Public Health Project Topics

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

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

Chapters One

Objectives of Study

  1. 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.
  2. To assess the practices of oral rehydration therapy exercised by these mothers when their child experienced a diarrheal
  3. To find the association between the knowledge, attitude and practices with selected demographic variables.



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 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.


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.


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

  1. Fluid and electrolyte replacement to prevent dehydration- ORS or use of appropriate fluids available in the home if ORS is not available,
  2. Zinc treatment
  3. 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.




 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:

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




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.




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.


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


  • Park’s Text book of Preventive and Social Medicine 20th
  • 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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