PREVALENCE OF DIARRHEA IN SUMMER SEASON

2022 IN DISTRICT KOHISTAN

By
Altaf Hussain
Roll No. 56712

DEPARTMENT OF ZOOLOGY
HAZARA UNIVERSITY MANSEHRA
2023
PREVALENCE OF DIARRHEA IN SUMMER SEASON
2022 IN DISTRICT KOHISTAN

Submitted By Altaf Hussain

BS 8th

Research Supervisor Dr. Muhammad Fiaz Khan

Assistant professor,
Department of Zoology

DEPARTMENT OF ZOOLOGY
HAZARA UNIVERSITY MANSEHRA
2023

ii
 DECLARATION

The material presented in this thesis entitled “Prevalence of Diarrhea in

Summer Season 2022 In District Kohistan” by Altaf Hussain under the
supervision of Dr. Muhammad Fiaz Khan this conclusion is made by me
whom I came after the research.

This work is not presented previously by me elsewhere for any degree.

______________
Altaf Hussain

iii
 DEPARTMENT OF ZOOLOGY
Hazara University Mansehra
Ph. # 0997-414167

CERTIFICATE
This to certify that the thesis entitled “Prevalence of Diarrhea in Summer Season
2022 In District Kohistan” submitted by Altaf Hussain Roll No. 56712 to the Hazara
University Mansehra, Pakistan in partial fulfillment for the award of the degree of
Bachelor of science in Zoology is a bonfire record of research work carried out by
him under my supervision.

Dr. Muhammad Fiaz Khan

Supervisor
Department of Zoology
Hazara University, Mansehra

Dr. Shumaila Noreen

Chairman,
Department of Zoology
Hazara University, Mansehra

iv
 Dedication

I dedicate

This to my beloved parents

Who have been so close to me whenever I

Needed and motivated me to set higher targets.

This thesis is also dedicated to my

Teachers and friends without whom

It was almost impossible to

Complete my thesis work.

v
 ACKNOWLEDGEMENTS

I would like to express my deepest respect to Almighty Allah who created me

in the universe as a zoologist. I am grateful to my parents those sacrifices

helped me to Come into this universe. I show special gratitude to the staff of

Hazara university who Financed me to study in Mansehra through the need

base scholarship. I am grateful for the co-operation of all hypertensive

patients who participated In this study. I would also like to thank nurses in

charge of wards and all nurses for their help during data collection. I would

like to express my deepest appreciation to the following persons for their kind

personal and academic support.

Thanks to all my friends.

Altaf Hussain

vi
 TABLE OF CONTENTS
ABSTRACT ............................................................................................................................. x

CHAPTER-1 ............................................................................................................................ 1

INTRODUCTION.................................................................................................................. 1

1.1. Background ....................................................................................................... 1

1.2. Problem statement ........................................................................................... 4

1.3.1. Broad Objective ..................................................................................................... 5

1.3.2. Specific Objectives................................................................................................. 5

1.5 Aim of the Study ............................................................................................... 6

CHAPTER-2 ............................................................................................................................ 7

LITERATURE REVIEW ........................................................................................................ 7

2.1. Prevalence of Diarheal diseases among the under-fives. ........................... 7

2.2. Factors Predisposing To Diarrheal Disease among Under-Fives.............. 9

2.3. Case-Fatality Rate Of Diartrhoea among Under-Fives ............................. 13

CHAPTER-3 .......................................................................................................................... 15

METHODOLOGY ............................................................................................................... 15

3.1 A Descriptive Cross-Sectional Study was employed ................................. 15

3.2 Ethical Consideration ..................................................................................... 15

CHAPTER 4 ........................................................................................................................... 16

RESULTS ............................................................................................................................... 16

CHAPTER -5 ......................................................................................................................... 21

CONCLUSION, DISCUSSION AND RECOMMENDATION .................................. 21

5.1 Limitations of the Study ................................................................................. 23

5.2 Conclusion ........................................................................................................ 23

5.3 Recommendations ........................................................................................... 24

REFERENCES ....................................................................................................................... 25

vii
 LIST OF FIGURES

Figure 1: The peak incident of dirrhea ................................................................... 18

Figure 2: The Age Wise Prevalence of diarrhea in Separated Months is
Delineated .................................................................................................................. 19
Figure 3: Gender wise Prevalence of diarrhea cases ............................................ 19
Figure 4: The Ratio of diarrhea was Increased in Hot Weathers ....................... 20

viii
 LIST OF TABLES

Table 1: The diarrheal cases ..................................................................................... 17

Table 2: The percentage of diarrhea in different months of summer ................ 18

ix
 ABSTRACT

Introduction: Diarrhea is one of the leading causes of death in developing

countries and its prevalence is very high in rural areas like in the valley of

Pattan district Kohistan lower because there is no system of chlorination and

purification of drinking water.

Objective: The objective of the study was to estimate the prevalence of

diarrhea in the valley of Pattan Kohistan in summer season of 2022.

Methods: A descriptive cross sectional study was conducted over a period of

six months in district headquarter hospital of tehsil Pattan Kohistan. The

statistics of frequency of age wise and gender wise distribution of diarrhea

were calculated.

Tables, bar charts and plotted charts were used to present the data.

Results: Total 2057 cases of diarrhea were identified in the six months

duration of the study. The total number of males with the diarrhea disease

were 1226 (59.6 %), whereas, total females with diarrhea were 831(40.3%). In

addition, the total numbers of diarrheal cases less than 5 years were 767, and

that of more than five years were 1290.

Conclusion: The prevalence and percentage of diarrhea in the valley of Pattan

Kohistan was much high as compared to other big cities of the country.

Keywords: Diarrhea; Seasonal variation; Age distribution; Gender

distribution; Pattan valley; Kohistan;

x
CHAPTER-1

INTRODUCTION

1.1. Background

Globally diarrhea kills 2,195 children every day—more than AIDS, malaria,

and measles combined. That is like losing nearly 32 school buses full of

children each day! 1 in 9 child deaths are due to diarrhea, making 801, 000

child deaths from diarrhea every year. This makes diarrhea the second

leading cause of death among the under-fives. For children with HIV,

diarrhea is even more deadly; the death rate for these children is 11 times

higher than the rate for children without HIV (CDC, 2012).

Diarrhea causes death through depletion of body fluids resulting in profound

dehydration and electrolyte imbalances. It can have a detrimental impact on

childhood growth and cognitive development. More than 80% of diarrhea-

associated deaths are attributable to unsafe water, inadequate sanitation, and

insufficient hygiene.

According to the CDC, rotavirus is the leading cause of acute diarrhea and

causes about 40% of hospitalizations for diarrhea in children under 5. Most

diarrheal germs are spread from the stool of one person to the mouth of

another. These germs are usually spread through contaminated

water, food, or objects which become contaminated with stool in many ways

including people and animals defecate in or near water sources that people

drink, contaminated water is used to irrigate crops, food handlers do not

1
wash their hands before cooking, people with contaminated hands touch

objects, such as doorknobs, tools, or cooking utensils etc. Strides made over

the last 20 years have shown that, in addition to rotavirus vaccination and

breastfeeding, diarrhea prevention focused on safe water and improved

hygiene and sanitation is not only possible, but cost eff ective: every $1

invested yields an average return of $25.50 (CDC, 2012).

The incidence of diarrhea is higher among the under-fives particularly in low

income-countries (LICs), then followed by middle-income countries (MICs)

and then least in high-income countries (HICs). Even though the variation is

not that substantial, the case fatality ratios are. The top killers among the

under-fives are infectious diseases, especially pneumonia, diarrhea, and

malaria (Black et al., 2010)(Liu et al., 2012).

In the year 2010, there were about 1.73 billion cases of diarrheal disease and

2% of episodes progressed to severe disease(Fischer Walker et al., 2013). Of

7.6 million deaths in the underfives in 2010, 64% (4.879 million) could be

attributed to infections and 10.5% were due to by diarrhea (Liu et al., 2012).

The largest proportion of these childhood deaths are in Sub-Saharan Africa

where half of the deaths are from diarrhea. Among all children under-fives,

deaths as a result of diarrhea decreased by 4% per year as from 2000 – 2010

(Liu et al., 2012).

Despite this positive trend seen globally resulting from socioeconomic

development and implementation of child survival interventions, in Africa

the state of affairs is still worrisome.

2
The average child in developing countries experiences three or more episodes

of diarrheal disease each year, accounting for up to 4 billion cases annually.

Diarrhea is a disease in which the patient has three or more than three loose

stools in a day It is one of the leading causes of deaths in under developed

countries.

According to an estimate 165 million people suffers from shigellosis

worldwide and 99% cases occur in developing countries, 69% victims are

children in the age group of 1-5 years . It is a general assumption by many,

that diarrhea is related to consumption of contaminated water, food and

would mostly occur in hot areas. However, a lot of patients were observed

presenting with frequency of loose stool in district headquarter hospital of

tehsil Pattan district Kohistan.

Kohistan valley is the coldest valley in the province of Khyber Pakhtunkhwa

of Pakistan. It is famous for its natural beauty and therefore remains a

popular spot for tourists. In addition, as per the local residents the food and

water here are considered pure and free from any of contamination. Diarrhea

remains the leading cause of morbidity and mortality in children under 5

years of age worldwide.

The burden is disproportionately high among children in low- and middle-

income countries and is very fatal in the young age and may cause death if

not treated properly.

3
Although, how fatal disease diarrhea is, but unfortunately, there is no data

available on the prevalence of diarrhea in Kohistan valley because no such

research has been done.

The magnitude of diarrheal cases is high enough in the valley in summer

season. This study was planned to find out the prevalence of diarrhea in

summer session in the District of Kohistan

1.2. Problem statement

Diarrhea is the fifth cause of death among the under-fives causing more death

than malaria, HIV and measles combined. This is an equivalent of losing 32

buses full of children daily (CDC, 2012).

50% of these childhood deaths occur in sub-Saharan Africa and despite the

improvement in decline witnessed in childhood deaths elsewhere in the

world, the trend in Africa is frightening. This is despite the several

interventions put in place to improve childhood survival. As countries

elsewhere are showing positive progress towards achieving the Millennium

Development Goals(MDGs) and Sustainable Development Goals (SDGs),

progress in Africa is under jeopardy since reduction of childhood mortality,

particularly among the under-fives is the fourth goal (MDG4) (United

Nations, 2015). In Kiryandongo, many deaths among under the age of five

years are caused by diarrhea and its complications (Bbaale, 2011). For this

reason, the researcher proposed to conduct this study in DHQ Hospital

4
Kohistan.

1.3. Study Objectives

1.3.1. Broad Objective

To assess the prevalence and associated factors of diarrhea attending DHQ

Hospital Pattan Kohistan.

1.3.2. Specific Objectives

1. To determine prevalence of diarrhea in patients attending DHQ Hospital

Pattan Kohistan.

2. To identify the various factors that predispose to diarrhea attending DHQ

Hospital Pattan Kohistan.

3. To assess diarrhea-related deaths attending DHQ Hospital Pattan Kohistan.

1.4 Research Questions

1. What is the prevalence of diarrhea disease in patients attending DHQ

Hospital Pattan Kohistan.?

2. With the advent of immunization against childhood diarrhea, has there

been a shift in the diarrheal causes among the under-fives attending DHQ

Hospital Pattan Kohistan.

3. What are the various factors that predispose to diarrhea disease in patients

attending DHQ Hospital Pattan Kohistan?

5
4. What is the case-fatality rate of diarrhea in patients attending DHQ

Hospital Pattan Kohistan?

1.5 Aim of the Study

The aim of the study was to ―estimate the prevalence of diarrhea cases in the
valley of Kohistan in summer season 2022.

6
CHAPTER-2

LITERATURE REVIEW

2.0. Introduction

This chapter looked into the literature reviewed on the prevalence of

diarrheal disease among the patients, the factors that predispose these

diarrheal diseases and diarrhea-related deaths.

2.1. Prevalence of Diarheal diseases among the under-fives.

Pneumonia and diarrhea remain major killers of Diarrheal diseases account

for 1 in 9 child deaths worldwide, making diarrhea the second leading cause

of death among children under the age of 5. For children with HIV, diarrhea

is even more common and deadlier; the death rate for these children is 11

times higher than the rate for children without HIV. About 2195 children die

daily of diarrhea each day. It is estimated that about 801,000 children die from

diarrhea every year (CDC, 2012).

Each year, an estimated 2.5 billion cases of diarrhea occur among children

under five years of age, and estimates suggest that overall incidence has

remained relatively stable over the past two decades. More than half of these

cases are in Africa and South Asia, where bouts of diarrhea are more likely to

result in death or other severe outcomes. Mortality from diarrhea has declined

over the past two decades from an estimated 5 million deaths among children

under-fives in 1996 to 1.5 million deaths in 2016, which parallels downward

trends in overall under-five mortality during this period. Despite these

7
declines, diarrhea remains the second most common cause of death among

children under five globally, following closely behind pneumonia, the leading

killer of young children. Together, pneumonia and diarrhea account for an

estimated 40 per cent of all child deaths around the world each year. Nearly

one in five child deaths is due to diarrhea, a loss of about 1.5 million lives

each year. The toll is greater than that caused by AIDS, malaria and measles

combined (Wardlaw et al., 2010).

This is shown in appendix six. Pf young children. Together, these diseases

account for 29% of all deaths of children less than 5 years of age and result in

the loss of 2 million young lives each year (UNICEF, 2013). Proportions

contributed by pneumonia and diarrhea to underfive deaths are high as

shown in appendix seven. In a study done in urban slums of India on burden

of health morbidities in 2015 it was shown that acute diarrheal infections were

number four with a prevalence of 18.33%. this was next to protein energy

malnutrition (PEM)(67.62%) followed by Acute Respiratory Infections (ARI)7

(40.48%), and pyrexia of unknown origin (PUO)(20.24%) (Lakshminarayanan

& Jayalakshmy, 2015).

A study in Eastern Ethiopia showed that the two-week prevalence of diarrhea

among children under five years of age was 22.5% (95% CI: 20.3 - 24.6)

(Mengistie, Berhane, & Worku, 2013). In Mkuranga District, Tanzania in 2014

the prevalence of diarrhea in children below the age of five years as reported

by heads of households was 6.1% and most affected were children in age

groups 12 – 17 and 18 – 23 months (11.6% and 15.8% respectively; p – value

8
0.001) (Mashoto, Malebo, Msisiri, & Peter, 2014). In Kanyanda, Luweero

District, the prevalence of childhood diarrhea disease was found to be at a

staggering 47.7% (Kakungulu, 2016).

2.2. Factors Predisposing To Diarrheal Disease among Under-

Fives

So many risk factors are associated with diarrheal disease among the under-

fives. The causative organisms can gain access through so many pathways.

Among factors that have been cited the major ones include environmental

contamination and increased exposure to entero pathogens. Additional risks

include young age, immunodeficiency, measles, malnutrition, and lack of

exclusive or predominant breast-feeding. Malnutrition increases the risk of

diarrhea and associated mortality, and moderate to severe stunting increases

the odds of diarrhea-associated mortality 1.6- to 4.6-fold.

The fraction of such infectious diarrhea deaths that are attributable to

nutritional deficiencies varies with the prevalence of deficiencies; the highest

attributable fractions are in sub-Saharan Africa, south Asia, and Andean Latin

America. The risks are particularly higher with micronutrient malnutrition; in

children with vitamin A deficiency, the risk of dying from diarrhea, measles,

and malaria is increased by 20- 24%. Zinc deficiency is estimated to increase

the risk of mortality from diarrhea, pneumonia, and malaria by 13-21%

(Marcdante & Kliegman, 2014).

9
In a study carried out in Kabul, Afghanistan it was found that the highest risk

of diarrheal illnesses was during the summer months (incidence 5.71 episodes

per child-year (95%CI 5.48– 5.96) and lowest during winter months (2.12

episodes per child year (95%CI 2.02–2.21). The seasonal trends in hazards are

illustrated in Fig. 2. The risk of diarrhea was 63% lower in winter as compared

to summer (HR = 0.37, 95%CI 0.35–0.39, p<0.001). Among children less than

six months of age the incidence of diarrheal episodes was 2.35 per child-year

(95%CI 2.15–2.57). For children aged six months to less than one year, the

incidence was 3.89 episodes per child-year (95%CI 3.73–4.06).

In univariate analysis, the risk of diarrheal illness was 60% greater among

children aged six months to one year in comparison to those less than six

months of age. For children greater than one year of age, the incidence of

diarrheal illness was 3.48 episodes per child-year (95%CI 3.36–3.60) with a

48% greater risk of recurrent episodes. Malnourished children and those from

impoverished households had a greater risk for recurrent illnesses. Children

who were born to mothers with greater than primary education had a lower

risk recurrent events as compared to those born to mothers with primary

education or less.

Among children from homes using wells the risk of diarrheal illnesses was

lower in comparison to a piped water source. Water treatment with chlorine

was found to confer a reduced risk of diarrheal illnesses however no

significant difference was found when treatment with boiling was reported.

Food storage with refrigeration, having an in-home well, use of a toilet with

10
septic/canalization and maternal hand washing with soap post- toilet use

were all associated with a reduced risk of diarrheal disease.

In recurrent event multivariate analysis malnourishment and being from an

impoverished household were associated with an increased risk of childhood

diarrheal illnesses at 15% and 20% respectively (aHR = 1.15, 95%CI 1.03–1.29,

p = 0.016 and aHR = 1.20, 95%CI 1.05–1.37, p = 0.006). Levels of maternal

education, maternal hand washing with soap post-toilet, and use of a toilet

with septic/canalization were found to be protective against recurrent

illnesses. Maternal education post primary school was associated with 21%

lower risk (aHR = 0.79, 95%CI 0.69–0.91, p = 0.001), and hand washing with

soap a 17% reduction (aHR = 0.83, 95%CI 0.74–0.92, p<0.001).

Children from households using toilets with septic/canalized systems were

had a 24% lower risk of diarrheal illnesses (aHR = 0.76, 95%CI 0.63–0.93, p =

0.006). A trend of reduced risk was found among households using an open

well versus a piped water source (aHR = 0.87, 95%CI 0.76–1.00, p = 0.053). No

significant association was found in relation to diarrheal illnesses and tube

wells. Treatment of drinking water, food storage, distance to water source,

sleeping with other children and number of rooms in the home were not

significantly associated with risk of diarrheal illness in multivariate analysis

(Samwel et al., 2014).

In a study conducted among the nomadic populations of Northeast Ethiopia,

it was noted that the occurrence of diarrheal disease was associated with the

number and age of under-five children in the households. The occurrence of

11
diarrhea was 4.3 times more likely to be higher among households with two

children compared with households with only one child [AOR = 4.3, 95% 9 CI

= (2.9, 6.3)]. Similarly, the likelihood of diarrhea occurrence was also 22.4

times higher among households with three children compared with

households who had one child [AOR = 22.4, 95% CI = (7.8, 64.5)]. Children

aged between 6.0 and 11.0 months had 4.8 times more chance to have diarrhea

than children aged under 6 months [AOR = 4.8, 95% CI = (2.1, 10.8)].

Similarly, the occurrence of diarrhea among under-five children aged

between 12.0–23.0 and 24.0–35.0 months was 6.0 and 2.5 times more likely to

be higher compared with children aged under 6 months [AOR = 6.0, 95% CI =

(2.9, 12.2)] and [AOR = 2.5, 95% CI = (1.2, 5.4)], respectively.

Furthermore, childhood diarrheal disease was statistically associated with the

educational status of mothers and household economic status. The likelihood

of diarrhea occurrence was 2.5 times higher among children whose mothers

had no formal education compared with their counterparts [AOR = 2.5, 95%

CI = (1.2,5.2)]. The occurrence of diarrhea was 1.6 times higher among

children whose families were economically poor compared with children

whose families had medium income [AOR = 1.6, 95% CI = (1.0, 2.2)] (Woldu,

Bitew, & Gizaw, 2016).

12
2.3. Case-Fatality Rate Of Diartrhoea among Under-Fives

Diarrhea kills 2,195 children every day—more than AIDS, malaria, and

measles combined. Diarrheal diseases account for 1 in 9 child deaths

worldwide, making diarrhea the second leading cause of death among

children under the age of 5. For children with HIV, diarrhea is even more

deadly; the death rate for these children is 11 times higher than the rate for

children without HIV (Centres for Disease Control, 2018).

Diarrhea is a major cause of mortality in children under 5 years of age in

developing countries, contributing up to 21 % of deaths. Globally, rotavirus

diarrhea causes more than 450,000 deaths annually in children below five

years, with 80 % of deaths occurring in sub-Saharan Africa and South Asia

(Bwogi et al., 2016). In 2013, an estimated 47 100 rotavirus deaths occurred in

India, 22% of all rotavirus deaths that occurred globally. Four countries

(India, Nigeria, Pakistan, and Democratic Republic of Congo) accounted for

approximately half (49%) of all estimated rotavirus deaths in 2013 (Tate et al.,

2016).

These deaths, however, have declined since the advent of Rotavirus

vaccinations in children. A study conducted in Mexico, for instance,

documented a substantial and sustained decline in diarrhea-related

hospitalizations and deaths in Mexican children associated with

implementation of rotavirus vaccination. These results highlighted the public

health benefits that could result in countries that adopt rotavirus vaccination

into their national immunization programs (Sánchez et al., 2016). Similar

13
reports came from Botswana where following introduction of RV1 into the

national immunization program, significant declines in hospitalizations and

deaths from gastroenteritis were observed among children in Botswana,

suggestive of the beneficial public health impact of rotavirus vaccination

(Enane et al., 2016). In Uganda, a majority of the under-five deaths are due to

malaria, followed by diarrhea, severe/moderate anaemia and

severe/moderate malnutrition (Nambuusi et al., 2019).

14
CHAPTER-3

METHODOLOGY

3.1 A Descriptive Cross-Sectional Study was employed

This descriptive cross sectional study was conducted in government district

hospital of Pattan Kohistan. The data was collected using the hospital records

of patients from 1st March 2022 to 31th August 2022. The duration of six

months was taken because the weather in these months is a little warmer and

is consider as summer. In addition, the population also gets increase in this

season because the residents as well as many tourists visit the valley. The

study participants were all the OPD and emergency patients.

Microsoft excel 2013 was used to analyze the data. The two variables taken

were, gender wise prevalence of diarrhea and age wise prevalence of

diarrhea. The age wise distribution was taken as having diarrhea for less than

five years and more than five years. The statistics of frequency of distribution

of diarrhea in age wise as well gender wise were obtained. Moreover, the

percentages of diarrhea patients in the separate months were obtained. The

tables, bar charts and plotted charts are used to represent the data.

3.2 Ethical Consideration

Written permission was obtained from in charge of the government district

headquarter hospital Pattan Kohistan.

15
CHAPTER 4

RESULTS

The total admissions in the six months duration from March 01 to July 31,

2022 were 21,523. These admissions included the daily OPD patients and

emergency patients. The diarrheal cases among these admissions were 2,057

as shown in the Table 1. The month wise prevalence of diarrheal cases was 67

in March, 153 in April, 316 in May, 562 in June, 564 in July and 395 in August

respectively. The bar graph in figure-2 shows the month wise prevalence of

diarrhea. The gender wise prevalence of diarrhea among total cases of

diarrhea was 1,226 male patients and 831 female patients. In addition, the age

wise prevalence of diarrheal cases was 767 less than 5 years patients and

1,290 more than five years patients. The peak incident of diarrhea was in the

months of June and July, which were 562 and 564 respectively, as illustrated

in the graph chart in Figure 1.

The age wise prevalence of diarrhea in separated months is delineated in

Figure 2. The month wise total cases of diarrhea less than five years were 26,

63, 119, 246, and 204, 109 respectively. Whereas, the month wise cases of

diarrhea more than five years were 41, 90, 197, 316, 360 and 286 respectively

as shown in Table 1. The gender wise prevalence of diarrhea of male patients

in the months of March, April, May, June, July and August were 35, 97, 177,

341, 326, and 250 respectively. Among the female patients, the prevalence in

these months was 32, 56, 139, 221, 238 and 145 respectively as shown in Figure

16
3. By looking to the percentage of diarrhea in different months of summer, it

becomes clear from Table 2 that it was increased in the months of June and

July that were 13.6 % and 10.9 % respectively of 2022

Table 1: The diarrheal cases

Total Diarrhea Male Female <5 >5 Other

Month
admission cases patient patients years years cases

March 1711 67 35 32 26 41 1644

April 2154 153 97 56 63 90 2001

May 4307 316 177 139 119 197 3991

July 5136 564 326 238 204 360 4572

August 4088 395 250 145 109 286 3693

Grand
21523 2057 1226 831 767 1290 19466
Total

17
 Figure 1: The peak incident of dirrhea

Table 2: The percentage of diarrhea in different months of summer

% of males % of females
Diarrhoea with >5 years cases %
Month with <5 years %
% % Other
Diarrhoea Diarrhoea

March 3.91583869 52.23880597 47.76119403 38.80597015 61.19403 96.08416

April 7.10306407 63.39869281 36.60130719 41.17647059 58.82353 92.89694

May 7.33689343 56.01265823 43.98734177 37.65822785 62.34177 92.66311

June 13.6176399 60.67615658 39.32384342 43.77224199 56.22776 86.38236

July 10.9813084 57.80141844 42.19858156 36.17021277 63.82979 89.01869

August 9.66242661 63.29113924 36.70886076 27.59493671 72.40506 90.33757

18
Figure 2: The Age Wise Prevalence of diarrhea in Separated Months is Delineated

Figure 3: Gender wise Prevalence of diarrhea cases

19
Figure 4: The Ratio of diarrhea was Increased in Hot Weathers

20
CHAPTER -5

CONCLUSION, DISCUSSION AND RECOMMENDATION

As the previous researches also show that diarrhea is very prevalent in

different regions of Pakistan. Beside this, it is more common in urban and sub

urban areas. Diarrheal diseases are frequent in Pakistan claiming about

118,000 lives each year, most of which are children <5 years living in rural

communities. In addition, it was often observed that adult urban and

suburban dwellers also face diarrheal episodes.

The findings of this study also showed that the proportion of diarrhea was

high enough in the region. There were total of 2,057 cases of diarrhea among

21,523 admitted patients. The percentage of diarrhea was round about 10%

(9.55%), which is high enough because the population of Kohistan is not as

large as other big cities of Pakistan. The findings of a study across Pakistan

showed that in a duration of two years, the total numbers of patients with

acute watery diarrhea from April 2019 to May 2021 were: 23,212 in LCH

(Lahore), 2,028 in RGH (Rawalpindi), 937 in MHPMC (Peshawar), 2,417 in

NICH (Karachi) and 1,991 in KGH (Karachi). In comparison to the above

study, the results of our study are alarmingly high, because this data was

collected in six months duration and valley Kohistan is a comparatively small

region as compared to the mentioned big cities of Pakistan.

The total males with the diarrhea disease were 1226 (59.6 %), and the total

females with the diarrhea disease were 831(40.3%) as shown in Table 1. This

21
significant difference may be due to the consumption of street food by males

in hotels and bazars. This particular is in line with the findings of a study in

Pakistan where, there was significant difference in pin point prevalence of

diarrhea males (10.4%) were more prone to diarrhea than that of females

(8.1%) .

The same finding is also confirmed by another study, that rotavirus is the

single most common cause of acute watery diarrhea worldwide and studies

have shown that rotavirus affect male gender more than female. In addition,

the weather has also great impact on the health of the population. It was also

found out that the ratio of diarrhea was increased in hot weathers (Figure 4).

The weather in August and after words becomes colder in the valley, so the

incidents of diarrhea also get decrease. The occurrence of infectious disease in

hot weather is due to a number of reasons. In hot and humid weather, the

growth of pathogenic organisms in the food and other material get increased,

also summer is the breeding season for flies that act as mechanical vectors

carrying enter pathogens to food and water . Moreover, the prevalence of

diarrhea in summer season was high, that was 42.6%.

In addition, the hygienic condition of rural communities is not good which

also adds to the outbreak of the infectious diseases. The drinking water

resources in rural areas are mainly contaminated by animal wastes ,garbage,

low improvement index of bathroom and toilet,pipe breakage due to

corrosion and long track, agricultural activities, lack of personal and food

hygiene, the lack of regular and continuous chlorination and lack of water

22
treatment facilities . Our study’s findings are in corroboration with the above

mentioned study as Kohistan valley is also a rural area where most of the

drinking water resources such as water tanks and springs are contaminated

by above mentioned impurities when there is heavy rain fall. Through rain

water these contaminants get mixed with the drinking water, which

ultimately leads to spread of infectious diseases like diarrhea.

Approximately 44 % of Pakistani communities have no access to safe drinking

water and the situation is far worse in rural areas 90% of the population is

deprived of safe drinking water [10]. This clearly indicates that drinking ater

in rural areas cannot be considered safe

5.1 Limitations of the Study

The main limitation of the study is that data was collected from one hospital

only. Although, this civil hospital is the biggest in the region, still majority of

the people visits other centers as well. So, if the data was collected from all

health centers of the region, the results would be more fruitful..

5.2 Conclusion

In conclusion, based on the study findings it can be stated that infectious

diseases like diarrhea is not confined to hot and populated regions only. The

study results clearly showed that the prevalence of diarrhea is much high in

the region as compared to the other big cities of the country. There were total

2,057 cases of diarrhea cases identified in only one hospital of the region

23
5.3 Recommendations

It is suggested that the government should give proper

attention to this issue. Moreover, efforts should be made to improve the

sanitation system of the residential areas of Kohistan valley. Provision of safe

drinking water has to be made sure for people of the region. For this purpose,

water purification plants should be installed. Further research studies should

be carried out on larger scales to identify the burden of different w ater borne

diseases

24
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