Trends in preventive practices against diarrhoeal disease among under-five children: experience from the largest diarrhoeal disease hospital in Bangladesh

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BACKGROUND: The burden of childhood diarrhoea remains one of the most important public health problems in countries like Bangladesh, which can be reduced by effective preventive measures. We aimed to investigate the trends in preventive measures practised among under five children with diarrhoea over the last 12 years. METHODS: Data was extracted from the Diarrhoeal Disease Surveillance System at Dhaka Hospital for the period 2012-2023. STATA 15 was used for analysis. We used the Joncheere-Terpstra trend test to examine the trend in preventive measures against diarrhoea and the slope index of inequality (SII) to determine their association with the wealth index. RESULT: Among 20 373 participants, 61.0% were male, with a median (IQR) age of 11 months (8.0-16.0). Most (88.3%) had access to sanitary latrines, and 40.3% of households consumed boiled or filtered water. We found that 50.3% children aged 6-59 months received vitamin A, and 88.4% of children >9 months had measles vaccination. Breastfeeding practices were observed in 17.8% of the children. Significant upward trends were observed for sanitary latrine use and measles vaccination (p<0.001). Receiving vitamin A supplementation and boiled/filtered water consumption showed a declining trend (p<0.001). Parental education and maternal media exposure were found to be significantly associated with the preventive measures (p<0.05). The wealth index showed a significant association with vitamin A supplementation (p<0.01). However, SII does not indicate inequality between the groups. We found that children from wealthier quintile families had a significantly higher rate of measles immunisation, as indicated by the SII (p value=0.039). CONCLUSION: Improving practices of preventive measures can significantly reduce diarrhoeal diseases among children under five. Emphasis should be placed on vitamin A supplementation and the consumption of boiled or filtered water. A targeted approach is essential, including promoting health education, enhancing health awareness, and increasing media exposure for mothers.

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