Eco-social and behavioural determinants of diarrhoea in under-five children of Nepal: a framework analysis of the existing literature

Abstract

BackgroundWhile diarrhoea is the second major killer among the under-five children in the world with an estimation of 760,000 deaths annually, it stands as a major killer in Nepal with an annual incidence of 500 per 1000 under-five children with diarrhoea. Diarrhoea is responsible for a wide range of morbidity and mortality among children in Nepal. The objective of this review work is to identify the eco-social and behavioural determinants of diarrhoea among the under-five children of Nepal.MethodsA literature review was conducted using the Dahlgren and Whitehead model (1991) between June and October 2015. PubMed, Nepal Journals online and Google Scholar were used to search for literature published between 1989 and July 2015 using defined keywords.ResultsChildren of age group 6–23 months are at higher risk, as supplementary diets are introduced to the children from the age of 6 months. Male children have better access to healthcare services. Malnourished children also have a higher chance of developing persistent diarrhoea. Provision of safe water and sanitation has direct link with the prevention and control of diarrhoea. Male gender with high income positively influences the treatment-seeking behaviour. Mother’s education and hand-washing practice have direct influence in child health. Hand-washing practices with soap which are protective are influenced by the cultural beliefs. Involvement of community health volunteers increases the access to the health system, thereby reducing the diarrhoeal burden in the community.ConclusionAge, gender, hand-washing behaviour, nutritional status of children, education of mothers, water and sanitation, healthcare services, cultural and societal values and income of the household were identified determinants for diarrhoea in under-five children of Nepal.

Humanitarian Intervention, Health Behavior and Health Outcomes in Conflict Affected North East Nigeria: A Cross Sectional Survey Study

“…These factors, i.e. poverty and nutrition, have already been established in the literature as determinants of health both in emergency and nonemergency settings (39)(40)(41). We nd a signi cant positive relationship for household wealth, food security and frequency of sickness.…”

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

“…While the level of education attained is deemed important [30, 32, 33, 36, 38, 51–54], a lack in knowledge also exists regarding either availability of services, severity of illnesses and/or vulnerability to diseases [48–50, 56–58, 60–62]. Healthcare practices in households have deep roots in cultural beliefs and gender roles [19] thus a strong education system is required to advance this area. Nepal clearly has work to do to strengthen community level health literacy and this will underpin the attainment of SDG3: Ensure healthy lives and promote well - being for all at all ages .…”

“…Gaps to address the social determinants of health exist in Nepal. While Nepal still faces a burden of infectious diseases struggling with inadequate basic hygiene and sanitation along with deep rooted cultural beliefs, the burden of non-communicable diseases is also on the rise [18, 19]. Limited research has been found mentioning health literacy in Nepal [20–22] and level of health literacy of the people of Nepal is not known.…”

Diarrhea in Under Five Year-old Children in Nepal: A Spatiotemporal Analysis Based on Demographic and Health Survey Data

“…According to the framework on eco-social and behavioural determinants of children diarrhea proposed by Budhathoki and colleagues, as well as other influencing factors identified by other studies through a literature review [16,21,35], we considered a range of factors, data of which can be either obtained from NDHS or other open-access databases, as potential risk factors in this study. These factors included children's personal factors (i.e., child's age, child's gender and whether the child living with mother), maternal-related factors (i.e., mother's years of education, mother's age at birth of the child and number of children under five years old in the family), socio-economic factor (i.e., wealth index, type of place of residence, residing status), and household-related factors (i.e., water source, sanitation facility and fuel type), information of which obtained from the NDHS Women's questionnaire.…”

“…In addition, personal behaviors (e.g., personal hygiene habits) also play an essential role in childhood diarrhea [18]. Budhathoki and colleagues did a framework analysis of eco-social and behavioural determinants of children diarrhea in Nepal, eliciting age, gender, hand-washing behaviour, nutritional status of children, education of mothers, water and sanitation, healthcare services, cultural and societal values and income of the household as the identified determinants [21]. Furthermore, seasonality, environment and climatic factors (e.g., temperature, elevation, humidity and flooding) showed important relationships with diarrhea risk in some studies [22][23][24].…”