Factors Associated with Diaper Dermatitis among Children Aged 0-24 Months Admitted in Mbagathi Sub County Hospital, Nairobi County, Kenya

Abstract

Diaper dermatitis (DD) is a highly prevalent condition in infants and toddlers. Globally, the reported prevalence of DD varies ranging from 15% in Italy, 16% in UK, 43.8% in China, 75% in US and 87% in Japan. Although diaper technology has evolved to substantially lessen the severity of DD, its prevalence and burden still remains high. In Sub-Saharan Africa (SSA), prevalence has been variably reported between 4%-35%. Currently, there is no scientific report of local prevalence of diaper dermatitis in Kenya. Understanding the factors associated with diaper dermatitis is vital in its prevention and in the promotion of good quality care for children. The aim of this study was to determine the factors associated with DD among children aged 0-24 months at Mbagathi sub-county hospital. The study was a descriptive cross sectional study conducted among 384 mother/child pairs. Systematic sampling was used to select participants for the study. The sampling frame was estimated from the hospital by calculating the average number of children seen daily. Based on the sampling interval every 5th child coming to the hospital of the outpatient pediatric department was included in the sample until the desired sample size was attained. The first child to be included in the sample was randomly chosen by blindly picking one of two pieces of paper one with Y/N for the first two patients daily. Data was collected using a pre-tested semi-structured questionnaire administered to mothers at the pediatric department. Physical examination of the children to assess for DD was also done by trained nurses working at the pediatric department. Data was analyzed using SPSS v20. Descriptive analysis using means, frequency and proportions were computed. Chi-square tests and odds ratio, CI 95% were computed to establish the association between the dependent variable; diaper dermatitis and independent variables; socio-demographic characteristics, breast feeding practices, diaper care practices and health seeking behaviour at P-value < 0.05. Multivariate logistic regression using adjusted odds ratio with corresponding 95% CI was estimated to examine independent association of factors with DD. Multiple logistic regression revealed the following factors as independently associated with diaper dermatitis: maternal level of education [AOR=3.77; 95%CI=1.36-10.46; P=0.011], type of diaper [AOR=5.46; 95%CI: 1.21-24.54; P=0.027], diaper cleansing practice [AOR=2.90; 95%CI: 1.56-5.40; P=0.001], presence of oral thrush [AOR=2.94; 95%CI: 1.53-5.67; P=0.001]. The study findings concluded that DD is a common problem for children and its prevalence and burden still remains high at 27.3%. In addition, the study findings showed that risk factors for DD are multi factorial and their significance varies. Low levels of maternal education, diaper cleansing agents such as cotton and water, cloth diapers and presence of oral thrush were identified as being predictive of DD. It was recommended that more attention needs to be given to awareness programs presented by health staff regarding protective genital care practices for mothers with lower education levels. A prevention- focused approach that encourages the use of disposable diapers and frequent diaper changes is important. Further, the study recommends that children presented with diaper dermatitis should be examined for coexisting oral thrush as this may result in the recurrence of diaper dermatitis.