Knowledge Of Preventive Measures Of Diarrhea Disease Among Mothers Of Under Five Children (A Case Study Of Ardo-Kola L.G.A, Taraba State)
The purpose of the study was to investigate the knowledge of preventive measures of diarrhoea disease among mothers of under five children in Ardo-Kola LGA. Literature pertinent to the study was reviewed under the following headings: conceptual framework, factors associated with knowledge and management practices of childbearing mothers regarding childhood diarrhoea, and theoretical framework. The survey research design was adopted for the study. The study population comprised of registered mothers attending MCH clinics in Ardo-Kola LGA at the time of the study. The multi-stage sampling procedure was utilized to draw the sample. The researcher designed questionnaire that constituted two sections was the instrument utilized for collection of quantitative data. Out of the 300 copies of the questionnaire distributed, 284 copies were used for data analysis. The SPSS batch system was employed for data analysis. The findings of the study indicated that: Mothers had high (71.21%) level of knowledge of the concept of childhood diarrhoea (KCD); Mothers had very high (84.94%) level of knowledge of the signs and symptoms of childhood diarrhoea; Mothers had high (76.58%) level of knowledge of the modes of transmission of childhood diarrhoea; Mothers had high (77.82%) level of knowledge regarding the dangers of childhood diarrhoea; Mothers had high (60.28%) level of knowledge regarding the preventive measures of childhood diarrhoea; and Majority of mothers adopted all the management practices of childhood diarrhoea ranging from 72.2%- 90.5% except “giving their babies only breast milk during diarrhoea (42.3%) and (35.6%) mothers who allowed their children to defecate in bushes or open spaces. It was recommended that the health workers at the various MCH in Ardo-Kola LGA should strengthen their teachings on the management practices of mothers regarding childhood diarrhoea. Since these mothers varied in their responses in all the management practices.
Table Of Content
- Title Page
- Table of Content
- 1.1 Background To The Study
- 1.2 Statement Of The Problem
- 1.3 Research Objectives
- 1.4 Research Questions
- 1.5 Hypotheses
- 1.6 Significance Of The Study
- 1.7 Definition Of Terms
- 1.8 Organization Of Study
2.0 Literature Review
- 2.1 Conceptual Review
- 2.2 Preventive And Management Practice
- 2.3 Theoretical Framework
- 2.3.1 Health Action Process Approach
- 2.3.2 Systems Management Theory
- 2.3.3 Self-Efficacy Theory
- 3.1 Research Design
- 3.2 Area Of Study
- 3.3 Population For The Study
- 3.4 Instrument For Data Collection
- 3.5 Method Of Data Collection
- 3.6 Method Of Data Analysis
4.0 Results And Discussion
- 4.1 Results
- 4.2 Discussion
5.0 Conclusion And Recommendation
- 5.1 Conclusions
- 5.2 Recommendations
1.1 Background To The Study
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, in the developing countries of Asia, Africa and Latin America, approximately five million children under five years of age die 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 (2002) submitted 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. Of the annual 3 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 very high diarrhoea morbidity and mortality rates, in children under-five years including 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. The first line of management of diarrhoea, is therefore, the prevention of dehydration. This can be achieved at home using Oral Rehydration Therapy (ORT).
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, Hilpert & Isliker, 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, 2001). Any passage of three or more watery stools within a day (24 hours) is referred to as diarrhoea (Tauxe, 1997). The consistency and the volume of stool constitute how to classify diarrhoea.
World Health Organization – WHO (1993) 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. Morley (2000) 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 of 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 according to them 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 (2000) 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 fontanelle, 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 (2001) noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan (2004) 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.
The main dangers of diarrhoea are dehydration and malnutrition (WHO, 1993). Dehydration according to WHO is most often caused by loss of a large amount of water and salt from the body, while malnutrition can be caused by an inadequate diet due to poverty, a lack of appropriate foods or incorrect beliefs about feeding, frequent infections of which diarrhoea is one of them.
Spradley and Allender (1996) stated that the most common modes of transmission of diarrhoea are contaminated food and water, dirty feeding utensils (especially feeding bottles and teats) and the faecally contaminated fingers of the infants or the mother. Infection occurs through ingesting food contaminated with adequate doses of Salmonella, and Shigella or E. Coli. The cycle begins when the infectious agent multiplies and grows in the food medium. The agent subsequently invades the host upon ingestion of the food.
There are other physical modes of transmission of diarrhoea as identified by the United Nations Children‟s Fund – UNICEF (1998). These include: poor source of water supply, especially in rural areas; poor environmental sanitation leading to attitudinal problems of defecating in open spaces, pit latrine, bushes and in the streams (used for drinking and bathing). Feeding bottle is also a feature of infection (Federal Rebublic of Nigeria – FRN 2002). Lucas and Gilles (2009) also maintained that transmission of diarrhoea occurs by the faecal-oral route due to poor standards of personal and environmental hygiene. These conditions will determine the seriousness of infection of diarrhoea. The most important aspect of managing a child with diarrhoea are preventing or treating dehydration and maintaining good nutrition.
These preventive practices according to WHO (1993) include breast feeding, improved weaning, use of plenty of water for hygiene and clean water for drinking, hand washing, use of latrines, proper disposal of the stools of young children, use of Oral Rehydration Therapy (ORT) and Oral Rehydration Solution (ORS) and immunization against measles. Cutting (1994) stressed that drinking extra fluid in the early stages of diarrhoea is crucial in preventing dehydration and subsequent death. He also noted that the combination of giving more fluid than usual as soon as diarrhoea starts and continuing feeding is an effective home therapy for acute diarrhoea. The knowledge and practice of these becomes necessary for the mothers in the issues of childhood diarrhoea.
Traditionally, mothers are expected to spend most of their time in the house, looking after their children and carrying out other domestic functions. It may be right and natural, therefore, that the first person to manage a diarrhoea episode at home is possibly the mother. Mothers on this basis have been identified as the most important people involved in the management of childhood diarrhoea, hence mothers are used for this study. Landy (1992) referred to them as the key persons and managers of the home. She asserted that people, especially mothers possess adequate knowledge about their baby‟s health and disease prevention. Thus, they are recognized as very important persons for the smooth running of the family, including supervision of health of their children. Macleans (1998), on his own part, accorded mothers the traditional responsibility of looking after their children with regard to weaning and nursing care. This, according to him, is because of their being close to their children. This situation is similar to the relationship between mothers and their children in Ardo-Kola LGA. As asserted by Davely and Wilson (1981) and Bethann, Gopel, Douglas and Lynn (1992), literate mothers are better able to look after their children than non-literate ones. Thus, those who possess the appropriate knowledge are more likely to be able to take the appropriate action to protect their children especially the under-five (childhood).
WHO (1993) identified a number of management practices and these are: breast feeding, Oral Rehydration Therapy(ORT), weaning practices, use of plenty of water for hygiene and use of clean water for drinking, hand washing, use of latrines, safe disposal of stools of young children and measles immunization. Early knowledge and practice of these in the home may increase the chances of its efficacy and likely reduce complications following diarrhoea. It is most likely that mothers who are the home-makers will make use of them in order to save their children when they are informed. Okafor (1993) opined that women are better able to understand information and follow instructions if their level of education and information should be raised. The way of determining if women possess adequate knowledge regarding childhood diarrhoea is to assess the level of knowledge they possess about the aspects of the disease.
Level of knowledge and practice can be ascertained in numerous ways. Ashur (1977) opined that a proportion of less than 40 per cent correct response should be taken as indicator of low level of knowledge, 40 – 59 per cent is considered average and 60 – 80 per cent is considered high, while over 80 per cent is regarded as very high level of knowledge. Okafor (1997) modified Ashur‟s four scales of measurement into five scales by carving two levels that is, 10-20 per cent as “very low” and 21-39 per cent as “low” out of Ashur‟s proportion of less than 40 per cent described as “low” level of knowledge. The Ashur‟s (1977) principle was adopted in the present study to determine the knowledge of preventive measures of diarrhea disease among mothers of under five children in Ardo-Kola LGA, Taraba State.
1.2 Statement Of The Problem
Adequate and accurate knowledge has been admitted as a prerequisite for the adoption of desirable health behaviour. WHO (1995) asserted that when a person is well-informed, the individual will be equipped to make the right decision concerning the health of the children and family and will take an active role in improving the society in which the person lives. Mothers should have adequate knowledge of the childhood diseases, among which diarrhea is one. This knowledge which they gained from the different MCH clinics should help the mothers to take adequate and accurate care of their children.
Regrettably, in spite of the knowledge gained by these mothers, childhood diarrhea is found to be the second main cause of under-five mortality the world over, in the developing countries and in Nigeria in particular. It is not unlikely that low level of knowledge of mothers in Ardo-Kola LGA may militate against the effective performance of diarrhea prevention practices. It is against this background of the cases and magnitude of diarrhoeal diseases, its associated implications and complications and the need for child safety and health promotion that the researcher was motivated to ascertaining the knowledge of preventive measures of diarrhea disease among mothers of under five children in Ardo-Kola LGA of Taraba State.
1.3 Research Objectives
The aim of the study is to assess the knowledge of preventive measures of diarrhea disease among mothers of under five children in in Ardo-Kola LGA.
Specifically, the study intends to find out:
- Level of knowledge of the concept of diarrhoea possessed by mothers in Ardo-Kola LGA;
- Level of knowledge of the signs and symptoms of childhood diarrhoea possessed by mothers.
- Level of knowledge of modes of spread or transmission of diarrhoea possessed by mothers.
- Level of knowledge of the dangers of childhood diarrhoea possessed by mothers in Ardo-Kola LGA.
- Level of knowledge of preventive measures against childhood diarrhoea possessed by mothers.
1.4 Research Questions
The following research questions were formulated to guide the study;
- What is the level of knowledge possessed by mothers regarding concept of childhood diarrhoea?
- What is the level of knowledge possessed by mothers regarding signs and symptoms of diarrhoea?
- What is the level of knowledge possessed by mothers regarding modes of transmission of childhood diarrhoea?
- What is the mother’s level of knowledge of the dangers of childhood diarrhoea?
- What is the level of knowledge possessed by mothers regarding the preventive measures of childhood diarrhoea?
The following null hypotheses are hereby postulated for the study and will be tested at .05 level of significance.
- There is no statistically significant difference in the level of knowledge of mothers regarding childhood diarrhoea according to age.
- There is no statistically significant difference in the level of knowledge of mothers regarding childhood diarrhoea according to level of education.
- There are no statistically significant differences in the management practices of childhood diarrhoea by mothers according to parity.
- There is no statistically significant difference in the level of knowledge of mothers regarding childhood diarrhoea according to parity.
- There are no statistically significant differences in the management of childhood diarrhoea by mothers according to age.
1.6 Significance Of The Study
Information, of both local and foreign origin abounds regarding childhood diarrhoea in Nigeria. The study will ginger interest in the area of childhood health and disease in Nigeria. Mothers especially childbearing women will benefit from the result of the study as it will provide them with appropriate information on the concept, signs and symptoms, modes of transmission and the preventive measures of childhood diarrhoea. This will enable the women to make informed choices on the adoption of the management practices. Appropriate knowledge will influence them and enhance their practice. It will also help them in educating the public on the preventive measures of childhood diarrhoea. Low level of knowledge on the other hand will equally compel health policy makers to step up efforts in the area of education, seminars, workshops especially in rural areas with a view to raising the level of knowledge of the people regarding childhood diarrhoea and its management practices.
The result on the management of childhood diarrhoea by mothers will be useful to mothers and caregivers. Appropriate practice will be encouraged and allow these mothers and caregivers to carry out these practices in the already established direction. On the other hand, inappropriate practice will call for adjustment and improvement and provide enlightenment efforts to achieve better results. Specifically, the data to be generated on the management practices of mothers may likely sensitize the mothers on the childhood diarrhoea in Ardo-Kola LGA to encourage identified sound practices while engineering changes in the unwholesome practices of mothers towards childhood diarrhoea.
The findings will be useful to the general public who may need appropriate information on childhood diarrhoea. Researchers will benefit from the study. They can build on the findings for further research is this area of knowledge. The data concerning this study may help to enrich the pool of data on the subject matter. Such data may also be beneficial to both Health and Education ministries in Taraba state, and may form the basis for future policy formulation and modification.
Finally, scholars and reading public will benefit from the theoretical significance of the study. It will contribute to the synthesis of the relevant theories in the field of study. It seeks to explain why people think, feel, and act the way they do. The study will add to the existing literature in the field of health education and child health in particular.
1.7 Definition Of Terms
Loose, watery stools that occur more frequently than usual. Diarrhoea is usually caused by a virus, or sometimes, contaminated food. Less frequently, it can be a sign of another disorder, such as inflammatory bowel disease or irritable bowel syndrome.
Means any reasonable measures taken by any person in response to an incident, to prevent, minimize, or mitigate loss or damage
A mother is the female parent of a child. Mothers are women who inhabit or perform the role of bearing some relation to their children, who may or may not be their biological offspring.
Refers to children under the age of five
1.8 Organization Of Study
The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.
5.0 Conclusion And Recommendation
Based on the findings and discussions of the study, the following conclusions were attained;
- Mothers had high knowledge (71.21%) of the concept of childhood diarrhoea.
- Mothers had very high knowledge (84.95%) of the signs and symptoms of childhood diarrhoea.
- Mothers had high knowledge (76.58%) of the modes of transmission childhood diarrhoea.
- Mothers had high knowledge (77.82%) of the dangers of childhood diarrhoea. This answers research question 4.
- Mothers had high knowledge (71.21%) of the preventive measures of childhood diarrhoea.
- Mothers adopted various childhood diarrhoea management practices such as promptly cleaning a baby who defecated (90.5%), continue breast feeding baby especially during diarrhoea (88.7%), boiled water used in making drinks for the children (85.6%), prepared food hygienically during diarrhoea episode (83.1%), washed hands with soap and water in preparing ORS (75.75), mixed ORS in the right proportion (73.65) and gave ORS as soon as diarrhoea starts (72.2%). Whereas lower proportion of the mothers gave their babies only breast milk during diarrhoea (42.35) and allowed their children who has diarrhoea to defecate in bushes or open spaces (35.6%).
Based on the finding and conclusion of this study, the following recommendations were drawn:
- The health workers at the various MCH in Ardo-Kola LGA should strengthen their teachings on the management practices of mothers regarding childhood diarrhoea. Since these mothers varied in their responses in all the management practices.
- More scientific research should be conducted in Ardo-Kola LGA on factors that hinder the management of childhood diarrhoea by mothers. This is essential for developing rational and effective intervention to the problem.
- All methods of ORT should be uniformly taught to mothers so that they can have a variety of choice based on conveniences to them.
- Since there was significant difference in the knowledge and management practiced of mothers regarding childhood diarrhoea according to level of education. The state government should provide free and compulsory education for both younger and older mothers to enable then acquire education up to tertiary level so as to widen their scope in all spheres of life including health issues such as childhood diarrhoea.
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