We assessed the prevalence of diarrhoea and risk factors among children < 5 years of age in Pajule subcounty in Pader district, northern Uganda. Overall, the caregivers/mothers reported that the prevalence of diarrhoea among children under 5 years in Pajule was 29.1%, which is higher than the 20% rate reported for the same age group in the Ugandan Demographic and Health survey of 2016 (6). However, our reported prevalence rate is lower than the 41.3% reported in a similar study in children < 5 years conducted in Adjumani Refugee camp in West Nile, Uganda (18). The high prevalence of diarrhoea in Pajule sub-county than the national average is could be due to the fact that the area suffered a prolonged conflict which disrupted the social services, e.g., education and health, and economic fabric of the society, as well as infrastructural development (9). For example, 11.1% of the mothers or caretakers had no formal education, and the majority (68.0%) had stopped in the lower primary (Primary one to four). Although this was not significant in our analyses, the role of formal education cannot be under-rated, as less educated people are less likely to take seriously their hygiene and sanitation, and those of their children.
The prevalence of diarrhea was highest in the age group 13–24 months (13.6%), followed by 0–12 months (8.2%), 49–59 (11.2%), 25–36 months (5.3%) and least in age group 37- 48 months (0.8%) (Table 2). The finding of high prevalence in age group 13–24 months is in contrast with results conducted in Bukina Faso, where highest rate of diarrhoea (44%) was in children < 12 months (19). Bezatu et al., 2013 (20) reported higher prevalence among children in the age of 6–11 months and 12–23 months compared to children above 35 months in Eastern Ethiopia. The age bracket (6–24 months) coincides with stage during which children start to crawl and are highly mobile, literally picking and ingesting any contaminated materials that may potentially contain diarrhoea-causing germs. In addition, this high prevalence of diarrhea at this age group can be attributed to the introduction of contaminated weaning foods. The decreasing prevalence of diarrhea after 24 months is probably because the children have developed immunity to pathogens after repeated exposure (21).
Our results showed that diarrheal sickness was significantly associated with hand washing practices of mothers or caregivers at critical times such as before starting to feed a child, when preparing food and after visiting latrines (Table 5). Despite the relatively high latrine coverage in the district (79.9% of households), however, hand washing after latrine visits was very low as only 31.1% of households had hand-washing facilities erected near their latrines. Nationally, only one in four Ugandans wash hands properly with soap and water after using a latrine or toilet, explaining why about 75% of the country’s disease burden is listed as preventable and linked to poor hygiene and inadequate sanitation facilities and practices (22). Hand-washing with soap and water at critical times has been shown to reduce the occurrence of diarrhea and other water-borne diseases by half (23).
Additionally, we found that diarrhoeal prevalence was reportedly relatively higher among boys compared to girls. This is similar to the results of a study carried out in Sudan (24) but differs from the results of a study by (25) in Senegal where prevalence was higher among girls (27.6%) compared to boys (24.4%). Our finding could possibly be explained by the differences in cultural practices in the different places. For example, in the Acholi land where the study area was conducted, most women tend to adore their daughters and take care of them more than they do for the sons. It’s always envisaged that boys can always “take care of themselves” and are always left to play more independently. Besides girls are culturally more valuable because their bride price is a source of wealth to the parents.
The results of the present study indicated that the prevalence of diarrhoea was significantly associated with weaning of children at less than one year, and introduction of supplementation at less than 6 months (Table 5). Given the poor hand washing practices and general unhygienic conditions as observed in this study, preparations of such foods have the potential of spreading diarrhoeal causing germs to the infants. Weaning foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and thus are a major factor in the cause of diarrhoeal diseases and associated malnutrition(21).
Although the number of children <5 years in a household was not significantly associated with the occurrence of childhood diarrhoea, overall household size (those with more than two individuals) had a significant relationship with the occurrence of diarrhoea (Table 5). High number of individuals in a household potentially compromises hygiene and sanitation, making children more prone to contact with potential pathogens. In Pajule, house sizes are also generally small temporary huts where humans, and sometimes pets, occupy the limited space, further reducing cleanliness in the household.
The caretakers’ age was also significantly associated with diarrhoea in children < 5 years. Children under the care of caretakers that fell within the age group 6–15 years had more chances of having diarrhoea than their counterparts having older caretakers (16 years and above) (Table 5). This finding is consistent with a study, which noted that the level of knowledge of mother or caretaker on diarrhoea management had significant relationship with their age (26). More so, older caretakers tend to have experience in caring and handling of the children compared to their younger counterparts. They are also likely to have better knowledge of proper food preparation, hand washing and disposal of faeces for diarrhoea prevention.
Our study also showed that the prevalence of diarrhoea was significantly associated with the nature of water source being unprotected. This finding is in line with a study by (27) in Kenya who found that sources of drinking water was one of the households’ characteristics that had significant influence on childhood diarrhea. However, a study conducted in southwest Ethiopia by (28) did not find any significant association of diarrhoeal occurrence and drinking water sources. Nevertheless, unprotected water sources have higher chances of fetching germs from the intruding animals or from running water carrying waste matters to contaminate it. In Pajule, like the rest of northern Uganda, access to safe water is a major challenge due to inadequate funding for construction of clean water sources and/or inadequate training of users in water source maintenance (29)(14). Due to lack of access to safe water, communities are forced to utilize unsafe sources such as streams, which requires boiling to make it safe. This creates an additional burden for women and children, who typically spend hours every day collecting firewood and water. Even so, boiling water does not always guarantee that it is absolutely safe to drink, thus water-borne diseases continue to afflict the community.
Our study also showed that animals’ presence in households is highly associated with diarrhoea. This result agrees with a study done in Uganda by (8) where family ownership of dogs was highly associated with acute diarrhea caused by rotaviruses. This could be because some diarrheal pathogens are zoonotic in nature(30); for example, the rotaviruses and Cryptosporidium spp that cause acute diarrhoea (31). More so animals create filthy environments with their droppings or dungs attracting mechanical vectors such as houseflies and cockroaches.