D IARRHOEAL D ISEASE

Severe diarrhoea leading to dehydration is a major cause of morbidity and mortality among young children in Ghana. Death can be prevented by administering oral rehydration therapy (ORT). Exposure to diarrhoea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. In the 2014 GDHS, mothers were asked whether any of their children under five years of age had diarrhoea during the two weeks preceding the survey. If a child had diarrhoea, the mother was asked about feeding practices during the diarrhoeal episode and what actions were taken to treat the diarrhoea. Because the prevalence of diarrhoea varies seasonally, the results of the 2014 GDHS—which relates to the fieldwork period from September to December, 2014—should be interpreted with caution.

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10.6.1 Prevalence and Treatment of Diarrhoea

Table 10.7 shows the percentage of children under 5 with diarrhoea in the two weeks preceding the survey, by select background characteristics. One in ten children (12 percent) had diarrhoea during this period; 2 percent had diarrhoea with blood, which could be a sign of dysentery.

Table 10.7 Prevalence of diarrhoea

Percentage of children under age 5 who had diarrhoea in the two weeks preceding the survey, by background characteristics, Ghana 2014

Diarrhoea in the two weeks preceding the survey

Number of children Background

characteristic All diarrhoea Diarrhoea with blood Age in months

Middle/JSS/JHS 11.5 1.2 2,124

Secondary+ 7.9 1.7 748

1 See Table 2.1 for definition of categories.

2 See Table 2.2 for definition of categories.

3 Facilities that would be considered improved if they were not shared by two or more households

Very young children under six months are least likely to have had diarrhoea (6 percent) when compared with older children, presumably because most of them are exclusively breastfed and hence less exposed to contaminated food. Diarrhoea prevalence increases with age and peaks at 12-35 months (16-17 percent), then declines at older ages. Age 12-23 months is when children start to walk and are at increased risk of contamination from the environment. The introduction of other liquids and foods at the time of weaning can also facilitate the spread of disease-causing agents. Differences in diarrhoea prevalence by sex and by urban-rural residence are small. Children in the Brong Ahafo region have a higher prevalence of diarrhoea (17 percent) when compared with children in the other regions. Prevalence of diarrhoea is lowest

among children in the Western, Greater Accra, and Volta regions (7 percent each) and among children of mothers with a secondary or higher education (8 percent). As expected, diarrhoea prevalence is lowest among children who live in households with improved, unshared toilet facilities (5 percent), and households that are in the highest wealth quintile (7 percent). Surprisingly, diarrhoea prevalence is nearly the same among children residing in households with an improved source of drinking water (12 percent) and those residing in households where the source of drinking water is unimproved (11 percent).

Mothers of children with diarrhoea in the two weeks preceding the survey were asked what was done to manage or treat the illness. Table 10.8 shows the percentage of children with diarrhoea who were taken to a health facility or provider for treatment, the percentage who received ORT, and the percentage given other treatments, by background characteristics.

Overall, 45 percent of children with diarrhoea were taken to a health provider for treatment. Children age 12-23 months are more likely to be taken to a health facility for treatment than children of other ages.

Children with bloody diarrhoea (59 percent) are more likely to be taken to a health facility for treatment compared with children with non-bloody diarrhoea (43 percent). There is no clear pattern for treatment-seeking behaviour by sex of child, and mother’s education.

Oral rehydration therapy (ORT), which involves giving children with diarrhoea a solution, prepared from oral rehydration salts (ORS) or recommended home fluids (RHF)—usually a home-made sugar-salt-water solution—is a simple and effective response to diarrhoeal illness. In the 2014 GDHS, about half of children with diarrhoea were treated with either ORS or RHF (53 percent). Nineteen percent of children were given increased fluids. Children with bloody diarrhoea (63 percent) are more likely to receive ORT than children with non-bloody diarrhoea (52 percent). There is no clear variation in proportions of children likely to receive ORT by sex, residence (rural or urban), education, or wealth quintile of the child’s mother.

Overall, 62 percent of children under 5 with diarrhoea were treated with ORT or increased fluids.

The MoH of Ghana has included zinc supplementation in the management of acute watery diarrhoea and dysentery in children under 5¹. In the 2014 GDHS, only 7 percent of children with diarrhoea were given zinc supplements. Children age 12-23 months were more likely to receive zinc for diarrhoea than the other age groups. Zinc supplementation in children with diarrhoea varied very little by sex and rural-urban residence. Children with bloody diarrhoea (11 percent) were more likely to have been given zinc supplementation than those with non-bloody diarrhoea (7 percent). Children of mothers with a secondary or higher education were less likely to be given zinc supplementation compared with children of mothers with lower educational levels.

Antibiotics are generally not recommended for use in managing non-bloody diarrhoea in young children. In the 2014 GDHS, one-third of children with diarrhoea were treated with antibiotics, with a notable difference between bloody and non-bloody diarrhoea (42 percent and 32 percent, respectively). The use of antibiotics is highest among children whose mothers have the highest educational level. To the contrary, children of mothers in households in the lowest wealth quintile are more likely to receive antibiotics when they have diarrhoea. Home remedies were given to 23 percent of children with diarrhoea, and 5 percent received antimotility medicines. One in six children with diarrhoea (17 percent) was given no treatment at all.

1 Under-5 Child Health Policy: 2007-2015 MoH, Ghana.

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Table 10.8 Diarrhoea treatment

Among children under age 5 who had diarrhoea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage given other treatments, by background characteristics, Ghana 2014

Percentage of

Note: ORT includes fluid prepared from oral rehydration salt (ORS) packets and homemade fluids. Figures in parentheses are based on 25-49 unweighted cases.

1 Excludes pharmacy, shop, and traditional practitioner

10.6.2 Feeding Practices

Mothers are encouraged to continue normal feeding of children with diarrhoea and to increase the amount of fluids given during the diarrhoeal episode. These practices help to reduce dehydration and minimise the adverse consequences of diarrhoea on the child’s nutritional status, thus preventing death or complications. Mothers interviewed in the 2014 GDHS were asked whether they gave the child less, the same amount, or more fluids and food than usual when their child had diarrhoea. Table 10.9 shows the percent distribution of children under 5 who had diarrhoea in the two weeks preceding the survey by feeding practices, according to background characteristics.

Nineteen percent of children with diarrhoea were given more to drink than usual, 45 percent were given the same as usual, and 36 percent were given less to drink (i.e., somewhat less and much less) or nothing at all. It is particularly disheartening that 18 percent of children with diarrhoea were given much less to drink or nothing to drink. This is a retrogression from the 2008 GDHS, where 38 percent of children with diarrhoea were given more to drink than usual and 10 percent were given much less to drink or nothing to drink. Giving extra fluids to children with diarrhoea does not vary substantially by background characteristics; however, children whose mothers have no education were the least likely to receive more fluids compared with children of mothers with primary education or better.

As in the 2008 GDHS findings, food intake is curtailed even more than fluid intake during episodes of diarrhoea. Only five percent of children with diarrhoea were given more to eat than usual, 37 percent were given the same amount of food as usual, and 53 percent were given less food to eat than usual or nothing at all. These patterns reflect a gap in practical knowledge among some mothers regarding the nutritional requirements of children during diarrhoeal episodes. These findings are similar to the 2008 GDHS and reveal a need for further efforts on education and behaviour change communication in order to reduce the number of children that become dehydrated and/or malnourished because of improper fluid and feeding practices during diarrhoea.

Overall, 12 percent of children with diarrhoea were given increased fluids and continued feeding, and 42 percent were given increased fluids, continued feeding, and ORT. There are no marked differentials in these indicators by background characteristics; however, there was an increase in both indicators with increasing wealth quintile.

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Table 10.9 Feeding practices during diarrhoea

Percent distribution of children under age 5 who had diarrhoea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhoea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhoea, by background characteristics, Ghana 2014

Amount of liquids given Amount of food given Percent- age given Note: It is recommended that children should be given more liquids to drink during diarrhoea, and food should not be reduced. Figures in parentheses are based on 25-49 unweighted cases.

1 Continued feeding practices include children who were given more, same as usual, or somewhat less food during the diarrhoea episode.