Original Article

Clinical Features of Acute Gastroenteritis in

Children at University of Nigeria Teaching Hospital,
Ituku‑Ozalla, Enugu
Ezeonwu BU, Ibeneme CA1, Aneke F2, Oguonu T3
Departments of Pediatrics, Federal Medical Center, Asaba, Delta State, 1Federal Medical Center, Umuahia, Abia State,
2
Departments of Microbiology, and 3Pediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Address for correspondence: Abstract

Dr. Ezeonwu U Bertilla,
Department of Pediatrics, Federal Background: Acute gastroenteritis (AGE) is a major cause of morbidity and mortality in
Medical Center Asaba, children world‑wide with the highest incidence in the developing countries. The persistence
Delta State, Nigeria. and effect of this condition require a study of the features and characteristics of the disease
E‑mail: [email protected] especially, within any (each) locality in order to offer possible control solutions. Aim: To
determine, the clinical and social characteristics associated with AGE among children seen in
the University of Nigeria Teaching Hospital, Enugu. Subjects and Methods: A hospital‑based
population study in which children admitted in the children emergency room of the University
of Nigeria Teaching Hospital whose parents/caregivers gave their consent were enrolled, over
a 7 month period. Appropriate statistical tools: Chi‑square, t-tests, correlation and logistic
regression were used to determine significant values and associations. Results: A total of 76
children with AGE were enrolled; 69.7% (53/76) were males. The mean age of the subjects
was 11.3 (6.6) months. Majority 94.7%, (72/76) of cases of AGE occurred in children less
than 24 months, with children 6‑11 months contributing the highest percentage 42%, (32/76).
The study population was predominantly urban dwellers; 78.9%, (60/76, P = 0.40) and water
cistern constituted 77.6% (58/76) of waste disposal method. Those who had potable water
supply were 23.7%, (18/76, P = 0.30) and 19.7% of the children were exclusively breast fed.
Fever and vomiting were the commonest associated symptoms, occurring in 82.9% (63/76) and
73.7% (56/76) of the subjects respectively. A good percentage of the subjects 64.5%, (49/76)
had ORS before presentation. Conclusion: AGE is more common in older infants among those
who were not exclusively breast‑fed and the severity was unrelated to place of domicile and
waste disposal habits.

Keywords: Enugu, Gastroenteritis, Older infants

Introduction water, and un‑salutary sanitary habits.[4] Several studies in

Nigeria showed that diarrheal disease is one of the three
Acute gastroenteritis (AGE) manifests as diarrhea and/ most common causes of morbidity and mortality among
or vomiting, [1] and fever occasionally. [2] Acute infective children admitted in hospitals.[5,6] Ibeziako in Enugu and
gastroenteritis is a major global health problem,[3] causing Abhulimhen‑Iyoha in Benin,[5,6] documented diarrheal disease
about 2 million deaths annually among children under 5 years as one of the first three prevalent causes of morbidity and
of age.[2‑4] The greatest burden of AGE is in the developing mortality in pediatrics ward. These studies have shown little
countries, because of poor sanitation, lack of safe drinking if any change in the effect of diarrhea in children in Nigeria.

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Is this due to the socio‑economic conditions, health practices
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of the population in the country? Or is it due to the failure to
Website: www.amhsr.org
address the situation as identified by these studies?

DOI:
The study, which was an observational descriptive
10.4103/2141-9248.117948 hospital‑based study, sought to identify the clinical features
of childhood diarrheas and health practices of the caregivers

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 Ezeonwu, et al.: A cute gastroenteritis children, Enugu

among the population of children admitted in University of Results

Nigeria Teaching Hospital Enugu. The findings although
showed some significant inferences, which could help to define Baseline characteristics of subjects
possible interventions to improve child survival. However, Ninety‑two children admitted with history of diarrhea/vomiting
due to the small sample size enrolled, further research with were recruited from November 2009 to October 2010. However
a larger population will further validate the outcome of the due to infrequent disruption of services in the hospital from
current study. August to October 2010 complete data of 16 children (9 males
and 7 females: 7 were infants, 8 were pre‑nursery and 1 was
Subjects and Methods nursery school age) could not be obtained and were excluded
from the analysis. In consequence 76 children were eligible
Study area for data analysis, 53 males and 23 females (male: female ratio
This study was carried out in the University of Nigeria of 2.3:1). Their mean age was 11.3 (6.6), (95% CI = 9.8‑12.9,
Teaching Hospital, (UNTH), Ituku‑Ozalla in Enugu State. P = 0.001) months with the median age of 9 months (range
Ethical approval was sought from Health Research and Ethics 2‑36 months). Majority, 63.2%, (48/76) of cases of AGE
Committee of UNTH, Enugu before commencing the study. occurred in infants as shown in Table 1. The study population
was predominantly urban dwellers; 78.9%, (60/76) P = 0.40)
Methods and water cistern constituted, 77.7% (58/76) of waste disposal
The children with AGE, who met the inclusion criteria, and method, (P = 0.70, Table 2). Those who had potable water
whose caregivers gave informed consent, were enrolled. The supply were 23.7%, 18/76 (P = 0.30). Children on exclusive
children admitted in the emergency room were those with breast feeding were 16.7%, (15/76) and 80.3% (61/76) were
moderate to severe disease, which constitute 32% of total not exclusively breastfed. All the 17 children 0‑6 months of age
number of cases with diarrhea per annum. One in every 6 who had diarrhea were not exclusively breast‑fed. Among the
children was enrolled and was stratified into three different older infants (7‑12 months) more children were not exclusively
age groups; 0‑12 months (infants), 13‑36 months (pre‑nursery), breast‑fed, (P < 0.001) [Table 3].
37‑60 months (nursery school age). This stratification was done
to relate the probable severity of the disease to the children’s Clinical features
feeding and the health related practices. Fever and vomiting were the most common associated
symptoms, occurring in 82.9% (63/70) and 73.7% (56/76)
History of diarrhea alone or with vomiting, other clinical
symptoms as well as the basic demographic characteristics such Table 1: Age distribution of children with acute
as age, sex, place of domicile, were obtained from each child’s gastroenteritis
caregiver/parent. Furthermore, information such as waste Age in months Frequency Percent
disposal methods, sources of drinking water, prior use of oral 0‑12 48 63.2
rehydration solution (ORS) and medications were obtained. 13‑36 28 36.8
Physical examination of children was conducted to determine 37‑60 0 0
the associated clinical features such as pyrexia, low volume Total 76 100.0
pulse, tachycardia, and state of hydration. Stool samples were
collected and sent to the laboratory for analysis. Thereafter,
Table 2: Method of waste disposal
management/treatment was instituted on each participant as
determined by the clinical diagnosis. Method of Number Percentage
waste disposal
Bush 8 10.5
All data were entered by the designated research personnel, Pit 10 13.2
real time, on the case record form and later transcribed Water cistern 58 76.3
into an electronic data using SPSS statistical software for Total 76 100
Windows® version 19, 2012 (IBM Inc, Chicago Illinois, χ2=1.92, P=0.70

USA). Analyses of the variables were performed using SPSS

and EpiInfo (version 3.5.4, CDC, Atlanta, USA) software. Table 3:Breastfeeding of children
Variables such as sex, age, were expressed in frequency
Age in Exclusively Not exclusively
tables. Significant values of variables; continuous and months breastfed breastfed
categorical were determined using t-tests and Chi‑square tests 0-6 0 17
as appropriate. Spearman correlation co‑efficient was used to 7-12 14 17
determine risk associations of the different variables such as; 13-36 1 27
stool frequency, place of domicile, waste disposal and source 36-60 0 0
of drinking water. Significant values were set at P ≤ 0.05, with Total 15 61
confidence intervals of 95% where applicable. χ2=28.2, df=2, P=0.0001

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 Ezeonwu, et al.: A cute gastroenteritis children, Enugu

of the subjects respectively [Table 4]. The average stool among the infants. This finding showed the similarity with
frequency was less than two motions in a day with those of other workers.[1,2,7] Kazemi, et al.[1] found 84.2%
30.3% (23/76) of the subjects passing between 6 and 10 of children with AGE were under 2 years of age and those
motions in a day. Majority of the subjects 68.4% (51/76) had 6‑12 months were predominantly affected. Huilan, et al.[7]
a stool frequency of equal or less than 5 motions in a day. found 60% to be less than 1 year. Goldman, et al.[8] however,
Among the different age groups 14 infants had stool frequency documented a mean age of 22.4 (14.9) months. In our study,
of more than 5 motions per day while 9 children older than among the infant population those more than 6 months of age
12 months of age had similar stool frequency (RR = 0.99, were affected more. The incidence of AGE among infants
95% CI = 0.73‑1.35, P = 0.84). is probably attributable to the possible lack of immunity
against common enteral infectious pathogens. In another
Seventy four percent of the subjects had concomitant consideration, the protective effect of breast milk seemed to
symptoms of vomiting and diarrhea. The frequency of stooling have been reflected on the number of infants below the age of
is unrelated to the vomiting, P = 0.60. Likelihood ratio = 1.04. 6 months with AGE as none who was exclusively breast‑fed
had diarrhea. Those who were non‑exclusively breast‑fed and
A good percentage of the subjects 64.5% (49/76) had ORS older infants were more affected and may be due to factors
before presentation, and out of this number of children, such as the feeding practices adopted for them. It is at this
majority (67.9% 38/76) who was vomiting received ORS. age that weaning diets are commenced which may lead to
About forty‑five percent, 44.7% (34/76) and 21.1% (16/76) exposure to pathogens. From this study, even those older
were already on anti‑microbial and anti‑diarrheal respectively infants who were exclusively breastfed in the first 6 months
before presentation to the hospital. Minority 19.0% (12/76) of of life also had AGE. Modarres et al.,[9] found the frequency
those who had fever were on anti‑diarrheal medication while of AGE among breast‑fed and bottle‑fed children as 19.1%
44.4% (28/76) were on anti‑microbial. and 48.5% respectively, probably inferring the protective
effect of breast milk against infection.
Half of the children (50% 34/76) had positive malaria
parasite in their blood film examination, while 26% (26/76) There were predominantly more males than females, as was
showed presence of white blood cell in the stool, there was a also documented by Huilan, et al.[7] who found that 60% of
concordance of 17%. the children with AGE were males. Goldman, et al.[8] found no
gender difference. With the variance in gender relationship to
Using the stool frequency as a mark of the severity of the AGE it is difficult to define the possible contribution of gender
condition, (analyses were performed to determine the possible to the prevalence or severity of the condition. It is expected
association of the place of domicile and waste disposal that given the same environmental factors any evidence of a
system of the subjects, non‑significant weak correlations were difference may not be of significance.
noted (Spearman rho’s, r = −0.15, OR; 0.43 95% CI, 0.07‑1.83,
P = 0.20 and r = 0.09, P = 0.2, OR; 1.53, 95% CI, 0.43‑5.22, Poor sanitation has been implicated as a major risk‑factor
respectively). These factors were not strong predictors of in the incidence of AGE.[10] Our study subjects were mostly
severity of diarrhea. urban dwellers and use water cistern method of waste
disposal. The high incidence of AGE among the urban
Discussion dwellers could be due to lack of adequate water supply in
the urban area. Whereas, the number of rural dwellers is less
This study showed that AGE predominantly occurs in than that of urban dwellers the relative proportion with AGE
children below 2 years of age with the highest prevalence among the rural children is significantly less in comparison.
Inefficient water supply leads to increase incidence of
Table 4: Associated clinical features faeco‑oral transmission of diarrheal pathogens. [4] Only
Clinical features Number of patients Percentage 23.7% of the children have access to potable water supply.
Fever 63 82.9 There was a moderate relationship between the place of
Vomiting 56 73.7 domicile and water supply and waste disposal, which may
Increased thirst 51 67.1 imply that the increase incidence of diarrhea among the
Sunken eyes 23 30.3 urban dwellers may not be translated to their ability to
Dry buccal mucosa 23 30.3 limit diarrhea. It is known that the provision of the most
Depressed fontanel 15 19.7 hygienic method of waste disposal alone does not ensure
Abdominal distension 10 13.2 good sanitation; there is still need for adequate water supply
Decreased urine output 7 9.2 for their efficient use.
Loss of skin turgor 7 9.2
Abdominal pain 3 3.9 The most common symptom among the children with diarrhea
Small volume pulse 2 2.6 was fever, which could be interpreted to mean the possibility
Cold extremities 1 1.3 of infective cause of the cases studied. Although, the study

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 Ezeonwu, et al.: A cute gastroenteritis children, Enugu

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in the older infants. Fever and vomiting are the most common
associated symptoms. Lack of exclusive breastfeeding and How to cite this article: Ezeonwu BU, Ibeneme CA, Aneke F, Oguonu T.
contamination of weaning foods may be risk‑factors. Infections Clinical features of acute gastroenteritis in children at University of
may be the primary cause of AGE among the children studied. Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Ann Med Health Sci
Res 2013;3:361-4.
The places of domicile and waste disposal methods were
unrelated and non‑predictors of the severity of diarrhea. Source of Support: Nil. Conflict of Interest: None declared.

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