Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.
PIP: In southern central Ethiopia, weekly interviews with mothers of 1315 children aged 0-5 years over a period of one year were conducted so public health workers could analyze child health and nutritional and obstetric determinants of the under-five population in the Butajira Rural Health Project. 99.4% of the children were breast fed at birth. By age 4 months, only 0.8% of them had stopped. Introduction of supplementary foods appeared to protect from excess morbidity. The median age for termination of breast feeding was 27 months. Children receiving care from a public health service facility had slightly lower morbidity rates than those receiving assistance from a pharmacy, community health agent, or a traditional herbalist. Less than 50% of mothers sought medical care from local health facilities. Birth order and variables associated with prenatal care and delivery did not affect subsequent morbidity independently of other variables. The presence and involvement in child care of both parents had a beneficial effect on morbidity. In terms of morbidity, children benefited from sleeping with adults. Fully immunized children were at lower risk of morbidity than those not fully immunized. Gastroenteritis was particularly associated with child care factors (health care source, parents, sleeping, immunization, and sunshine exposure). On the other hand, acute respiratory infections (ARI) were particularly associated with nutritional factors (breast feeding, cow's milk, formula milk, porridge, cereal, meat, vegetable protein, and fruit and vegetables). Lack of immunization, low birth weight, and pre-term delivery (1 month early) did not have an independent effect on morbidity. These findings will be used to prepare for an intervention study on ARI.