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AN ASSESSMENT OF THE ASSOCIATION BETWEEN DOMESTIC HYGIENE, DIARRHOEA AND NUTRITIONAL STATUS IN
CHILDREN UNDER TWO YEARS IN KHAYELITSHA HREC 104/2012
Manyeleti Sambo
MPhil Thesis
University of Cape Town
School of Child and Adolescent Health
Supervisors: Prof. Michael Hendricks
Prof. Lesley Bourne
BACKGROUND
BACKGROUND
BACKGROUND
Diarrhoea Deaths in Cape Town 2009
Neonatal 35%
Diarrhoea 16% Pneumonia 13% Causes of death in children under 5 years, Western Cape 2009. Groenewald, et al. 2012
Diarrhoea cases in Khayelitsha
Source: De Azevedo, 2011. The Diarrhoeal Disease Season Plan in Cape Town
Objectives To determine the anthropometric status of children <2
years who had not experienced diarrhoea the previous month before the study
To observe hygiene practices of mothers/caregivers in the home environment
To explore the relationship between socio-demographic factors, domestic hygiene and diarrhoea
Case Control design
Case
Diarrhoea (age <2yrs)
No diarrhoea episode
(1 month before study)
HIV negative status
Control
No diarrhoea
(age <2yrs)
No diarrhoea episode
(1 month before study)
HIV negative status
Methodology
METHODOLOGY Stratified sampling method
The sample size of 200 was proportionally allocated to each clinic, based on the number of diarrhoea cases seen per day
City Health/Provincial clinics Cases Controls
Nolungile clinic 52 52
Matthew Goniwe clinic 4 4
Town Two clinic 8 8
Zakhele clinic 1 1
Khayelitsha site B CHC 35 35
Total 100 100
Data Collection for Anthropometry
Data Collection
Study population (200)
Cases (100) Controls (100)
100 Questionnaires
100 Anthropometry
46 Household observations
100 Questionnaires
100 Anthropometry
46 Household observations
Analysis
Descriptive analyses were performed using frequencies and percentages (%)
Logistic regression was used to identify possible predictors of diarrhoea for each variable.
Anthropometry Results
WAZ
> 2 SD
HAZ WHZ
- 2 to +2 SD
< - 2 SD
Multiple logistic results Variables OR 95% CI p-values
Child care by family/relative/day-care 2.79 1.25-6.21 0.012*
Wash dishes in container 0.39 0.19-0.84 0.015*
Grandmother preparing food for child 0.38 0.91-0.98 0.046*
Rats in the house 2.01 0.93-4.33 0.074
Toilet problems 2.21 0.91-5.40 0.081
Kitchen not separate from other rooms 1.72 0.91-3.27 0.096
Maternal/caregiver < 25 years 1.73 0.93-3.22 0.083
LIMITATIONS HIV status could not be confirmed in most of the cases
and controls
Not all households were located for hygiene observations.
Not all variables on the checklist were observed
Data was collected in both summer and winter seasons
STRENGTHS OF STUDY
The case-control study assessed multiple risk factors
It obtained findings quickly
Required minimal funding and limited resources
Logistic regression was used to control for mediating and confounding factors
Conclusion
Mothers provide a protective effect for children from diarrhoea
Grandmothers have a protective effect for diarrhoea when they prepare food for the child
Kitchen sink does not have a protective effect from diarrhoea
Recommendations Health Care facilities, Day Care facilities and community
health promotion, education and interventions
Breastfeeding
Safe food preparations
Hygiene (water and sanitation)
Maintenance and proper use of private and public toilets
Waste management and pest (rats & flies) control
Acknowledgements
Prof. Michael Hendricks
Prof. Lesley Bourne
Participants
Mrs Jawaya Shea
Dr Christiaan van Woerden
