Determinants of diarrhoea prevention among caregivers of under-five children in households in Burumba ward, Matayos subcounty, Busia county, Kenya

Abstract

Diarrhoea is a leading cause of illness and death among children under five globally, and in Kenya, it ranks as the fourth most common illness in this age group. In Busia municipality, the diarrhoea prevalence stands at 16%, reflecting the national statistics as of 2017. Despite interventions such as vaccinations, breastfeeding promotion, and the 2015 declaration of Busia county as open defecation free, Burumba ward in Matayos sub-county consistently reported the highest diarrhoea cases at Busia County Referral Hospital from 2014 to 2019. Understanding the determinants of diarrhoea prevention among caregivers of young children is crucial for reducing the disease's impact. This was a cross-sectional study aimed at assessing the determinants of diarrhoea prevention among caregivers of children under five in Burumba ward. The specific objectives were to determine the prevalence of diarrhoea, examine caregivers' knowledge, attitudes, and practices (KAP) regarding diarrhoea prevention, and determine the socio-economic and sanitation factors associated with diarrhoea in this population. A sample of 207 caregivers was selected from a target population of 2255, using systematic sampling with a random start, in four out of eight randomly selected villages. Probability proportional to size method was used to determine the number of households to be sampled from each village. Data collection involved structured questionnaires and observation checklists, to verify availability of sanitation facilities. A recall period of two weeks was applied to obtain information of diarrhoea occurrence. Descriptive statistics was used to obtain data on the proportion of children under five with diarrhoea, while caregivers’ knowledge and practices was described as good or poor based on the average total scores above or below (50%) respectively. Attitude was determined using a Likert scale, and regarded as negative (mean score < 3) or positive (mean score > 3) depending on approach towards diarrhoea prevention. Chi square test of independence and Logistic regression analysis was used to test the association between socio-economic and sanitation factors with diarrhoea prevention. A p-value < 0.05 was considered as statistically significant. The diarrhoea prevalence was 42.5% based on the two-week recall period. Although 79% of caregivers had good knowledge of diarrhoea prevention, only 6.3% were aware that breastfeeding could prevent diarrhoea. Good practices towards diarrhoea prevention was observed in 71.5% of caregivers, but negative attitude was observed towards boiling and filtering of drinking water with 105 (50.7%) disagreeing to using boiled drinking water, while 172 (83.3%) also disagreeing to filtering their drinking water. Level of education was the only socio-economic factor that showed significant relationship with diarrhoea prevention (χ2 (4) =1.2298; P=0.032). Further logistic regression showed that secondary school level of education was independently associated with diarrhoea prevention (OR= 3.243; 95% CI= 1.073 – 9.806; P= 0.037). Overall, sanitation was good in 86.5% of households, and none of the sanitation factors was found to be significantly associated with diarrhoea prevention, in this study. These findings underscore the need for continuous health promotion campaigns emphasizing the role of breastfeeding in regard to diarrhoea prevention. Highlights the need of boiling or filtering drinking water in preventing diarrhoea in Burumba ward.