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This study examines the risks for diarrheal disease in young children with particular emphasis given to the behavioral determinants of diarrhea morbidity. Anthropological and epidemiological approaches provided the framework for the qualitative and quantitative methodologies employed in data collection. Diarrhea morbidity, nutritional status and the occurrence of certain behaviors within the household unit associated with increased risk for diarrhea were assessed during the 6 month study period. The sample was comprised of 349 high caste village children in Nepal. This study uses an analytical framework assessing the underlying, intermediate and outcome variables as proposed by Mosley and Chen (1984) and operationalized in the Cebu study (1991). Analysis procedures include Poisson and multiple linear regression to examine determinants of diarrhea morbidity and the pathways through which these variables operate. Three additive risk scales constructed from groups of variables related to hygiene and ingestion behaviors and environmental risks are examined to determine their interrelationships and association with diarrhea morbidity. Results indicate a relationship between socioeconomic status and quality of the household environment. As parental education and family wealth increases, the level of environmental contamination in the household decreases. Parental education remains a strong determinant of environmental quality after controlling for household wealth. Household environment is significantly associated with ingestion behaviors observed in the study children which, in turn, affect diarrhea incidence. Handwashing activity is not related to socioeconomic status but is significantly associated with ingestion behaviors. While neither the household environment nor handwashing activities are directly related to diarrhea incidence, they are strongly associated with ingestion behaviors. Nutritional status, age of the sample children, and the observed ingestion behaviors are important determinants of diarrhea incidence. Specific risk behaviors that are associated with diarrhea include consumption of leftover food, putting fingers in the mouth and the cleanliness of the child. This study suggests that parental education is associated with the quality of the household environment which is related to ingestion behaviors. Ingestion behavior, in turn, is a determinant of diarrhea morbidity. Parental education is also associated with nutritional status, a strong determinant of diarrhea incidence. |
