Assessment Of Knowledge And Strategies For Prevention And Management Of Diarrhea Disease Among Under Five Children In: Oko-Erin Community Mothers’ Experience Ilorin West Local Government Kwara State
Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. This study was conducted on the assessment of knowledge and strategies for prevention and management of diarrhea disease among under five children in Oko-Erin Community Mothers experience Ilorin West Local Government, Kwara State. A descriptive study design was used for the study. A total number of One Hundred and Twenty One (121) mothers were selected as respondents. A structured interviewer administered questionnaire was developed to capture questions related to knowledge of diarrhea causation, risk factors, mode of transmission, prevention and control of diarrhea, to assess the effectiveness of the strategies put in place by the Oko erin community and to investigate the ability of such strategizes to reduce morbidity and mortality due to diarrhaea among under 5 children in the study area. It was clear through the data collected that most of the selected mothers have great awareness about diarrhea as a deadly disease for the under five babies. Health workers should endeavor to educate mothers and create more awareness on how to tackle the disease headlong especially among under three babies.
1.1 Background of the Study
Diarrheal disease is highly preventable, yet accounts for nine percent of all deaths among children under age five worldwide [Liu, 2013]. In 2013, this translated into about 580,000 child deaths, or, on average, 1,600 children dying each day due to preventable diarrhea [WHO, 2014].
Diarrhoea is the disturbance of the gastrointestinal tract comprising of changes in intestinal motility and absorption, leading to increase in the volume of stools and in their consistency [Ballabriga, et al 2000]. In diarrhoea, stool contains more water than normal stool and is often called loose or watery stool. In certain cases, they may contain blood in which case the diarrhoea is called dysentery [Obionu, 2007]. Any passage of three or more watery stools within a day [24 hours] is referred to as diarrhoea [Cairncross et al, 2010].
Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. Each year,third world countries of Asia, Africa and Latin America, record approximately five million deaths of children under five years of age from acute diarrhoea. About 80 per cent of these deaths are in the first two years of life [Lucas & Gilles, 2009]. In the developing world as a whole, about one-third of infant and child deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal deaths are caused by dehydration – the loss of large quantity of water and salts from the body, which needs water to maintain blood volume and other fluids to function properly [Gupta & Mahajan, 2005]. UNICEF  summated that in Nigeria, infant mortality rates are twice as high in rural settings as they are in urban ones due to poor hygiene and poor sanitation. About three million infant births in Nigeria, approximately 170,000 result in deaths that are mainly due to poor knowledge and management practices of childhood diarrhoea. Several factors are likely to contribute to the high rate of diarrhoea morbidity and mortality in children under-five years these include poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services [Park, 2009]. Malnutrition is another established risk factor for mortality among children with diarrhoea disease. This may be due to inadequate case management. In 2004, WHO and UNICEF issued a joint statement on clinical treatment of acute diarrhea, recommending the use of low-osmolarity oral rehydration salts [ORS], zinc supplementation, increased amounts of appropriate fluids, and continued feeding [WHO; 2014]. Treatment of diarrhea with ORS is a simple, proven, high-impact intervention that can be provided in home settings by caretakers or by health care providers at community and facility levels to prevent dehydration due to diarrhea and decrease related deaths. The first line of management of diarrhoea is therefore, the prevention of dehydration. This can also be achieved at home using Oral Rehydration Therapy [ORT].
The consistency and the volume of stool constitute how to classify diarrhoea. World Health Organization – WHO  classified diarrhoea as acute or persistent based on its duration. An episode of diarrhoea that lasts less than two weeks is acute diarrhoea, while diarrhoea that lasts more than two weeks is persistent. Calogero et al further classified diarrhoea according to its typology: Secretary Diarrhoea, osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from active process in the intestinal epithelium stimulated by the presence of toxin, chemical or nutritional product in the intestinal linning. Osmotic diarrhoea is caused by the presence in the intestinal linning of osmotically active solutes that are poorly absorbed by the injection of laxatives such as magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated with damage to the mucosa lining leading to outpouring of mucus, blood and plasma protein among other substances. However, it is important to note that the classification of diarrhoea does not influence the cause.
Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Diarrhoea in most cases is caused by three major groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites [Lucas & Gilles, 2009]. The main agents of diarrhoea are enteroviruses [e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera, salmonella [non typhoid], entamoeba histolytica, giardia lamblia, cryptosporidium]. These are further grouped in the following ways: Viruses [e.g. Rota virus]; Bacteria [e.g. shigella, escherichia coli, vibrio cholerae, salmonella non typhoid, campylobacter spp]. Parasites [e.g. entamoeba histolytica, crytosporidium and giardia lamblia]. All over the world, viruses especially rotavirus has been identified as the major cause of acute diarrhoea in children. Studies in Nigeria also found viruses as the major causes of diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20 per cent. Most of these pathogens are transmitted by faeco-oral route. Childhood diarrhoea within the context of this study refers to any type of loose, watery stool that occurs more frequently than usual in a child. The various causative agents vary according to the signs and symptoms manifesting from the disease.
The main consequence of diarrhoea are frequent loose or watery stools, the risk of dehydration, damage to intestine [especially when there is bloody diarrhoea] and loss of appetite with or without vomiting. However, Victoria, Bryce, Fountaine and Monasch  asserted that signs of dehydration are not evident until there is acute fluid loss of approximately 4-5 per cent of body weight. The signs and symptoms of dehydration include sunken fontanels, dry mouth and throat, fast and weak pulse, loss of skin elasticity and reduced amount of urine. This loss leads to shock and untimely death of under-five. Werner  noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan  are passage of frequent loose watery stools, abdominal cramps or pain, fever particularly if there is an infectious cause and bleeding. Bacteria and parasites often can produce bloody diarrhoea [dysentary]. In addition, inflammatory bowel disease, polyps and colorectal cancer can cause blood and mucus in the stools, nausea and vomiting may also be present in the case of infection.
1.2 Problem Statement
The diarrhea prevalence rate in Nigeria is 18.8% and is one of the worst in sub-sahara Africa and above the average of 16%. Diarrhoea accounts for over 16% of child death in Nigeria and estimated 150,000 deaths mainly amongst children under five year occur annually due to this disease mainly caused by poor sanitation and hygiene practice. Various literature suggest 2.7% of prevalence rate in Jos representing north central which include Nasarawa, Benue, Kogi and Kwara State. (WHO Global Report for research in infection diseases of poverty 2012 Geneva)
In Nigeria diarrhoea is responsible for almost all child’s death in every year, Nigeria was estimated to have a total number of annual child death due to diarrhoea to be 151,700 (WHO, 2009). Diarrhoea was the most commonly reported cause of water borne infection in the North West in Nigeria which include Kano, Jigawa, Katsina, Sokoto, Kebbi, Zamfara and Kaduna with prevalence rate of 10%. (Unicef State of World Children 2013)
According to the manufacture instruction using G zard generation Rida Screen Elisa kit (R Biopharm AG Germany) and demographic data were collected via questionnaire to administered to parent/guardians of the subject and analysis was done using online easy chi-square (P<0.05) statistical package, show the prevalence rate of diarrhoeal in north east state including Borno, Bauchi, Adamawa, Gombe, Taraba and Yobe State is between 6.7% (40/600) and 5.0% (30/600) respectively across the north east region (2013-2014). An hospital base study in Lagos reported a prevalence rate of diarrhoea in South-West region of Nigeria that include Lagos, Oyo, Ondo, Osun, Ogun and Ekiti State was found in 4/50 (8% 2010-2015). (Unicef at glance Nigeria http//www.unicef.org/inferby conty)
Through World Health Organisation (WHO) Research International (2015-2017) at University of Nsukka on prevalence rate of diarrhoea across southeast which include Abia, Anambra, Ebonyi, Imo and Enugu which present with prevalence rate of 57% and the prevalence rate for diarrhoea in South South region of the country which include Akwa Ibom, Cross river, Bayelsa, Rivers and Delta states has prevalent rate of 15.6%. (WHO Geneva report for research on infection of disease of poverty 2012 Geneva). Despite the several studies highlighted above cutting across most or all of the geopolitical zones, diarroeal disease seem yet to be effectively controlled within the Nigerian society.
Community-based strategy for prevention and management of diarrhea disease among under five children appeared not to have received adequate research attention. Finding out these, certainly, will represent a positive step forward in the effort to promote the childhood diarrhoea knowledge and management practices. Following from these therefore, one is then inclined to ask, what are the community-based strategy adopted for prevention and management of diarrhea diseases among under five children in Oko-Erin community of Ilorin West local government? How effective are these strategy adopted by the community? What are the factors influencing the strategy towards achieving the desire goal?
1.4 Research Objective
1.4.1 General Objective
To investigate strategies put in place by the community for prevention and management of diarrhoea among under five children.
1.4.2 Specific Objective
- To assess the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment.
- To assess different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area.
- To assess the effectiveness of the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children.
- To investigate the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area.
1.5 Research Questions
This research work aims at providing answer to the following questions;
- What is the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment?
- What are different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area?
- How effective are the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children?
- What is the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area?
1.6 Scope of the Study
This study covers the community-based strategies in the prevention and management of diarrhoea among under five in rural Nigeria using the study location as a case study. It therefore, examines various home remedies in the treatment and management of diarrhoea. This study gives attention to mothers and care givers who are directly involved in the subject matter, that is, those whose child or children are within the age bracket of this study and care givers including community health workers/practitioners. Little attention is given to hospital diagnosis and treatment of diarrhoea. The scope of this study is limited to children of under five years of age while the data collection is also limited to Oko-Erin community of Ilorin West local government of Kwara State.
1.7 Operational Definition
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland.
Oral Rehydration Solution (ORS) A liquid preparation developed by the World Health Organization that can decrease fluid loss in persons with diarrhea
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube
A solution of glucose-based salt solution used in oral rehydration therapy. WHO and UNICEF recommend a single formulation of glucose-based ORS to treat or prevent dehydration from diarrhea from any cause, including cholera, and in individuals of any age.
Village Health Workers those are people who volunteer themselves to the health services in a village
Reproductive and Child Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes and functions.
Discussion of Findings, Summary, Conclusion and Recommendation
This chapter discusses the major findings of the research work with regards to the research questions. It also contains the implication for Community Health, summary, limitation of the study, recommendation, suggestions for further study and conclusion.
5.1 Discussion of findings
The findings revealed that majority of the mothers selected for the study are aware of diarrhea as they have been counseled by the health care provider on what the disease entails. They acknowledged that their children have been treated for the disease at one time or the other.
The study also revealed that mothers adopted indigenous method by the use of herbs and concoction for the prevention and management of the disease which the study revealed that it’s not all that effective, though these local methods are easily and highly accessible.
Apart from the local methods of herbal and concoction, Oral Rehydration Salts (ORS) was confirmed by the selected mothers to be highly effective with no side effect. A better understanding of the reasons for use or no use of ORS and other intervention could help inform public health and commercial efforts to promote or market ORS more effectively and in turn increase coverage. (Ram et al, 2008)
The ability of strategies that are place in Oko Erin community to reduce morbidity and , mortality have been highly impactful and successful because the selected mothers have more awareness of the inherent danger in Children having to live in an unkempt environment, drinking unsafe water and so on.
5.2 Summary of findings
This study was conducted on the assessment of knowledge and strategies for prevention and management of diarrhea disease among under five children in Oko-erin Community Mothers experience Ilorin west Local Government, Kwara State. The objectives are to assess the level of knowledge of mothers on diarrhea, methods of prevention and management, to assess different indigenous methods os strategies adopted for the prevention and management of diarrhea, to assess the effectiveness of the strategies put in place by the Oko erin community and to investigate the ability of such strategizes to reduce morbidity and mortality due to diarrhaea among under five children in the study area.
Related and relevant literatures were reviewed as it is concerned to the research. A descriptive study design was used for the study.
Target population consists of mothers living within Oko- Erin community. Multi stage sampling technique was used in selecting the respondents used for the study.
A total number of One Hundred and Twenty One (121) mothers were selected as respondents. Thereafter, data collected from the questionnaires were presented in frequency distribution tables and charts like bar charts and pie charts.
The findings revealed the obvious awareness of the mothers on diarrhea as a disease that is communicable and deadly. It also revealed the different indigenous method and strategies adopted by the nursing mothers ranging from the use of Herbs and concoction to the use Oral Rehydration Solution.
5.3 Limitation of the Study
Time factor and financial constraints are the major limitations experienced while carrying out this study.
5.4 Implication for Community Health
- This will serve as source of awareness to the Community Health workers on how to health educate mothers on how to prevent and manage diarrhea especially for the under five babies to survive.
- This research work will serve as good source of further research commitments for Community Health officers in various fields for broader knowledge and integration of different approaches learned into the prevention and management of the disease especially with the under five babies.
In conclusion it was clear through the data collected that most of the selected mothers have great awareness about Diarrhea as a deadly disease for the under five babies. While different strategies, like drinking of safe water, hygiene environment among others, were adopted to reduce the morbidity and mortality of the disease, local methods like herbs and concoction were also discovered to have been used but with their attendant side effects with the use of Oral Rehydration Solution preferable due to easy access.
Based on this research study, the following are recommended:
To the individual mothers
Mothers should try as much as possible to ensure that they are in a clean and hygiene environment, always drink clean water, present their babies for checkup and to report any change in their health condition as early as possible and also adhere to the treatment regimen.
To the Community Health workers
Health workers should endeavor to educate mothers and create more awareness on how to tackle the disease headlong especially among under five babies.
To the government
The government should ensure that basic infrastructures are provided, and hospital management should make the health center more affordable and ORS more accessible for the prevention and management treatments of diarrhea among the under five to stem down the morbidity and mortality rate of the disease.
5.7 Suggestion for Further Study
For further studies more studies should be carried out on the following:
- To conduct the research in more elaborate manner that involves a larger community.
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