CHAPTER 1

INTRODUCTION

1.1 BACKGROUND OF THE STUDY:

Diarrhea is a major cause of morbidity and mortality in the developing world.

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. Deaths are mainly due to poor knowledge and management practices of

childhood diarrhea. Important factors to cause diarrhea in children under-five years

including poverty, female illiteracy, poor water supply and sanitation, poor hygiene

practices and inadequate health services. Diarrhea 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.

Diarrhea is loosely defined as passage of abnormally liquid or unformed stools at

an increased frequency. For adults on a typical Western diet, stool weight >200 g/d. In

certain cases, they may contain blood in the stool which is called dysentery. Any passage

of three or more watery stools within a day (24 hours) is referred to as diarrhea. The

consistency and the volume of stool constitute how to classify diarrhea. Children with

diarrhea often lose their appetites and may lose weight. Persistent diarrhea (lasting 14

days or more) or recurrent diarrhea can lead to death through negative effects on

nutrition status. Several studies have shown that children with persistent diarrhea are

more likely to die than children with diarrhea of shorter duration.

1
  Diarrhea occurs when the food and fluids that ingests pass too quickly through the

colon. Diarrhea can quickly deplete the body's supply of water and electrolytes (such as

sodium and potassium) that tissues need to function. Acute diarrhea, which lasts from

two days to two weeks, is typically caused by a bacterial, viral or parasitic infection.

Chronic diarrhea persists longer than does acute diarrhea, generally longer than

four weeks. Chronic diarrhea can indicate a serious disorder, such as ulcerative colitis or

Crohn's disease, or a less serious condition, such as irritable bowel syndrome. They are

characterized clinically by watery, large-volume fecal outputs that are typically painless

and persist with fasting. Most often chronic disease is non-infectious. A significant

proportion of diarrheal disease can be prevented through safe drinking-water and

adequate sanitation and hygiene. Globally, there are nearly 1.7 billion cases of childhood

diarrheal disease every year. Diarrhea is a leading cause of malnutrition in children

under five years old.

1.2 OBJECTIVES:

GENERAL OBJECTIVE:

To find out the “Knowledge, Attitude and Practices” among the parents

residing at Trevi condominium, Makati. Based on the survey of Knowledge, Attitude, and

Practices on Diarrhea especially among children’s. This research will be conducted to

determine how the diarrhea affects the child.

SPECIFIC OBJECTIVE:

2
 1. To determine the demographic variables of the respondents knowledge, Attitude

and Practices of diarrhea among the parents residing at Trevi condominium,

Makati.

2. To explore the association between mothers hand washing habits and

defecations behavior and health service utilization factors with diarrhea among

the parents residing at Trevi condominium, Makati.

1.3 STATEMENT OF THE PROBLEM:

The study focuses on survey diarrhea based on Knowledge, Attitude, and Practices

among the residents of Trevi.

1. What is the profile of the respondents in terms of the demographic variables

namely:

a. Age of the participants

b. Education level

c. Mother’s occupation

d. Total Number of children

e. Housing & Sanitation Conditions

 Source of Water supply

 Taste of water

f. Diarrhea Episodes in Children

2. What is the level of the respondents’ Knowledge about diarrhea?

3. What is the level of the respondents’ Attitude About Diarrhea?

3
 4. What is the level of the respondents’ Practices on Diarrhea?

5. Is there a significant relationship among the respondents’ Knowledge about

diarrhea, Attitude About Diarrhea, and Practices on Diarrhea?

1.4 Hypothesis:

NULL HYPOTHESIS (H0): There is no significant relationship of demographic variables

and Knowledge about diarrhea, Attitude About Diarrhea, and Practices about Diarrhea.

ALTERNATIVE HYPOTHESIS (H1): There is significant relationship of demographic

variables and Knowledge about diarrhea, Attitude About Diarrhea, and Practices about

Diarrhea.

1.5 SIGNIFICANCE OF THE STUDY:

 To the respondents: The study will serve as a genesis of awareness in

healthy lifestyle.

 To the future researches: This research will be helpful to guide in choosing

the lifestyle habits.

1.6 SCOPE AND LIMITATION

This study focuses on demographic variables of Diarrhea how it affects the

Knowledge, Attitude and Practices among the residents of Trevi, Makati. The researches

asks the respondents to give answers of the standardized questionnaire. By the means

of this research, researchers bring out the changes in the surrounding. Researchers are

here to find out how the poor sanitation causes diarrhea.

4
 KNOWLEDGE
1. What is diarrhea to you?
1.7 CONCEPTUAL FRAMEWORK
2. How do you recognize
diarrhea?
3. What are the causes of
Socio- diarrhea?
demographic 4. What should be done to
s prevent diarrhea incidences
and improve child health?
1. Age.
2.
Educational
level.
ATTITUDE
3. Mother
Diarrhea 1. Whether caregivers regard it
occupation.
normal for children get
4. Total no of diarrhea?
children.
2. Whether caregivers are
5. Housing satisfied with their sanitation
and situation in the area?
sanitation.
3. Whether caregivers can
6. Source of prevent their children from
water supply. getting diarrhea illness?

7. Taste of
water supply
8. Diarrheal
episodes in PRACTICE
children. 1.Washing of hands with soap and
water before a meal and after
defecation, washing utensils.
2. Boiling water for drinking.
3. Breast feeding for at least 6
months.
4. Hygienic preparation of food.
5. Proper disposal of fecal matter
by use of latrines.

5
 The conceptual framework above illustrates the relationship between the

knowledge, attitudes and practices of diarrhoea in children through proper practices

like: washing of hands before eating and after using the toilet, boiling water for drinking,

breast feeding, Hygienic preparation of food, proper and hygienic disposal of faecal

matter and other waste. The caregivers' knowledge, affects the attitude therefore

influencing their practices in preventing diarrheal.

1.8 DEFINTIONS OF TERMS:

DIARRHEA: A condition in which feces are discharged from the bowels frequently and in

a liquid form.

KNOWLEDGE: Dehydration resulting from diarrhea continues to be a cause of

morbidity, mortality, and increased health care costs in the United States. This study

assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also

examines parental-care practices during an episode of diarrhea.

ATTITUDE: The term ‘attitude’ is used to refer to the perception or way of thinking and

‘Practice’ to refer to the actions or behavior relating to children’s education.

PRACTICE: Diarrhea is defined by the World Health Organization as having three or more

loose or liquid stools per day, or as having more stools than is normal for that person.

6
 CHAPTER 2

REVIEW OF LITERATURE

This chapter presents the literature and related studies which have direct

relevance to this study. These previous studies and literatures help researchers to

conduct a better understanding of the proposed study. Its gives the researches an idea

and guide in thinking of a possible solution for the present study.

CAREGIVERS' KNOWLEDGE OF DIARRHEA :

Knowledge simply means information and skills acquired through experience or

education (oxford dictionaries, 2012). In this study, knowledge was defined as the

theoretical or physical understanding of prevention of diarrhea. Knowledge is very

important in recognition and prevention of diarrhea. This fact is consistent with findings

of a study conducted among care givers in (Tanzania by Mwambete and Joseph 2010) ,

which showed that only third of caregivers were aware of the risk factors and causes of

childhood diarrhea, which showed that only one third (1/3) of caregivers were aware of

the risk factors and causes of childhood diarrhea. About 33% of the caregivers were not

aware of the risk factors of diarrhea, where as 30% described diarrhea as normal in the

child's growth stage (Mwambete and Joseph, 2010). This reveals a deficit in the

caregivers' knowledge.

Caregivers staying in a community like a slum where there is overcrowding, are

bound to have and be influenced by certain beliefs, though they may not necessarily be

cultural. Since they have deficit in biomedical knowledge, this leads to misinformation as

7
shown by a study conducted in (Santo Domingo, Domican Republic) where 142 (44.2%)

caregivers reported terminating boiling of drinking water because children might get sick

if they returned to drinking purified water after drinking non purified

water(McLenman,2000).

Caregivers with limited knowledge tend to have more incidences of diarrhea

among their children thus the parents then tend to visit the clinics or hospitals often.

CAREGIVERS ATTITUDE OF DIARRHEA:

Attitude of caregivers are important in the fight of prevention of diarrhea as they

motive an individual to do something. A study conducted by Lui (2009) showed that 50%

of the mothers had negative attitude towards hand washing as they were dissatisfied

with their current water supply situation, because the water was of poor quality,

insufficient to meet theirs needs, and clean water was expensive. Furthermore, 39.3% of

caregivers stated that they did not improve the sanitation or hygine situation around

their homes because they were only renting the house. About 49.9% of the caregivers

felt that it was normal for children to get diarrhea regularly (Lui,2009).

Attitude of caregivers affect child health outcomes in that caregivers who have

time for their children guide them through different aspects like washing of hands

before they eat, which helps prevent a child from getting diarrhea. This however, is not

shown by a study in Santo Domingo, Dominican Republic by McLennan (2000).

The health of a child highly depends on the mother or a primary caregiver. The

use of a practice by a caregiver depends on the knowledge which then affects attitude to

8
practice a behaviour leading to prevention of diarrhea. A study conducted in New Delhi

India by Rasania et.al. (2005), demonstrates that mother who were highly literate were

more inclined to practise proper preventive practices of diarrhea due to their attitude

change.

CAREGIVERS PRACTICES OF DIARRHEA:

Prevention of diarrhea in children can take place if caregivers practice preventive

practices. However, in a study conducted in Santo Domingo, Dominician Republic by

Mclennan (2000), revealed that 55% of caregivers did not boil water for their children,

38% did not always wash hands of their children prior to meals and 54% of the

caregivers breastfed their children for less than a year. Furthermore, 46% of the

caregivers reported that one of the children had got diarrhea in the last month. The high

rates of diarrhea in this study may be related to deficit in prevention in the last month.

The high rates of diarrhea in this study may be related to deficits in prevention practices,

lapse in care giving, erroneous beliefs, and non-compliance of the children.

CHILD AGE AND DIARRHEA:

Diarrhea is least found in children between 0-6 months(5.6%) because they are

usually exclusively breastfed , in The Ghanaian communities, so less exposed to

contaminated food. Older children between 6-23 months are at increased risk of having

diarrhea because of introduction of supplementary feeds and likely exposure to

contamination. Children aged between 6-23 months start to crawl, stand and walk and

9
any contaminated things they pick from the environment goes in their mouth which

predispose them to diarrhea. (Ameyaw R, Ameyaw E, Acheampong AO, et al. , 2017)

Diarrheal diseases are a leading cause of morbidity and mortality among young

children in low-income countries. Although oral rehydration has been shown to reduce

early child mortality , the diarrhea-specific mortality in children less than 5 years of age

in Africa has been estimated at about 10.6 per 1000. At St. Francis Designated District

Hospital, Diarrhea is the forth most common diagnosis in inpatients and outpatients and

the forth most common cause of death in admitted children (D. Schellenberg, Personal

communication).Diarrhea accounts for 19% of deaths of under fives in South Africa and

for 46% on African Continent [1,4]. Globally, diarrhea is the 2 nd leading infectious cause

of death, accounting for 9.2% deaths in under fives. In the initial National Burden of

Disease (NBD) study for South Africa conducted in 2000, diarrhea accounted for 8.8% of

the total years of healthy life lost (DALYS) and was ranked the third leading cause of

death preceded only by HIV and low birth weight . In 2010, diarrhea was the second

leading cause of death in under fives. One DALY can be thought of as one lost year of

healthy life. It combines the year of life has lost due to premature deaths (YLLs) and

years of life lived with disability (YLDs). YLLs due to diarrheal disease can be estimated

from adjusted cause-of-death data from vital registration.

POOR MATERNAL EDUCATION :

Childhood diarrhea remains a problem in countries like Nigeria where access to

potable water, good hygiene and sanitation are lacking. Maternal education is an

10
important determination of health status of under five children. Very few studies have

investigated the relationship between maternal education and diarrhea in children in

Nigeria . Therefore , this study was implemented to fill the gap.( Afr J Reprod Health

2017). In Nigeria, most of the studies linking maternal education and child nutrition have

focused on detecting different ways through which the education of a mother affects the

health of her children .(Raji and Ibrahim 2011) argued further that the education of the

mother plays an important role in determining child survival . The pathways highlighted

by his paper include improved mothers health knowledge and greater control over the

health choices for her children, among others. (Gwatkin ) found that prevalence of child

health especially diarrhea is lower among children of educated mothers.

It is therefore not unlikely that low level of mother’s knowledge may militate

against the effective performances of diarrhea prevention practice. Despite the

advances in health and sanitation, sub – Saharan Africa continues to show pattern of

high childhood mortality mainly due to infectious and parasitic disease, with diarrhea as

one of the leading cause (Kirkwood, 1991; WHO1995). In Ghana, diarrhea has been

identified as the second most common health problem treated in outpatient clinics

(Agyei et al ., 1988). Although treated water and adequate sanitary facilities are essential

in reducing the risk of childhood diarrhea, a significant number of people in sub- Saharan

Africa lack access to such facilities (World Bank, 2002).

The premise derives from previous research that associates high level of maternal

education with better understanding and appreciation for hygiene and health related

matters . given this, educated mothers without adequate facilities could be expected to

11
take steps to ensure a health environment. This could, for instance, be done by

decontaminating untreated water and disposing of feces in a sanitary manner than their

less educated counterparts and by so doing, reduce the vulnerability of their children.

(Cochrane et al., 1980; Meegama , 1980; Ware , 1984)The main independent variables

are the households and drinking water facilities with maternal education as a stratifying

variable. The toilet facilities are categorized as no facility and toilet facility while drinking

water is classified as piped, well , borehole and stream/river/dam. Given the association

between household facilities and child health in general and diarrhea morbidity in

particular (Dikassa et al ., 1993; Johannes et al., 1992 Mock et al., 1995; Root , 2001;

Tagoe, 1995; Woldemicael, 2001 ).

Children whose mother are in polgynous unions are also expected to have higher

risk because of the relative size of such households combined with their low socio-

economic status. Children in such households may receive less attention than their

monogamous counterparts , and it is possible that their general wellbeing and

nutritional status may be poorer, and thus increasing their vulnerability. Polgynous

marriage have also been associated with traditional childbearing practices (Kuate Defo,

1996) which could potentially predispose child to the risk of diarrhea.

ENVIRNOMRNTAL SANITATION AND HYGIENE:

Piped water on the premises is expected to be less contaminated, as by the nature

of its construction the pipe water system protect against outside influences(WHO &

UNICEF 2013). In addition , house hold connected to piped water can improve their

12
health outcomes because more water is available for cleaning the house thus facility a

better hygiene situation.(Fewtrell et al., 2005).water , sanitation and hygiene

interventions to reduce diarrhea in less developed countries . connection to piped water

does not, however, always guarantee better water quality as in less developed regions

the water is often not continuously running this means that household still have to store

water in the home that is then vulnerable to recontamination(Fewtrell et al.,

2005;Shaheed et al., 2014; Wright,Gundry,Conroy 2004).

It has been estimated, at least for Africa, that 85% of the burden of disease

preventable by water supply is caused by feco-oral, mainly diarrheal diseased, largely

due to the substantial child mortality which hey cause. (Dr John Snow 1854) famously

incriminated the water from the Broad St pump as the vehicle of cholera a transmission

in London’s Soho, but much of the medical establishment continued to uphold the

miasma theory for many years thereafter. Ever since then, the role of water in diarrhea

transmission and prevention has been hotly debated. More recently, awareness has also

grown about the importance of excreta disposal in preventing diarrheal disease,

culminating in the recent pool of readers of the (British Medical Journal ) in which

sanitation was voted the greatest advance in public health in the last century.

When the quality of the available water supply is less than ideal , treating the

water by boiling, chlorinating, filtering or other method is an important behavioral

strategy for reducing the risk of diarrhea(Clasen, Schmidt, Rabie, Roberts& Cairncross

2007). Point of use water treatment improves the microbial safety of the water before

consumption(Sodha et al., 2011). However , the benefits of this treatment are not

13
guaranteed, as the cleanliness of the treated water is often not maintained during

storing and serving. It might for instance be touched while being put in or removed from

the containers, which reduces the protective effects of treatment(Sodha et al., 2011;

Wright et al., 2004).Besides clean water, a good sanitation facility is proactive against

diarrhea. Such a facility separates the human excreta from direct contact with humans

and ensures a safe disposal of the feces, thus reducing the risk of feces

contamination(Andres et al., 2014).

Control factors at community level are availability of health facilities, level of

regional development, urbanization, adult education and the position of women in the

area. Household in more developed or urban regions can generally benefit from better

infrastructure, including more and better health facilities. Living under better

circumstances in terms of infrastructure and health services may benefits the

households in the area, including their children.(Fotso & Kuate-Defo 2005).At the

household level , we include mothers education and household wealth. An educated

mother may have a higher level of awareness about hygiene.(Alderman et al.,2003).

Poorer households have fewer resources to fulfill their basic necessities, have poorer

living condition and have a lower health status, all factors that increases diarrhea

risk(Hatts & Waters 2006).

The material other than brick used in the construction of habitation was identified

as a risk factor to diarrhea occurrence in the univaraities analysis, suggesting that the

precarious housing condition can result in home hygiene difficulty, a factor that can

14
increase the occurrence of diarrhea disease. On the other hand, this variable is also an

indicator of poverty and low family income(IBGE 2000).

The absence of sewage was not associated with diarrhea occurrence in the

univariate analysis; however, an interaction of this variable with the use of precarious

material in the construction of habitation has been indentified, raising the risk of

diarrhea occurrence by almost 15times for children that live in residences where this

condition was found. This result confirms the healthy housing concept of (Azeredo et

al.,2007), which consider that housing is a health agent and related to the geographic

and social territory, the materials used in this construction, health education of the

inhabitants and other characteristics in the surrounding context.

Absence of sewage interferes with the health of children by polluting the

environment and enabling the spread of excreta related disease, especially those of the

parasitic variety that have diarrhea as the main symptoms . absence of proper sewer

disposal systems in urban settlements, is not only an important cause of surface and

underground water pollution, but is also a risk to the population health, especially when

there is no knowledge of water borne disease(Giatti 2004). Sanitation research in

Iporanga , verified that the researched water coursed presented microbiology indices

that indicated the presence of pollution caused by domestic sewage due to local

sanitation failure, considering that 91% of the households had feces in trench, mostly

rudimentary.

15
 Scenarios found in (Recreio de Sao Jorge) reflect the situation per urban areas,

which are characterized by indices of population increase in protected areas

(Porto,2003) or legally restricted areas. This situation generates precarious housing,

water and sanitation condition and contributes to environment degradation mainly in

reservoir catchment protected areas, besides the verified public health problems.

Studies verified an association between housing in invaded areas or slums and infants

mortality in Campinas(Almeida 2004) and the southern zone city of Sao Paulo. (Shoeps,

2007) suggest that the locality of this housing is indicative of social exclusion. In this

study interaction between precarious home construction materials and on existence of

sewage indicates social exclusion and increment of conditions to pathogen exposure

explain the high risk of diarrhea in children living in precarious housing with poor

sanitation.

Water supply access and diarrhea occurrence do not show significant association

with the research results, possibly because almost the whole population has this service.

However, according to ACS, many families use water from the public supply together

with well and river water because of the high level of intermittence of this service.

Access to and consumption of water from public services decrease the probability of

diarrheal disease occurrence because of the required portability standard in the system

that guarantees the water as a safe for human consumption.

Quality and quantity of water for basic needs are not guaranteed when using

alternatives sources of water (Razzolini e Gunther, 2008). However problems with

intermittence in water supply enable satisfactory condition for the infiltration of

16
pathogens in the water supply. Network because of a negative pressure on it (Lee e

Schwab,2005). Another consequences of interrupted provision is the possibility of

storing water in precarious recipients without sanitation, representing a vulnerability

factor to water quality.

Regarding child characteristics, it was observed that the age group of 10 months

and beyond was more associated with occurrences of diarrhea. In this group, other kinds

of food were introduced into the children’s diets, and without adequate health care in

preparation, could present risks of pathogen transmission. Furthermore, children from

this age group posses great mobility, thus increasing the chance of environmental

contamination. (WHO 2003)Child malnutrition was associated with occurrence of

diarrhea in the univaraite analysis: but in the last adjustment of the regression model, it

was excluded. Many studies show an association between child malnutrition and

occurrence of diarrhea (WHO/UNICEF/USAID/SIDA,1990). Elderly presence in families

and malnutrition were observed collinearly, suggesting that children can ,live in on

traditional families and such families can present unfavorable characteristics (Camarano

2004).

BREASTFEEDING DIARRHEA:

Exclusive breast feeding is the best nutrition for the children during the first 6

months of life. It fulfills the physical needs of the child and also is the psychotic

complementary for the child and specially the mother (Agostoni et sl.,2009).world

health organization recommends the practice of exclusive breast feeding for the first six

17
months, in addition to its continuation with the addition of supplementary foods until 2

years or more (Muula, 2009). The importance of breast feeding in the prevention of

infectious disease during infancy is well-documented (Bahl et ai., 2005).During the past

years the main reasons for children’s mortality have been malnutrition, respiratory

infection and diarrhea. Some reports claim that exclusive breastfeeding has a

remarkable decreasing effect on such illness (Rakhshani and Mohammadi, 2009).

A meta-analysis of data from three developing countries showed that those

infants who were not breastfed (Anonymous, 2000) and a similar protective effect of

breastfeeding has been shown in studies of morbidity from infectious disease (Bhandari

et al., 2003).exclusive breastfeeding has positive effects on child and mother and it also

causes some effects on family and society economy, because they have to avoid baby

formula consumption (Marandy, 1992).A Recent estimation from the Bellagio child

Survival study Group , using the results of systemic reviews from low and and middle-

income countries, predicted that exclusive breastfeeding for the first year of the could

prevent 1.3 million child deaths worldwide, making promotion of breastfeeding a key

strategy of child-survival programmers (Yates,2009).

Despite the importance of this subjects, there is little research on it in Iran.

One of the most important surveys was a national project, showing that only 43% of

people perform breastfeeding in both rural and urban regions (Rakhshani and

Mohammadi, 2009).Although , Exclusive breastfeeding is the most comfortable and cost-

18
effective way of fulfilling the child’s but some factors such as practitioner mothers have

negatively affected the subject (Mascarenhas et al., 2006).

The relative’s recommendations and specially the mother’s attitude and wrong

believes about lactation have negative effects on this subject too (kannan et al., 1999).

Because of the importance of the subject and lack of up to dated published studies in

the country, the researchers felt the need for further studies on the subjects. This study

tends to determine the prevalence of exclusive breastfeeding during the first six months

of life and some affecting factors on it among the referring children to Mashhad health

centers (Northeast of Iran)

The groups in (Guatemala and Bangladesh) proceeded to explore the mechanism

whereby diarrhea causes growth failure, focusing on dietary intake and intestinal

malbsorption. (Martorell et al., ) reported that fully weaned Guatemalan children

reduced their energy intake by ~ 30% during acute infections, whereas (Brown et al.,)

found that Bangladesh children who were still breast feeding reduced their intakes by

only about 7% suggesting the breastfeeding may protect against diarrhea induced

reduction in take. During a subsequent study in Peru, intakes of breast milk energy and

non-breast milk food sources were examined separately; and this analysis of

disaggregated data confirmed the foregoing hypothesis. Whereas intake of non-breast

milk energy declined by about 30% during illness, there were no changes in breast milk

consumption. Thus, the overall impact of illness on energy intake was partially mitigated

by breastfeeding.

19
 (Rowland et al.) discovered that the previously observed diarrhea-induced growth

deficit was absent in fully breastfeeding infants in an urban field site in West Africa, and

they concluded that exclusive breastfeeding prevents the adverse nutritional

consequences of diarrhea.( Lutter et al) found that the usual diet also influenced the

growth response ton diarrhea in older children. Whereas the Colombian children in

these studies who lived in control villages displayed the expected negative relationship

between diarrheal prevalence and height at 3 year of age , there was no effect of

diarrhea on the height f those children who lived in villages where food supplement

were being distributed.

Ideally breast milk is adequate for nutritional requirements for children up to 6

completed months. Breast-fed children have better chance of survival than artificially-

fed children. Breast milk protects children from malnutrition and various infections. The

protective agents in breast milk like macrophage, lymphocyte, secretary IgA anti-

streptococcal factor, lactoferrtin lysozyme offer protective roles against common

childhood disease like diarrhea, necrotizing enterocolitis , respiratory infections in first

few months of life. In the background, our study attempted to assess the pattern of

diarrheal episodes and to find out any association between breast feeding and its

protective role in diarrhea in under five children of a rural block of West Bengal of India.

More recently a study by (Quigley et al.) reported that breast feeding, particularly

when exclusive and prolonged, protects against severe morbidity in the united kingdom.

A population level increase in exclusive, prolonged breast feeding would be of

considerable potential benefit for public health. Our findings are consistent with

20
previous observation of a negative relation between breastfeeding and diarrheal

morbidity in children in areas with modem water supply and sanitation facilities. Finally,

the mechanism through which breast feeding may protect children against diarrhea are

well known.

The most appropriate public health interventions are evidence based, cost

effective and culturally-appropriate, and targeted at improving human health and

reducing harm to individuals from disease . To improve child survival and health

outcome, as well as ensure efficient use of limited health resources in Nigeria, it is

essential to understand not only the distribution of suboptimal breastfeeding but also

how current inappropriate breastfeeding practices impact health outcomes among

children under five years. Using the comparative risk assessment approach described by

(Murray and Lopez). The burden of diarrhea morbidity and mortality attributable to

suboptimal breastfeeding can be estimated to provide an in depth understanding on the

impact of suboptimal breast feeding on diarrhea among children aged under at the

population level in Nigeria to inform policy decision making problems.

COWS MILK CAUSING DIARRHEA

Cow’s milk has been a staple of the American diet ever since the medical

community publicized its nutritional benefits in the 1920s (Mendelson 2011). However,

health concerns over cow’s milk began as early as the mid-19 th century, when the public

began to focus on unhygienic conditions of cows and dairy processing plants. Food

borne illness from consuming milk were common during this time, and were mostly due

21
to bacterial contamination (Garber 2008; Gillespie et al.2003). Food borne illness are

often limited to ephemeral symptoms such as nausea, vomiting and diarrhea, but can

also include more serious and chronic complications, such as hemolytic uremic or

Guillain-Barre syndrome; in some cases illness can lead to death (U.S Food and Drug

Administration 2012).

In response to the public’s concerns regulatory and hygienists improved the

practices of caring for and milking cows as well as how milk was distributed to

consumers (Gould et al. 2014;leedom 2006).at a similar time, a heat treatment process

that could kill microbes, known today as pasteurization, was introduced to further

ensure milk safety. Pasteurization requires heating milk to a specific temperature for a

minimum period of time, and then quickly cooling it back down to refrigeration

temperatures (De Buyser et al. 2001; walstra et al. 2006). Many heat time combinations

are effective. Classic pasteurization involves heating milk for 30 minutes. However, as

pasteurization become widely accepted and dairy plants become more

industrialization ,higher temperature short time pasteurization (HTST) and ultra high

temperature pasteurization (UHT) become common place (Mendelson 2011; Walstra et

al. 2006).

The raw milk was began to ban on mid 1950s (Mendelson 2011) and in 1987 the

U.S food and drug administration prohibited the interstate shipment and sale of raw

milk for human consumption. These laws and along with the more hygienic farm

practices (Langer et al.2012) reduced the milk borne outbreaks from almost a quarter of

all reported the intestinal infectious diseases to <1%. There was superior taste to

22
pasteurized milk and there have also been claims that raw milk is cleaner (Lejeune and

Rajala Schultz 2009). Currently some states permit the sale of raw milk, usually allowing

small amounts to be sold directly at local farms or through cow share programs. Since

past 15 years they reflecting the communication and outreach of raw milk advocates. In

the interstate sales some of these were illegally expanded. Now a days it is currently

estimated that 0.5-3.5% of the U.S population drinks raw milk and with the great

majority of these people residing on farms (Lejeune and Rajala Schultz 2009). There has

been also an increase in raw milk availability, which has concerned public health officials,

as they believe this may increase the risk of food borne illness (U.S Food and Drug

Administration 2012).

This is one of the greatest and most widespread concern of overall milk is

microbial contamination, and this is due to presence of infectious bacteria or viruses.

The most common pathogens found in milk includes Salmonella species, Campylobacter

jejuni, Shiga toxin producing Escherichia coli, and Listeria monocytogenes. These

bacteria are also found naturally in the environment. This is due to that cows can be

exposed to the environment sources of microbes on the farm, which can be causing

mastitis. Mastitis is an infection of the udders that can spread pathogens during milking.

The fecal contamination from the cows during milking can also allow high amounts of

pathogenic microbes to enter the milk.

By the time of large scale pasteurized milk production, the unprocessed milk is

sent from dairy farms to dairy processing plants in bulk tanks where the large quantities

of milk were stored (Oliver et al. 2005). Bacteria and viruses can grow in these tank and

23
spread t previously uncontaminated milk. At this point the milk production was

pasteurized and assuming the heat treatment is performed appropriately, most

pathogens will not survive (Oliver et al. 2005). The post pasteurization contamination,

however is possible usually through microbial biofilms in the distribution pipes and

unhygienic practices of employees, or the use of unsterilized containers or the post

pasteurization equipment (Leedom 2006). The major risk of microbial transmission also

occurs via dairy workers at all the points milk processing, including the equipment and

practices on the farm. After the milk was distributed, the failure to keep the milk at

refrigeration temperatures can allow the pathogenic microbes to multiply and greatly

increasing the risk of illness from consuming the milk. The improper storage can be fault

of the dairy distributers but also retail workers and milk consumers (Gould et al. 2014).

The pasteurization milk can reduce microbial contamination and it does not ensure that

milk is sterile throughout the supply chain (Lejeune and Rajala Schultz 2009).

Cattle on the farms are often not confined to dense, industrial sheds and may

graze on the nearby grass instead of being fed soya and corn from elsewhere. There are

some systematic differences between the large scale milk production was described

above and the small scale farming, where raw milk is commonly sold. These differences

may influence the risk of microbial contamination in the milk. The raw milk for sale is

typically not stored in the bulk tanks and the distribution of milk is usually minimal, with

most customers purchasing directing on the farm. But while the cross contamination of

milk after collection is reduced the risk of contamination during collection remains (e.g.

fecal contamination or mastitis of cow udders). Because small scale farmers may not be

24
subject to state and federal sanitary regulations and testing. There may be greater

likelihood of some raw milk being contaminated with hazardous microbes and thus pose

a risk to consumers (Mendelson 2011).

Allergies are a symptom of autoimmunity, which is characterized by the immune

system attacking its own body (Melnik et al. 2014). Cow’s milk has multiple benefits

including its nutritional value. In recent years there have been claims that raw milk can

reduce allergic reactions and cure other ailments. The frequency and prevalence of auto

immunological conditions, such as asthma, have been increasing in recent decades and

some believe that living in to sterile of an environment may contribute to this increase.

This hygiene hypothesis could be the reason why some believe that drinking

unpasteurized milk, which contains many natural proteins, antibodies, and microbial

communities may reduce these health risks (Baars 2013; Hodgkinson et al. 2014).

However recent reports have asserted that these potential health benefits have not

been sufficiently investigated (Macdonald et al. 2011).

In the 2014 session of the Maryland general assembly, a bill was introduced in the

house of delegates that would allow for the limited distribution of raw milk intended for

consumption in the state via “cow shares” (Hubbard 2014).

MALNUTRITION:

Several studies have been conducted to examine association among malnutrition,

deficiencies in cell-mediated immunity and the incidence of gastrointestinal or

respiratory infection children under 5 years of age. In 2001, the world health

25
organization (WHO) established the external child health epidemiology reference Group

(CHERG) to develop estimates of the proportion of deaths in children’s younger than age

5 years attributable to pneumonia, diarrhea malaria and measles. Of the estimated

8,795 million deaths in children younger than 5 years worldwide in 2008, infectious

disease caused by 68% (5,970 million), with the largest percentages due to pneumonia

(8%) . A separate study reported different risk estimates, with stronger associations

between nutritional status and mortality for gastrointestinal and acute respiratory

infections that coincide with malnutrition.

TRAVELER’S DIARRHEA:

Diarrhea is a common problem affecting between 20 and 60% of travelers,

particularly those visiting low and middle income countries. Traveler's Diarrhea is

defined as an increase in frequency of bowel movements to three or more loose stools

per day during a trip abroad usually to a less economically developed region. This is

usually an acute self limiting condition and is rarely life threatening. In mild cases it can

affect the enjoyment of a holiday, and in severe cases it can cause dehydration and

sepsis. We review the current epidemiology of travelers’ diarrhea, evidence for

different management strategies and the investigation and the treatment of persistent

diarrhea after travel. Enter toxic Escherichia coli (ETEC) is the most common cause of

acute traveler’s diarrhea globally. Chronic diarrhea (more than 14 days) diarrhea is less

likely to be caused by bacterial pathogens. Prophylactic antibiotic use is only

recommended for patients vulnerable to severe sequel after short a short period of

diarrhea, such as those with ileostomies or immune suppression. A short course ( 1 to 3

26
days) of Antibiotics taken at the onset of travelers diarrhea reduces the duration of

illness from 3 days to 1.5 days. Refer patients with chronic diarrhea and associated

symptoms like such as weight loss for assessment by either an infectious diseases

specialist or Gastro Enterologist.(BMJ,2016)

Participants and subject eligibility. The trial was conducted during may 2001 in

Nakhon Sri Thammarut. Thailand, and during May 2001 in Phitsanulok , Thailand.US

military personal who presented with acute diarrhea at field clinic where enrolled in the

trial after they provided written informed consent. Diarrhea was defined as the

occurrence of either more than or equal to 3 loose stools or more than or equal to 2

loose stools with more than or equal to one associated complaint Of abdominal cramps,

nausea, vomiting or fever) during a 24 hour period. Additional inclusion criteria included

symptoms with a duration of less than or equal to 96 hours an ambulatory

management. (Oxford University Press,2019)

27
 CHAPTER 3

METHODOLOGY

3.1 Research design

In order to collect data and answer research question, descriptive method was

used in this study. Researchers will conduct a survey method to determine the

knowledge, attitude and practice on diarrhea. Researchers use descriptive study to

gather quantifiable information that can be used for statistical inference on a target

audience through data analysis. As a consequence this type of research takes the form

of closed-ended questions. As the sampling will be chosen randomly, sampling

technique method will be used. Descriptive method is defined as a research method that

28
describes the characteristics of the population or phenomenon that is being studied.

This methodology focuses more on the “what” of the research subject rather than the

“why” of the research subject.

3.2 Population and sample:

In order to answer the research questionnaires the study has utilized trevi, Makati.

Total no of respondents used in this study will be 100 belonging to the both the sexes

and various age groups.

The Laureano di Trevi is a three-tower condominium in Don Chino Roces Avenue

in Makati. This condo project was developed by vista residences. It is a prime property

on one of Makati’s key avenues. It is about 5000 sqm. It is 3 tower condominium with

commercial areas at the ground floor . The condominium with three towers rising at 28,

37 and 24 respectively. Tower 1 will have 378 units, Tower 2 will have 540 units, Tower 3

will have 306 units. The tower consists of studio type rooms , one bedroom and 2

bedroom. The tower has the following facilities : gym, parking , play ground, security ,

swimming pool and garden . It is very close proximity to mall such as Walter mart,

green belt , Makati cinema square; school such as Don Bosco , Assumption college and

AMA school of Medicine; and hospital such as Makati Medical Centre; and the nearest

airport is Manila Ninoy Aquino International Airport , 8km from the property. Many

peoples are willing to stay because its located near popular commercial establishment

and adding more convince to the life style of the people.

29
 Residents of Trevi will be sampled using systemic random sampling method.

Systemic sampling is a type of probability sampling method in which sample members

from a larger population are selected according to a random starting point and a fixed,

periodic interval. This interval, called the sampling interval, is calculated by dividing the

population size by the desired sample size.

3.4 Data collecting tool:

To measure the diarrhea a standardized questionnaire is used. The questionnaire

is composed of 3parts of knowledge, attitude and practices. Knowledge consists of 12

questions, attitude consists of 6 questions and practices consists of 21 questions. which

responses a yes or no questions. The calculation is based on the score of “0” for wrong

answer and “1” for right answer. The respondents will be informed that the true identity

of each participant will not be disclosed in order to keep up with ethical consideration of

this study and respect to the personhood of each participant.

3.5 Data collecting producer:

The survey questionnaire diarrhea practices will be given. The respondents will be

given time to the answer the questionnaires. This questionnaire is composed of 39 items

with response of” yes or no “. The responses of the respondents will be recorded and

scored according to the questionnaire. In those data gathering surveys each time the

respondents of this study will be given written informed consents before answering

those questionnaires mentioning the risks and benefits of the process. The respondents

will also be informed that the true identify of each participant will not be disclosed in

30
Where:
order to keep up with ethical consideration of this

c is the Degree of freedom study and respect to the personhood of each

participant.
∑ stands for summation

3.6 Data analysis/statistical tool

O Observed value

The researchers will use regression test to

E Expected value
measure knowledge, attitude , perception and practice

on diarrhea. (Given below is the regression test formula)

Regression

3.7 Ethical considerations:

The participation of all the participants would be voluntarily. All the participant

would be informed about the beneficent and maleficent effect of the study. A verbal

and written inform consent would be given to all the participants. All the participants

have complete right to withdraw from the study at any time. No any penalty would be

charge if the participant withdraw from the study. All the information provided by the

participants would be kept confidential. All the written documents of the study would

31
be kept by the researcher in lock and key. The softcopy of the documents would be kept

under password protected file.

CHAPTER 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This section contains the details about the research findings. It discusses the most

important information about how the research inquiries were answered and how the

data in this research were interpreted in the light of providing solution to these

inquiries.

Research Problems

Table 1

1. What is the profile of the respondents in terms of the demographics variables?

a. Age of the participants

b. Education level

32
 c. Mothers occupation

d. Total number of children

e. Housing and sanitation condition

 Source of water supply

 Taste of water

f. Diarrheal episodes in children

a. Age

Table 4.1 Profile of the respondents according to age

Age Frequency(f) Percentage(%)

1-20 1 1%
21-40 74 74%
31-60 21 21%
61-80 4 4%
Total 100 100%

The above table 4.1 shows that the respondents of age 1-20 is 1%, 21-40 is 74%, 31-60 is

21%, 61-80 is 4%.

Table 4.2

Average age of the respondents

Respondents Mean Standard deviation

Average age 34.24 9.64

33
The Above table, Table 4.2, shows that on average, the respondents of this research is

27 years old, as given in the mean figure of 34.24. With a standard deviation of 9.64.

The youngest respondents is 17 years old while the oldest is 61.

B. Education level

Table 4.3 Profile of respondents according to education level

Educational level F %
No education 1 1%
Primary/ secondary 15 15%

Graduate 75 75%

Others 9 9%

Total 100 100%

The Above table, Table 4.3, shows that there were 75% of respondents who have

received Graduate level education. However there were 0% of respondents who are

illiterate and 1% of respondents have not received any formal education, but they know

reading and writing.

C. Mothers occupation

Table 4.4 Profile of respondents according to mother’s occupation

Mother occupation F %

34
ACCOUNTING 4 4%
ADMINISTRATIVE 3 3%
AP ANALYST 1 1%
ARCHITECT 2 2%
BEADER 1 1%
BUSINESS 6 6%
CSR 1 1%
DECEASED 1 1%
DOMESTIC HELPER 2 2%
EDUCATION 4 4%
EMPLOYEE 2 2%
ENGINEER 3 3%
FRAUD ANALYST 1 1%
FRONT DESK 1 1%
4 4%
OFFICER 1 1%
GOVERNMENT 4 4%
GRADUATE 26 26%
HOUSEKEEPER 1 1%
HOUSEWIFE 1 1%
INTERNIST 1 1%
LAUNDRY STAFF 1 1%
MILK TEA CREW 3 3%
MISSIONARY 2 2%
N/A 1 1%
NONE 1 1%
NURSE 2 2%
OFFICE 2 2%
OFFICE 1 1%
OFW 2 2%
PRIVATE EMPLOYEE 5 5%
PROFESSOR 1 1%
REAL ESTATE 3 3%
REGISTERED NURSE 1 1%
SALES 3 3%
SCRA 1 1%
SECRETARY 1 1%
SECURITY GUARD 1 1%
TRAFFIC OFFICER

35
The above table, Table 4.4 shows that majority of the respondents are House wife, as

shown by the frequency of 26, comprising of 26% out of 100 respondents. The least

frequent jobs are AP Analyst, Beader, CSR, Deceased, Fraud Analyst, Front Desk Officer,

Graduate, Internist, Laundry Staff, Milk Tea Crew, Missionary, Nurse, Office, Private

Employee, Registered Nurse, SCRA, Security Guard and Traffic Officer as shown in their

frequency of 1 or 1% out of 100 respondents.

d. Total number of children

Table 4.5 Profile of respondents according to number of children

No. of children F %
1 44 44%

2 27 27%

3 57 17%

4 8 8%

5 3 3%

6 1 1%

The Above table, Table 4.5, shows that there are 44% of respondents who have one

child and only 1% of respondents have 6 children.

e. Housing and sanitation

36
Table 4.6 Profile of respondents according to housing and sanitation conditions

Source of water supply F %

Boring water/ well 36 36%

water
Tanker supply water 31 31%
Tap water inside 30 30%

Hand pump 0 0%

None 3 3%

The Above table, Table 4.6, shows that there are 36% of respondents who use Boring

water/ well water and 0% of respondents use hand pump.

f. Taste of water

Table 4.7 Profile of respondents according to taste of water

Taste of water F %
Fresh water 77 77%
Salt water 5 5%

Others 18 18%

The Above table, Table 4.7, shows that there are 77% of respondents who taste Fresh

water, only 5% of respondents who taste salt water and 18% of respondents who taste

different from salt and fresh water.

g. Diarrheal episodes in children

Table 4.8 Profile of respondents according to diarrheal episodes in children

Diarrhea episodes in F %

children
37
 Yes 51 51%
No 49 49%

The Above table, Table 4.8, shows that there are 51% of respondents children who

suffer from diarrhea and 49% of children does not suffer from diarrhea. This study

analysis that most of the children don’t get proper breastfeed, so many experience

diarrhea formula consumption (Marandy, 1992).

Table 2

What is the level of the respondents’ Knowledge about diarrhea?

Table 4.9 Level of the respondents’ Knowledge about diarrhea

Mean Std.
Deviation
KNOWLEDGE ON 10.2500 2.03691
DIARRHEA
Valid N (listwise)

The level of respondents on the knowledge about diarrhea having total of 100

respondents with minimum value of 5, maximum value of 20, mean of 10.3 and

standard deviation of 2.04.

Table 3

What is the level of the respondents’ Attitude About Diarrhea?

Table 4.10 level of the respondents’ Practices on Diarrhea

Mean Std.
Deviation
ATTITUDE ON 5.5500 .89188
DIARRHEA

38
 Valid N (listwise)

The level of respondents on the attitude about diarrhea having total of 100 respondents

with minimum value of 1, maximum value of 6, mean of 5.56 and standard deviation of

0.89

Table 4

What is the level of the respondents’ Practices on Diarrhea?

Table 4.11 level of the respondents’ Practices on Diarrhea

Mean Std.
Deviation
PRACTICES ON 14.3900 2.72991
DIARRHEA
Valid N (listwise)

The level of respondents on the practices about diarrhea having total of 100

respondents with minimum value of 5, maximum value of 19, mean of 14.4 and

standard deviation of 2.73.

Regression analysis on knowledge, Attitude and Practices

ANOVAa
Model Sum of Df Mean F Sig.
Squares Square
Regression 34.602 2 17.301 2.387 .097b
1 Residual 703.188 97 7.249
Total 737.790 99
a. Dependent Variable: PRACTICES ON DIARRHEA

39
b. Predictors: (Constant), ATTITUDE ON DIARRHEA, KNOWLEDGE ON

DIARRHEA

The above table shows there no significance on practices(.097) since the p

value is greater than the alpha value (0.05). This study analyzed that is poor

significance.

Coefficientsa
Model Unstandardized Standardized T Sig.
Coefficients Coefficients
B Std. Error Beta
(Constant) 16.211 2.054 7.892 .000
KNOWLEDGE ON .154 .134 .115 1.146 .255
1 DIARRHEA
ATTITUDE ON -.612 .306 -.200 -1.998 .049
DIARRHEA
a. Dependent Variable: PRACTICES ON DIARRHEA

The above table shows there no significance on Knowledge(.255) since the p value is

greater than the alpha value (0.05) but there is a significant value for the Attitude on

diarrhea, the p value for attitude is 0.49 which is lesser than the alpha value 0.05. This

study analyzed that knowledge is poor significance and attitude on diarrhea is good

significance.
Table 5

Is there a significant relationship of demographic variables and Knowledge about

diarrhea, Attitude About Diarrhea, and Practices on Diarrhea?

40
 Table 5.1 Model Summary
Model R R Square Adjusted R Square
Std. Error of the
Estimate
a
1 .241 .058 -.014 3.62512
Predictors: (Constant), OCCUPATION CONDITION SANITATION, EDUCATION OF

MOTHER, EPISODES OF DIARRHEA, CHILDREN IN HOUSEHOLD, QUALITY OF WATER,

AGE

The above table shows that in a regression analysis using demographic variables as

predictors in accounting for knowledge, attitude and practices about diarrhea among

the respondents only 5.8% of the occupation of mother, sanitation conditions,

education, episodes of diarrhea children in house hold, quality of water and age.

Table 5.1 ANOVAa

Model Sum of Df Mean F Sig.
Squares Square
Regression 74.375 7 10.625 .809 .582b
1 Residual 1209.015 92 13.141
Total 1283.390 99
Dependent Variable: TOTAL OF KNOWLEDGE, ATTITUDE, PRACTICES

41
Predictors: (Constant), OCCUPATION, CONDITION SANITATION, EDUCATION

OF MOTHER, EPISODES OF DIARRHEA, CHILDREN IN HOUSEHOLD, QUALITY OF

WATER, AGE

The above table shows the F test for regression analysis model where the

predictors occupation of mother, sanitation condition, education of mother,

episodes of diarrhea, children in household, quality of water, age are noted to

have no relation with the dependent variable, knowledge, attitude, practices

about diarrhea, as noted that F value of .0809 associated with the p value of .

582 which is higher than the .05 cut off alpha. This study analyzed that is poor

significance since the p value is greater.

Table 5.2Coefficientsa
Model Unstandardized Standardized T Sig.
Coefficients Coefficients
B Std. Error Beta
(Constant) 28.426 2.172 13.086 .000
AGE .041 .041 .109 .980 .330
EDUCATION OF -.290 .313 -.098 -.926 .357
MOTHER
CHILDREN IN .401 .335 .131 1.198 .234
HOUSEHOLD
1 CONDITION
SANITATION -.032 .404 -.009 -.079 .937
QUALITY OF WATER .585 .505 .127 1.159 .249
EPISODES OF -.030 .740 -.004 -.041 .968
DIARRHEA
OCCUPATION OF .022 .039 .059 .557 .579
MOTHER

42
Dependent Variable: TOTAL OF Knowledge, Attitude, Practices

Table 5 shows different variables in assessing knowledge, attitude and practices. This is

indicated by their p value of .330 predicts the value of age of the mother, .357 predicts the

value of education of the mother, .234 predicts the value of children in household, .937 predicts

the value of sanitation, .249 predicts the value of quality of water, .968 predicts the value of

episodes of diarrhea, .579 predicts the value of occupation of the mother respectively, higher

than the alpha cut off of .05. So the above values shows that demographic variables predict no

significance between knowledge, attitude and practices. This study analyzed that it is poor

significance.

43
 CHAPTER 5

SUMMARY, CONCLUSIONS & RECOMMENDATIONS

5.1 SUMMARY

This study was carried out in trevi condominium, Makati. In this study the baseline

survey about Knowledge, Attitude, Practices of the parents residing at trevi regarding

the management of diarrhea was steered, because diarrhea is the most common disease

among the children. The knowledge, attitude and practices studies on demographic

profiles with their p values of , Age(0.330), education of mother(0.357), children in

household condition(0.234), sanitation(0.937), quality of water(0.249), episodes of

diarrhea(0.968) and occupation of mother(0.579). So the p values of these demographic

profile is greater than the alpha value(0.05). So there is no relation between these

significant values. The p values of knowledge(0.255), attitude(0.049) and

practices(0.097). The p values of knowledge and practices is greater than the Alpha

value(0.05) and for attitude the p value is lesser than the alpha value(0.05).

The knowledge, attitude and practices among parents regarding different

contributing factors of diarrhea were different. Different contributing factors are about

hand hygiene, water treatment, sanitary condition, dietary habit of children and

diarrhea management tools.

The prevalence of diarrhea is not reduced significantly with the increase in

knowledge and practice score, because the p value is greater than 0.05 whereas the
44
increase in attitude score can reduce the diarrhea prevalence significantly p value is

lesser than 0.05. This means that there is a need for health education and for increasing

the practices of mothers for reducing the episodes of diarrhea in children.

5.2 Conclusion:

The data obtained in this study and the results from the analysis help the

researchers to conclude the followings:

There is a significant relation of attitude on diarrhea, so null hypothesis has been

rejected.

There is no significant relation of demographic variables with knowledge, attitude,

practices of diarrhea.

5.3 Recommendations:

 Based on the results and the conclusion the proponents of the study want to

recommend the followings: It is recommended to all people, to give the

awareness about diarrhea, its causes, knowledge, attitude and practices.

 It is recommended for the future researchers should investigate about the

knowledge, attitude and practice about diarrhea.

 There is need to provide wash education to improve their knowledge on causes

of diarrhea and hand washing practice.

This indicates the need for provision of water, proper food, proper hygiene,

sanitation etc.

45
 CHAPTER 6

BIBLIOGRAPHY

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16. Mwambete KD, Joseph R, 2010, Knowledge and Perception of mother and caregivers

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49
APPENDIX A

Informed consent:

CONSENT TO ACT AS A PARTICIPANT

Title of study:

KNOWLEDGE, ATTITUDE AND PRACTICES ON DIARRHEA AMONG THE PARENTS RESIDING

AT TREVI CONDOMINIUM, MAKATI.

Researcher’s Name:

Palraj, Rohini

Perumal, Jothi

Prasanna Kumar, Thanu Priya

Sivaji, Yogasri

Participant’s Name: Participant’s Contact

Number:

Purpose of study:

To know about Knowledge, Attitude and Practices on diarrhea among the residents of

Trevi, Makati.

50
Study procedures:

This study will utilize a descriptive study method using a questionnaire to evaluate

Knowledge, Attitude, Practices on diarrhea. The participants are required to complete

the questionnaire and the instructions will be given on how to do it.

The researchers will gather the information from the answered questionnaire to

evaluate Knowledge, Attitude, Practices on diarrhea. The researchers require one week

time to conduct the research.

The researchers will be taking photos while the participants are answering the

questionnaire which is a part of requirement in research paper.

The researchers will be collecting the entire Trevi towers in Makati to evaluate the

survey on Knowledge, Attitude and Practices.

Risks:

There is no risk in this research.

Benefits:

This study will more bring about understanding and awareness about the diaarhea

among the residents of Trevi.

Confidentiality:

Measures taken to ensure confidentiality are listed below,

51
  Keeping notes, interview documents and any other identifying participant

information in a locked file cabinet in the personal possession of the researchers.

 Assigning numbers for participants that will be used on all research notes and

documents.

Participant’s data will be kept confidential except in cases where the researcher is legally

obligated to report specific information during specific incidents. These incidents

include, but may not limited to, incidents of abuse and suicide risk.

Contact information:

If you have questions at any time about the study, or you experience adverse

effects as the results of participating in this study, you may contact researcher whose

contact will be mentioned on the front page. If you have any clarifications about your

rights as research participants, you can freely contact any of our research group

members.

Voluntary participation:

Your participation in this study is voluntary. It is up to you to decide whether or not

to take part in this study. If you decide to take part in this study you be asked to sign this

consent form. After you sign the consent form you are still free to withdraw at any time

and without giving any reason. Withdrawing from this study will not affect the

relationship you have, if any, with the researcher. If you withdraw from the study after

data collection is done, your data will be returned or destroyed completely.

52
Consent:

I have read and I understood the provided information and have had the

opportunity to ask questions. I understand that I will be given a copy of this consent

form. I voluntarily agree to conduct this study. I voluntarily accept to give my complete

co-operation for this study.

Participant’s signature over printed name

53
APPENDIX B

Questionnaire:

KNOWLEDGE, ATTITUDE AND PRACTICES ON DIARRHEA AMONG PARENTS RESIDING

AT TREVI CONDOMINIUM, MAKATI.
A. Demographic Profile of Respondents:
1. Age of the participants: _______________________
2. Education level:
No education
Elementary
High school
Senior high school
College
Post Graduate course
3. Mother occupation: _____________________________________
4. Total Number of children: __________________________
B. Housing & Sanitation Conditions:
6. Source of Water supply:
Boring water
Tanker supply water
Tap water inside
Hand pump
None
7. Taste of water:
Fresh water

54
 Salty water
Others
C. Diarrhea Episodes in Children:
8. Since last one year does your child suffer from diarrhea?
Yes No
9. If yes, what was the age of children when he had diarrhea?
Less than 6 month 12 to 17 month
6 to 11 month 18 to 23 month
1. Participant Name: (Optional) __________________
2. Do you have any child?
O Yes O No
Don’t know (if Yes Proceed, otherwise the participant is not eligible for participation)

1. Knowledge about Diarrheal diseases:

1. Do you think the diarrheal diseases can be transmitted from because of drinking
contaminated water?
-1 Yes
-0 No
2. Do you think diarrheal diseases can be spread because of lack of sanitary measures?
-1 Yes
-0 No
3. Do you think filter machine or filtering water by placing clothe help in reducing the
incidence of diarrheal diseases?
-1 Yes
-0 No
4. Do you think diarrhea can be prevented in infants and children via exclusive breast
feeding?

55
 -1 Yes
-0 No
5. Do you know use of any chemical can disinfect the water contaminants?
-1 Yes
-0 No
6. Do you think that bottle feeding can be a factor for diarrhea morbidity among children
under 2 year of age?
-1 Yes
-0 No
7. Do you think that vaccination can help in the prevention of diarrheal diseases?
-1 Yes
-0 No
8. Do you know about method of ORS (Oral Rehydration Solution) preparation?
-1 Yes
-0 No
9. Do you think that use of banana is useful in reducing the electrolyte imbalance in
diarrhea?
-1 Yes
-0 No
10. Do you think that use of yogurt is act as probiotic in diarrhea?
-1 Yes
-0 No
11. Do you think that eating food with dirty hands can cause diarrhea?
-1 Yes
-0 No
12. Do you think abstinence from food in diarrhea can prevent further episodes of
diarrhea ?
-1 Yes
56
 -0 No

2. Attitude for Diarrheal Disease & its Prevention:

1. It is good to keep children hand clean always
-1 Yes
-0 No
2. Need to wash hands with soap after going to latrine
-1 Yes
-0 No
3. Wash hands before eating is a healthy practice for the prevention of diarrhea
-1 Yes
-0 No
4. Breast feeding is useful for preventing diarrheal episodes among children under 2
years
-1 Yes
-0 No
5. Boiled water is useful for preventing diarrheal episodes
-1 Yes
-0 No
6. We need to give bottle milk to children in boiled water for preventing diarrheal
episodes
-1 Yes
-0 No

3. Practices for Preventive Measure for Diarrheal Diseases:

1. Do you breast fed your children?
-1 Yes
-0 No

57
2. Do you bottle fed your children?
-1 Yes
-0 No
3. Do you use Cow milk to your children for feeding?
-1 Yes
-0 No
4. Do you use formula milk you your children for feeding?
-1 Yes
-0 No
5. Do you boil water before drink?
-1 Yes
-0 No
6. Do you boil bottle feeders?
-1 Yes
-0 No
7. Do you boil bottle feeders before every feed?
-1 Yes
-0 No
8. Do you abstain all types of food in diarrhea?
-1 Yes
-0 No
9. Do you filter water by use of muslin cloth?
-1 Yes
-0 No
10. Do you use any chemical e.g. chlorine tablets etc in tank for killing water germs?
-1 Yes
-0 No

58
11. Do you wash your hands before eating foods?
-1 Yes
-0 No
39. Do you use banana in diarrhea?
- 1 Yes
-0 No
12. Do you use yogurt in diarrhea management?
-1 Yes
-0 No
13. Do you wash your hands after passing stools?
-1 Yes
-0 No
14. Do you use ORS in case of diarrhea?
-`1 Yes
-0 No
15. Have you vaccinated your child against typhoid vaccine?
-1 Yes
-0 No
16. Have you vaccinated your child against rotavirus induce diarrhea?
-1 Yes
-0 No
17. I always remind the children to wash hands before and after eating
-1 Yes
-0 No
18. I wash hands after bathing children
-1 Yes
-0 No

59
19. I wash my hands after changing diapers
-1 Yes
-0 No
20. I do not wash hands before touching children
-1 Yes
-2 No

APPENDIX C

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APPENDIX D

CURRICULUMVITAE

Name : PALRAJ,ROHINI.

Age: 21 years old

Gender: Female

Birthday: 27 december, 1997

Birth place: Tanjore,Tamil Nadu, India

Civil status: Single

Religion: Hindu

Citizenship: Indian

Contact #: 09446683192

Email Address: rohinip914@gmail.com

Father’s Name: K. PALRAJ.

Mother’ Name: P. SARASWATHI.

City: Makati

Provincial Address: Tanjore, Tamil Nadu, India

Educational Attainment:

77
Primary/Elementary: E.D THOMAS., MEM., HER., SEC., SCHOOL ., N.V KUDIKADU .,
TANJORE., INDIA.

High School: E.D THOMAS., MEM., HER., SEC., SCHOOL ., N.V KUDIKADU ., TANJORE.,
INDIA.

Secondary/Intermediate: E.D THOMAS., MEM., HER., SEC., SCHOOL . N.V KUDIKADU .,

TANJORE., INDIA.

Position : 3B-B3 ; 3RD YEAR MEDICINE STUDENT OF AMA SCHOOL OF MEDICINE,

MAKATI.
Name : PERUMAL, JOTHI.

Age: 32 years old

Gender: Female

Birthday: 04 June, 1986

Birth place: Labbaikudikadu, India

Civil status: Married

Religion: Hindu

Citizenship: Indian

Contact #: 09611361682

Email Address: vivadejoe@gmail.com

Father’s Name: PERUMAL

Mother’ Name: JEYALALITHA

City: Makati

Provincial Address: Trichy, Tamilnadu, India.

Educational Attainment:

Primary/Elementary: THIDAKUDI GIRLS HIGHER SECONDARY SCHOOL., TAMILNADU

INDIA.

78
High School: THIDAKUDI GIRLS HIGHER SECONDARY SCHOOL., TAMILNADU INDIA.

Secondary/Intermediate: THIDAKUDI GIRLS HIGHER SECONDARY SCHOOL., TAMILNADU

INDIA.

Position : 3B-B2 ; 3RD YEAR MEDICINE STUDENT OF AMA SCHOOL OF MEDICINE,

MAKATI.

Name : PRASANNA KUMAR, THANUPRIYA

Age: 22 years old

Gender: Female

Birthday: 21 August, 1996

Birth place: Hosur, Tamilnadu ,India

Civil status: Single

Religion: Hindu

Citizenship: Indian

Contact #: 09425258595

Email Address: thanu7priya@gmail.com

Father’s Name: PRASANNA KUMAR. R

Mother’ Name: MEENAKSHI. N

City: Makati

Provincial Address: Hosur,Tamilnadu, India.

Educational Attainment:

Primary/Elementary: MAHARISHI VIDYA MANDRI., MEM., HIGHER., SEC., SCHOOL.,

HOSUR., TAMILNADU ., INDIA.

79
High School: MAHARISHI VIDYA MANDRI., MEM., HIGHER., SEC., SCHOOL., HOSUR.,
TAMILNADU , INDIA.
Secondary/Intermediate: MAHARISHI VIDYA MANDRI., MEM., HIGHER., SEC., SCHOOL.,
HOSUR, TAMILNADU , INDIA .

Position : 3B-B3 ; 3rd YEAR MEDICINE STUDENT OF AMA SCHOOL OF MEDICINE, MAKATI

Name : SIVAJI,YOGASRI

Age: 22 years old

Gender: Female

Birthday: 31 March, 1997

Birth place: Tanjore,Tamil Nadu, India

Civil status: Single

Religion: Hindu

Citizenship: Indian

Contact #: 09436683478

Email Address: connectyogasri@gmail.com

Father’s Name: T.SIVAJI

Mother’ Name: S.VISALAKSHI.

City: Makati

Provincial Address: Tanjore,Tamil Nadu, India

Educational Attainment:

Primary/Elementary: E.D THOMAS., MEM., HER.M SEC., SCHOOL.,N.V KUDIKADU.,

THANJAVUR, INDIA.

80
High School: E.D., THOMAS., MEM., HER., SEC., SCHOOL., N.V KUDIKADU., THANJAVUR.,
INDIA

Secondary/Intermediate: BRINDHAVAN ., HER. SC., SCHOOL. TAMILNADU., INDIA.

Position : 3B-B2 ; 3rd YEAR MEDICINE STUDENT OF AMA SCHOOL OF MEDICINE, MAKATI

APPENDIX D

BUDGET

Equipment

1. Papers to print = 1500Php

2. Statistician Fee (If needed) = 2500Php

3. Calculator = 100Php

4. Consultant fee = 5000Php

Supplies

1. Box of pen = 100Php

2. Writing pad = 100Php

Total = 9300

PROJECT ACTIVITIES TIME

1. Data collection December 16th to May 10
2. Data Analysis March 31
3. Report Writing and Presentation April 5
4. Correction May

81
 GANTT CHART

CORRECTION

REPORT
WRITING AND
PRESENTATIO
N

DATA
ANALYSES

DATA
COLLECTION

16 DEC 04 FEB 26 MAR 15 MAY 4 JUN 11 JUN

START DATA

DURATION

82