Determinants of diarrhoeal disease in children living in low-income households in a periurban community in Cape Town, South Africa

Background. Water, sanitation and hygiene are critically important in reducing morbidity and mortality from childhood diarrhoeal disease and malnutrition in low-income settings.Objectives. To assess the association of diarrhoeal disease with factors relating to domestic hygiene, the environment, sociodemographic status and anthropometry in children <2 years of age.Methods. This was a case-control study conducted in a periurban community 35 km from the centre of Cape Town, South Africa. The study included 100 children with diarrhoeal disease and 100 age-matched controls without diarrhoea, who were recruited at primary healthcare clinics. Sociodemographic status, environmental factors and domestic hygiene were assessed using a structured questionnaire; anthropometry was assessed using the World Health Organization's child growth standards. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with diarrhoea. Results. The results of the univariate logistic regression showed significant susceptibility to diarrhoea in study cases compared with controls when the caregiver was ≥25 years old (odds ratio (OR) 1.82; 95% confidence interval (CI) 1.02 - 3.23; p=0.042); when children were in day care or cared for by a family member or a relative than when cared for by their mother (OR 1.97; 95% CI 1.06 - 3.65; p=0.032); and when the mothers were employed rather than at home (OR 2.23; 95% CI 1.21 - 4.12; p=0.01). Multivariate logistic regression analysis was used to identify predictors of diarrhoea, which entailed relaxing the inclusion criteria for the univariate analysis variables (p<0.25). The predictors significantly associated with diarrhoea were household problems relating to rat infestation (OR 2.44; 95% CI 1.13 - 5.28; p=0.027); maternal employment (OR 2.47; 95% CI 1.28 - 4.76; p=0.007); and children in day care or cared for by a relative (OR 2.34; 95% CI 1.21 - 4.54; p=0.01). Significantly more of the mothers who were employed than those who were unemployed had children in day care or cared for by a relative. Conclusion. Practices relating to employment, childcare and the domestic environment were significant predictors of diarrhoea. Effective policy implementation on water, sanitation and domestic hygiene could prevent diarrhoeal disease and reduce its impact on children's growth, especially during the annual diarrhoeal surge season in this and similar periurban communities.

Quality of Care in Primary Health Centres of Tafa Local Government Area of Niger State; North Central Nigeria; The Clients' Perspective

Background: Quality of care is one of the major public health concerns in this 21 century.We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area in Niger state North central Nigeria. Methodology: A cross sectional descriptive study was conducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. Results:Result from the research shows that more than one-third (39) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7) of the total clients load. On their experiences during receiving care all the clients (100) were seen by the health worker; more than half of the clients (57) obtained all drugs prescribed; three-quarter (76) were satisfied with questions asked during consultation and less than half (44) were examined. Furthermore; more than four-fifth (83) were informed on how to take drugs and 62were informed of when to come back. More than one-third of the respondents (36.7) waited for about 1- 3hrs.. When their overall satisfaction was placed on the Likert's 5-point scale; 3highly satisfied; 8were satisfied; 39fairly satisfied; 29dissatisfied and 9were highly dissatisfied. Conclusion:In conclusion; despite the level of advancement attained in health care in the 21 century which is regarded as the era of Total Quality Management; Quality of care in primary health care centres leavesmuch to be desired. This therefore calls for an urgent; deliberate; sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system

Quality of Care in Primary Health Centres of Tafa Local Government Area of Niger State; North Central Nigeria; the Clients' Perspective

Quality of care is one of the major public health concerns in this 21 century.We tried to assess the clients' perspectives of quality of care provided by the primary health centres of Tafa Local Government Area in Niger state North central Nigeria. A cross sectional descriptive study was conducted among the 273 clients utilizing services in the 3 primary health centres of Tafa Local Government Area of Niger state in the North central geo-political zone of Nigeria. Result from the research shows that more than one-third (39) of the clients attending the primary health centres were children within the age group of 0-9 months. Outpatient services for common health care problems such malaria and diarrhoea account for more than onethird (35.7) of the total clients load. On their experiences during receiving care all the clients (100) were seen by the health worker; more than half of the clients (57) obtained all drugs prescribed; three-quarter (76) were satisfied with questions asked during consultation and less than half (44) were examined. Furthermore; more than four-fifth (83) were informed on how to take drugs and 62were informed of when to come back. More than one-third of the respondents (36.7) waited for about 1- 3hrs.. When their overall satisfaction was placed on the Likert's 5-point scale; 3highly satisfied; 8were satisfied; 39fairly satisfied; 29dissatisfied and 9were highly dissatisfied : In conclusion; despite the level of advancement attained in health care in the 21 century which is regarded as the era of Total Quality Management; Quality of care in primary health care centres leaves much to be desired. This therefore calls for an urgent; deliberate; sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system