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RISK FACTORS FOR ACUTE DIARRHEAL DISEASES IN CHILDREN
TREATED AT THE CUANZA NORTE PROVINCIAL MATERNAL AND
CHILD HOSPITAL FROM MARCH TO OCTOBER 2024
Sara Pilarte António1
Neusa de Fátima João Domingos Manuel2
Abstract: Acute diarrheal diseases represent one of the main causes of infant morbidity and mortality
in developing countries, especially in regions with poor sanitation and limited access to potable water.
This study aimed to identify the risk factors and prevalence of acute diarrheal diseases in children
treated at the Cuanza Norte Provincial Maternal and Child Hospital between March and October
2024, also analyzing the prevention measures adopted. A cross-sectional descriptive study with a
quantitative-qualitative approach was conducted, involving a sample of 505 children. Data collection
was carried out using a data collection form. Of the 505 cases analyzed, 35 were positive for acute
diarrheal diseases. The majority were female, with 22 cases (63%). The most affected age group
was 1 to 5 years, with 16 cases (46%). The neighborhood with the highest incidence was Bairro
Posse, with 13 cases (37%). Escherichia coli was the most prevalent etiological agent, with 20 cases
(57%), while Giardia lamblia had the lowest occurrence (9%). The main risk factor identied was
the consumption of contaminated water (43%), followed by insufcient breastfeeding (23%). The
results show that acute diarrheal diseases are still a relevant problem in the local child population,
being strongly related to environmental and behavioral factors. Investing in basic sanitation, water
treatment, promoting breastfeeding, and educational campaigns are essential measures to reduce the
incidence of these diseases.
1 Holds a degree in Clinical Analysis and Public Health from the Ndalatando Higher Polytech-
nic Institute.
2 Master’s degree in Health Management from a private university in Angola.
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Keywords: risk factors, disease, acute diarrhea.
Introduction
There were several motivations that were the basis for the elaboration of this work, with
greater emphasis on the fact that, with it, it will enable her to obtain the degree of licentiate in clinical
analysis and public health. In this work, we will address the risk factors for acute diarrheal diseases
in children assisted at the provincial maternal and child hospital of Cuanza Norte from March to
October 2024.
Diarrheal disease still persists as a public health problem, being one of the main causes of
infant mortality in underdeveloped countries, and it should be noted that such deaths are considered
an indicator of situations of poverty (Sczwarcwald, 1997).
The risk factors associated with hospitalization for acute diarrhea can be explained within a
multicausal model that includes a large number of interrelated socioeconomic-demographic, biological
and cultural variables (Fuchs, 1996).
The World Health Organization (WHO) denes acute diarrhea (AD) as a sudden change in
bowel habit, characterized by the occurrence of liquid bowel movements in three or more episodes in
24 hours, or a single semi-liquid containing mucus and blood in 12 hours. The duration of the same
must not exceed a period of 15 days, (World, 1988).
In the last two decades, advances have been achieved in the recognition of new etiological
agents that produce AD, as well as the mechanisms by which enteric infections produce malabsorptive
effects have been better elucidated. The use of new laboratory techniques for etiological detection
currently results in positive identication for pathogens in 50 to 84% of children and adults with acute
diarrheal disease (Prado, 2010).
Regarding the association between environmental garbage and child diarrhea, a study carried
out in Salvador, Bahia, demonstrated the risk of occurrence of the disease almost four times higher
among children living in places where there was no garbage collection (Rêgo, 1996).
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Among the biological determinants, several studies have shown the existence of an association
between the child’s age, morbidity and severity of the diarrheal episode, with the risk of death being
higher among children under six months of age (Fuchs, 1996).
According to the World Health Organization (WHO), infectious and epidemiological studies
in areas with a higher frequency of diarrheal disease reveal that the most common bacterial infectious
agents are Escherichia coli (diarrheagenic strains), Shigella sp., Salmonella sp., Campylobacter jejuni,
Y. enterocolitica.
Problematic situation
Human health is not disassociated from the environment in which we live, the food and
water we consume daily, both for body hygiene as well as biological activities. Several studies on the
etiology of diarrheal diseases have shown that the prevalence of pathogens associated with diarrhea
varies widely with several factors, such as the socioeconomic class of the individuals under study, in
an attempt to contribute to a better knowledge of the distribution of etiological agents of diarrhea in
Cuanza Norte, we raise the following Scientic Problem:
Scientic Problem
What are the risk factors for acute diarrheal diseases in children?
General Objective
To know the risk factors for acute diarrheal diseases in children assisted at the provincial
maternal and child hospital of Cuanza Norte from March to October 2024.
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Specic objectives
Characterize the gender and age groups most affected by acute diarrheal diseases in children
cared for at the maternal and child hospital of Cuanza Norte from March to October 2024;
Describe the prevention measures against acute diarrheal diseases in children assisted at the
Mother and Child Hospital of Cuanza Norte from March to October 2024;
List the main etiological agents of acute diarrheal diseases in children cared for at the
maternal and child hospital of Cuanza Norte from March to October 2024;
To identify the risk factors for acute diarrheal diseases in children assisted at the Mother and
Child Hospital of Cuanza Norte from March to October 2024;
Justication
During the year 2019, during my stay in the Possse neighborhood, I observed many cases of
diarrhea in children and also many aggravations. That is why I have raised numerous concerns such
as: What are the causes of diarrheal diseases, how is it transmitted and how to prevent them?
METHODOLOGY, ANALYSIS AND INTERPRETATION OF RESULTS
Type of research
This is a cross-sectional descriptive study with a quantitative-qualitative approach based on
data collection.
Descriptive Study
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For Marconi, (2003) focuses on the description of a disease in a given population. It is the one
that, when we intend to study a phenomenon, we have to go back to the record of existing information,
whether on patients who have passed through hospital services, or on patients who have been observed
(in outpatient consultations or emergency bank), or even past hospitalizations.
Cross-sectional study
For Silva, (2012) it is a type of observational study that analyzes the frequency of a condition
or characteristic in a population at a given time. It is usually used to assess the health needs of a
population, identify points that need intervention, plan public health policies, generate hypotheses
about risk factors or causes of disease.
Quantitative-qualitative approach
It is a scientic research method that differs by the way data is obtained and analyzed. The
quantitative approach is based on numbers while the qualitative approach deals with narrative and
individual experiences (Marconi, 2003).
Population and sample
Silva, (2012) denes Population or universe as being a dened group of elements that share
certain characteristics.
As a population, we had 505 children treated at the provincial maternal and child hospital, in
the province of Cuanza Norte.
According to Marconi, (2003) the sample is a subset of a population.
Our sample consisted of 35 children treated at the provincial maternal and child hospital with
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a diagnosis of Diarrheal Disease.
Sampling technique:
We used the probabilistic technique, because all the elements of the universe had the same
chance of being selected for the sample, but only those selected were part of the study.
Inclusion Criteria
All children who are treated at the provincial maternal and child hospital with a clinical
history of acute diarrhea during the research period.
Exclusion Criteria
All children who do not present a clinical picture of acute diarrheal diseases;
Study methods
It is a development used to address an ascertainment of accuracy, in the learning of a sapience
or to approximate a denite closure.
Method of study is the component of the investigator, who at the end of his search procedure
unveils and presages a complex of adventures resulting from the execution of his conjunctures (Francis
Bacon).
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Methods in data collection instruments
The data collection necessary for this study was carried out through the application of the
data collection form technique.
Analysis and interpretation of the results
Graph nº1 - Presentation of positive and negative cases
Source: data collection form.
According to the number of cases, we had 470 negative cases, which corresponds to 470, and
35 positive cases, which corresponds to 7%, in a total sample of 505 cases of the sample collected.
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Graph nº2 - Distribution of the sample according to Gender
Source: Data collection sheet
According to gender, the most predominant was female, with 22 children, which corresponds
to 63%, while male, there were 13 children, which corresponds to 37%.
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Graph 3 - Distribution of the sample according to age group
Source: data collection form.
According to the age that most predominated was 1-5 years of age, which corresponds to
46%, and the one that least predominated was 11-14 years of age, with 6 children, which corresponds
to 17%.
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Graph 4 - Distribution of the sample according to risk factors
Source: Factsheet
According to the risk factors, the most prevalent was contaminated water, with 15 children,
which corresponds to 43%, and the least predominant was the decit in breastfeeding, with 8 children,
which corresponds to 23%.
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Graph nº5 - Distribution of the sample according to etiological agents
Source: Data collection sheet
According to the etiological agent, the one that predominated was Escherihia ecoli with 20
children, which corresponds to 57% and the least predominant was Giardia lamblia, with 3 children,
which corresponds to 9%.
Graph 6 - Distribution of the sample according to forms of prevention
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Source: data collection form.
According to the forms of prevention, it was water treatment with 16 children, which
corresponds to 46%, what was less predominant was foods with proteins, with 7 children, which
corresponds to 20%.
Graph nº7 - Distribution of the sample according to the origin of the cases
Source: data collection sheet.
According to provenance, the neighborhood that most predominated was the possession
with 13 children, which corresponds to 37% and the one that least predominated was Vieta, with 10
children, which corresponds to 29% children.
DISCUSSION
According to the World Health Organization (WHO), in the last two decades, there has been
a signicant reduction in mortality from infectious diarrhea in children under the age of ve globally.
And in the present study, it shows that children aged 1-5 years were more frequent with 46%.
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In recent decades, there has been a signicant reduction in infant mortality due to diarrheal
diseases. UNICEF data indicate that, globally, the mortality rate in children under ve years of age
has decreased by 51% since 2000. In Brazil, this reduction was even more signicant, reaching 60%
in the same period This positive trend can be attributed to improvements in sanitation conditions,
greater access to health services, and effective prevention and treatment programs.
The World Health Organization (WHO) highlights that environmental factors play a crucial
role in the incidence of diarrheal diseases in children. In 2012, it was estimated that 26% of deaths and
25% of the total burden of disease in children under ve years of age could be avoided by reducing
environmental risks, such as contaminated water, lack of basic sanitation, and inadequate hygiene.
These data corroborate the ndings of the present study, where the main source of infection identied
was the consumption of contaminated water. representing 43% of the cases.
Diarrhea in children can be caused by a variety of pathogens, including viruses, bacteria, and
parasites. Studies indicate that Escherichia coli is one of the main etiological agents, with frequencies
ranging between 25% and 40%. In the present study, E. coli was responsible for 57% of the cases,
which is in line with the existing literature. Accurate identication of the causative agent is essential
to direct appropriate treatment and implement effective preventive measures.
According to the 2015-2016 Multiple Indicators and Health Survey (IIMS), the prevalence
of diarrhea in Angolan children under ve years of age was 15.6%. It was observed that children
between 6 and 23 months had a higher rate, reaching 27%, while those between 48 and 59 months had
the lowest prevalence, with 6%. These data indicate that diarrhea affects children in the early stages
of development more signicantly.
The same survey revealed that the prevalence of diarrhoea is slightly higher in urban areas
(16.1%) compared to rural areas (14.8%). In addition, lack of access to adequate basic sanitation has
been identied as a signicant risk factor for increased incidence of diarrhoea among children. These
ndings highlight the importance of improvements in sanitation and water supply infrastructures for
disease prevention.
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Studies carried out at the Bengo General Hospital have identied several pathogenic agents
responsible for diarrheal conditions in children, including viruses, parasites and bacteria. Although
rotavirus is often highlighted as one of the main etiological agents in developed countries, in Angola,
Escherichia coli has also been pointed out as a signicant cause of childhood diarrhea. Accurate
identication of these agents is crucial to target appropriate therapeutic and preventive interventions.
CONCLUSION
Acute diarrhoea remains a signicant public health challenge in Angola, especially among
children at an early age, where vulnerability is accentuated by socio-economic and environmental
factors. The research revealed that poor sanitation, consumption of untreated water and lack of
knowledge about hygiene practices directly contribute to the spread of diarrhoeal diseases, perpetuating
cycles of morbidity that affect child development and overload the health system.
The prevalence of pathogens such as Escherichia coli reinforces the need for constant
epidemiological surveillance and sustainable prevention strategies, such as community health
education programs, distribution of oral rehydration solutions, and encouragement of exclusive
breastfeeding in the rst months of life. In addition, family breakdown and inequalities in access
to health services accentuate the vulnerability of certain groups, making it even more urgent to
implement public policies that integrate health, education, and social assistance.
To mitigate the impacts of diarrheal diseases and reduce infant mortality rates, it is essential
to strengthen primary health care, ensure the expansion of vaccination coverage, and promote regular
awareness campaigns. Building a community support network, combined with investments in sanitation
infrastructure and water supply, is crucial to transform the reality of the most affected communities.
Thus, the prevention and control of these diseases involve the articulation of intersectoral efforts that
prioritize comprehensive child health care, promoting, in the long term, a signicant improvement in
the quality of life of the population.
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SUGGESTIONS
After analyzing and concluding the present work, we suggest the following:
1- That the management of the Provincial Mother and Child Hospital of Cuanza Norte carry
out more routine diagnostic tests in order to control and combat the etiological agents of DD.
2- Carrying out massive awareness campaigns on acute diarrheal diseases in order to provide
greater prevention of the disease.
3- Encourage the participation of parents in lectures on parasitic diseases in general.
1. Improvement of Sanitation and Water Supply
Access to drinking water: Installation of water treatment systems in communities.
Construction of safe latrines: To prevent fecal contamination in the environment.
Waste management: Promote proper garbage and sewage disposal practices.
2. Promotion of Personal and Food Hygiene
Hand washing: Encourage hand washing with soap after using the toilet and before meals.
Safe food preparation: Store and cook food thoroughly to eliminate pathogens.
3. Exclusive Breastfeeding
Breastfeeding up to 6 months: Protects against gastrointestinal infections, strengthening
children’s immunity.
4. Community Education and Awareness
Awareness campaigns: To teach the population about the modes of transmission of the
disease.
Training of community health workers: To promote good hygiene practices and identify
suspected cases early.
5. Vaccination and Prophylaxis
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Rotavirus vaccination: Signicantly reduces severe cases of diarrhea.
Periodic deworming: To eliminate worms that cause gastrointestinal disorders.
6. Improving Access to Health Care
More equipped health centres: For rapid diagnosis and appropriate treatment.
Oral Rehydration Serum (ORS): Distribute and teach families how to use it to prevent
dehydration.
7. Epidemiological Monitoring and Surveillance
Identication of outbreaks: For authorities to intervene quickly.
Water quality analysis: Check and correct contaminated sources.
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