Risk Factors of Diarrhea in Children Under Five Years in Urban Slums

Introduction: Diarrhea is a leading cause of mortality in children in developing countries and the condition is worse in slums. In order to provide effective preventive and management strategies, it is important to identify factors associated with the disease. This study was carried out to investigate the risk factors of diarrhea in  children under five years of age in urban slums. Methods: Parents of all children under five years from the urban slums of Tansen municipality, Palpa, Nepal were interviewed using a standardized pretested questionnaire and proforma. Parental variables, environmental factors, and presence of diarrhea in those children in past three months were collected by trained enumerators and the data were analyzed with statistical software SPSS-10. Results: A total of 450 under five years children were enrolled in the study. There were 216 (48%) male and 234 (52%) female children with F:M ratio of 1.08:1. Occurrence of diarrhea was lower if the children were breast-fed for more than six months, well-nourished, used fountain water for drinking, or used boiled or treated water. Similarly, diarrhea prevalence was lower if father had a regular job, daily income in the family was more than one US dollar, there was a toilet in the house, practice of hand washing was followed before feeding or preparing food, or there was no child suffering from diarrhea in the neighborhood. Conclusion: There are a few variables that are significantly related to diarrhea in children under five years of age. In order to decrease the diarrheal episodes in children in the slums of the developing countries, priority could be given in the improvement of those variables

Childhood Tuberculosis and its Relation with Nutrition: A five Year Retrospective Study

Introduction: Tuberculosis is the sixth leading cause of mortality in Nepal. Childhood tuberculosis consisted 5.54% of newly registered 32,056 cases in 2016-17. Malnutrition is a predictor of tuberculosis and is associated with poorer outcomes. This study evaluates the clinico-epidemiologic profile of childhood tuberculosis and its relation to nutritional status. Methods: This was a retrospective review of 60 cases of tuberculosis admitted over a period of five years. Details regarding demographics, anthropometry, symptomatology and examination findings were retrieved. Diagnosis was categorized as pulmonary, extra-pulmonary and disseminated tuberculosis. Findings of various investigations were noted. Nutritional status of the patients was assessed using the WHO standard charts. Association of malnutrition and anemia with types and severity of tuberculosis was assessed. Results: A total of 60 patients were included in the study. Mean age was 7.9 years (SD = 4.6). The commonest presenting symptom was fever (83.3%) followed by decreased appetite (33.3%) and weight loss (26.7%). Cough was the predominant symptom in pulmonary tuberculosis (45%). Only eight cases were bacteriologically confirmed. Underweight, wasting and stunting were observed in 68.4%, 63.3% and 53.3% of cases respectively. Wasting was significantly associated with severe forms of tuberculosis (p = 0.03). Anemia was present in 89.5% of under five children (p = 0.02). Conclusion: Malnutrition often co-exists in a significant proportion of children with tuberculosis. Diagnosis in resource limited settings heavily relies on clinical suspicion and supporting investigations. Anemia is significantly associated with childhood TB, especially under five children