Introduction: According to the World Health Organization “diarrhea” is the defecation of
three or more loose or watery stools per day, which could lead to the failure of absorption of
the necessary minerals and water for the organism resulting in dehydration. Dehydration is
the leading cause of hospitalizations from diarrhea among children under five years old.
Dehydration existence and degree are measured using Capillary Refill time, skin turgor,
respiratory rates and signs of shock (based on the Royal Children's Hospital Melbourne
guideline). In Armenia, according to Armenia Demographic and Health Survey 2010,
diarrheal disease prevalence was 9% among under five children and 7% of all infant deaths
were related to diarrheal diseases.
Objective: The aims of this study were to identify risk factors for severe/moderate
dehydration among children less than five years old hospitalized because of acute diarrhea
and to develop recommendations for early management of acute diarrheal disease to prevent
severe/moderate dehydration and reduce hospitalization rates among targeted children.
Method: The study utilized a case-control study design to identify the main risk factors of
severe/moderate dehydration among children under five years old. Cases (n=62) were under
five children admitted to “Nork” infectious clinical hospital with the initial diagnosis of acute
diarrhea and with the diagnosis of severe or moderate dehydration at the admission defined
by the Royal Children's Hospital Melbourne guidelines. Controls (n=125) were children
under five years old who had been admitted to “Nork” infectious clinical hospital with the
initial diagnosis of acute diarrhea and with no or mild dehydration at the admission defined
by the same guideline. The student investigator conducted face to face interviews with
mothers of the children from both groups using interviewer-administered questionnaire. The
response rate was 98%. Simple and multiple logistic regression analyses were performed by
the student investigator to test the associations between dehydration severity and its possible
determinants, while controlling for the potential confounders.
Results: This study identified several independent determinants of child’s severe/moderate
dehydration. Mother’s higher KAP (Knowledge, Attitude and Practices) score on correct
diarrhea home management was negatively associated with the child’s dehydration status.
Each additional unite increase in this score decreased the risk for a child of being
severely/moderately dehydrated by 32%. Being vaccinated against rotavirus, child's good
general health rating by the mother, living in Yerevan compared to other regions, child's age,
child’s high weight before the disease and high socio economic status score (the sum of
perceived rating of family’s living standards and monthly expenditures) of the family were
among factors protecting from severe/moderate dehydration, while higher birth order,
repeating vomiting during the disease and female gender were among its risk factors.
Conclusions: Based on these findings, the study recommends increasing mother's
knowledge, attitudes and practices on diarrhea home management through public education
interventions and improved counseling in Primary Health Care facilities. Also, the coverage
of under-five children with rotavirus vaccination and mothers’ awareness about diarrhea
danger signs (especially on repeating vomiting) should be increased. Future research is
needed to understand reasons of mothers’ poor knowledge on and barriers against right
practices of diarrhea home management.