Original Article
Bowel Habits and Toilet Training in Rural and Urban Dwelling Children in a Developing Country

https://doi.org/10.1016/j.jpeds.2010.11.024Get rights and content

Objectives

To determine the bowel habits and toilet training of developmentally normal children ages 5 to 8 years in rural and urban areas of the province of Sindh, Pakistan.

Study design

We conducted a descriptive cross-sectional study, conducted at households of rural (District Khairpur) and urban (Karachi) areas of Sindh, Pakistan, which enrolled 1000 children between 5 and 8 years of age, (half from rural and half from urban areas). A questionnaire regarding age, ethnicity, and sex was completed by two separate investigators from each setting. Recall information was elicited about bowel habits for the previous 2 weeks and the frequency and quality of stools, size of stools, and dietary habit for the previous 24 hours. A constipation score that was based on modified Rome III criteria was developed for each child.

Results

Functional constipation was reported 1.6 times more in the rural than the urban population (P < .001). Toilet training was initiated and completed earlier in the urban (18.6 ± 6.8 and 46 ± 12.5 months) than the rural children (28.6 ± 6.1 and 56.5 ± 6.7 months) (P < .001). The daily calorie, macronutrient, fiber, and water intake was higher in the urban population (P < .001). Functional constipation was significantly (P = .016) negatively correlated (r = −0.076) with the fiber intake.

Conclusions

Functional constipation was found more frequently in the rural area. Toilet training was initiated and completed significantly earlier in the urban population.

Section snippets

Methods

This cross-sectional, descriptive study was conducted in the rural and urban areas of the province of Sindh, Pakistan, from September 2009 to February 2010. Initially a pilot study was done by interviewing 50 parents of children between 5 to 8 years of age regarding bowel habits and toilet training.

Approval to conduct this study was obtained from the institutional review board of Dow University of Health Sciences, Karachi. The sampling technique was purposive sampling. In the actual study, two

Results

A total of 1000 questionnaires, 500 from the rural and 500 from urban areas for developmentally normal children between 5 and 8 years of age were obtained. Age, sex, and BMI were comparable in the two populations. The mean ± SD age of all children in the study was 6.5 ± 1.1 years. In the rural population it was 6.1 ± 1.1 years, and in the urban population it was 6.4 ± 1.0 years (Table I). For both populations, the number of boys and girls were comparable. Most of the rural (98%) and urban

Discussion

On the basis of the Rome III Pediatric Committee definition of functional constipation13 and the Bowel Habit Questionnaire score used by Wald et al,14 a constipation score for every child was calculated, on the basis of which we concluded that constipation was likely to be more prevalent in rural children. Most children in our study had daily bowel movements. In a cohort of 300 Burmese children, 90.3% of children defecated once or twice daily.15 This is also consistent with the findings in

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    The authors declare no conflicts of interest.

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