Practices of the mothers of under-five children towards the prevention of diarrhea – a cross-sectional approach

 

Shivaleela P. Upashe¹*, Rahul Shil²

¹Associate Professor, Department of Child Health Nursing, College of Nursing and Health Sciences,

Dayananda Sagar University, Kumaraswamy Layout, Bengaluru-560078, Karnataka, India

Assistant Professor, Department of Medical & Surgical Nursing, College of Nursing and Health Sciences, Dayananda Sagar University, Kumaraswamy Layout, Bengaluru-560078, Karnataka, India.

 

ABSTRACT:

In the globe, under-five children experience on a mean of 3.2 episodes of diarrhea per annum and consequently, million children will die from dehydration associated with diarrheal disease. And within developing countries, diarrheal disease among under-five children accounts for about 21% of all deaths. Therefore under-five children are vulnerable to diarrhea-related death if proper measures are not taken. In India up to a third of total pediatric admissions are due to diarrheal disease and up to 17% of all deaths in indoor pediatric patients are related to dehydration related to diarrhea. Thus the researchers wished to conduct a research study on practices among the mothers of under-five children on prevention of diarrhea in selected hospitals in Bengaluru. A total of 75 mothers were recruited randomly. A descriptive research design with cross – sectional approach was used. Practice questionnaire developed by the investigator which was used to collect data. The study findings showed that 35 mothers (46.7%) had a poor level of practice, 31 mothers (41.3%) had a moderate level and only 9 mothers (12.0%) had a good level of practice towards the prevention of diarrhea.

 

 

 

INTRODUCTION:

Diarrhea is one of the foremost common manifestations of illness in infants and youngsters. Each year 500 million episodes of diarrhea occur in India, five million of which require treatment at health facilities. An individual child suffers 10 to 15 episodes of diarrhea in the first 5 years of life.¹ Diarrhea may cause inflammatory and malabsorption disorders and Impairment of the functional integrity of gastrointestinal tract. Also besides since the immune system and mucosal barrier continue to mature after birth, infectious diarrhea can cause significant alternations in fluids and electrolyte balance in infants and children. In any disorder that involves gastrointestinal losses, particular a large amount of fluid dehydration poses a serious threat to  life and demand immediate attention. ²

 

Children under 5 years of age constitute 15 to 20 percent of the population in developing countries, 35 to 60 percent of all death occur in this age group is major because of diarrheal diseases, malnutrition, and acute infectious disease, and these are all preventable.³The life-threatening events for women and the vicious circle of undernourishment mothers during pregnancy and lactation leads to low birth weight babies which may, in turn, have 3-4 times greater risk of dying of these babies due to majorly diarrhea, acute respiratory infections, etc³.

 

The two main risks of diarrhea is malnutrition and death. A child may lose almost as much water and electrolytes from the body during an episode of diarrhea as an adult and one liter of fluid from the body of a child weighing 7kg approximately 50% of body loss. Significant dehydration disturbing the balance of electrolyte and acid-base status of the body occurs in about 2 to 5% of all cases of diarrhea. Such significant of those cases loss may prove fatal if fluids and electrolytes aren’t replaced to revive normal circulation and body functions.⁴

 

In India, diarrheal disease is a major public health problem among children under the age of 5 years. In health institutions up to two-third of total pediatric admissions are due to diarrheal disease and up to 17% of all deaths in indoor pediatric patients are related to dehydration related to diarrhea.⁵Fluid electrolyte imbalances related to continuous diarrhea in under-five children is one of the chief problems in an early stage of life. In most of the developing countries of the world is increasing in a number of diarrhea is due to, lack of resistance to pathogenic agents, widespread prevalence of malnutrition, inadequate medical facility, poverty, poor sanitization, lack of mother knowledge, and awareness of fluid-electrolyte imbalances and the knowledge of the health care providers about the complications and its prevention. Diarrhea is still the most common cause of mortality in most of the tropical and subtropical countries⁶ and according to 2017 figures for every 1000 live births in India, up to nine babies die before celebrating their fifth birthday⁷.

 

Therefore, this study was aimed to assess the knowledge and attitude of the mother of under–five children towards the prevention of diarrhea in selected hospital Bengaluru. The information obtained from this study will be used by policymakers and stakeholders to identify the awareness and attitude to provide information about diarrhea prevention in the study area.

 

OBJECTIVES:

1.       To assess the level of practice on prevention of diarrhea among mothers of under five children.

2.       To find out the association between practice and with selected demographic variables.

 

METHODOLOGY:

A descriptive research design with cross – sectional approach was used. A total of 75 mothers between the age group of 20 to 35 years who were having under-five children were randomly selected using simple random technique who were willing to participate in the study. The data collection instrument was developed by the investigators. The reliability and validity of the tool were done with the help of nursing experts, pediatrician, and statistician. The practice part included the questions on diarrhea spread, a continuation of breastfeeding during diarrhea, ORS preparation, and hand hygiene practices during diarrhea, sanitation, and physical condition of the child during diarrhea. 10 statements were included regarding aspects of practice to prevent diarrhea and the response included (Yes, No). To complete the data a master data sheet was prepared by the investigator. Demographic data containing sample characteristics were analyzed using frequency and percentage. Practice score was analyzed in terms of frequency, percentage and mean, and standard deviation. Chi–square test was computed for finding out the association between attitude score with demographic variables. Institutional research committee approval was taken. Formal approval was also obtained from the medical superintendent and hospital authority of the selected hospitals. The investigator introduced the self to the participants and the purpose of the study was explained to ensure better cooperation during the data collection period.

 

RESULTS:

Section – A

Table - 1 Description of Socio demographic variables and its frequency and percentage

Demographic variables		No. of mothers	%
Age of the mother	20 -25 years	25	33.3%
	26 -31 years	44	58.7%
	31 -36 years	6	8.0%
Religion	Hindu	38	50.7%
	Muslim	22	29.3%
	Christian	15	20.0%
Type of family	Joint family	40	53.3%
	Nuclear family	31	41.3%
	Broken family	4	5.3%
Location of family	Urban	11	14.7%
	Semi urban	33	44.0%
	Rural	31	41.3%
Father education	Secondary	18	24.0%
	Higher Secondary	43	57.3%
	Graduated	14	18.7%
Mother education	Secondary	28	37.3%
	Higher Secondary	39	52.0%
	Graduated	8	10.7%
Occupation	Government service	26	34.7%
	Private service	20	26.7%
	Agriculture	29	38.7%
Income	Rs.10000 -20000	2	2.7%
	Rs.5000 -10000	50	66.7%
	<Rs.5000	23	30.7%

 

Table-1 shows the frequency and percentage distribution of the demographic variables of mothers of under-five children’s and the majority of them are in the age group of 26-31 years. Many of them were Hindus (50.7%) and living in a joint family (53.3%) and they reside in semi-urban (44%) areas. The majority of them completed their higher secondary degree education and works in the agricultural sector with an income of 5000 – 10000/months (66.7%).

 

Table – 2 Level of practice towards prevention of Diarrhea

Level of practice	No. of mothers	%
Poor	35	46.7
Moderate	31	41.3
Good	9	12.0
Total	75	100%

 

Table-2 shows the knowledge towards the practice of diarrhea among under-five children mothers was assessed related to diarrhea spread, a continuation of breastfeeding during diarrhea, ORS preparation, hand hygiene practices during diarrhea, sanitation, and physical condition of the child during diarrhea. The total score obtained by each practice level was classified into poor practice score (<50%), Moderate practice score (50-75%), and good practice score (>75%). Table 2 gives the distribution of practice level towards the prevention of diarrhea. Our study indicates that 46.7% of the mothers had poor practices towards prevention of diarrhea, 41.3% had moderate and only 12.0% had a good level of practice. The overall mean practice score of the mothers of the under-five children’s was 5.89 ± 1.42 and the overall practice level is 58.9%.

 

Table–3 depicts the association between practice level and their demographic variables. It shows that higher respondents that are (60.0%) of 20-25 years of age noticed with poor practice level as compared to (54.5%) of the 25 to 30 age group who had inadequate practice level. Further, (66.7%) of age 30 to 35 years of age found with good practice level. However, the association between age and practice level was found statistically significant (c2=22.85). Regarding religion majority (46.7%) of Christian respondents had moderate practice as compared to Muslim (45.5) and Hindu (50.0%) noticed with the poor level of practice. The nuclear families (12.9%) have a good level of practice as compared with joint families (45.0%) and broken family (25.0%). Regarding the location of the family, semi-urban category people have a good level of practice than Urban and Rural people. Itis observed that higher education of both father and mother, better is the practice to prevent diarrhea among the respondents. However among parents, mother practice level was found statistically significant (c2=9.44). Regarding occupation, almost similar response towards practice level observed among all categories.

 

It can be concluded that the association between religion, type of family, location of the family, father education, occupation, and family income was found to be statistically non-significant (p>0.05). Two variables i.e., age and mother education found to be highly significant (p>0.05).

 

Table 3: Association Between Level of Practice and their Demographic Variables

Characteristics	Category	Practice Level						N	Chi-square  Test
		Poor		Moderate		Good
		n	%	n	%	n	%
Age (years)	20 -25	9	36.0	15	60.0	1	4.0	25	c2=22.85 (P=0.01) **
	25 -30	24	54.5	16	36.4	4	9.1	44
	30 -35	2	33.3	0	0.0	4	66.7	6
Religion	Hindu	19	50.0	15	39.5	4	10.5	38	c2=0.51 (P=0.97)
	Muslim	10	45.5	9	40.9	3	13.6	22
	Christian	6	40.0	7	46.7	2	13.3	15
Type of family	Joint	18	45.0	17	42.5	5	12.5	40	c2=2.46 (P=0.65)
	Nuclear	16	51.6	11	35.5	4	12.9	31
	Broken	1	25.0	3	75.0	0	0.0	4
Location of family	Urban	6	54.5	4	36.4	1	9.1	11	c2=3.34 (P=0.50)
	Semi urban	15	45.5	16	48.5	2	6.1	33
	Rural	14	45.2	11	35.5	6	19.4	31
Father education	Secondary	12	66.7	6	33.	0	0.0	18	c2=6.05 (P=0.19)
	Higher Secondary	17	39.5	20	46.5%	6	14.0	43
	Graduated	6	42.9	5	35.7	3	21.4	14
Mother education	Secondary	15	53.6	13	46.4	0	0.0	28	c2=9.44 (P=0.05) *
	Higher Secondary	18	46.2	15	38.5	6	15.4	39
	Graduated	2	25.0	3	37.5	3	37.5	8
Occupation	Government	12	46.2	12	46.2	2	7.7	26	c2=1.04 (P=0.90)
	Private	10	50.0	7	35.0	3	15.0	20
	Agriculture	13	44.8	12	41.4	4	13.8	29
Family Income/month	Rs.10000 -20000	1	50.0	1	50.0	0	0.0	2	c2=1.34 (P=0.85)
	Rs.5000 -10000	23	46.0	22	44.0	5	10.0	50
	<Rs.5000	11	47.8	8	34.8	4	17.4	23

 

DISCUSSION:

Diarrhea remains the 2nd leading cause of death among children under 5 globally.^8,9 It kills more young children than AIDS.^10,11 Diarrheal disease is one of the commonest illnesses that has the greatest negative impact on the growth and development of infants and young children.¹² Contaminated weaning food, inappropriate feeding practice, lack of clean water, poor hand washing, limited sanitary disposal of waste, poor housing conditions, and lack of access to adequate and affordable health care are aggravated factors of the under 5 diarrheal disease.^13,14,15,16Optimal infant and young child feeding practices could prevent more than 10% of deaths from diarrhea. On the other hand, better hygiene practices, particularly handwashing with soap and the safe disposal of excreta can reduce the incidence of diarrhea by 35%.^17,18

 

In the present study, most of the mothers had fairly good practice regarding ORS preparation, providing liquids to the child, hand washing practice, observation of physical condition, and signs of malnourishment of dehydration. But more effort can be put into educating these mothers cleaning their hands before eating, proper sanitation, and sites of defecation.

 

This study indicates that 46.7% of the mothers had poor practices towards prevention of diarrhea, 41.3% had moderate and only 12.0% had a good level of practice. The overall mean practice score of the mothers of the under-five children’s was 5.89 ± 1.42 and the overall practice level is 58.9%. The finding is lower than the previous study done in Ethiopia, Diredawa city, and Fagitalekoma district, Ethiopia which was 58% and 77% respectably.^19,20 possible due to less information.

 

Our study found 45.3% of the mothers practiced to continue breastfeeding during the diarrheal episodes but the percentage is higher in the study done by Laxmipati and k. Shreedhara.²¹

 

In this study similar response has found in the practice of proper sanitation i.e. 33.3% and 33% respectively but the poor practice sanitation level is higher than the study done by Sasasiva Padhy, Rajesh kumar sethi and Narendra Beherai.e 66.7% and 42%.²²

 

In the present study, most of the mothers had fairly good knowledge about the preparation of the ORS. This supports the findings from the study conducted in Ethiopia, I.e.  65.3% and 65%, and also the findings is higher than the study done in Odisha by SasasivaPadhy, Rajesh kumarsethi, and Narendra Behera.²³i.e. only 19%. And the difference could be because since mothers who had information about diarrhea have a good opportunity to manage diarrhea at home.

 

It is observed that higher education of both father and mother, better is the practice to prevent diarrhea among the respondents. However among parents, mother practice level found statistically significant (c2=9.44) (p=0.05).

 

CONCLUSION:

Diarrheal disease is that the second leading explanation for death in children under five years old. It is both preventable and treatable. The findings of the study show that the level of practice towards the prevention of diarrhea among the under-five mothers was unsatisfactory. In this study, the association between religion, type of family, location of the family, father education, occupation, and family income was found to be statistically non-significant and two variables i.e. age and mother education found to be highly significant. Therefore, health education, dissemination of data, community conversations regarding best practices should plan and implement to make a positive practice towards the higher prevention of under-five diarrheal diseases.

 

LIMITATION OF THE STUDY:

Since it was a cross-sectional study, it is difficult to know the cause and effect at the same time. In rare cases, there might be recalled bias among the respondents. There is a shortage of literature for factors associated with practice level.

 

CONFLICTS OF INTEREST:

There is no conflicts of interest.

 

ETHICAL CONSIDERATION:

No ethical issue exists.

 

REFERENCES:

1.        Ms. Jessie. M. Chellappa, Paediatric Nursing, 2 nd Edition Bangalore Ganajana Book Publisher and Distributor 2005.Page No.58

2.        Essential of Paediatrics Nursing, Fifth Edition, Whales and Wong’s Page No.803, 804.

3.        K. Park Essential of Community Health Nursing;3rd edition Jabalapur Banasaridas Bhanot Publisher 2000. Page No.277, 248

4.        O.P Ghai essential Paediatrics 6th edition New Delhi CBS publisher and distributor 2005. Page No.269

5.        WHO, weekly epidemiological record 1995 Volume-II, Park K, Prevention and social medicine, Bansaridas Medicine Publisher, Jabalpur, 15th Edition, Page No.171 to 172.

6.        Park K, Prevention and social medicine, Bansaridas Medicine Publisher, Jabalpur, 15th Edition, Page No.171 to 172.

7.        MaitriPorecha, https://www.thehindubusinessline.com/news/variety/pneumonia-diarrhoea-claim-over-two-lakh-indian-kids-every-year/article29953310.ece.

8.        World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers. Geneva: WHO; 2005.

9.        Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226–2234. doi: 10.1016/S0140-6736(03)13779-8. 

10.     Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E. Diarrhea: why children are still dying and what can be done. Lancet. 2010;375(9718):870–872. doi: 10.1016/S0140-6736(09)61798-0.

11.     Walker CLF, Aryee MJ, Boschi-Pinto C, Black RE. Estimating diarrhea mortality among young children in low- and middle-income countries. PLoS One. 2012;7(1): e29151. doi: 10.1371/journal.pone.0029151.

12.     Motarjemi Y, Kaferstein F, Moy G, Quevedo F. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ. 1993;71(1):79–92.

13.     Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226–2234. doi: 10.1016/S0140-6736(03)13779-8. 

14.     Motarjemi Y, Kaferstein F, Moy G, Quevedo F. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ. 1993;71(1):79–92.

15.     CSA, International I. Ethiopia demographic and health survey 2011. Addis Ababa and Calverton: Central Statistical Agency and ICF International; 2012. p. 430.

16.     Keusch GT, Fontaine O, Bhargava A, Boschi-Pinto C, Bhutta ZA, Gotuzzo E, et al. Disease control priorities in developing countries. 2006. Diarrheal diseases; pp. 371–388.

17.     WHO? UNICEF. WHO-UNICEF joint statement on the clinical management of acute diarrhea. Geneva: World Health Assembly; 2004.

18.     Benenson AS, Chin J, Heymann DL. Control of communicable diseases manual. Washington, DC: American Public Health Association; 1995.

19.     Hailemariammekonnenworkie, Abdilahisharifnursharifabdilahi and Esubalewmuchieaddis.Mothers’ knowledge, attitude and practice towards the prevention and home-based management of diarrheal disease among under-five children in Diredawa, Eastern Ethiopia, 2016: a cross-sectional study. BMC Pediatrics, 2018:18;358.

20.     Bogalekassahundesta, Negatezeraassimamaw and Tesfayedemekeashenafi. Knowledge, Practice and Associated Factors of Home-Based Management of Diarrhes among caregivers of Children attending Under-five clinic in FagitaLekoma District, Awi Zone, Amhara Regional State, Northwest Ethiopia, 2016. Hindawi, Nursing Research and Practice, vol.2017, article ID 8084548, 8 pages,2017.

21.     Laxmipati Hanumantagouda Gollar, K. Shreedhara Avabratha. Knowledge, attitude and practice of mothers of under-five children regarding diarrheal illness: A study from coastal Karnataka. Mullar journal of Medical Sciences and Research.2018:9;02.

22.     Sadasiba Pandhy, Rajesh Kumar Sethi and Narendra Behera. Mothers Knowledge, attitude and practice regarding prevention and management of diarrhea in children in Southern Odisha. International Journal of Contemporary Pediatrics. 2017:04;03.

23.     Sadasiba Pandhy, Rajesh Kumar Sethi and Narendra Behera. Mothers Knowledge, attitude and practice regarding prevention and management of diarrhea in children in Southern Odisha. International Journal of Contemporary Pediatrics. 2017:04;03.

 

 

 

Received on 23.10.2020          Modified on 12.12.2020

Accepted on 15.01.2021      ©AandV Publications All right reserved