Sammendrag
Background. The investigation aims to explore the factors giving rise to the development of persistent diarrhoea (PD) and to find out the prevalence of persistent diarrhoea and Giardia lamblia in children aged 6 to 23 months. The main reasons for carrying out the study were: (i) Lack of knowledge about PD in Mozambique. (ii) Infant mortality rate in Mozambique has changed little in the last 20 years. (iii) Diarrhoea is the second cause of morbidity and mortality among children in Mozambique. (iv) An active national programme on health education concentrated on the treatment of acute diarrhoea, while less effort was put into information about PD.
Methods. A “case-control study” was carried out. 100 children who had diarrhoea for two weeks or more(PD) were compared firstly with 100 children without diarrhoea (WD) and secondly with 100 children with acute diarrhoea (AD), described as symptoms for more than two days but less than two weeks. Laboratory examinations and focus group discussions were also carried out.
Results. In general, PD was associated with low nutritional status (p<0,005). The association was more pronounced for parameters of chronic malnutrition (HAZ) than it was for mild (WAZ) or acute
malnutrition (WHZ). PD was also significantly associated (p<0,05), with low migration of the mothers (OD=0,46); high use of protected drinking water (OD=3,59), treated water (OD=2,35), and use of
medicines (OD=0,24); with high number of children who had diseases(OD=3,82) and with children who had diarrhoea in the 2 months prior to the data collection (OD=3,63)). Prevalence of PD in Magude village was 4,65% and of Giardia lamblia infection was 5,3%.
Discussion. In general the risk factors for development of persistent diarrhoea were the same as those described in studies carried out in other African countries. Poor nutritional status was a risk factor for
developing PD and was more pronounced between stunted children than underweight or wasted children. It may be an indication that the deterioration in nutritional status had started before the present episode of PD. This finding underlines the crucial role-played by nutrition for development of PD. The diet given to the child during episode of diarrhoea was a significant risk factor, which also underlines the interplay between nutrition and PD. A history of having migrated out of the district during the civil war was3
negatively associated with PD. A probable explanation for this is that the families were living where life conditions were better and the health services were more accessible. Access to protected and treated water was positively associated factors to PD. This is surprising but it is likely that people were too trusting of
water supply, which could explain the consequent diarrhoea between vulnerable populations. Use of medicines was negatively associated to PD because the drugs have been used to treat very ill children as
was mentioned in focus group discussions. Health history of the child was a risk factor, which was described in other studies. A lack of knowledge in the community about PD was found during focus group
discussions. It is suggested that there should be a focus on nutrition and chronic diseases in health education programs. Further work is proposed in order to determine the real influence of water on PD in this area. The low prevalence of PD (4,65%) is approximately the same as the 5% find by Ketema (1997). The presence of Giardia lamblia (5.3%) was not associated with PD in this setting.