Animal Research International (2015) 12(1): 2107 – 2113 2107

PREVALENCE AND MANAGEMENT OF DIARRHOEA AMONG CHILDREN IN

NSUKKA, NIGERIA

1
OMELONYE, Kelvin Ebere, 1OKOLO, Chidinma Adanna, 2and3NWIBO, Daniel Don,
4
CHUKWUKA, Christian Onyeka, 5NWIBO, Mirabel Ifeyinwa and
1
UBACHUKWU, Patience Obiageli
1
Department of Zoology and Environmental Biology, University of Nigeria, Nsukka.
2
Laboratory of Pharmaceutical Microbial Medicinal Chemistry, Graduate School of Pharmaceutical
Sciences, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.
3
Department of Chemistry, University of Nigeria, Nsukka, Nigeria.
4
Department of Biology/Biotechnology, Federal University, Ndufu-Alike, Ikwo, PMB 1010, Abakaliki,
Ebonyi State, Nigeria.
5
Department of Food Science and Technology, Faculty of Agricultural Sciences, University of Nigeria,
Nsukka, Nigeria.

Corresponding Author: Okolo, C. A. Department of Zoology and Environmental Biology, University

of Nigeria, Nsukka. Email: [email protected] Phone: +234 8069076354

ABSTRACT

Two months preliminary survey of the prevalence of diarrhoea among children (aged 5 –
10 years) was carried out in Nsukka area of Enugu State, Nigeria. Questionnaires were
used to obtain information on the demographic details of the parents and children,
prevalence, management and control of diarrhoea among children of this age group.
These were distributed to parents of the children used for the study. Using Pearson's
correlation coefficient, we found that diarrhoea among children of this age was neither
correlated with residential location (r = -0.47, p = 0.652), occupation of the parent (r =
0.134, p = 0.194) nor sex of the child (r = 0.092, p = 0.377). However, the educational
level of the parents was correlated with childhood diarrhoea (r = 0.346, p = 0.001).
These results suggested that the children of less educated people were more prone to
diarrhoeal infection when compared to children of the more educated counterparts.

Keywords: Prevalence, Management, Diarrhoea, Children, Nsukka

INTRODUCTION gastrointestinal infection caused by bacteria

(Lastovica and Le Roux, 1993), virus, parasitic
Diarrhoea is derived from the Greek word organisms and protozoa. The infection is spread
‘diarroia’ meaning ‘flowing through’. World through contaminated food or drinking water or
Health Organization (WHO) defined diarrhoea as from person to person as a result of poor
having three or more loose or liquid stools per hygiene. As noted above, chronic diarrhoea
day, or having more stools than normal for any leads to fluid loss and may be life threatening,
individual. Diarrhoea is common in children and especially in young children, malnourished
usually accompanied by vomiting, abnormal individuals, and immunocompromised patients.
increases in stool weight and liquidity. Hogue et The most severe symptom in many patients is
al. (2000) suggested that increase in stool water the urgency of defecation and faecal
excretion above 150 to 200 ml every 24-hour is inconsistencies (Haslett et al., 1999). All over
an objective parameter for acute diarrhoea (a the world, diarrhoea is leading cause of child
chronic form of the disease). In terms of morbidity. In 2004, it was the third leading
pathology, diarrhoea often results from cause of death among populations of low-

ISSN: 1597 – 3115 ARI 2015 12(1): 2107 – 2113

www.zoo-unn.org
Omelonye et al. 2108

income countries, and the second leading cause sodium phosphate and citrate, antacids), and
of death among children under five years of age ingestion of mannitol and sorbitol. Digestion and
responsible for 6.9% of the overall deaths and absorption of nutrients is a complex, highly
accounting for 1.5 million the deaths of children coordinated and extremely efficient process;
yearly. Unfortunately, 80% of these deaths normally less than 5% of ingested carbohydrate,
were estimated to occur among those less than fat and protein are excreted in the faeces. Acute
two years of age (Bryce et al., 2005; WHO, diarrhoea is extremely common and usually due
2009; Fischer-Walker et al., 2012). Traveller’s to faecal-oral transmission of bacterial toxins,
diarrhoea, a peculiar kind of diarrhoea that viruses, bacteria or protozoan organism.
commonly affects travellers visiting developing Infective diarrhoea is usually short-lived and
countries, is an attack of usually abrupt and patient with a history of diarrhoea lasting more
watery stool with abdominal cramps, anorexia than 10 days rarely have an infective cause
and vomiting lasting for 2 – 5 days (Hogue et (Haslett et al., 1999). The most common cause
al., 2000). However, in 60 – 70% of affected of chronic or relapsing diarrhoea is irritable
patients, no organism is identified on bowel syndrome, which can present with
examination. Antibiotics and cytotoxic drugs can increased frequency of defecation and loose,
also cause drug-induced form of diarrhoea. watery or pellet stool. Diarrhoea rarely occurs at
According to CHRSPR (1998), diarrhoea night and is most severe before and after
is one of the top causes of childhood mortality breakfast. The stool often contains mucus but
in sub Sahara African and has been estimated to never blood, and 24 hour stool volume is less
be responsible for 25 to 75% of all childhood than 200g. Chronic diarrhoea can be
illnesses in Africa. In addition, episodes of categorized as disease of the colon or small
diarrhoea leads to about 14% of outpatient bowel, or mal-absorption (Haslett et al., 1999).
visits, 16% of hospital admissions and accounts Contaminated food or water, early introduction
for an average of 35 days of illness per year in of milk formula or solid food, poor personal
children less than five years old. The report also hygiene, lack of maternal education and care,
stated that unlike the decline in mortality rates, diseases and malnutrition, are the common
diarrhoea incidence does not appear to have means of acquiring diarrhoea. Transmission of
changed substantially over the last decade. In diarrhoeal pathogens through human faeces is
Nigeria, available reports indicate that more very common. Such pathogens from
than 315,000 deaths of preschool age children contaminated faeces excreted into the
are recorded annually as a result of diarrhoea environment, often get onto people’s hands or
disease (Ogbu et al., 2008). A study “review of water bodies where they are consumed.
diarrhoeal disease cases admitted to a busy Significant transmitters of diarrhoeal pathogens
referral hospital in Ghana” (Baffoe-Bonnie et al., include flies and animals. Flies that have come
1998) indicated that children less than 5 years in contact with faeces easily transmit pathogens
of age make up 84% of all child admissions and to food and water as they perch around, while
56.5% of them being infants below one year. animals (especially in rural settings) also spread
Approximately, one third of deaths among the pathogens by walking in faecal material and
children less than 5 are caused by diarrhoea by frequenting domestic environments they
(Snyder and Merson, 1982). In terms of make contacts with children, domestic materials
mechanism of infectivity inhibition of ion and foods (Curtis et al., 2000). This study
absorption, stimulation of ion secretion, attempts to establish a link between prevalence
retention of fluid in the intestinal lumen, and of diarrhoea and demographic variables among
disorders of intestinal motility may cause children in Nsukka, Nigeria.
diarrhoea. Retention of fluid in the bowel lumen
may also occur precipitated by food intolerance MATERIALS AND METHODS
associated with carbohydrate malabsorption,
disaccharides deficiencies, lactulose therapy, Description of Study Area: Nsukka (latitude
poorly absorbable salts (magnesium sulphate, 6o51oN and longitude 7 o 271E) (Figure 1) is a

Animal Research International (2015) 12(1): 2107 – 2113

Prevalence and management of diarrhoea in children 2109

town and Local Government Area (LGA) in Data Analysis: The questionnaires were
Enugu State, south eastern Nigeria. The analyzed using SPSS (Statistical Package for
landmass and topography is characterised by hill Social Sciences). Percentage frequencies were
and grasslands where rodents are widely obtained for variables while correlation was
distributed. Nsukka LGA has an area of used to ascertain relationship between variables
1,810km2 and a population of 270,257 at the and diarrhoea.
2006 census (Okoye and Obiezue, 2008).
Nsukka is a tropical rainforest region with RESULTS
sharply falling density population to average
density. The prevalence of diarrhoea in Nsukka was
higher, with 24.2% infections. Following it was
Ajuona (7.4%), while University of Nigeria
Nsukka, Bishop Shannahan Hospital, Onuiyi,
Odim and Amaigbo had percentage of 6.3. Also,
from the sampled population, the age bracket of
18 – 30 years had the highest prevalence
(45.3%), while 40 and above had the lowest
prevalence (25.3%). More female parents
(68.4%) were sampled than the males (31.6%).
Meanwhile, from the educational level of the
parents, more of the parents sampled had
university education (64.2%), followed by those
that attended Senior Secondary School (SSS)
(13.7%). Only 1.1% of the parents left the
question unanswered. Civil servants however,
recorded the highest prevalence (48.4%), while
Figure 1: Map of Nsukka town showing students and traders followed with 24.2% and
locations of study area. Source: Topographic 18.9% respectively. 4.2% of the parents did not
Map of Nigeria (2000)
respond to the question (Table 2).
The study area can be seen as underdeveloped On the other hand, 42.1% of the
or still developing, save for the university children at 5 years of age had the highest
campus located within it. It is dotted by areas of prevalence. Children at 10 years recorded
farmlands close to residential areas, poor 18.9% and then, 6 and 7 year – old – children,
drainage systems leading to flooded roads and 15.8% and 13.7% respectively. More male
pools of stagnant waters, indiscriminate children (53.7%) were sampled than the
construction of houses and unplanned females (46.3%). The educational level of the
urbanization. The annual rainfall for Nsukka child indicated that children in primary school
town varies from 986 mm to 2,098.2 mm recorded the highest prevalence (71.6%), while
(Oformata, 1978). nursery school children recorded only 18.9%
prevalence, but 1.1% of the children had no
Data Collection: Information on the diarrhoea response (Table 3).
status of children was collected using structured The questionnaire also revealed that
questionnaire. The questionnaire was 54.7% of the children had diarrhoea before
distributed to parents of the children used for 2011, while 31.6% had diarrhoea in 2011. On
the study. The questionnaire was made up of the other hand, 38.9% of the children had not
information on the demographic details of both diarrhoea before 2011 and 62.1% had not
the parents and the child. Also, the prevalence, diarrhoea in 2011, while 1.1% of the sampled
management and control measures of diarrhoea population left the question unanswered (Table
were included in the questionnaire (Table 1). 4). While the children suffered this ailment,
42.1% of the parents sampled visited the

Animal Research International (2015) 12(1): 2107 – 2113

Omelonye et al. 2110

Table 1: Data collection instrument for diarrhoea patients

Dear Respondent,
This interview is designed to find out your views on prevalence and management of diarrhoea in
children aged 5 to 10 years. Your response will be strictly confidential.
A: Demographic Details of the Parent
1) Residential Area ……………………………
2) Age (years): 18-30 [ ] 30-40 [ ] 40 and above [ ]
3) Sex: Male [ ] Female [ ]
4) Educational Level: Primary[ ] JSS [ ] SSS/O’Level [ ] A Level [ ] University [ ]
Other (specify)…………
5) Occupation: Trader [ ] Farmer [ ] Civil servant [ ] other (specify)……………………
B: Demographic Details of the Child
1) Age (years): 5 [ ] 6 [ ] 7 [ ] 8 [ ] 9 [ ] 10 [ ]
2) Sex: Male [ ] Female [ ]
3) Educational Level: Nursery School [ ] Primary [ ] Other [ ]
C: Prevalence and Management of Diarrhoea
1) Has your child had diarrhoea before? Yes [ ] No [ ] Can’t say [ ]
2) Has he/she had diarrhoea this year? Yes [ ] No [ ] Can’t say [ ]
3) Which of these healthcare providers did you see when your child suffered the ailment?
Doctor [ ] Pharmacist [ ] Nurse [ ] Chemist [ ] Herbal home [ ] other (specify)……………
4) Did the healthcare provider tell you about diarrhoea? Yes [ ] No [ ] Can’t say [ ]
D: Control of Diarrhoea
5) Were you told that poor personal hygiene (e. g. not washing the hands after using the toilet,
not washing vegetables or fruits before eating etc) can cause/trigger the transmission of
diarrhoea? Yes [ ] No [ ] Can’t say [ ]
6) Do you know that lack of good toilet facilities can cause/trigger the transmission of diarrhoea?
Yes [ ] No [ ] Can’t say [ ]
7) Do you know that lack of good drinking water can cause/trigger the transmission of
diarrhoea? Yes [ ] No [ ] Can’t say [ ]
8) Do you regularly honour appointment dates with the healthcare providers based on your
child’s health condition? Yes [ ] No [ ] Can’t say [ ]
9) Do you give your child the medication prescribed by the healthcare providers?
Yes [ ] No [ ] Can’t say [ ]
10) If No, how then do you manage your child’s health condition? ………………………..

Thank you.

hospital (doctor) for treatment. 32.6% of the DISCUSSION

question was not attempted either because their
wards had not suffered the ailment or due to It is widely recognized that diarrhoea is a major
self medication. However, 9.5% met nurses, cause of child morbidity and mortality and it is
while 7.4% visited the pharmacist (Table 5). affected by several socio-economic,
Notwithstanding, most of the contacts environmental and behavioural factors, this has
were aware that poor personal hygiene, lack of rarely been confirmed by longitudinal studies or
good toilet facilities, lack of good drinking water clinical diagnosis. There are a number of studies
etc can trigger/cause diarrhoea (Table 6). on diarrhoeal morbidity based on cross-sectional
The residential location was not surveys. However, the measurement of
correlated with diarrhoea. Occupation of the diarrhoea from such surveys is complicated and
parent, age and sex do not also have any comparison across different background
influence on the prevalence of childhood characteristics is difficult (Woldemicael, 1995).
diarrhoea because they were not significantly In Nigeria, the prevalence of diarrhoea was
correlated with diarrhoea. However, educational found to be highest among children 6 – 12
level of the parent was significantly correlated months of age, the period when most children
with diarrhoea (r = 0.218, p= 0.034) and (r = are weaned (Olugbemiro et al., 1994).
0.346, p = 0.001) (Table 7).

Animal Research International (2015) 12(1): 2107 – 2113

Prevalence and management of diarrhoea in children 2111

Table 2: Demographic details and of this work suggested that diarrhoea was
percentage composition of the parents of prevalent in the age bracket researched on.
children diagnosed for diarrhoea in Nsukka,
Children at 5 years showed the highest infection
Nigeria
Variables Number Percentage
rate because they were still acclimatizing to the
(%) environmental conditions dirty floor,
Location contaminated food and/or water etc which
Nsukka 23 24.2 causes/triggers diarrhoea. Consequently, the
Ajuona 7 7.4
UNN 6 6.3 educational level of the parents of the child is
BSH 6 6.3 one of the determinants of diarrhoeal infection.
Onuiyi 6 6.3 This suggests that the children of less educated
Odim 6 6.3
people are more prone to diarrhoeal infection
Amaigbo 6 6.3
Age (Years) than children of more educated individuals who
18 – 30 43 45.3 must have read or heard much about the
40 and Above 24 25.3 ailment. Though in this research work,
Sex of Parent
Male 30 68.4
residential area and age of the child has little or
Female 65 31.6 no correlation with diarrhoea, Woldemicael
Educational Level (1995) noted that the level of diarrhoeal
University 61 64.2 morbidity are the age of the child, number of
Senior Secondary School 13 13.7
No response 1 1.1 children in the house, type of floor material and
Occupation place of residence.
Civil servant 46 48.4
Student 23 24.2
Table 4: Prevalence of diarrhoea among
Trader 18 18.9
No response 4 4.2 children in Nsukka, Nigeria
Diarrhoeal cases/ Number Percentage
Response (%)
Table 3: Demographic details and
percentage composition of children Diarrhoea before
diagnosed for diarrhoea in Nsukka, Nigeria Yes 52 54.7
Demographic Number Percentage No 37 38.9
details (%) Can’t say 6 6.3
No response _ _
Age of the child (years) Diarrhoea this year
5 40 42.1 Yes 30 31.6
6 15 15.8 No 59 62.1
7 13 13.7 Can’t say 5 5.3
10 18 18.9 No response 1 1.1
Sex of child
Male 51 53.7 Table 5: Healthcare provider visited
Female 44 46.3 during childhood diarrhoea in Nsukka,
Educational level Nigeria
Healthcare Number Percentage
Primary 68 71.6
provider (%)
Nursery 18 18.9
Doctor 40 42.1
No response 1 1.1
Nurse 9 9.5
Pharmacist 7 7.4
It was also reported that at five years, children No response 31 32.6
are still very much prone to this disease
because the child has lost inborn immunity and Table 6: Control measures of childhood
diarrhoea in Nsukka, Nigeria
it is exposed to different types of infections from
Control measures Response
eating food prepared by unclean water and from Yes No
unhealthy environment (Woldemicael, 1995). Poor personal hygiene 91.6 5.3
Although, researches have not really been Lack of good toilet facilities 87.4 7.4
carried out on the stipulated age bracket (5 – Lack of good drinking water 89.5 7.4

10 years), the reports generated in the course

Animal Research International (2015) 12(1): 2107 – 2113

Omelonye et al. 2112

Table 7: Correlationship between /9740650.html. Accessed 17th February,

diarrhoea and some demographic variables 2011.
Variables r p BRYCE, J., BOSCHI-PINTO, C., SHIBUYA, K. and
Diarrhoea before BLACK, R. E. (2005). WHO estimates of
Residential location -0.179 0.082 the causes of death in children. Lancet,
Educational level of parent 0.218 0.034
Occupation 0.123 0.235 365: 1147 – 1152.
Age of the child 0.022 0.834 CHILD HEALTH RESEARCH SPECIAL PROJECT
Sex of the child -0.127 0.219 REPORT (CHRSPR) (1998). Child Health
Diarrhoea this year
in Sub Saharan Africa. http://www
Residential location - 0.047 0.652
Educational level of parent 0.346 0.001 .harpnet.org/doc/spec2.pdf. Accessed
Occupation 0.134 0.194 17th February, 2011.
Age of the child 0.022 0.851
Sex of the child
CURTIS, V., CAIRNCROSS, S. and YONLI, R.
-0.092 0.377
(2000). Domestic hygiene and
diarrhoea: pinpointing the problem.
Conclusion: Parents who visit the hospital
Tropical Medicine and International
should be educated on safe food and water
Health, 5(1): 22 – 32.
precautions which are the mainstream of
FISCHER-WALKER, C. L., PERIN, J., ARYEE, M.
diarrhoea prevention. There must be co-
J., BOSCHI-PINTO, C. and BLACK, R. E.
operation between patient and medical
(2012). Diarrhea incidence in low- and
practitioners for easy and correct physical
middle-income countries in 1990 and
examination, history and diagnosis. Rural
2010: a systematic review. BMC Public
residents should be sensitized on the
Health, 12: 220.
behavioural effects of diarrhoea, and then be
HASLETT, C., CHILVERS, E., HUNTER, J. A. A.
provided with the essential/basic amenities like
and BOON, N. A. (1999). Principles and
pipe-borne water, which they mostly need to
Practice of Medicine. 18th Edition,
keep themselves, children and homes clean.
Churchill Livingstone, New York.
Also, parents should teach their children to
HOGUE, V. W. (2000). Constipation and
practice the act of regular washing of hands
diarrhoea. Pages 571 – 588. In:
mostly after using the toilet, playing and before
HERFINDAL, E. and GOURLEY, D.
and after meal. This survey would help
(Editors). Textbook of Therapeutics:
necessary authorities in formulating and
Drug and Disease Management.
implementing policies that would ensure a
Lippincott Williams and Wilkins,
`diarrhoea-free society` in Nsukka, Nigeria,
Philadelphia.
Africa and the world at large.
LASTOVICA, A. J. and LE ROUX, E. (1993).
Prevalence and distribution of
ACKNOWLEDGEMENT Campylobacter species in the diarrhoeic
stools and blood cultures of pediatric
We immensely acknowledge the critics of this patients. Acta Gastro-Enterologica Belgica,
study by members of the Parasitology and 56: 34.
Public Health Research Group, Department of OFORMATA, G. E. (1978). The Nsukka
Zoology and Environmental Biology, University Environment. First Edition, Fourth
of Nigeria, Nsukka. Dimension Publishers, Enugu.
OGBU, O., AGUMADU, N., UNEKE, C. J. and
REFERENCES AMADI, E. S. (2008). Aetiology of acute
infantile diarrhoea in the South-Eastern
BAFFOE-BONNIE, B., ADDO-YOBBO, E. and Nigeria: An assessment of
PLANGE-RHULE, J. (1998). Five-year microbiological and antibiotic sensitivity
review of diarrhoeal disease cases profile. The Internet Journal of Third
admitted to a busy referral hospital in World Medicine, 7(1): 34 – 38.
Ghana. http://www.cmj.hr/1998/39/3

Animal Research International (2015) 12(1): 2107 – 2113

Prevalence and management of diarrhoea in children 2113

OKOYE, I. C. and OBIEZUE, R. N. N. (2008). A WOLDEMICAEL, G. (1995). Diarrhoeal Morbidity

survey of the gut parasites of rodents in among Young Children in Eritrea:
Nsukka ecological zone. Animal Environmental and Socio-Economic
Research International, 5(2): 846 – 847. Determinants. Department of Statistics
OLUGBEMIRO, S., ADEYEMO, A. A., and Demography, University of Asmara,
GBADEGESIN R. A. and ADEMOWO, O. Asmara, Eritrea.
G. (1994). Persistent Diarrhoea in WORLD HEALTH ORGANIZATION (1996).
Nigerian Children Aged Less than Five Prevention and treatment of traveller’s
Years: A Hospital-Based Study. diarrhoea. www.who.int/topics/diarrh
University College Hospital, Ibadan, oea/en/. Accessed 29th March, 2011.
Nigeria. WORLD HEALTH ORGANIZATION (2005). The
SNYDER, J. D. and MERSON, M. H. (1982). The treatment of diarrhoea: a manual for
magnitude of the global problem of physicians and other senior health
acute diarrhoeal disease: a review of workers. Pages 8 – 13. www.who.int/
active surveillance data. Bulletin of topics/diarrhoea/en/. Accessed 20th
World Health Organisation, 60: 605 – February, 2011.
613. WORLD HEALTH ORGANIZATION (2009).
TOPOGRAPHIC MAP OF NIGERIA (2000). Diarrhoeal Disease. www.who.int/
Nsukka Town Planning Authority. topics/diarrhoea/en/. Accessed 29th
Nsukka sheet 287. March, 2011.

Animal Research International (2015) 12(1): 2107 – 2113