ABSTRACT
Diarrhoea remains the major cause of morbidity and mortality among under-five children in many developing countries including Nigeria. This study examined sex of the child, age of the mother, parity, birth order, when the child was put into breastfeeding, mother’s highest level of education, place of residence, wealth index, toilet facility and source of drinking water in association with diarrhoea among under-five children in Nigeria. Data were obtained from the 2013 Nigeria Demographic and Health Survey. The data were analysed using both logistic regression and the exponentiated logistic regression where one shape parameter was introduced into the binary logistic regression to make a two shape parameter distribution. These models were used to determine the risk factors of diarrhoea using predictors like age of the mother, birth order, mother’s highest educational level, sex of the child, place of residence, wealth quintile, toilet facility, when the child was put into breastfeeding, source of drinking water and parity. The results obtained from binary logistic regression were compared with the result from exponentiated logistic regression using AIC. A total of 2,924 or (10.6%) children under the age of five were captured in the two weeks preceding the survey. Result shows that majority of children who were diagnosed of diarrhoea were children of mothers whose age were less than 20 years (15.0%), children whose birth order were 4+ (11.3%), children of women with parity 4+ (10.7%), and children of mothers with no education (12.8%). The prevalence of diarrhoea was also found to be slightly higher in males (10.5%) than female children (10.4%). The percentage of children with diarrhoea in the rural areas (11.4%) was higher than that of the urban (9.3%). In terms of source of drinking water, children whose household obtain drinking water from unprotected sources show higher prevalence of diarrhoea (12.1%) as compared with the protected sources of drinking water. Risk factors that were found to be significantly associated with diarrhoea morbidity among children under five years of age were the mother’s age (WS = 163.02, p < 0.0001), birth order (WS = 175.31, p < 0.0001), mother’s educational level (WS = 3.33, p < 0.0343), parity (WS = 122.47, p < 0.0001) and source of drinking water (WS = 14.05, p < 0.0001) while other risk factors like sex of the child, place of residence, wealth index and toilet facilities were not statistically significant (p < 0.05). The findings show that among the risk factors considered, age of the mother at birth was the most significantly related to the incidence of diarrhoea among under-five year children in Nigeria.
TABLE OF CONTENTS
Title Page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Table of contents vi
List of tables viii
List
of Abbreviations ix
Abstract x
CHAPTER
1: INTRODUCTION
1.1 Background
of the Study 1
1.2 Statement
of the Problem 3
1.3 Aim and
Objectives of the Study 4
1.4 Significance
of the Study 5
1.5 Scope
of the Study 5
CHAPTER 2: LITERATURE
REVIEW
2.1
Diarrhoea Related Morbidity 6
2.2 Effects of Diarrhoea 12
2.3
Diarrhoea Morbidity and Its differentials 14
2.3.1 Age-Gender differential 14
2.3.2
Education and diarrhoea morbidity 14
2.3.3
Environmental Factors and diarrhoea morbidity 15
CHAPTER
3: METHODOLOGY
3.1
Source of Data 18
3.2
Variable Specification 19
3.3
Method of Analysis 19
3.3.1 Binary logistic regression 21
3.3.1.1 Parameter estimation in
logistic regression 22
3.3.1.2 Wald test for logistic regression 24
3.3.1.3 Performance comparison among
logistic regressions 25
3.3.1.4 Likelihood ratio test 26
3.3.2 The Exponentiated binary logistic
regression (EBLR) 26
[
CHAPTER
4: RESULTS AND DISCUSSION
4.1 Results 30
4.1.1 Bivariate results 30
4.1.2 Multivariate results 33
4.2 Discussion 44
CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion 48
5.2 Recommendations 49
REFERENCES 51
APPENDICES
58
LIST OF TABLES
3.1 Selected variables for the
study 19
4.1 Distribution of children under five years
of age by
their diarrhoea morbidity status in
the two weeks before
the survey by selected
characteristics, Nigeria, 2013 32
4.2 Summary of results for test of
multicollinearity 34
4.3 Binary logistic regression result showing risk
factors of
diarrhoea morbidity among
under-five year children in
Nigeria (Full model) 36
4.4 Binary
logistic regression result showing risk factors
of diarrhoea morbidity among
under-five year children
in Nigeria (Reduced model) 38
4.5
Exponentiated
binary logistic result showing risk factors
of
diarrhoea morbidity among under-five year children in
Nigeria based (Full model) 40
4.6 Exponentiated binary logistic result
showing risk factors
of diarrhoea morbidity among
under-five year children in
Nigeria (Reduced model) 42
4.7 Comparative result of binary
logistic regression and
the proposed exponentiated binary
logistic regression
for both full and reduced models. 43
LIST OF
ABBREVIATIONS:
AIC = Akaike information Criterion
CDF = Cumulative Density Function
LRT = Likelihood Ratio Test
MLEs = Maximum
Likelihood Estimators
NEEDS = National
Economic Empowerment and Development Strategy
NPC = National Population Commission
NDHS = Nigeria
Demographic and Health Survey
PDF = Probability
Density Function
R.C = Reference
Category
UNICEF = United
Nation Children Funds
VIF = Variance
Inflation Factor
WHO = World
Health Organization
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Globally, diarrhoea related morbidity
and mortality among under-five children have raised a major concern to health
practitioners and governments. Several studies have been conducted to unravel
the determinants of diarrhoea ailment and death among children under the age of
five in different parts of Africa (Sinmegn et
al., 2014; Kawakatsu et al.,
2017; Mohamed et al., 2016; Elmi and Dioso, 2017; Magbagbeola et al., 2017; Nwaoha et al., 2016).
Diarrhoea is described as the major
killer disease of children in the 0 – 5 age bracket (World Health Organization,
2000). In 2013, of the 6.7 million deaths among under-five children worldwide,
about half died due to communicable diseases, while diarrhoea killed over half
a million children (Thiam et al.,
2017). Although death caused by diarrhoea has decreased in the last 25 years, morbidity
from diarrhoea among under-five children in West Africa is still on the
increase (Takele et al., 2019). The
scourge of diarrhoea remains one of the main disease burdens among under-five
children in developing countries.
In Nigeria, increase in diarrhoea
morbidity as evidenced from the 2013 Nigeria Demographic and Health Survey
(NDHS, 2013) has attracted widespread public discussion on child’s health. The
loss of too much water brought about by diarrhoea contributes significantly to illness
and death among under-five children. Though this situation may without much
pains be treated, being subjected to germs responsible for diarrhoea is often
attributed to the drinking of infected water besides unhygienic practices. Most
of the low-income countries are faced with this endemic disease.
According to the United Nations’
sustainable development goals report 2011, the alarming rates of age zero to
five children morbidity continued to be in Sub-Saharan Africa. Estimates show
that at least one in eight children die before their fifth birth day (129
deaths per 1000 live births) which is nearly twice the average in developing
regions and about 18 times the average in developed regions (UNICEF, 2016).
Studies conducted in developing
countries have focussed on socio-economic and environmental variables that can
affect the incidence of diarrhoea, particularly housing conditions, parental
education, and income. However, it is widely recognized that diarrhoea is
common among developing countries which is determined by the age and gender of
the child, quality and quantity of water, having access to good toilet
facilities, place of residence, mother’s level of education, economic status,
feeding practices and the sanitary condition around the environment (Stephen,
2010). Children living in households with poor access to quality water supply,
poor toilet facilities, poor sanitary environment and among others, have been
identified to have increased risk of viral, bacterial, and parasitic pathogens
that predispose them to diarrhoea infection and death. (Kermani et al, 2010).
Also, according to (Black and Fawcett,
2008), more than 1.2 billion children worldwide gained access to cleaner
environment between 1990 and 2004, even with this progress, some 41% of the
world’s population an assessed 2.6 billion people including 980 million
children lack access to proper sanitation. Inadequate cleanliness, bad hygiene
and quality drinking water are great world-wide challenge. But, researchers in
their respective studies have developed models that have helped to identify
possible risk factors of diarrhoea related morbidity among under-five children.
The health of the mother and child is
of great importance and is a good reflection of the current health situation of
a nation. A good child’s health is synonymous with wealth of the future (Tawiah,
2005). This and more provided the motivation to embark on this study with the
objective of identifying the key factors such as sex of the child, age of the
mother, parity, birth order, when the child was put to breastfeeding, mother’s highest
level of education, place of residence, wealth index, toilet facility and
source of drinking water are responsible for high prevalence of diarrhoea among
under-five children in Nigeria. The results hopefully would support
evidence-based interventions to minimize diarrhoea disease burden among
under-five children in Nigeria.
1.2
STATEMENT OF THE PROBLEM
Update from World Health Organisation
(2017), indicates that diarrhoea ranks as the number two reason of mortality
involving under-five children globally, and is the cause of the death of about
525,000 children annually. It has been estimated in Africa, that every child
under aged five experience at least five (5) episode of diarrhoea each year and
about 800,000 children die of this illness annually.
In Nigeria, diarrhoea is the second
killer of children under age five and responsible for about 16 percent of
childhood deaths yearly (Dairo et al.,
2017). Moreover, it was estimated by (WHO, 2009) that, in Nigeria a total of
151,700 children under aged five die due to diarrhoea annually. Consequent upon,
diarrhoea leaves a huge responsibility on society. In addition, diarrhoea
morbidity in the long-term undermines the nutritional status, growth, fitness,
cognition and performance of children (Kosek et al., 2003; Institute of one World Health, 2000).
Therefore, there is need to study those
things responsible for increase of diarrhoea related morbidity among under-five
year children in Nigeria using data from the 2013 Nigeria Demographic and
Health survey.
1.3 AIM AND OBJECTIVES OF THE STUDY
The aim of this study is to identify of
the risk factors of diarrhoea related morbidity among children under five years
of age in Nigeria. The specific objectives of this study are;
i)
To identify the risk factors of diarrhoea related morbidity
among under-five children in Nigeria, using binary logistic regression model;
ii)
To identify the major risk factors of diarrhoea related
morbidity among under-five children in Nigeria, using exponentiated binary
logistic regression model;
iii)
To compare the results obtained using the exponentiated
binary logistic regression with that of binary logistic regression model.
1.4 SIGNIFICANCE OF
THE STUDY
The study will be beneficial to the
government, the general public, and the health practitioners because it will
help to identify the key agents which increase diarrhoea sickness among under-five
children in Nigeria.
Also, to other researchers it will
serve as a springboard and enhance further research work in the areas of
protected source of drinking water, mothers level of education, mother’s age,
and among others.
1.5 SCOPE OF THE STUDY
The scope of this study is limited to
the factors such as sex of the child, age of the mother, parity, birth order, when
the child was put into breastfeeding, mother’s highest level of education,
place of residence, wealth index, toilet facility, and source of drinking water
using binary logistic and exponentiated binary logistic regression model to
analyze the diarrhoea related morbidity among children within the age group of
zero to five years in Nigeria.
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