disease's incidence is also influenced by issues with access to clean drinking water, poor sanitation, and inadequate hygiene [14, 15]. Overcrowding, low maternal age [17], environmental factors, hospitalizations [18], and unemployment further compound the problem. Behaviors such as inadequate handwashing after defecation and before food handling also have a major part in the spread of gastroenteritis [19].

Rotavirus gastroenteritis primarily spreads through the fecal-oral route. However, other transmission modes may include ingesting contaminated food and water, interpersonal interaction, coming into close contact with excrement [20], breathing in respiratory droplets, and touching contaminated hands. Research has indicated that 70% of episodes of diarrhoea are caused by tainted food and drink [21, 22]. Occasionally, improperly cooked or reheated food can also be a source of gastroenteritis, along with non-infectious causes like heavy metal poisoning (e.g., arsenic and cadmium) [9]. Unhygienic and unsafe environments pose significant risks to children's health [23]. Breastfeeding should be maintained for children with acute gastroenteritis, even during the initial rehydration phase.

Conversely, there is ongoing debate regarding lactose-free or lactose-reduced formulas, which may only sometimes be necessary and can typically remain in the diet. A diet comprising bananas, rice, applesauce, toast, cereals, and potatoes can be offered [24]. Probiotics play a vital role in establishing a healthier balance in intestinal microflora, promoting overall well-being, and proving beneficial in reducing the duration and severity of diarrheal illnesses [25]

Study Design and Location:

This case-control study was conducted at AL-Diwaniyah Maternity and Children Teaching Hospital in Diwaniyah City, Al-Qadisiyah, Iraq.

Sample Selection and Criteria:

We conducted a study involving 200 children, consists of 100 cases and 100 controls, and it looks at the risk factors for gastroenteritis in kids under the age of one. The cases' inclusion criteria were children with a diagnosis of gastroenteritis, whereas the control group consisted of children in good health. Children who had been admitted to the Intensive Care Unit (ICU) or those suffering from severe illnesses unrelated to gastroenteritis were excluded from the case group. The control group comprised children without any underlying medical conditions.

Study Protocol:

Authorization for conducting the study was obtained from AL-Diwaniyah Maternity and Children Teaching Hospital. The pediatric ward of the hospital served as the recruitment platform. In the pediatric ward, we interviewed children using a standardized questionnaire to collect data on various risk factors linked to gastroenteritis. Informed permission was acquired from the parents or guardians of those who fulfilled the inclusion criteria for the cases and were enrolled in the research.

Data Collection:

A comprehensive survey was employed to collect data, including patient age, gender, history of chronic diseases, vaccination status (especially regarding rotavirus vaccine), feeding history, sterilization practices, water supply source, term or preterm birth, urban or rural residence, monthly income, parental education, history of anemia or pica, sewage system (underground or open), chronic medication history, presence of domestic animals, and nutritional status.

Demographic and Socioeconomic Status:

Information about the individuals' family structure, educational attainment, and monthly income was documented.

Clinical and Health Assessment:

The parents of the individuals were asked about symptoms related to gastroenteritis, and their answers were recorded. Mothers were questioned on the feeding history of their kid, including nursing, foods to wean the child off of, kinds of milk, how the mother handled the child's diarrhoea, and how the mother provided care. Mothers also gave advice on hand hygiene, rubbish disposal, and sources of drinking water when it came to sanitation and hygiene.

Socio-Demographic Characteristics of the Children:

The study cohort consisted of children primarily in their first year of life, with the mean age of controls being above six months, while cases were typically below six months of age. There were no discernible variations in the two groups' family sizes or the vocations of the patients' mothers and dads (p < 0.005). The age, gender, maternal education, family type, family income, and socioeconomic level of the patients, however, varied significantly. These results imply that decreased family income, a lower socioeconomic standing, and a lower degree of parental education might all be risk factors for the development of gastroenteritis.

Mean +/- SD/Frequency (%)
Variables			Control		Case		P- Value
Age (months)	Mean age(months)		> 6		< 6		0.006
Gender	Male		39		55		0.003
	Female		61		45
Patient’s	Uneducated		7		22
father	Less than		34		56
education	Intermediate						0.000
	More than		59		22
	Intermediate
Patient’s	Uneducated		6		35
mother	Less than		60		47
education	Intermediate						0.000
	More than		34		18
	Intermediate
Patient’s	Government		51		37
father	Private		39		55		0.75
occupation	None		10		8
Patient’s	Working		14		8
mother occupation	Housewife		86		92		1.75
Family size	>five		24		22		0.737
	<five		78		76
Daily Family income		< 10000	9	25
(IQD)		10000–25000	15	27		0.000
		> 25000	76	48
Socioeconomic		Satisfactory	72	56		0.014
status		Unsatisfactory	27	44
Vaccination		Male	76	24		0.731
(Rotavirus)		Female	65	35

SD = Standard Deviation, P = Probability, %= Percentage

Table 1. The cohort's sociodemographic features (n = 200)

Influence of Mothers Education on Child Health:

The study findings indicated substantial disparities in various aspects, including feeding patterns, the quantity of daily meals consumed by the child, the mother's response when the child experienced diarrhea, the consumption of boiled water, and the child's inclination to consume unpreserved foods. However, no statistically significant differences were observed in the timing of complementary feeding introduction, the provision of Oral Rehydration Solution (ORS) to the child, the child's water intake during episodes of diarrhea, overnight hospitalization during diarrhea, or changes in the child's weight and height.

From these outcomes, maternal education focusing on child meal intake and eating habits could play a pivotal role in enhancing the management of gastroenteritis.

Variables		Frequency (%)		P- Value
Variables		Control	case	P- Value
Age of	< 6 months	17	33
complementary feeding	> 6 months	83	67	0.009
How many	One time	10	17
times child	Two times	19	25
takes meal/day	Three times	14	33	0.000
	> 3 times	57	25
Water	Half glass	16	33
consumed by	One glass	52	41
the child during	2–3 glasses	28	18	0.013
diarrhea	One bottle	4	8
Offer boiled	Yes	51	27
water to child	No	32	55	0.001
	Mineral water	17	18
ORS was given to	Yes	48	40	0.254
child	No	52	60
Child admitted	Yes	24	37
in the hospital for overnight	No	76	63	0.046
Sewage	Underground	78	61	0.009
system	Open drain	22	39
ORS = Oral Rehydration Solution, %= Percentage, P = Probability

Table 2. Influence of Mother’s education on child health

Our study, conducted at AL-Diwaniyah Maternity and Children Teaching Hospital with a sample size of 200 cases, yielded valuable insights compared to similar studies in India and Egypt. Immunization coverage levels in our study population differed from those in the countries mentioned earlier. This variation in vaccination rates could be attributed to variations in healthcare system schedules among countries.

Our study highlighted a significant association between immunization status and the residential area of the population. Specifically, 70.5% of those living in certain areas had received vaccinations. This underscores the impact of residence on child vaccination rates, which was a 3.9% increase compared to another study conducted in Egypt, where the number of children in the household did not significantly affect vaccination rates.

Furthermore, our study identified a link between the level of parental education and immunization status. Notably, a more than intermediate level of education among parents was associated with a higher proportion of vaccinated children, aligning with findings from the study in Egypt. However, the study in India reported no significant effect of parental education on child vaccination.

Our study aimed to identify factors influencing the incidence of gastroenteritis and the prevalence of specific gastroenteritis-causing pathogens, particularly rotavirus, in a developing country. We observed increased gastroenteritis incidence with more children and increased crowding rates. Crowding settings significantly influence a child's potential exposure to infectious agents[26].

Rotavirus emerged as the most common pathogen associated with gastroenteritis outbreaks. Several control measures reported in other studies were corroborated in our findings, such as excluding children and personnel with gastroenteritis and avoiding staff mixing. Providing children with gastroenteritis with their facilities, such as toilets, also contributed to lower pathogen prevalence[27].

Educational efforts highlighting the benefits of these cohorting policies for children could enhance compliance. Education has effectively promoted adherence to hand hygiene routines[28]. However, whether increased compliance translates into improved gastroenteritis reduction effectiveness requires further investigation. Excluding ill children from daycare settings presents challenges for working parents, potentially impacting their employment[29].

It is important to note that our study collected fecal samples from children attending the hospital, which may introduce selection bias. Nonetheless, our sampling scheme likely detected enteric pathogens in pre- or post-symptomatic phases, contributing valuable insights[30].

The sociodemographic, facility-related, and policy-related aspects linked to the incidence of gastroenteritis and the prevalence of certain enteric infections among hospital patients were all investigated in our extensive longitudinal study. We discovered that the following factors lead to gastroenteritis: poor socioeconomic level, insufficient sanitation and hygiene practises, malnutrition, and low parental education. Furthermore, poor treatment procedures and moms' ignorance of gastroenteritis might make diarrheal problems worse.

Positively, our research indicates that better sanitation and hygiene practises can reduce the spread of disease. Moreover, mother caring practises during gastroenteritis episodes, together with understanding of the condition and how to treat it, might lessen the illness's severity.

Our study produced insightful findings despite having a limited sample size (200 patients) and a single hospital focus (AL-Diwaniyah et al. Hospital). When compared to more extensive research carried out in other cities and hospitals throughout other areas, these findings are remarkable.

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Competing interest reported. Pediatric medicine

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Associated risk factors of gastroenteritis in infancy

Status:

Version 1

Abstract

Introduction

Patients and Methods

Results

Introduction

Patients and Methods

Study Design and Location:

Sample Selection and Criteria:

Study Protocol:

Data Collection:

Demographic and Socioeconomic Status:

Clinical and Health Assessment:

Results

Discussion

Conclusion

References

Additional Declarations

Status:

Version 1