Abstract
Background: Diarrhoea is a leading cause of death among children under the age of five globally. However, there is a limited understanding of the factors that contribute to hospital admissions resulting from diarrhoeal disease in low- and middle-income countries.
Aim: This study aimed to investigate the prevalence of diarrhoea among children under the age of five, admitted to the Mitchell’s Plain District Hospital, from the Klipfontein district in Cape Town between January 2018 and December 2022.
Methods: In this descriptive cross-sectional study, we analysed secondary data from hospital folders of children under five admitted to Mitchell's Plain Hospital from Klipfontein district between 2018 and 2022. Using SPSS, we coded, recorded, and analyzed the data. Variables that significantly increased the likelihood of diarrhoea (p-value < 0.05) were considered causative. The findings were examined using the Pearson chi-square, Fisher exact test, and Cramer V statistical tests and were displayed as descriptive, cross- tabulation, and inferential statistics. The bivariate analysis' p-value<0.05 and 95% confidence interval (CI) for each variable that was shown to be significant were factored into the model. Variables that significantly increased the chance of diarrhoea (p-value < 0.05) were deemed to be causative variables. Tables and statements were used to display and indicate the results. The odds ratio at 95% CI was used to evaluate the strength of the relationship between the variables influencing the likelihood of diarrhoea.
Results: Between January 2018 and December 2022, it was found that 33.3% of children were hospitalised due to diarrhoea. Time-based prevalence analysis comparing 2018 to 2022 found that cases of diarrhoea increased from 14.4% to 19.9%. Females made up 51.7% of hospital admissions compared to males. The majority of participants came from Nyanga, Gugulethu, and Phillipi Phase Four with admissions peaking between January and March. 18.4% of children were not up-to-date on their immunisations, and only 48.3% received Oral Rehydration Solution (ORS). The study also found that out of the total number of babies with low birth weight, 79.4% stayed in the hospital for three days or more, while 20.6% stayed for less than three days. The Fisher exact test was conducted to determine if low birth weight was a significant factor in determining the length of stay for
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babies in the hospital. The result was 0.102, indicating that the low birth weight was not a statistically significant factor in determining the length of stay due to the small sample size. A Fisher exact test was conducted to determine if the length of stay for babies whose mothers were HIV-positive and those whose mothers were HIV-negative was significant. The result of 0.124 indicates that there is no association between a child's exposure to maternal positive status and the length of their hospital stay. Factors such as age, residential area, child immunisation status, and nutritional status were found to contribute significantly to diarrheal prevalence. However, the small sample size meant that statistical significance could not be determined.
Conclusion: Klipfontein district, primarily among children aged 6 to 12 months, showed a higher prevalence of diarrhoea. Admissions were recorded more often during the summer and autumn months, and these children tend to have longer hospital stays. The majority of those admitted reside in the Nyanga, Gugulethu, and Phillipi Phase Four areas of Klipfontein. Half of the admitted children received Oral Rehydration Solution (ORS) at home. To reduce the incidence of diarrhoea in children under five in the Klipfontein district, it is essential to evaluate existing interventions based on identified predictors for the affected age group. Multiple stakeholders, including the government, non-governmental organisations, policymakers, and health professionals, should consider these predictors while designing interventions to effectively reduce hospitalizations. Maternal and carer education is a crucial predictor of childhood diarrhoea. Encouraging education can help improve the understanding of mothers and carers on how to prevent and manage diarrhoea, ultimately leading to better child health.
Keywords: children under five years old, diarrhoea, informal settlement, sanitation and Oral hydration solution