TABLE OF CONTENTS
DECLARATION……………………………………………………………………………………………….. ii
DEDICATION………………………………………………………………………………………………….. iii
ACKNOWLEDGEMENTS……………………………………………………………………………….. iv
TABLE OF CONTENTS……………………………………………………………………………………. v
LIST OF TABLES……………………………………………………………………………………………. vii
LIST OF FIGURES…………………………………………………………………………………………. viii
ABBREVIATIONS AND ACRONYMS…………………………………………………………….. ix
DEFINITION OF TERMS………………………………………………………………………………… xi
ABSTRACT……………………………………………………………………………………………………. xiv
CHAPTER TWO: LITERATURE REVIEW
CHAPTER THREE – MATERIALS AND METHODS
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS
References………………………………………………………………………………………………………… 50
Appendices……………………………………………………………………………………………………….. 55
Appendix 1: Informed consent……………………………………………………………………………. 55
Appendix 2: Questionnaire………………………………………………………………………………….. 56
Appendix 3: Informed Consent Form in Somali…………………………………………………….. 62
Appendix 4: Questionnaire in Somali……………………………………………………………………. 63
Appendix 5: Interview guide………………………………………………………………………………. 69
Appendix 6: Interview Guide in Somali……………………………………………………………….. 71
Appendix 7: Map of Hodan District…………………………………………………………………….. 73
Appendix 8: Map of Somalia………………………………………………………………………………. 74
Appendix 9: Kenyatta University Research Authorization………………………………………. 75
Appendix 10: Kenyatta University Research Proposal Approval…………………………….. 76
Appendix 11: Research Authorization Ministry of Health & Human Services………….. 77
Appendix 12: Research Clearance Permit…………………………………………………………….. 78
LIST OF TABLES
Table4.1: Socio-demographic characteristics of respondents………………………………………….. 24
Table 4. 2: Demographic and socioeconomic factors associated with morbidity of diarrheal disease among under-five children in Hodan IDP camps……………………………………………………………….. 27
Table 4. 3: Water dimension factors associated with the occurrence of diarrhea among children under five in Hodan IDP camp…………………………………………………………………………………………….. 30
Table 4. 4: Records of health facilities inside Hodan IDP camps……………………………………. 40
LIST OF FIGURES
Figure 1. 1: Conceptual Framework……………………………………………………………………………… 8
Figure 4. 1: Occurrence of diarrhea among under five children in Hodan IDP camp in the past 2 weeks 25
Figure 4. 2: Occurrence of Diarrhea by Gender……………………………………………………………… 25
Figure 4. 3: Top diseases among under-five children in Hodan IDP camps reported by mothers/care givers 26
Figure 4. 4: Occurrence of diarrheal disease by type of toilet facility………………………………… 31
Figure 4. 5: Handwashing time by occurrence of diarrhea……………………………………………….. 32
Figure 4. 6: Occurrence of diarrhea by mode of hand washing after toilet use……………………. 32
Figure 4. 7: Method of garbage disposal by occurrence of diarrhea…………………………………… 33
ABBREVIATIONS AND ACRONYMS
| ACF | Action Form |
| AWD | Acute Watery Diarrhea |
| CDC | Communicable Disease Control |
| CHERG | Child health Epidemiology Reference Group |
| CSZ | Central South Zone |
| EPEC | Entero Pathogenic Escherichia Coli |
| EPHS | Essential Packages of Health Services |
| ETEC | Entero Toxigenic Escherichia Coli |
| FSAU | Food Security Assessment Unit |
| HH | Household |
| HIV | Human immune deficiency syndrome |
| IDMC | Internal Displacement Monitoring Center |
| IDPs | Internally Displaced Populations |
| IOM | International Organization for Migration |
| KII | Key Informant Interview |
| MICS | Multiple Indicator Cluster Survey |
| NGO | Non-Governmental Organization |
| NRC | Norwegian Refugee Council |
| OCHA | Office for Coordination and Humanitarian Affairs |
| SD | Standard Division |
| SPSS | Statistical Package for Social Sciences |
| UNDP | United Nation Development Program |
| UNHCR | United Nation Human Commissionaire Rights |
| UNICEF | United Nations Children’s Fund |
| WASH | Water, Sanitation and Hygiene |
| WHO | World Health Organization |
DEFINITION OF TERMS
Antibodies: A blood protein produced in response to and counteracting a specific antigen.
Children: Children in this study referred to any person who was under- five years. Cholera: An acute infectious disease of the small intestine, caused by the bacterium Vibrio cholera and characterized by profuse watery diarrhea, vomiting, muscle cramps, severe dehydration, and depletion of electrolytes
Conflict: Strong disagreement between people, groups, etc., that results in often angry argument.
Dehydration: Occurs when you use or lose more fluid than you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions
Developed countries: Industrialized country, or “more economically developed country” (MEDC), is a sovereign state that has a highly developed economy and advanced technological infrastructure relative to other less industrialized nations.
Developing countries: Also called a less developed country or underdeveloped country, is a nation with an underdeveloped industrial base, and a low Human Development Index (HDI) relative to other countries
Diarrhea: The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual) (WHO, 2013).
Disposal: The action or process of throwing away or getting rid of something
Dysentery: Infection of the intestines resulting in severe diarrhea with the presence of blood and mucus in the feces
Household: The smallest and most common unit of production, consumption and organization in a society. It involves all people or one person living in a house.
Hygiene: The science and practice of maintaining good health through cleanliness. Immunity: Is the balanced state of having adequate biological defenses to fight infection, disease, or other unwanted biological invasion, while having adequate tolerance to avoid allergy, and autoimmune diseases
Malnutrition: Is a serious condition that occurs when a person’s diet doesn’t contain the right amount of nutrients
Morbidity: A measure of sickness or disease within a geographic area Mortality: A measure of deaths within a population or geographic area. Mother/care givers: A person that is involved with provision of the child’s care.
Pathogens: Infectious agent is a biological agent that causes disease or illness to its host. Poverty: Condition where people’s basic needs for food, clothing, and shelter are not being met.
Prevalence: The percentage number of children who had diarrhea two weeks before the time of the study.
Reliability: Is the degree to which an assessment tool produces stable and consistent results.
Sanitation: The process of maintaining cleanliness and dealing with sewage.
Seasons: Are periods in a year marked by specific weather conditions, temperatures and length of day
Slums: A squalid and overcrowded urban street or district inhabited by very poor people.
Validity: The quality of being logically or factually sound; soundness or cogency.
Weaning: Accustom (an infant or other young mammal) to food other than its mother’s milk.
ABSTRACT
The last two decades of armed conflicts, lack of functioning government, economic collapse, and disintegration of the health system and other public services – together with recurrent droughts and famines, have turned Somalia into one of the world’s most difficult environments for survival. The under-five mortality in Somalia is estimated at 200 deaths per 1,000 live births, which is one of the highest in the world. Diarrhea is the main killer; contributing to 20-25 per cent of all under-five mortality. The main objective of this study was to assess the morbidity of diarrhea among under-five children living in Internally Displaced Persons (IDPs) of Hodan district which has the highest IDP settlement in Mogadishu with conditions that are conducive to occurrence of diarrheal disease in the district. The study used descriptive cross-sectional survey design and multistage sampling technique to select 236 children. Researcher administered structured questionnaires were used to collect data using face-to-face interviews with mothers/care givers of the children during a one-time visit to the households. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 21 software. Descriptive and inferential statistical findings were presented in form of text, tables, graphs and charts. Chi-square was used to show the relationship between variables. Fourth eight percent of households reported having children who suffered from diarrhea in the past 2 weeks preceding the study. Diarrhea was also the most common disease reported by mothers/care givers among under-five children in the camps, affecting 107(45.3%) of the children. Diarrheal disease occurrence was highest (74.3%) among children of mothers who did not attend school (p=0.001), children living in households provided water by Non-Governmental Organizations (NGOs) (p=0.025) and among children whose main source of water was public tap diarrhea (71.3%; p =0.001). Most parents in the camp delayed taking their ill children to hospital opting to first use traditional medicines resulting in many cases of admissions at the health facilities. From the study findings it can be concluded that diarrhea was the most prevalent disease among under-fives and is more likely to occur among children whose mothers had no education, and who lived in household whose main source of drinking water was public tap, supplied by NGOs. In addition, the study concluded that other environmental factors had no association with diarrhea occurrence. The study recommends educating mothers to reduce overall illiteracy rate of Somali women, and regular treatment of drinking water and evaluation of water quality by the Ministry of Health and Human Services. Given the high diarrhea prevalence and the fact that camp environmental conditions are conducive to its occurrence, the study also recommends promotion of improved hygiene and sanitation practices, even though these were not found to be associated with diarrhea in this particular study.
CHAPTER ONE: INTRODUCTION
Background
Diarrheal disease is the second leading cause of death among children under five globally; accounting for 9 percent of all deaths in 2012. This translates into 1,600 children dying each day or more than 580,000 children each year. These deaths mainly occur in south Asia and sub-Saharan Africa (UNICEF, 2012) In the African 300 000 children among under- five age die from diarrhea (WHO, 2013). In Somalia the prevalence of diarrheal disease among children under-five reached 19% in 2012 (WHO, 2012). The under-five mortality in Somalia is estimated at 200 deaths per 1,000 live births, which is one of the highest in the world. Diarrhea is the main killer, contributing 20-25 per cent of all under-five mortality (WHO, 2012).
