Project – Knowledge and practice of mothers in management of diarrhea in children under five years

CHAPTER ONE

INTRODUCTION

• Background to the Study

Diarrheal diseases remain a significant cause of morbidity and mortality among children under five years of age, especially in low-resource settings. According to the World Health Organization (WHO), diarrhea is one of the leading causes of death in children globally, particularly in sub-Saharan Africa and Southeast Asia (World Health Organization, 2022). In these regions, inadequate knowledge and poor management practices among mothers often contribute to the high incidence of diarrhea-related deaths. Effective management of diarrhea is crucial, as it can reduce the risk of dehydration and death. Studies suggest that maternal knowledge, attitudes, and practices regarding the management of childhood diarrhea are critical factors that influence the outcomes of the disease (Pardhan et al., 2017).

Mothers’ knowledge regarding the causes and treatment of diarrhea plays a crucial role in reducing child mortality. Research has shown that mothers with a higher level of education tend to have better knowledge and practices related to diarrhea management. A study by Hassan et al. (2018) in Bangladesh found that educated mothers were more likely to recognize the signs of dehydration and seek appropriate treatment for their children. They were also more familiar with oral rehydration salts (ORS) and the importance of continued feeding during diarrhea episodes. Conversely, mothers with lower levels of education and limited access to health information often rely on traditional remedies, which may not effectively address the underlying causes of diarrhea.

Oral rehydration therapy (ORT), which includes the use of oral rehydration salts (ORS), is one of the most effective treatments for diarrhea. The WHO recommends ORS as the first-line treatment to prevent dehydration, along with zinc supplementation to reduce the duration and severity of diarrhea (World Health Organization, 2020). However, despite the proven effectiveness of ORS, a significant number of mothers in developing countries are either unaware of its benefits or lack proper knowledge of how to prepare and administer ORS. Studies in Nigeria and India have reported that while some mothers are aware of ORS, a substantial number of them do not use it correctly (Sullivan et al., 2016). This lack of proper use of ORS contributes to the continued high morbidity and mortality from diarrhea.

In addition to ORS, mothers’ practices in terms of hygiene and feeding during diarrhea episodes are essential components of effective diarrhea management. Many studies have highlighted the role of continued feeding during diarrhea, as it helps maintain nutritional status and aids in recovery (Patel et al., 2016). However, in several low-income settings, mothers may withhold food during diarrhea due to misconceptions that it could worsen the condition. Furthermore, poor hygiene practices, such as inadequate handwashing and improper disposal of fecal waste, are also significant risk factors for the transmission of diarrheal diseases. The lack of clean drinking water and sanitation facilities exacerbates these issues and increases the likelihood of repeated diarrhea episodes in children (Umar et al., 2020).

Interventions aimed at improving maternal knowledge and practices regarding diarrhea management have shown promising results in some regions. Community-based health education programs, aimed at teaching mothers about the importance of ORS, continued feeding, and hygiene practices, have been successful in reducing the incidence of diarrhea and its complications. For instance, a study by Bhat et al. (2017) in rural India demonstrated that a community-based education program led to a significant increase in the use of ORS and improved hygiene practices among mothers. Such programs, when integrated into routine maternal and child health services, have the potential to significantly reduce childhood mortality and morbidity from diarrhea.

However, despite these positive outcomes, barriers to the adoption of recommended practices remain. Economic constraints, lack of access to healthcare services, and cultural beliefs often limit the effectiveness of educational interventions. For example, a study by Sahoo et al. (2018) found that while most mothers in rural India had heard of ORS, many did not have easy access to it due to financial constraints or lack of availability in local pharmacies. Furthermore, cultural practices, such as the use of herbal remedies, may interfere with the use of modern medical treatments, leading to delays in seeking appropriate care. Thus, addressing both the knowledge gaps and the socio-economic and cultural barriers is essential for improving diarrhea management in children under five years.

 

1.2. Statement of the Problem

Diarrheal diseases are a major public health challenge, especially for children under five years of age, who are particularly vulnerable to the consequences of dehydration and malnutrition caused by frequent episodes of diarrhea. Despite the availability of effective interventions, such as oral rehydration therapy (ORT) and zinc supplementation, the global burden of diarrhea-related morbidity and mortality remains high. In many low-resource settings, mothers’ knowledge and practices regarding the management of childhood diarrhea significantly influence the severity and outcomes of the disease. However, studies indicate that a large proportion of mothers lack adequate knowledge of proper management practices, leading to delayed treatment, inappropriate use of therapies, and increased risk of complications.

One of the key issues contributing to poor diarrhea management is a lack of awareness and understanding among mothers about the importance of early intervention and the appropriate use of oral rehydration salts (ORS). Although ORS is a life-saving treatment recommended by the World Health Organization, studies have shown that many mothers in low-income regions do not use it correctly or do not use it at all. Factors such as limited access to healthcare information, inadequate health literacy, and misconceptions about the causes and treatment of diarrhea often hinder the effective use of ORS. As a result, children are not adequately treated, which can lead to prolonged episodes of diarrhea, dehydration, and, in severe cases, death.

Moreover, maternal knowledge about the role of continued feeding during diarrhea, which is essential for maintaining nutritional status and promoting recovery, is often insufficient. In many regions, mothers continue to withhold food when their children have diarrhea, mistakenly believing that food exacerbates the condition. This practice can exacerbate malnutrition, hinder recovery, and increase vulnerability to future infections. Similarly, the lack of understanding regarding proper hygiene practices, such as handwashing with soap and ensuring clean water sources, contributes to the ongoing transmission of diarrheal diseases. These practices are crucial in preventing repeated infections, yet many mothers either lack awareness or do not have the resources to implement them effectively.

Despite the availability of health education programs and community-based interventions aimed at improving maternal knowledge and practices, barriers to successful implementation persist. Socioeconomic factors such as poverty, limited access to healthcare services, and cultural beliefs play a significant role in shaping mothers’ attitudes and behaviors towards the management of childhood diarrhea. In many rural and underserved areas, mothers face challenges in accessing health facilities, purchasing essential treatments such as ORS, and acquiring clean drinking water. Furthermore, traditional and cultural practices, such as relying on herbal remedies or seeking treatment from local healers, may interfere with the timely use of proven medical interventions.

A lack of coordination between health systems, community-based programs, and local cultural practices further complicates efforts to improve diarrhea management. Although some regions have seen improvements in the use of ORS and other recommended treatments through health education programs, these efforts are often fragmented and inconsistent. Inconsistent messaging, lack of follow-up, and poor integration of health education into existing maternal and child health services contribute to the persistence of ineffective management practices. Additionally, the role of healthcare workers in educating mothers about diarrhea prevention and treatment is crucial, yet in many areas, healthcare providers may not have the training or resources to effectively communicate these messages.

Given the persistent challenges related to the knowledge and practices of mothers in managing childhood diarrhea, there is an urgent need for comprehensive, context-specific interventions that address both educational gaps and socio-economic barriers. It is essential to design strategies that improve maternal knowledge, empower mothers to take appropriate actions, and promote the consistent use of proven therapies such as ORS and zinc supplementation. Furthermore, understanding the factors that influence maternal practices—ranging from healthcare access and affordability to cultural beliefs and health system support—will be key to developing more effective and sustainable solutions to reduce the burden of diarrheal diseases among children under five years.

1.3. Aim and Objectives of the Study

The aim of the study is to examine Knowledge and practice of mothers in management of diarrhea in children under five years. The specific objectives of the study:

1. To assess the level of knowledge among mothers regarding the causes of diarrhea in children under five years.
2. To evaluate the practices of mothers in managing diarrhea in children under five years.
3. To identify any gaps in knowledge and practices that may exist among mothers in the management of diarrhea.
4. To determine the factors influencing the knowledge and practices of mothers in managing diarrhea in children under five years.

1.4. Research Questions

The research questions are buttressed below:

1. What is the level of knowledge among mothers regarding the causes of diarrhea in children under five years?
2. What are the practices of mothers in managing diarrhea in children under five years?
3. Are there any gaps in knowledge and practices that may exist among mothers in the management of diarrhea?
4. What factors influence the knowledge and practices of mothers in managing diarrhea in children under five years?

1.5. Research Hypothesis

The hypothetical statement of the problem is buttressed below:

Ho: Level of knowledge among mothers will not affect the causes of diarrhea in children under five years

H1: Level of knowledge among mothers will affect the causes of diarrhea in children under five years

1.6. Significance of the Study

The significance of this study lies in its potential to improve the management of diarrhea in children under five years of age, which is a leading cause of morbidity and mortality globally. Diarrheal diseases are preventable and treatable, yet they continue to claim the lives of hundreds of thousands of children annually, particularly in low- and middle-income countries. By investigating the knowledge and practices of mothers regarding the management of diarrhea, this study could contribute to reducing the global burden of diarrhea-related deaths, as improved maternal knowledge and behavior are directly linked to better health outcomes for children. The findings could inform public health strategies and intervention programs aimed at educating mothers, thereby preventing unnecessary deaths due to diarrhea.

Understanding the gaps in maternal knowledge about diarrhea management is crucial for designing effective public health interventions. This study can provide insight into specific areas where mothers lack adequate information, such as the correct use of oral rehydration salts (ORS), the importance of continued feeding during episodes of diarrhea, or the role of proper hygiene practices in preventing transmission. By identifying these gaps, health professionals and policymakers can develop more targeted educational campaigns that address the most pressing issues. This could lead to a significant increase in the correct application of effective treatments, thereby improving the management of diarrhea and reducing the incidence of complications like dehydration and malnutrition.

The findings of this study could also have implications for maternal and child health policy at the local, national, and international levels. Many countries have national health policies aimed at reducing childhood morbidity and mortality from diarrhea; however, these policies often fail to translate into improved health outcomes due to poor implementation or lack of community involvement. By exploring the cultural, socio-economic, and educational factors that influence maternal practices, the study can provide actionable recommendations for improving the implementation of these policies. This could help policymakers design more inclusive health interventions that cater to the diverse needs of different populations, ensuring that health education and services are effectively reaching those who are most in need.

Another important aspect of this study is its potential to highlight the role of healthcare providers in the education and support of mothers. Healthcare workers, particularly those working in maternal and child health settings, are often the primary source of information for mothers regarding child health. Understanding the ways in which healthcare providers communicate information about diarrhea management, as well as the barriers they face in providing adequate education, can lead to improvements in the quality and delivery of health services. Strengthening the role of healthcare providers in delivering consistent and accurate information about diarrhea prevention and treatment can result in better health outcomes for children and more effective management of the disease at the community level.

Moreover, this study could contribute to the growing body of research on the integration of traditional practices and modern medical treatments. In many regions, mothers often rely on traditional remedies, such as herbal treatments or local healers, to manage diarrhea. While some of these practices may have cultural significance, they may not always be effective or safe for children. By understanding the factors that lead mothers to choose traditional remedies over scientifically proven interventions like ORS, this study could provide valuable insights into how health education programs can be designed to bridge the gap between traditional and modern approaches. This could help reduce delays in seeking appropriate medical treatment and encourage the adoption of scientifically-backed therapies.

Lastly, the study’s findings may also have broader implications for maternal empowerment and community health development. Improving mothers’ knowledge and practices regarding the management of childhood diarrhea can have a ripple effect on the overall health of communities. When mothers are better equipped to care for their children, they are more likely to share their knowledge with other caregivers and community members, thus fostering a culture of health awareness. Furthermore, as mothers gain confidence in managing common childhood illnesses like diarrhea, they may become more proactive in seeking healthcare services for other health issues, which could improve overall health outcomes in the community. Therefore, this study not only contributes to better diarrhea management but also promotes long-term improvements in community health and well-being.

1.7. Scope of the Study

The study examines knowledge and practice of mothers in management of diarrhea in children under five years. The study is limited to women attending Mother Child, Amuwo Odofin, Lagos.

 

1.8. Operational Definition of Terms

1. Knowledge: In the context of this study, knowledge refers to the understanding, awareness, and information that mothers possess about the causes, symptoms, prevention, and treatment of diarrhea in children. This includes their awareness of proper hydration techniques (e.g., the use of oral rehydration salts), the role of continued feeding during diarrhea, and the importance of hygiene practices in preventing diarrhea. Knowledge encompasses both factual information and the ability to apply it effectively in managing the child’s health.
2. Practice: Practice refers to the behaviors, actions, and strategies employed by mothers in the management of diarrhea in children. This includes decisions made regarding the use of specific treatments (such as ORS, medications, or traditional remedies), the implementation of hygiene and sanitation measures (like handwashing and clean water use), and the management of nutrition (such as continued feeding during diarrhea). Effective practices are those that align with recommended medical guidelines to prevent dehydration and malnutrition during a diarrhea episode.
3. Mothers: In this study, mothers are the primary caregivers of children under five years old. They are typically responsible for the health and well-being of their children and play a central role in managing childhood illnesses, including diarrhea. The term “mothers” includes biological mothers, as well as other female caregivers, such as grandmothers or older female relatives, who may be responsible for caring for children in different cultural or family settings.
4. Management: Management refers to the actions and strategies taken to prevent, treat, and control the impact of diarrhea in children. This includes providing appropriate treatments such as oral rehydration salts (ORS), ensuring proper nutrition (such as continued feeding), maintaining hygiene practices (like handwashing), and seeking medical care when necessary. Effective management aims to reduce the severity and duration of diarrhea, prevent complications like dehydration, and ultimately ensure the child’s recovery.
5. Diarrhea: Diarrhea is characterized by the frequent passage of loose or watery stools, typically resulting from infections (viral, bacterial, or parasitic), poor sanitation, or malnutrition. It is a leading cause of childhood morbidity and mortality, particularly in children under five years old. Diarrhea can lead to dehydration, which, if not managed properly, can result in serious health complications or even death. The management of diarrhea includes rehydration, proper nutrition, and sometimes medication, depending on the underlying cause.
6. Children Under Five Years: Children under five years refers to young children aged from birth to 59 months. This age group is particularly vulnerable to the effects of diarrhea due to their developing immune systems and higher fluid turnover. Diarrheal diseases are a leading cause of mortality in this age group, making effective management and prevention crucial for child health outcomes. The physical, developmental, and nutritional needs of children under five are central considerations when developing appropriate management strategies for childhood diarrhea.

Project – Knowledge and practice of mothers in management of diarrhea in children under five years