Factors of foodborne diarrhea in children under five years of age in Marracuene and Kamaxaqueni districts, Maputo Mozambique

Abstract

Introduction: Several foodborne diarrhea factors coexist. Prevention, diagnosis, and treatment of diarrhea are considered easy. This study investigated the factors associated with foodborne diarrhea and developed a local strategy for preventive measures against foodborne diarrhea in children under five years. Methods: The multiphase method was used. This study was divided into three phases. A quantitative method was utilized in Phase 1 to assess practices implemented by health professionals in the diagnosis and treatment of foodborne diarrhea, and a retrospective study was conducted using data from four referral health facilities from 2015 to 2019. All data regarding age, sex, signs and symptoms, diagnosis, and treatment were collected. In Phase Two, the study explored and described the household factors of foodborne diarrhea. Three hundred children, accompanied by mothers or caregivers, participated in the study, and the data were descriptively and mathematically analyzed using Epi Info modelling. In Phase Three, a local strategy to prevent foodborne diarrhea was developed using a Nominal Group Technique (NGT) telephonically invited stakeholders. Sixteen stakeholders from rural areas and 15 stakeholders from urban areas participated in this study. Findings: 9,041 cases were found in the retrospective study, of which 4,052 (44 8%) were female, and urban areas accounted for 7,668 (74.8%). Considering the age, children younger than six months, 1,013 (11.2%); from 6 to 11 months, 1,370 (15.2%); from 12 to 23 months, 2,535 (28%); from 24 to 35 months, 1,674 (18.5%), from 36 to 47 months 1,239 (13.7%) and from 48 to 59 months 1,210 (13.4%). Approximately 3,644 (40.3%) had a fever, 3,467 (38%) vomited, 1,999 (22%) blood in stool, and other symptoms; only 5 (1%) of the children’s stools were submitted for laboratory analysis. The clinical diagnoses were diarrhea 3,905 (43%), diarrhea and vomiting 2,037(22%), and others. The primary treatments were oral rehydration salts, 7,118 (79%) and 21% antibiotics. In Phase Two, caregivers mainly were female in both rural and urban areas 93.3% and 84%, respectively); they were aged between 18 and 38 years; children with diarrhea according to age; under six months of age, 23.3% in rural areas and 16.6% in urban; between 12 and 23 in urban areas, 36.6% and 30% in rural had diarrhea, urban relatives had similar symptoms before the child became ill were 12.6% rural and 13.3% urban). Before medical assistance, the children were treated with traditional medication in 51.3% rural, 16% rural, urban areas; water before drinking was not treated in 48% of rural and 45.3% of urban. Infants in urban areas, 24.6%) and 12.6 % in rural areas use feeding bottles. In Phase 3, 31 stakeholders participated in the NGT discussion, 16 in rural areas and 15 in urban areas. Among the 17 preventive measures for foodborne diarrhea, ten were elected, which compose the local strategy. It was observed that stakeholders bet on hand washing as the principal measure to prevent foodborne diarrhea and the need to always observe hygiene practices during the handling and care of children. Conclusion and Recommendations: Children with diarrhea were treated with antibiotics, without screening for etiological agents. The main factors associated with foodborne diarrhea were the use of traditional medications in rural areas, whereas bottle feeding and inappropriate water consumption were noted. In designing a strategy for preventive measures, it is important to involve stakeholders and consider their beliefs to be effective. Ten preventive measures for foodborne diarrhea were identified as priorities and were composed of the local strategy: hand washing and good hygienic practices by mothers or caregivers were bet up as fundamental to prevent diseases, including foodborne diarrheal diseases. It is recommended that agents be screened before the administration of antibiotics to develop a mitigation plan for the main factors found in the present study. Stakeholders should implement the strategy of preventive measures developed in the present study, and a future study should be conducted to assess the impact of the strategy within the community.