The effects of Environmental Sanitation and Water on Diarrhea in children under the age of five years in Misisi compound Lusaka, Zambia : a population based case control study

Abstract

Misisi compound is a high density, low -income residential slum within the city of Lusaka. It has poor environmental health services, inadequate water supply and unhealthy housing. The poor environmental health and hygiene conditions expose children aged less than five years to various health problems including watery diarrhea. Watery diarrhea is a major health problem in Zambia. It is ranked one of the top three causes of mortality in children aged less than five years after malaria and acute respiratory infections. Objective:To determine environmental health and personal hygiene factors which put children aged less than five years old at risk of contracting watery diarrhea. Setting:Misisi compound in Lusaka, Zambia. Method: A case control study was carried out in which a 1 in 2 systematic random sampling method was used to select cases and controls. Totals of 50 and 150 cases and controls, respectively, were to be recruited into the study. Data collection was carried out using face- to- face interviews on socioeconomic and demographic characteristics; environmental health and personal hygiene conditions; and, environmental sanitation and personal hygiene knowledge and practice of the respondents. Additional data were also collected by observation of the environmental sanitation and personal hygiene conditions of the respondents' households.. Pre-tested and validated structured questionnaires along with a check list were used as instruments Results: A total of 45 cases and 142 controls were enrolled in the study. The following factors were significantly associated with diarrhea in bivariate analyses: knowledge that flies cause diarrhea; knowledge that dirty water and dirty food cause diarrhea; and, presence of too many flies and too much garbage around the house. Upon considering these factors, and , adjusting for the age of the child and educational level of the caretaker in a multivariate logistic regression, only knowledge that dirty food causes diarrhea, presence of too much garbage around the house, and, education level of the caretaker were significantly associated with diarrhea. Respondents who knew that dirty food causes diarrhea were 60% less likely to have a child suffering from diarrhea (OR=0.40, 95%CI 0.24-0.67) compared to respondents who had no knowledge. Children from homes where too much garbage was observed around the houses were twice (OR=2.04, 95%CI 1.16-3.60) more likely to suffer from diarrhea compared to children from homes where no garbage was observed around the houses. Parents with low education level were 60% (OR=0.40, 95%CI 0.39-0.91) less likely to have a child suffering from diarrhea compared to parents with higher education. Conclusion: Poor environmental health services were associated with diarrhea in children aged less than five years old in Misisi compound. The main environmental health factor which put children aged less than five years at risk of contracting watery diarrhea in this compound was the presence of too much garbage around the houses. Mothers with higher education could have been more likely to be away from home at work, thus leaving the children under the care of older siblings or other relatives who might not have taken good care of the children. Practical interventions involving the community are urgently required. Interventions should focus on health education, environmental health awareness, behavior change, community participation and funding for infrastructure development.