A one-year community study of under-fives in rural Ethiopia: patterns of morbidity and public health risk factors

Abstract

A prospective weekly home surveillance study was undertaken to determine morbidity patterns within the Butajira Rural Health project in central Ethiopia. Overall prevalence of illness was 5.8% in 1216 person-years observed among rural Ethiopian children aged under 5 years. Acute respiratory infections (ARI) (prevalence 2.8%) and acute diarrhoea (2.4%) were the commonest conditions. Episodes of illness were distributed unequally among children, with a mean of 2.34 episodes per child. These included an average of 1.13 episodes of ARI (of which 0.16 had lower respiratory symptoms [ALRI]) and 1.17 episodes of acute diarrhoea. Sanitation factors were the principal risks for gastroenteritis, while living in rural areas predisposed children to ARI. Parental factors such as illiteracy were also linked to morbidity.

PIP: In 1991, in the rural Butajira district in southcentral Ethiopia, field workers visited every household weekly to collect morbidity data on 1315 under-five children so researchers could estimate morbidity and public health risk factors of childhood disease. The Butajira Rural Health Project, begun in 1986, is a continuous demographic surveillance system. 13.2% of the children had more than five episodes of illness. 24.2% had no episodes. 22% of the children had more than 50% of all illness episodes. The incidence of overall illness was 2.34 episodes/person-year, equalling 5.8% of child days. The incidence of reported illness and derived entities fell sharply after a child reached 1 year. The peak incidences of acute respiratory infection (ARI) and acute lower respiratory infection (ALRI) were 3-6 months and 1-6 months, respectively. Gastroenteritis incidence peaked at 1-6 months. The most prevalent conditions were ARIs (prevalence 2.8%) and acute diarrhea (2.4%). The sanitation index had a significant impact on gastroenteritis and ARI, especially gastroenteritis. Parental indices also affected gastroenteritis and ARI. Living in a rural area increased the likelihood of ARI. Lack of electricity or piped water were also important determinants of illness. Illiteracy among parents was associated with an increased morbidity rate among under-fives.