Knowledge and Acceptance of Oral Rehydration Therapy by Mothers in the Management of Diarrhea in Children 0-5 Years

Knowledge and Acceptance of Oral Rehydration Therapy by Mothers in the Management of Diarrhea in Children 0-5 Years

Chapters One

Objectives of Study

To assess the knowledge and attitude towards oral rehydration therapy for the management of diarrhea among mothers of under-five children in Akinyele LGA health post, Oyo state.
To assess the practices of oral rehydration therapy exercised by these mothers when their child experienced a diarrheal
To find the association between the knowledge, attitude and practices with selected demographic variables.

CHAPTER TWO

REVIEW OF LITERATURE

It is still unbelievable that diarrhea is one of the leading causes of childhood death in the world²¹. Every year 9.2 million children under five years of age die and 90% of these are from preventable conditions as diarrhea²². Diarrhea kills more young children around the world than malaria, AIDS and TB combined²³. As our world climate and demographics change diarrheal disease will become an even more significant global health threat. According to the International Federation of Red Cross approximately 60% of the request for emergency funding was related to acute diarrheal disease ²⁴.

THE DISEASE -DIARRHEA

The WHO defines diarrhea as the passage of three or more loose or liquid stools per day, or more frequently than is normal for an individual. However it is the recent change in consistency and character that is more important. Passage of even one large stool constitutes diarrhea¹. It is caused by bacterial, viral, and parasitic organisms and is usually a symptom of gastrointestinal infection. Diarrhea is life-threatening because it leads to fluid loss and can cause severe dehydration. Infants who are not exclusively breastfed, young children, and adults who are malnourished are at greatest risk²⁵.

There are three major diarrhea syndromes:

Acute watery diarrhea-the most common form that most likely leads to rapid dehydration. It last for 10-14 days. This form is the most deadly in young
Persistent diarrhea, a less common form and last beyond 14

It is disproportionally associated with an increased risk of death.

Bloody diarrhea is often related to malnutrition, intestinal damage, and secondary It is often associated with dysentery²⁵.

Diarrhea has both short-term and long-lasting effects, ranging from severe dehydration to malnutrition, which in turn can weaken its victims’ immune systems and make them more susceptible to future diarrhea episodes as well as other illnesses.

IT’S GLOBAL BURDEN

Diarrheal diseases continue to be a leading cause of morbidity and mortality in the world today. The WHO estimates about the mortality and burden of the disease shows that 2.169 million deaths and 72.73 million DALY lost due to diarrhea¹⁸. The actual incidence may be manifold.

Diarrheas remains the second leading cause of death among children under five globally. Diarrhea causes dehydration. Children are more likely than adults to die from diarrhea because they become dehydrated more quickly. Diarrhea is also a major cause of child malnutrition. Nearly one in five child deaths – about 1.5 million each year is due to diarrhea. More than half of these cases are in Africa and South Asia²⁶.

IT’S MANAGEMENT -ORAL REHYDRATION THERAPY

More proven interventions are available to prevent and treat diarrheal diseases than any other major child killer²⁷. The persisting high mortality from diarrheal disease in the presence of existing cost-effective interventions and available resources to implement them represents a continuing scandal. Reducing these deaths depends largely on delivering life saving treatment that includes

Fluid and electrolyte replacement to prevent dehydration- ORS or use of appropriate fluids available in the home if ORS is not available,
Zinc treatment
Continued feeding including breast milk and along with increase fluids in general²⁸.

Previously it could only be treated by qualified nurses or doctors using expensive intravenous infusion in an often inaccessible hospital. With the discovery of ORT, it can be treated by a mother giving her child the right mix of sugar, salt and water in her own home.

In the 1970 and 1980’s the international community committed itself in this regard by scaling up the use of ORT coupled with programmes to educate caregivers on its appropriate use. The effort met with great success. The UNICEF committed itself to make a major global push to achieve 80% ORS use rate by 1995²⁹.

CHAPTER THREE

METHODS AND MATERIALS

Study design: Community based cross sectional study.

Study area: This study was done in Akinyele LGA of Oyo state.

Study period: This study was done between October 2022 to February 2023.

Study population: Mothers who had children under the age of five living in the study area.

Inclusion criteria:

Willful mothers of under- five children who are permanent residents of the slum, as enrolled in the family register.

Exclusion criteria:

Mothers of under- five children who are not permanent
Mothers of children who are above five years of
Mothers who could not be contacted even after 3

CHAPTER FOUR

DATA ANALYSIS AND RESULT

SOCIO DEMOGRAPHIC PROFILE OF THE STUDY POPULATION

Age of respondents

The age of the respondents ranged between 19 to 37 years. The mean age was 25years. Among the study group 85.9 % of them were in the age group of 20-29 years. 1.8 % was less than 19 years and 12.3% were more than 30 years of age.

CHAPTER FIVE

SUMMARY AND CONCLUSIONS

SUMMARY

The study was a cross sectional study done in Akinyele LGA divisions in Oyo state city to assess the existing knowledge, attitude and practices of ORT among the mothers of under-five children. Most of the mothers in this study were in the 20-29 age group. Larger section of them had one under-five child. Most of them had either primary or middle school education. Majority of them were housewives and belonged to lower socioeconomic class.

The prevalence of diarrhea among the under-five children of these mothers was 19% and ORS use rate was 68.4%. With regard to the health seeking behavior 89.2% sought treatment for the diarrheal episode and medical officers were sought the most. Anganwadi workers were never contacted. 93.2% of mothers were aware of the health impacts of diarrhea and 78.8% of the mothers consider that diarrhea can be managed at home.

About 93.8% of the mothers knew that fluids should be given during the diarrhea episode. But with continuing foods, only 49% had the view that food should be given. 21% of mothers believed that food should be restricted during the diarrheal episode.

About 74.5% of mothers were aware of ORS and among those who said that they knew the method of preparing it, the correct procedure was demonstrated by 72.8 %. Only 64.1% knew that ORS is available free of cost in Government health facility. Medical officers were the major source of knowledge of ORS. There had never been demonstration on the method of reconstitution of the ORS solution.

The overall prevalence of ORT knowledge is that still more than 50% of the study population lack proper knowledge on ORT. There had been no knowledge on zinc supplementation.

The ORS use rate was 68.4%.and recommended home available fluids is 81.6%. But only 3% of the children received increased fluids during the diarrheal episode. The preservation and administration practices were mostly good except for the volume of the fluid administered which needs improvement. Only 0.9% of the child was fed with increased food and 24.4% were not given anything to eat. 26.6 % of mothers stopped breast feeding their child.

Lower educational status and lower socioeconomic status had negative impact on the ORT knowledge and ORS /HAF use. The age of the mother and the number of children borne by her did not have any impact on ORT knowledge. The knowledge on the role of ORS/HAF and source of knowledge had positive impact on ORS use. Mothers with better ORT knowledge had exercised better practices which is statistically significant. Thence raising the in depth knowledge of this life saving intervention is the need of the hour.

RECOMMENDATIONS

With waning importance, the proper knowledge on home based case management has reduced among the new cohort of under-five children’s mother. In this regard from this study I would like to make the following recommendations.

More attention has to be paid on educating the mothers about the importance of fluid replacement during diarrhea so that the practice shall be
The various misconceptions with ORS have to be cleared in the health education In-depth education on the fact that ORS is meant for fluid replacement and that it does not stop diarrhea has to be insisted upon. The importance of correct reconstitution has to be stressed upon. The mothers should be taught that taste should be given least importance.
Smaller packets for smaller amount of fluids can be considered for production by the Government to avoid wastage and incorrect reconstitution
The health care providers should be actively involved in motivating the mothers to bring about the needed behavioral
Since visualization retains for a longer time period, demonstration of the method of preparation is the need of the hour. The health day conducted in the sub centers should have an ORT session so that a new cohort of mothers gets educated in each meet.
The ICDS workers who are readily available to the people should be actively involved in this The women self help group can be involved in this task through better training and motivation
Since over the counter medication is widely prevalent in the country training and motivation of the pharmacist can bring significant rise in ORS usage.
The school education system has to be planned so as to impart basic knowledge on the home management of common prevailing diseases with particular emphasis on diarrhea and ARI.
The mass media must be utilized to the fullest potential so that even illiterates and inaccessible people can gain sufficient
Education on the preventive aspects of diarrhea and zinc supplementation should be given utmost priority because as the prevalence reduces mortality also gets
ORS and zinc supplementation tablet/syrup may be made available as a combo pack so that usage of zinc increases

References

Park’s Text book of Preventive and Social Medicine 20^th
World Health Organization Report of Training courses on organization of MCH Field practice programmes in Medical Colleges, WHO New Delhi, and SEA/MCH/56/Dec 1969
World Health Techn.Rep.Ser.No 600, 1976.
Mohammed Ali George Fuchs et al , Management of severe malnutrition and diarrhea by International Centre for Diarrheal Disease Research,Bangladesh .Nigerian Journal of Pediatrics 2001 68(1) ; 45.

Keusch G, Fontaine O, Bhargava A, et Diarrheal diseases. In: Disease control Priorities in Developing countries. New York: Oxford University Press; 2006: 371-388.
WHO. combating waterborne disease at the household level. Geneva: WHO; 2007.

World Health Organization, Global Burden of Disease estimates, 2004
WHO promotes research to avert diarrhea deaths [press release]. Geneva: WHO; March 10,
Banerjee K.B. and Narain J.P. combined surveys on ARI and diarrhea and EPI. NICD.1988

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