Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2022; 11(2): 160-172
Published online Mar 9, 2022. doi: 10.5409/wjcp.v11.i2.160
Functional constipation in Bangladeshi school aged children: A hidden misty at community
Md Benzamin, ASM Bazlul Karim, Md Rukunuzzaman, Md Wahiduzzaman Mazumder, Masud Rana, Rubaiyat Alam, Mohammad Majharul Islam, Md Shafiul Alam, Kamal Hossen, Afsana Yasmin, Kaniz Fathema, Mukesh Khadga, Aisharza Sultana Aishy
Md Benzamin, ASM Bazlul Karim, Md Rukunuzzaman, Md Wahiduzzaman Mazumder, Rubaiyat Alam, Md Shafiul Alam, Kamal Hossen, Afsana Yasmin, Kaniz Fathema, Mukesh Khadga, Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
Masud Rana, Department of Outpatient, Hazi Asmot Medical Centre, Bhairab 2350, Bangladesh
Mohammad Majharul Islam, Department of Paediatric Nephrology, Bangabandhu Shiekh Mujib Medical University, Dhaka 1000, Bangladesh
Aisharza Sultana Aishy, Jalalabad Ragib Rabeya Medical College, Sylhet 3100, Bangladesh
Author contributions: Benzamin M was the guarantor and designed the study; Rana M, Alam R, Hossen K, Yasmin A, Fathema K, Khadaga M, Aishy AS participated in data collection; Benzamin M and Alam R participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Mazumder MW, Rukunuzzaman M and Karim AS revised the article critically for important intellectual content.
Institutional review board statement: Prior to the commencement of this study, the thesis protocol was approved by the Institutional Review Board of BSMMU, Dhaka.
Informed consent statement: Written informed consent for publication was obtained from the parents.
Conflict-of-interest statement: The authors declare they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Md Benzamin, MBBS, MD, Doctor, Pediatric Gastroenterology Fellow, Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. drmd.benzamin@yahoo.com
Received: April 22, 2021
Peer-review started: April 22, 2021
First decision: May 24, 2021
Revised: June 2, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: March 9, 2022
Processing time: 321 Days and 6 Hours
Abstract
BACKGROUND

Constipation is a common problem in children and a frequent cause of hospital visit in both primary & specialized care, which needs proper evaluation & management. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.

AIM

To determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.

METHODS

This descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical history & physical examinations (without digital rectal examination) & available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests, P value of less than 0.05 was considered as statistically significant.

RESULTS

Total study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884–8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of > 2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time < 2 h (OR = 2.138, 95%CI: 1.063-4.301).

CONCLUSION

Constipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation.

Keywords: Bangladesh; Children; Functional constipation

Core Tip: The current study is the first population-based study of childhood constipation in Bangladesh. Frequency of constipation and functional constipation was 19% and 11% respectively. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation. Alternate hard and loose stool as one of the presentation of functional constipation.