Home Management Of Childhood Diarrhea Disease Among Caregivers

INTRODUCTION

1.1 Background of the Study
Diarrhoea is defined as the passage of unusually loose or watery stool at least three times in a 24- hour period (WHO/UNICEF Report, 2009). Diarrhoea is not a disease, but a sign of an underlying disorder like ulcerative colitis (WHO//IMCI, 2005). Causes of diarrhoea in infants and children include reaction to certain foods, unsterilized daily feeding utensils, poor sanitation, infections, or emotional problems especially during weaning.

Despite the decline of diarrhea-related mortality in the last 2 decades, diarrhoeal diseases remain a leading cause of pediatric morbidity and mortality worldwide (Kudlova et al., 2008). Globally, deaths in children aged under-five years in the year 2010 were estimated at 7.7 million (Kudlova et al., 2010). Diarrhoea accounts for 1.6 to 2.5 million childhood deaths annually, and each child in the developing world experiences an average of 3 episodes of diarrhoea per year (Kosek et al., 2003). About 19% of these childhood deaths due to diarrhoea occur in Africa (Ellis et al., 2007). In Eastern Ethiopia, diarrhoea morbidity was found to be relatively high- 22.5% among children under five years of age (Mengiste et al., 2013).

In Kenya, the national survey by the Ministry of Public Health and Sanitation revealed that diarrhoea is the fourth most common illness seen in health facilities in Kenya and accounts for one in five of all admissions in the hospitals. The Kenya Demographic Health Survey of 2008-09 showed a 30% increase in children under- five years’ mortality in Kenya compared to the period 1989-2003, with diarrhoea ranking as the third risk factor affecting 8% of children under five years old (KNBS, ICF Macro 2010). In Nyanza Province the prevalence of diarrhoea of children under- five years old was 16.2 % (KNBS, ICF Macro 2010). A study done in the former Nyando district in 2004 revealed that diarrhoea prevalence among children under five years old was 48% (Othero et al., 2008). In former Kisumu West District diarrhoea prevalence in children under- five years old in 2009 was 7.3% (KNBS, ICF Macro 2010). The most recent study that was done in Seme sub-County in East Seme location in 2013 showed a high prevalence rate of diarrhoea among children under five years old of 17% (Broesern et al., 2013).

This shows that there is still need to investigate more about the cause of this high rate Management of diarrhoea at home as defined in this study is the action taken by caregivers when their children under five years old have diarrhoea. It is one of the key household practices that has been targeted and could result in substantial reduction of under five-year-old deaths (IMCI/WHO, 2005). Appropriate home management is key to controlling diarrhoeal conditions and is achievable if caregivers have strategies for diarrhoeal therapy (Uchendu et al., 2007). The recommended appropriate management of diarrhoea at home is the restoration and maintenance of adequate rehydration electrolyte balance by use of ORT and maintenance of adequate nutritional requirements. (WHO Geneva, 2005). It is directed at preventing or treating dehydration that is a serious consequence of diarrhoea.

In African settings, diarrhoeal management is grossly inadequate, especially the method of preparation and administration of rehydration fluids (Uchendu et al., 2007). A study by Bhutta in West Africa, revealed that caregivers had inadequate knowledge on how to manage diarrhoea at home and did not use ORS during diarrhoeal episode (Bhutta et al., 2000). Caregivers’ practices during diarrhoea are significant components of home management and WHO’s CDD programme has given priority to prevention of diarrhoeal deaths rather than treatment of the cases by use of ORT (Victoria et al., 2000).

Despite much effort and success in the management of diarrhoea at home, the condition has remained among the top five causes of mortality and morbidity in Kenya particularly among infants and children below five years of age with a case fatality of 21% (Integrated Health Facility Survey/Division of Child and Adolescent Health Ministry of Public Health and Sanitation Kenya 2006). According to the Kenyan policy guidelines on diarrhoea, parents and other caregivers of children under five years of age are supposed to be empowered to initiate early treatment at home to the children with diarrhoea and to recognize danger symptoms and signs of dehydration that will enable caregivers to seek further treatment (Ministry of Public Health and Sanitation in Kenya, March 2010) Studies on caregivers’ knowledge on the causes of diarrhoea in Pakistan found that 47% of the caregivers did not know the causes of diarrhoea (Yasmin et al., 2011). However, in many developing countries, the perceived cause of diarrhoea is associated with cultural and spiritual reasons. In South Western Ethiopia, diarrhoea is associated with teething and evil eyes (Kaba et al., 2000)

In East Africa (Tanzania specifically) diarrhoea episodes are associated with normal growth stage caused by several illnesses (Mwambete et al., 2010). In Kenya, a cross-sectional study in the former Nyando District revealed that caregivers had varied knowledge on the causes of diarrhea-some of which could be harmful if not addressed in time.

A descriptive study done in Karachi in 2011 in a pediatric ward indicated that 17% of the caregivers knew that diarrhoea is caused by contaminated water and food, while the rest did not know the cause. This study was done in a hospital setting. My study concentrated on the community rural set up where home management is majorly practiced.

A similar study has not been done in Seme sub-County and the study done in East Seme was only about prevalence of diarrhoea among children under five years old (Broersen et al., 2013). This study therefore sought to find out knowledge on the causes of diarrhoea.

Diarrhoea is caused by microbial agents that are usually transmitted through food and water that is contaminated (WHO, 2009). However, in many developing countries the perceived causes of diarrhoea by caregivers is associated with cultural and spiritual reasons. For instance, childhood diarrhoea is associated with teething and evil eyes in South Western part of Ethiopia (Kaba et al., 2000). In developing countries, for instance Tanzania diarrhoeal episodes were perceived wrongly as normal growth stage and that were caused by several illnesses which are treated using traditional remedies (Mwambete et al., 2010). In Kenya a cross-sectional study done in Nyando district revealed that caregivers had wide perceptions on causes and treatment of diarrhoea some of which could be harmful to health (Othero et al., 2008).

Diarrhoea is lethal but it is also preventable and treatable if managed properly. Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among young children in Kenya (KNBS, ICF Macro 2010). Knowledge on the signs of dehydration by care-givers is important because the signs are indicative of severe illness. Improper knowledge of the caregiver and their misdirected approach towards its management may lead to gross mismanagement resulting in severe dehydration and death.

A study carried out in Nepal showed that knowledge about signs of dehydration and the management approaches of diarrhoea at home was poor (Mukhtar et al., 2011). In Nakuru municipality in 2007, a study revealed that majority of the caregivers had inadequate knowledge on signs of dehydration and complications of diarrhoea and most of them used inappropriate treatment methods to manage diarrhoea (Mugo et al., 2007). This led to high mortality rate of 61 deaths per 1000 admissions in Nakuru Provincial Hospital. Therefore, this is a barrier to achievement of Kenya’s Vision 2030 of economic growth. About 76.4% of caregivers in Nyando district were not able to recognize danger signs of dehydration and the signs of dehydration due to diarrhoea (Othero et al., 2008).

To achieve a significant reduction in morbidity and mortality, due to diarrhoea, requires an improvement in diarrhoea case management at home within the community. The few studies that have been done in management of diarrhoea at home in Kenya have shown unsatisfactory levels of knowledge and poor methods of home management of diarrhoea. There is however no current study on the subject in Kisumu County. This study therefore seeks to determine the current caregiver’s knowledge on management of diarrhoea at home and the factors that influence it. The study will form the basis of extensive education on diarrhoea management within the community.

A study in Philadelphia (Yoder and Mommick et al., 1997), showed that most care-givers of children with diarrhoea gave some form of treatment at home, but were influenced by severity of the episode suggesting that the perception of care-givers on the severity of an episode of diarrhoea is an important factor in the choice of treatment. In another study, maternal education and perceived severity were significantly associated with seeking traditional treatment. Illiterate caregivers were two and half times more likely to seek traditional treatment than those caregivers with formal education, showing that perception of the caregiver influences action taken during diarrhoea (Tizito, 2014).

A study done in Tanzania in 2010 demonstrated high frequency of diarrhoea which was manifested by the fact that almost all the respondents had experienced diarrhoea which they perceived as normal growth condition depicting the existence of substantial knowledge–gaps regarding diarrhoeal predisposing factors (Mwambete et al., 2010).

There are certain fluids which are beneficial to give during diarrhoea but most of the caregivers in, a rural community in Kenya were unaware of most of these fluids (Othero et al., 2008). The optimum practice for childhood diarrhoea is to continue feeding and provide ORT or increased fluids or both (WHO, 2009). In Kenya, only 43% of children with diarrhoea are given continued feeding, as well as ORT or increased fluids (KNBS, ICF Macro 2010). The feeding pattern has not changed much in children with diarrhoea from 2003 to 2008 in Kenya, showing that there is still a gap in knowledge on appropriate management of diarrhoea among some caregivers regarding nutritional requirements of children during diarrhoea episodes (KNBS, ICF Macro 2010). Dehydration due to diarrhoea in this sub-County was found to be a major cause of morbidity and mortality among young children (KNBS, ICF Macro 2010).

Appropriate management of diarrhoea at home can alleviate the consequences of diarrhoea including malnutrition, impaired development, growth faltering, and mortality. The recommended appropriate management of diarrhoea is the restoration and maintenance of adequate rehydration, electrolyte balance by use of ORT and maintenance of adequate nutritional requirements (WHO Geneva, 2005). The safe and effective management of the household health environment is critical in addressing the problem of childhood diarrhoea.

Management of diarrhoea at home is directed at preventing or treating dehydration that is a serious consequence of the condition. No studies have been conducted on management of diarrhoea at home in Benin city where diarrhoea prevalence is high. This study will therefore focus on caregiver’s knowledge, perception, and practices in reducing diarrhoeal morbidity and mortality rates among children 

1.2 Statement of the Problem

In Nigeria mothers being the key caregivers to young ones below five years needs knowledge and management skills which are vital in reducing the effect of diseases and death rates which are related to diarrhoea conditions. (Kitony, 2016). Epidemiological researches have shown a clear relationship between diarrhea and physical growth and development of a child which had a negative effect. Every day of sickness secondary to diarrhea results in reduction of weight by 20 to 40 grams. Imbalanced nutrition is linked with more severe and persistent diarrhea. (Ferdous et al., 2013). According to Schlaudecker et al. (2011), episodes of diarrhea may predispose to pneumonia in undernourished children. Despite the health worker’s efforts to educate mothers and caregivers on prevention and management of diarrhea and on improving quality of life for there has been increasing trends in the number of children presenting in the clinics with diarrhea and related complications including dehydration. The reports from routine program monitoring suggest that more than 75% of children admitted for treatment in the facility presented with diarrhea and most of them had severe dehydration. This was a clear indication that the care provided at home prior to hospital presentation was inappropriate as the state of a child with acute diarrhea at first presentation to a health facility was highly dependent on the care provided at home. Regrettably, in spite of the education and presumed information achieved by these caregivers, diarrhea among the young ones was noted to be the second major cause of illness in below five years’ age children in the facility after pneumonia and respiratory related infections. This study therefore sought to establish Home management of childhood diarrhea disease among caregivers in Benin city Edo state

1.3 Research Questions

(i) What is the level of knowledge on home management of diarrhea among caregivers of children below five years in Benin city Edo state?

(ii) How is the practice of home management of diarrhea among caregivers of children below five years in Benin city Edo state?

(iii) What is the relationship between caregivers’ individual factors and home management of diarrhea among caregivers of children below five years in Benin city Edo state?

1.4 Aims and Objectives
The study was guided by the following objectives:

Broad Objective

To establish the determinants of home management of diarrhea among caregivers of children below five years in Benin city Edo state.

Specific Objectives

(i) To assess the level of knowledge on home management of diarrhea among caregivers of children below five years in Benin city Edo state.

(ii) To determine the practice of home management of diarrhea among caregivers of children below five years in Benin city Edo state.

(iii) To determine the relationship between caregivers’ individual factors and home management of diarrhea among caregivers of children below five years in Benin city Edo state.

1.5 Scope of the study
The study is limited to Home management of childhood diarrhea disease among caregivers in Benin city Edo state

1.6 Justification of the Study

Due to poor diarrhoeal management and oral rehydration related knowledge, in the rural communities, diarrhoea remains a major public problem and West Seme is not an exception. Child care cannot be adequate if caregivers have no knowledge, have wrong perceptions and perform inappropriate practices with regard to diarrhoeal management. Diarrhoeal conditions are a major cause of childhood hospitalization due to dehydration.

It is therefore an economic burden since caregivers loose working hours in the hospital and even lose their children to diarrhoea. There was need to explore caregivers’ knowledge, perception and practices on the management of diarrhoea at home to improve its outcome and consequently reduce mortality rate.

To effectively prevent and manage diarrhoea at home, it is important that the risk factors associated with diarrhoea management be investigated in the communities. However, local epidemiology and determinants of diarrhoeal management has not been researched. Most studies in Nigeria have focused on the prevalence and prevention of diarrhoea rather than its home management. With a prevailing high mortality rate of children less than five years old due to diarrhea, as was found in Edo, Benin city, this study would help local health care providers to reduce morbidity and mortality due to diarrhoea among young children in this area.

1.7 Significance of the Study

The findings of this study will be useful for planning and decision making at the Ministry, in educating the caregivers on management of diarrhoea at home. Knowing the perceptions of caregivers and the extent of their awareness in the management of diarrhoeal conditions will help scale up interventions to reduce morbidity and mortality due to diarrhoea among young children under five years old in the location. Appropriate management of diarrhoea at home can alleviate many of the consequences of diarrhoea which includes malnutrition, impaired development, growth faltering and mortality (Mwambete et al., 2010). Adequate knowledge on management of diarrhoea will reduce the number of children becoming dehydrated or malnourished from diarrhoea.