Do community level interventions work in the same way on incidence and longitudinal prevalence of diarrhoea among under five children in rural and urban slum settings? Insights from Stop Diarrhoea Initiative in India

Abstract

# Background Childhood diarrhoea is one of the leading causes of under-five morbidity and mortality globally including India. The National Family Health Survey in India shows that prevalence of diarrhoea among under 5 children has increased from 9.0% in 2005-06 to 9.2% in 2015-16 reflecting no impact on prevalence in a decade. As the burden of diarrhoea is influenced by health behaviors and set of risk factors prevailing in an environment where people live in, the authors in this study attempted to understand how community based interventions on prevention, control and treatment of diarrhoea work in rural areas and urban slums differently. # Methods The methodology of this study comprise pre and post intervention survey and following cohorts of under five children for four weeks before and after one year of community based interventions including prevention, control and treatment of diarrhoea. The data analysis was done using an Excel spreadsheet (Microsoft Inc, Seattle WA, USA) and SPSS 2015 (IBM, New York NY, USA) and reported at 5% margin of error. # Results After the intervention, community behavior and healthy practices have shown improvement in both rural areas and urban slums such as around 20 percentage points more mothers can recognize diarrohea correctly in rural areas and around 28 percentage points more mothers washed their hands after cleaning child feces. The results also show that management of diarrhoea as per National Guidelines in India has also improved at the community level (around 3% points in rural area and 2% points in urban area). However, we noticed that comparative change in incidence is more in rural area than that in urban slums but change in longitudinal prevalence is more in urban slums than that in rural areas. # Conclusions In the rural areas reducing diarrohea incidence seems apparently simpler than in urban slums but treatment of childhood diarrohea in rural areas seems more challenging. For public health programme planning and policy making, differential approaches based on risk factors, access issues and community behavior should be considered for greater effectiveness.