MOTHERS NEEDS TO KNOW MORE REGARDING

MANAGEMENT OF CHILDHOOD ACUTE DIARRHEA

Harmeet Singh Rehan
1
, Kunta Gautam
2
& Khargamaya Gurung
3


1. Associ ate Professor, Dept. of Pharmacology, Lady Hardinge Medical College, New Del hi -110 001.
2 & 3 Fi nal year B. Sc. Nursi ng student, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Correspondi ng address: Dr. Harmeet Si ngh Rehan, Associate Professor, Dept . Of Phar macol ogy, Lady
Hardi nge Medi cal Col l ege, New Del hi -110 001, Emai l : harmeetrehan(S)hotmail.com
Harmeet Singh Rehan et at. KAP of mothers regarding diarrhea
INTRODUCTION
Diarrhea is one of the commonest causes of morbidity in children in developing countries.
Diarrhea is responsible for 4000 million episodes and 2.4 million deaths each year in children under 5
years
1
. In Nepal, the prevalence of diarrhea is 15% with higher rate in rural areas
2
. In the last two
decades the mortality due to diarrhea in children under 5 years has reduced. This reduction may be
due to correct case management as per standard treatment guidelines recommended by WHO and
use of oral rehydration therapy as a keystone in the management
3
.
According to WHO guidelines for the management of diarrhea, antidiarrheal, antiamoebic and
antibacterials have little role to play
4
. Despite this fact over use of antimicrobial agents have reported
for the management of the diarrhea
5
. Community health education is of utmost importance for
effective case management, since it has potential to establish productive contact between the health
services and the community to increase capability of families to recognize the danger signs of
diarrhea in children and to encourage appropriate and early care seeking behaviors. Effective health
education can only be provided on the basis of an accurate understanding of prevailing knowledge,
attitude and practices (KAP) of the community. Therefore, it is necessary to have relevant information
concerning KAP of mothers about diarrhea for successful implementation of control activities. The
study was conducted with the following objectives: (a) to determine the knowledge regarding cause
and recognition of diarrhea; (b) to elicit health seeking practices and management of acute diarrhea
and (c) to determine the home care practices of mothers about children with diarrhea.
MATERIAL AND METHODS
A cross-sectional descriptive study was conducted in Dharan Townshi p, Sunsari , Nepal from
15
th
Dec. 1997 to 1
st
Feb. 1998. A cluster sampling method was employed in the study. Eleven clusters
(wards) with 30 households in each cluster were selected systematically i n the townshi p. The only
inclusion criterion being that there was at least one under-five child in that household, but not
necessarily has been a recent attack of acute diarrhea. The respondent was the mother of under-five
children. If the mother was not available at home, that household was excl uded from the study. The
mothers were interviewed orally by a doctor or trained medical students. Direct questions were put to
the mothers regarding their knowledge of standard case management of di arrhea. They were asked
regarding the source of knowledge and attitude regarding diarrhea, reasons for worry, availability of
health care facilities ana
1
problem confronted by mothers in connection with the treatment of diarrhea.
Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 41 Jan.- June., 2003
Harmeet Singh Rehan et al. KAP of mothers regarding diarrhea
The answers of the respondents were entered on the pre-tested questionnaire and the data was
tabulated and analyzed.
RESULTS
All 330 households initially selected agree to participate in the survey and all had children
under five years of age. Total number of children under-five were 397 with a mean for 1.2 under-
five children per household. Of the total 397 under-five children, only 275 (69.3%) children had
diarrheal episode in proceeding year with a mean of 0.8 diarrheal episodes per household. Mean
income per household was NRs 2168/- (US $ 30). Average years of maternal and paternal
education was 3.6 (0-15) and 4.7 (0-12) years respectively.
In this study regarding the knowledge of causative factor, 110 (33.3%) mothers said that
diarrhea is always associated with vomiting, which is probably because of predisposing factors like
altered food and water habits 165 (50.0%). Only 3.6% of the mothers knew that the microorganisms
were the cause of diarrhea, where rest of the mothers said they do not know. Regarding the signs and
symptoms of diarrhea nearly 62% of mothers knew that loose motions and pain abdomen were
symptoms of diarrhea.
When knowledge on signs of
severe dehydration i.e. dry buccal
mucosa, loss of skin turgor and
marked sunken eyeballs was probed,
only 12.1%, 1.2% and 5.7% of
mothers had experienced these signs
respectively (Table - 1). Concerning
the attitude on an important
dangerous sign i.e. reduction in urine
formation did not alarm any mother.
TABLE-1: Maternal knowledge and attitude on danger
signs of diarrhea is their children (n =330)

Regarding care seeking practice of mothers for diarrhea, self-medication was found to be common
(57.4%). When the type was system of medicine used were analyzed, western medicine was
found to be the top priority (64.5%), followed by indigenous (19.6%) and traditional (10.1%)
Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 42 Jan.-June., 2003
Harmeet Singh Rehan et al. KAP of mothers regarding diarrhea
system of medicine (Table - 2). One -fourth of the mothers (25.1%) pref erred t o vi si t pri vat e
practitioners was followed by government health facilities (14.5%) (Table - 2).
Home care practices of mothers
regarding management of diarrhea were
focused in this survey, where it was found
that 140 (42.4%) mothers gave a usual
amount of food, water and / or breast
feed, 138 (41.8%) of the mothers reduced
or stopped the usual food, water and / or
br east feed and only 52 (15.7%) of
mothers gave increase amount of fluid to
children with diarrhea.
TABLE-2: Actions taken for Acute diarrheas (n =275)

Of the total mothers, 120 (36.3 %) knew oral rehydration fluid (J eewan Jal ). Seventy mothers had
knowl edge of salt, sugar solution, but only 20 mothers knew compl et e procedure f or i t s
preparation. Sixty (18.2%) mothers preferred pulses soup and rice water as home remedy.
DISCUSSION
The study arrived to understand the knowledge, attitudes and pract i ces of mot her duri ng
acute diarrhea in order to identify the lacuna in their knowledge, attitudes and practices and to modify
their practices.
Most mothers did not know the etiology of diarrhea. They considered the predisposing factors
such as sudden exposure to heat / sun and change in type of food, water and air as et i ol ogi cal
agents. Moreover, most of the mothers had not experienced or aware of danger signs of di arrhea.
Therefore, using audio-visual aids should highlight the etiology of diarrhea and important danger si gn
in health education material, possibly.
In developing countries, maternal education has been linked to the i nf ant morbi di t y and
mortality
6
. Mean monthly income per household and years of parental education was l ow i n t hi s
study. Lower parental education has been reported from Mexico
7
. Lower educat i on and soci o-
economic status did influence knowledge, attitudes and practices, househol d wi t h l ower soci o-
Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 43 Jan.-June., 2003
Harmeet Singh Rehan el al. KAP of mothers regarding diarrhea
economic status tends to rely more on local options, especially drug stores where, higher socio-
economic status households preferred to visit private physicians and even distant options more
frequently
7
.
Regardi ng health care seeking practices, self-medication was found common among 158
(57.4%) mothers; the use of safe household (over the counter drugs) medicine should be i ncl uded in
t he heal t h program. In this study, mothers preferred to visit private general practitioners t o
government heal th clinic (Table-2), according to this WHO should organize a training program for
general pract i t i oners on standard case management of acute diarrhea. Health survey should be
conducti ng to assess the reasons for non-utilization of government health clinic. Similar findings were
reported from Mexico, where mothers preferred to visit local paid allopathic health clinic
7
. Even in this
st udy, mot hers preferred allopathic drug as first option as self-medication. Sepulveda, et al . (1988)
have report ed t hat drug stores were found to be the most frequent home option amongst t he l ow
socio-economic households, a group that frequently has diarrheal morbidity and mortal i ty
8
. The drug
st ores have been ignored in public health interventions, drug stores may represent an i mport ant
set t i ng f or educat i ng the community regarding the proper case management of childhood diarrhea
and may present an ideal outlet for the distribution of oral rehydration therapy. In- home treatments for
di arrhea used by mothers in this study were pulses soup, rise water and gi vi ng burnt f eat her of
peacock etc., similar findings of using burnt birds' feather have been reported by other workers
9,10
.
Despi te efforts by public health authorities in Nepal, use of standard oral rehydration therapy (ORT)
was i nf requent . Possible explanation for the lower level of ORT ut i l i zat i on i ncl ude l ack of
effecti veness and / or penetrance of public health promotion efforts, lack of availability in stores and
l ack of utilization by physicians, pharmacists and traditional healers. Government health clinic was
pref erred onl y by 14.5% of mothers in this study, the possible explanation include the perceived
inaccessibility of the government health clinics due to limited operating hours, long waiting time and
interethnic differences between the community and the clinic physician. Many committees have
integrating new medical approach (paradigm) into the belief of people for better utilization health
care
11,12

This study showed that the knowledge, attitude and practices of mothers is not satisfactory
but if dissemination of health education to the target population regarding early case management of
childhood diarrhea may lead to decrease in diarrheal morbidity and mortality.
Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 44 Jan.-June., 2003
Harmeet Singh Rehan et al. KAP of mothers regarding diarrhea
REFERENCES
1. Bern C, Martiner J , Zoysa I and de Glass Rl. The magnitude of t he gl obal probl em of acut e
di arrheal disease: a ten year update. Bull WHO 1992; 70:705
2. Anonymous. Measuring health chapter - 2, The world health report 1998. WHO, Geneva, 1998,
p-45.
3. Anonymous. Acute diarrhoeal diseases. Multiple indicator, surveillance. Heal th & Nutri ti on -
cycl e. January to March 1995. A collaboration between the Nati onal Pl anni ng Commi ssi on
secretari at HMG Nepal & UNICEF. Nepal March 1996; 46-47.
4. WHO. The rational use of drugs in management of acute diarrhoea in children, WHO, Geneva
1990.
5. Granich R, Cantwell MF, Long K, Maldonado Y and Parsonnet J. Patterns of heal th seeki ng
behavi or during episodes of childhood diarrhea: a study of Tzot zi l - speaki ng Mayans i n t he
highlands of Chiapas, Mexico. Soc Sci Med. 1999; 48: 489-95.
6. Berlin EA, Berlin B. Medical Ethnobiology of the highland Maya of Chiapas, Mexico, Princeton,
New Jersey.
7. Hielscher S and Sommefeld J . Concepts of illness & utilization of health care services in a rural
Mal i an Vi l l age. Soc Sci. Med. 1985; 21 (4): 469-81.
8. Mwabu G. Health care decisions at the household level: results of rural health survey in Kenya.
Soc. Sci Med 1906; 22(3): 315-19.
9. Redman S, Booth P, Smyth H, Paul C. Preventive health behaviors among parents of infants
aged four months. Aus J . Pub. Health 1992; 16(2): 175-81.
10. Reyes H, Guiscafre H, Sorti E, Montoya Y, Topia R, Gutierrez. Urban rural variation of medical
care of children with diarrhea in Mexico. Salud Publica Mex, 1996; 38(3): 157-66.
11. Supulveda AJ, Willett W, Munoz A. Malnutrition and diarrhoea. A longitudinal study among
urban chi l dren. Am J . Epidem 1988; 127(2): 365.
12. Nizami SQ, Khan IA and Bhutta ZA. Drug prescribing practices of general pract i t i oners and
pediatricians for childhood diarrhea in Karachi, Pakistan. Soc Sci Med 1996; 42 (8): 1133-1139.

Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 4 5 Jan.-June., 2003