CHAPTER ONE

INTRODUCTION

1.1     Background of the Study

Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms most of which are spread by faecal contaminated water (Charles, 2012). Infection is more common when there is a shortage of adequate sanitation and hygiene and safe water for drinking, cooking and cleaning. Water contaminated with human feaces e.g from sewage, septic tanks and latrines may contain the infectious diarrheoal pathogens that may contaminate food during preparation. Diarrhoeal disease can also spread from person to person, aggregated by poor personal hygiene. Food is a major cause of diarrhoea when it is prepared or stored in unhygienic conditions (Smith, 2010).

Childhood diarrhoea can be caused by numerous things, ranging from a change in diet to an intestinal infection. Infection is caused by a virus, bacteria or parasite through mediums such as contaminated drinking water, food and unclean surroundings (Briggs, 2008). Children can pick up the bacteria and viruses that cause diarrhoea through contact with contaminated food or water or by touching contaminated surfaces and then placing hands into their mouths. Frequent hand washing is important to prevent diarrhoea especially before and after eating, after changing daipers and after using bathrooms and toilets (Ahmed, 2012).

The contribution of factors to the current global burden of diarrheal disease is closely linked to conditions in and around people’s homes. This is because the major source of environmental pollutants originates from households that do not have efficient means of disposing off their waste products. In urban centres, most of the determinants of urban ill health lie within the sectors of water and sanitation and housing condition. When people are overcrowded in an area, they exert pressure on the available social amenities like toilets facilities and water sources. This scenario is commonly found in slums and other deprived environments like marginalized areas (Maria, 2013).

The World Health Organization (WHO, 2011) has identified at least four environmental health risks in its world health report. These risks are: unsafe drinking water, poor sanitation, unhygienic conditions and outdoor pollution. Childhood diarrhoea is one of the major health risk associated with household and community environment. Lush (2009) and Ezzati, (2014) classified health risks estimated and attributed to disease burdens as including: household environmental risks such as contaminated source of water, poor disposal of human waste, un hygienic conditions, indoor air pollution from solid-fuel use and exposure to malarial mosquitoes; community environmental risks such as urban outdoor solid pollution like ineffective disposal of household and industrial wastes and water pollution. Moreover, people living in conditions of urban poverty often suffer from a wide range of other health problems, many of which have little to do with the physical environment, even if they are closely linked to poverty (Smith,  2011).

Since 1950, urban population has grown from under 17% of the world’s population to approximately 50% in 2000. It is estimated that 90% of future population growth will be in urban areas and most of the growth is likely to be among the poor (UNICEF, 2010). Approximately 0.5 billion people in the world lack adequate sanitation, contributing to more than 5 million deaths each year, of which more than half are children (United Nations, 2011). Currently, about 50% of the developing world’s population is exposed to polluted water sources and poor sanitation. Inadequate sanitation remains a leading cause of poor health and death at a global level.

A recent report by the World Health Organization and UNICEF (2013) estimated that approximately 2.5 billion people live without improved sanitation, of which almost 1 billion people continue to defecate in open. Despite this, sanitation remains a neglected issue with global financial investments representing only 1/5 of the total water, sanitation and hygiene sector expenditure.

Within Sub-Saharan Africa, there are regional differences in the rural and urban areas in the under five years diarrhoea mortality differentials. According to the World Health Organisation (2014), diarrhoeal diseases of under five years accounted for an estimated two million in developing countries each year. It has long been among the principal diseases affecting children of less than five years of age and the burden of these diseases falls predominantly on infants and children’s living in low-income settings in what is termed as slums in developing countries.

Diarrhoea among children below five years is one of the leading causes of childhood mortality in developing countries. In Nigeria it is the third highest cause of death after malaria and tuberculosis among children below five years (Johnson,  2012). Despite diarrhoea being a disease that is easy to prevent and treat in Nigeria, it continues to be a major burden of disease to the Nigerian economy where close to 100 children die every day from diarrhoeal diseases (UNICEF, 2013). The mortality due to diarrhoea disease is worse in slums which are characterized by poor hygiene and poor sanitation.

In Nigeria, overcrowded urban settlements have been found to pose high prevalent rates of diarrhoea of about 31% among children below five years of 31% (African Population and Health Research Centre, APHRC, 2009). These areas are the low income urban environments commonly referred to as urban slums.

In Nigeria, diarrhoeal disease is one of the most frequent causes of childhood morbidity and a major contributor to childhood mortality (Philips, 2014). In Nigeria, 31% of child mortality rate is attributed by diarrhoea (WHO, 2015). The Ministry of Health (MOH, 2010) acknowledged that 16 million (48%) Nigerians out of 39 million do not have access to safe drinking water and majority of these constitute 13 million who live in the rural areas and in urban informal settlements. Since 1999, Nigeria has been implementing water sector reforms to address disparities and shortcomings noted in the service delivery of water supply.

1.2     Statement of the Problem

The under five years old children morbidity due to diarrhoea disease is worse in Nigeria which is characterized by poor hygiene and sanitation due to its many informal settlements (31%). Statistics from the Nigeria National hospital show that on a given day paediatricians attend to between 10 and 20 cases of diarrhoea in children below five years (Kadiri, 2010). The numbers also show that 3 to 5 of these cases are severe and are therefore referred for admission. The high prevalence of diarrhoeal disease is largely attributable to by poor sewerage disposal, contaminated water and poor hygiene at house hold level.

The major contributors of diarrhoea of under five years have been found to be contaminated drinking water and food, lack of proper toilet facilities, ineffective disposal of household wastes, lack of hand washing practice after visiting toilets and before handling foods as well as low education levels especially among mothers of under five years children.

Childhood diarrhoeal cases have however remained high and unchanged in urban informal settlements despite vigorous attempts by the Government, Community Based organizations and NGOs to reduce the incidence of childhood diarrhoea. The improved sanitation facilities for over six years period in the study area may have explained the reduction in death resulting from diarrhoea between 2003 and 2011 while more research is needed to establish the reasons for high and rather stable childhood diarrhoea morbidity rate over a period of time.

1.3     Purpose of the Study

The purpose of this study is to examine an appraisal on control of diarrhoea among children within the age bracket of under 5 years in Bebuawhan community in Obudu Local Government Area of Cross Rivers State. This study sought to establish:

1. The risk factors and occurrence of diarrhoeal disease in children below five  years in the study area.

2. The social effects of diarrhoeal disease in children below five years in the study area.

3. The Policy recommendations on strategies that can be used to reduce childhood diarrhoea in the study area.

1.4     Significance of the Study

The study hopes to provide an informed assessment of risk factors leading to diarrhoea in children in a deprived urban environment such as Bebuawhan community.

Furthermore, the study hopes to provide additional information required for the national development of such policies and activities that will constitute the effective interventions on social considerations such as the availability of resources on such types of settlement environments.

Information on disease burden relating to risk factors rather than diseases is likely to be more relevant to policy makers because it may allow action to be directly targeted to modify exposure.

This study is therefore of great significance in identifying the extent to which the identified determinants contributes to diarrhoea morbidity among children below five years. The findings can also help to improve the health standards and livelihoods of the people affected directly and indirectly.

1.5     Research Questions

This study sought to address the following questions:

i. What are the risk factors and occurrence of diarrhoeal disease in children below five years in the study area?

2. What are the effects of diarrhoeal disease in children below five years in the study area?

3. What Policy recommendations on strategies can be used to reduce childhood diarrhoea in the study area?

1.6     Scope of the study

This study is centred on the appraisal on the control of diarrhoea among children within the age bracket of under 5 years in Bebuawhan community in Obudu Local Government Area of Cross Rivers State. It is hoped that Bebuawhan community would have known the causes and social effects of diarrhoea  among children of under five years in the course of this research work.

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