Hygiene practices as a contributing factor to diarrhoea in preschool children in Mpumalanga Township, KwaZulu-Natal
Authors:   , Ntshangase Samukelisiwe Nomonde 
Published: May 2022

Background: Diarrhoeal disease is reported by the World Health Organisation (WHO) as the second leading cause of mortality in children under five years old, and worldwide is responsible for the deaths of almost 525 000 children annually. Diarrhoea is defined as the passage of three or more loose or liquid stools per day, or more frequent passage than is normal for the individual and can last for several days. Diarrhoea is typically a symptom of an infection in the intestinal tract, caused by a variety of bacteria, viral and parasitic organisms. The disease is spread through contaminated food or drinking water or from person-to-person as a result of poor hygiene practices. Acute diarrhoea is a major cause of hospitalisation in South Africa, especially in children under two years of age. Diarrhoea is the main cause of morbidity and mortality in KwaZulu-Natal, even though case fatality decreased between 2014/15 and 2015/16. South Africa has improved the health and well-being of children through the introduction of the rotavirus vaccine into the National Immunisation Programme in 2009, the only known preventative measure against rotavirus diarrhoea. Aim/Objectives: The study aimed to determine if hygiene practices of parents/guardians and ECD educators contributed to diarrhoea in children attending the centres. Interdependent factors related to diarrhoea in children were also investigated. The objectives of the study included determining the prevalence of diarrhoea in children five years and under at ECD centres in Mpumalanga Township, KwaZulu-Natal; identifying risks factors that may contribute to diarrhoea in children; and assessing the knowledge, attitudes and practices of ECD educators and parents/guardians to diarrhoea and hygiene. Methodology: A descriptive cross-sectional study design was conducted using self-administered questionnaires at the research tool. The study was done at ten Early Childhood Development (ECD) centres in Mpumalanga Township, KwaZulu-Natal, South Africa. The total number of centres registered with the Department of Social Development in the area was 41 at the time of the study, with the total of educators approximating 177 and 3326 children attending the ECD centres. Simple random sampling was used in order to achieve a degree of accuracy and representativeness. The parents/guardians were selected from the same schools that were randomly selected for the educators. To achieve a 95% confidence level, respondents were invited to participate having signed informed consent. Statistical analysis was performed using SPSS version 26.0. Frequency distribution of categorical variables and means, standard deviation and ranges of continuous variables were calculated. Various graphs and tables were used to illustrate variables. The Pearson’s Chi-squared test was used where applicable for bivariate associations between categorical variables. Multivariate regression modelling was done with the inclusion of relevant covariates. Odds ratios were calculated for binary outcome variables. Confidence intervals of 95% were calculated and p values < 0.05 were considered statistically significant. Results: A total of 385 parents/guardians of 427 children attending ECD centres and a total of 121 ECD educators answered the questionnaires. The results indicated that 91.6% (n=350) of parents/guardians had flushing toilets and all the ECD centres had flushing toilets. Over 87.2% (n=333) parents/guardians reported that the toilets were indoors and 86.8% (n=105) ECD educators indicated that the centres had indoor toilets. The data revealed that over 60% (n=210) of parents/guardians said their child uses the toilet and 22.8% (n=76) had children who used nappies, thereby disposing the stools in the municipal collected waste. Only 0.9% (n=3) of parents said they buried the stools and 3.6% (n=12) said they left the child’s stools in the open. Drinking water was easily accessible in this study population as households had indoor taps (n=311, 80.8%), outdoor tap on the premised (n=70, 18.2%) and ECD centres indoor taps (n=109, 90.1%). Approximately 85% (n=307) of parents/guardians washed their hands more frequently after defecating when there was an indoor tap. Furthermore, parents/guardians who had handwashing sinks closer to the toilet washed their hands more frequently compared to those with handwashing sinks furthest (p=0.000). The study found that parents/guardians with a tertiary qualification were five times more likely to seek medical care than parents/guardians with a primary education education (OR=5.201, 95%CI=1.48-18.28, p=0.010). The administration of ORT was consistent across all levels of parental/guardian education (primary school, secondary school and tertiary). Homemade oral rehydration solution was mostly administered by parents/guardians with primary (n=5, 20.0%) and secondary education (n=21, 19.3%) compared those with tertiary education. The mean number of children under five years who had diarrhoea in the 12 months preceding this study was 1.23 (SD=0.53). Cryptosporidium infection was the likely cause of the watery diarrhoea in this population since rotavirus immunisation was given to the children. Conclusion: This study found that children were more likely to get diarrhoea from other children, compared to adults. How parents/guardians washed their hands was 1.239 times likely to contribute to children under the age of five getting infected with diarrhoea. The p-value of 0.010 was obtained in the association of type of toilet in the household and a child having diarrhoea. Knowledge around diarrhoea must be strengthened, more so in prevention, and when seeking medical care. Caregivers should be encouraged to have oral rehydration treatment readily available, to be used as needed.