Universal Journal of Public Health 5(1): 40-45, 2017 http://www.hrpub.

org
DOI: 10.13189/ujph.2017.050106

Awareness and Knowledge of Diarrhoeal Home
Management among Mothers of Under-five
in Ibadan, Nigeria
Olubunmi Omowumi Olopha*, Bolaji Egbewale

Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Ladoke Akintola University of Technology,
Nigeria

Copyright©2017 by authors, all rights reserved. Authors agree that this article remains permanently open access under the
terms of the Creative Commons Attribution License 4.0 International License

Abstract Improving maternal and child health care is Childhood stage of development is characterized by
one of the most utmost priorities of every responsible near-total dependence by the children on adults and health
society. Civilization is adjudged by the level of assistance care services provided by them. Under-five children
and help a society renders to its most vulnerable groups. constitute an important population group in terms of
Under-five children constitute an important population vulnerability to health conditions that could adversely affect
group in terms of vulnerability to health conditions that their health and well-being. Diarrhoea disease has been
could adversely affect their health and well-being. reported to be one of the most common causes of infant
Diarrhoea disease has been reported to be one of the most deaths especially in the developing countries of the world.
common causes of infant deaths especially in the The United Nation International Children Fund and World
developing countries of the world. Oral rehydration therapy Health Organization (UNICEF and WHO) [1] estimated that
(ORT) with oral rehydration solution (ORS) is the diarrhoea is responsible for nearly one in five deaths among
appropriate management of diarrhoeal dehydration and is children (about 1.5 million child`s deaths each year) which
the single most effective strategy in preventing diarrhoeal account for 16% of all under-five deaths every year.
deaths in children. The extent to which mothers of Diarrhoea is the passage of three or more loose or watery
under-five children can adopt this therapy is tied to their stools in a 24-hour period. It can be an increase in daily stool
level of knowledge on its efficacy and preparation. This fluidity, frequency or volume from what is considered to be
study was designed to examine awareness and knowledge normal for individual. It can be acute or chronic, and may
of ORS in diarrhea home management among mothers of also contain blood as in dysentery. Diarrhoea can result from
under-five in Ibadan. The cross-sectional descriptive survey a wide range of factors, which include infection such as
was employed in the study and data was generated from bacterial, protozoa and viral infections, examples are
households using a self-developed and validated rotavirus, cholera, and typhoid enteritis which are
questionnaire. Generated data were analysed using transmitted through the faecal-oral route. It can also be
descriptive statistics of frequency counts and percentages. non-infective origin such as dietary indiscretions and
Findings showed that while awareness of ORS in diarrhea problems of mal-digestion and mal-absorption [1].
prevention was high, knowledge relating to its preparation Available evidence shows that diarrhoea poses a grave
and use was found to be low. Population-specific health threat to child health and well-being in Nigeria. It has
intervention to improve knowledge of under-five mothers been estimated that more than 194,000 Nigerian children die
on diarrhea home management was recommended. of diarrhoea annually [2]. 94% of diarrhoea disease burden
in Nigeria has been attributable to the environment and
Keywords Diarrhoea, Home Management, ORS, associated with risk factors such as unsafe drinking water,
Under-five Mothers lack of sanitation and poor hygiene [3]. In the same vein,
other researchers reported that poor weaning methods which
promote bottle feeding and insanitary environment also
make the children susceptible to infections [4]. It is also
1. Introduction important to report that adherence to superstitious beliefs
and traditions and acceptance of incorrect facts with respect
Civilizations are adjudged by the level of assistance and to the causes and management of diarrhoea has also
care a society can render for its most vulnerable populations. contributed immensely to the worrisome burden of diarrhoea

This distribution of drugs through the private market. Mothers are the key caregivers to under-five 3. A study by Mellinda [15] on the has. disease is critically important. mothers’ rotavirus is the most frequent etiological agent of diarrhoeal poor knowledge and attitude about the cause of diarrhoea [6] and of the bacterial infectious agents. it is very and salt. the management as researchers agreed that it is the hallmark of study aims at investigating and documenting: diarrhoea control programme in Nigeria [4. 12]. Specifically. because almost any kind of drug (including preventing diarrhoeal deaths in children. dehydration. However. was reviewed by UNICEF/WHO through which a joint Its use has been recommended by World Health statement was released in 2004 has stated clearly the Organization (WHO) Homemade sugar and salt solution guidelines for diarrhoea management with emphasis on oral (SSS) is not quite as good as commercial oral rehydration rehydration therapy. The diarrhoeal considered as inexpensive and can be easily administered at control programme launched by the WHO in 1978 which home by the mothers as soon as a diarrhoea episode begins. more slowdown has been explained by ignorance of ORT. which have countries with high-mortality due to diarrhoea such as contributed to a significant decline in mortality among Nigeria. and lack of conviction by medical staff analgesics and anti-diarrhoea drugs are being employed about its effectiveness [11]. their knowledge about this common diarrhoea related death among children. On the paramount importance to reduce diarrhoea-related causative factor of the disease. cause convulsions. salts (ORS). has the major risk factors for death from diarrhoea. and inexpensive treatments. use of zinc tablets. Therefore. 2) Knowledge of diarrhoea home management among correct feeding during diarrhoeal episodes and recognition of respondents time to seek health care) lies on the fact that diarrhoea starts at home. awareness and knowledge of diarrhoea home management Adequate knowledge in correct measurement techniques are among mothers of under-five in urban and peri-urban essential for the preparation of oral rehydration solutions but locations in Ibadan. Escherichia coli are might limit them from taking appropriate timely actions. Oral rehydration therapy (ort) with oral rehydration Similarly. O'Reilly. too much salt can. since the 1970s. in diarrhoeal stools. effective. Research Questions children. ORT use treatment from private retailers such as pharmacies and drug experienced a growth rate of 9% between 1995 and 2010. recommended oral rehydration therapy effect of oral rehydration solution (ORS) and recommended (ORT) [9]. ORT during bouts of diarrhoea consists of using home fluids (RHFs) on diarrhoea mortality showed that ORS either a solution prepared from sachets of oral rehydration may reduce diarrhoea mortality by up to 93% in home. If the solution has too much salt the child may refuse to drink it. They are the ones who decide about the type of food given to the child and the overall management of the The study provided answers to the following research . 2017 41 in Nigeria [4]. sugar community and facility settings. known as the salt-sugar solution (SSS). in extreme cases. solution as it does not contain potassium. widespread misuse. This study was designed to examine the diarrhoea is easily preventable by this simple therapy. On the other hand. the World Health Organization (WHO) can often be prevented. and individual as well as nutritional status. and continues at home on return after being seen at a health facility. This is worsened by the risk of unregulated compared to 30% growth between 1980 and 1995 [10]. Tate and Parsons [5] stated that poor and perception towards diarrhoea. Nyaguara. shops. This therapy is rational use of drugs and education of parents regarding readily available and often lifesaving and death from home management. Too little salt does no harm but is less effective in preventing The main objective of this study is to investigate dehydration. ORS has been antibiotics) can be sold over the counter. In order to fight child is correctly fed. Universal Journal of Public Health 5(1): 40-45. when they are not indicated [16]. its expensive and ineffective treatments such as antibiotics. the major pathogens afflicting children aged less than five According to Uchendu and Emoli [14] a lot of fluid is lost years [7]. Jaron. studies have revealed that morbidities and mortalities [13]. Wessells and Brown [17] also submitted that solution (ORS) is the appropriate management of diarrhoeal this problem has increased and has reached enormous dehydration and is the single most effective strategy in proportions. The 1) Awareness level of respondents on diarrhoea home importance of home management of diarrhoea (which management essentially is administration of fluid. 2. and lack of breastfeeding are household actions to prevent and/or manage the disease. dehydration and nutritional damage against dehydration. dangerous or ineffective solutions may also result from the inherent variability of the method and ingredients. continued feeding during diarrhoea. Awareness of management Ochieng. Still on factors increasing vulnerability to disease. These are important to make use of ORS that is correctly prepared. or a solution prepared at home with water. and if suitable fluids are given in Most of diarrhoeal episodes are self-limited however the adequate volumes soon after the onset of diarrhoea and the mortality is primarily due to dehydration [8]. the prevailing practice among mothers is to seek children less than five years of age [10]. awareness and knowledge of diarrhoea home management Home treatment is an essential part of diarrhoeal among mothers of under-five in Ibadan. In simple. Research Objectives Also.

management among mothers of under-five children in The target population constituted mothers of under-five in a Ibadan? community based household survey. local Freq Percent governments in the study area were stratified into urban and Items Variables .9 three LGAs were randomly selected from the two strata to children with diarrhoea: I don’t know 253 60.9% answered `no` to this question..7% wrongly stated administration of zinc twice.3%) 5. Awareness of ORS in Diarrhoeal Home Management under-five diarrhoea in Ibadan? 2) What is the level of knowledge of diarrhoeal home Yes No management among mothers of under-five children in Have you heard of oral rehydration solution as 385 33 a means of managing childhood diarrhoea at Ibadan? (92.5 make six LGAs.0% of the respondents conducted for five months with the assistance of seven correctly reported administration of zinc tablet or suspension research assistants. Since this study aimed at surveying the level of awareness and knowledge of diarrhea disease among Question Two mothers of under-five children. only 10-14 days of the respondents correctly What is the level of awareness of mothers on the use of reported that zinc is given 10-14 days with the largest .1 five years was omitted until 35 mothers/primary care givers Zinc is given for were surveyed in each of the 12 selected wards to make 420 7days 13 3.3% and 0. At the first sampling stage. Ethical approval for the study was obtained know. Lower level of knowledge was reported on the timing from Oyo State Ministry of Health and the fieldwork was of zinc administration as only 17. This level of suitability in finding answers to the research problem.9%) home? The table above shows the information about the status of 4. 5. the descriptive survey What is the level of knowledge of diarrhoeal home research design was adopted as the most appropriate design.5%) stated that they do not percentages.3 households in each of the selected wards. The instrument for data I don’t know 316 75. At the second sampling stage. Respondents’ Knowledge of Diarrhoeal Home Management: Use of Zinc sampling procedure.7 the study were drawn at household level by visiting all Zinc is given Thrice daily 14 3. Respondents for Twice daily 24 5. 3. Moreover. age peri-urban strata with each containing five and six local Zinc tablet or Yes 136 32. A sample of 420 respondents was selected for the study using a multistage Table 2.7%.4 language.0 selected LGAs to make a total of 12wards. Nigeria questions: oral rehydration solution in home management of under-five 1) What is the level of awareness of mothers on the use of diarrhoea in Ibadan? oral rehydration solution in home management of Table 1. the largest proportion of the respondents (72. The inclusion criterion was having at least one child 10-14 days 45 10.5% of the respondents rightly indicated that zinc knowledge of home management of diarrhea using zinc as tablet or suspension could be used in managing childhood well as ORS and SSS.6 collection in the study was a self-developed structured and validated questionnaire with a reliability of 0.78 Cronbach Findings of the study also reported poor level of Alpha. On the duration of zinc Question One administration. Results reported not having knowledge of the timing of administration of zinc. This awareness would only be considered advantageous if it design is employed when a researcher is interested in reflects in improved knowledge of ORS preparation as well surveying and describing variables of interests and their as in its utilization. Any household that did not have children below 5days 13 3.3 structured questionnaire that has been translated to local 3days 31 7.7 that is below five years old.42 Awareness and Knowledge of Diarrhoeal Home Management among Mothers of Under-five in Ibadan.9% erroneously indicated ‘no’ while the largest using descriptive statistics of frequency counts and proportion of the respondents (60.7 or primary care givers of children below five years using the I don’t know 306 72. suspension is used for No 29 6. Methodology awareness of respondents on the use of ORS in diarrhoeal control.1%) (7. The instrument was designed to generate data on knowledge of childhood diarrhoea management in table3 as awareness and knowledge of diarrhea as well as on only 32. 6. The third stage involved simple random sampling technique to select two wards from each of the six Daily 71 17.1) of mothers stated that they are aware of ORS while cross-sectional type was employed in the study because of its only 7.1 duration of in all.5 government areas respectively. daily. It is evident in this table that a significant percentage The descriptive survey research design of the (92. relationship how they naturally occur without any attempt to manipulate them. thrice and four times daily respectively. surveying mothers Four times daily 3 . The generated data were analyzed diarrhoea.

the prospect of How soon should After three days 16 3. Anyanwu and Okeke (20) noted that stated that ORS should be administered soon after the knowledge serves as the basis upon which right attitude is first/second motion of watery stool.5% stated that they do not know. Universal Journal of Public Health 5(1): 40-45.4% reported the use administration of ORS. Although a little purpose of ORS is to replace body salts. diarrhoea while 15.6%) correctly health behaviour.0 motion even higher awareness level (95. Odili. Reduce the duration of 21 5.7 they might not have scientific and accurate information regarding its preparation and use. 14. findings showed respectively.3 as experiences shared among mothers of under-five. Eko. 5.4%).6% reported that they do Findings showed that over 82% of the respondents’ not know. 1. a little above 50% reported that the of diarrhoea home management using ORS. on the administration of ORS. In the same vein.4 ORS in home management of childhood diarrhoea is ORS is given with Cup and spoon 338 80. In largest proportion of the respondents (54.2 under-five children in Calabar.2% reported reported low level of knowledge of diarrhoea home every hour. The result of the study also showed of feeding bottle while 4.8% reported the use of forced that the largest proportion of the respondents do not have feeding. translate to knowledge.0% reported that the purpose is for reduction of non-negligible proportion demonstrated lack of this basic diarrhoea.1 level of over 90% among their respondents in another study I don’t know 40 9. diarrhoea. 27. Just as envisaged. although.0 Although over 90% of the respondents indicated being aware diarrhoea of ORS in diarrhoea management.7 It is also in line with the findings of Olakunle.6 awareness.6 ORS in diarrhoea home management support the earlier After each bowel findings of Osonwa. However. making effort to seek information that could tilt watery stool noticed awareness to knowledge level is enhanced. 25.4 in diarrhoea proportion of the respondents reported awareness of ORS. awareness does not The work of Replace the body salts.6 watery stool have awareness about a particular therapy. after each bowel motion and after vomiting management.6 in Nigeria. On the commencement of ORS administration. With high level of ORS/SSS start first/second motion of 228 54. energy and water above 50% of the respondents correctly stated that the lost in diarrhoea.8% reported health behaviour.6%.7% reported administration to prevent that respondents demonstrated incorrect knowledge.8 consciousness needed to improve information seeking After two days of regarding preparation and use of ORS.8 seeking more information to deepen knowledge about that the use of Soon after the therapy would be greatly lowered. another major Nigerian city.6% stated that it built thereby resulting in manifestation of the appropriate should commence two days after while 3. The result of the study indicated a high level of awareness Table 3. administration: It is given To prevent diarrhoea 7 1.1% rightly reported that ORS should be findings of Macdonald. findings showed that about 80% of the respondents rightly On the administration of ORS.1 the study that reported high level of awareness on the use of Every hour 65 15.5 level of awareness on the existence and probably potency of Feeding bottle 60 14.0% and 2. When one does not 107 25. ORS and diarrhoea home management is in line with the However. the correct knowledge on frequent administration of ORS. 28.7% reported the purpose for prevention of knowledge. Moreover. For the fact that a substantial ORS is to energy and water lost 215 51.3% reported that the purpose is to stop purpose of ORS in replacing lost solute. the result of the study on knowledge of On the knowledge of the purpose of ORS in diarrhoea diarrhoea home management showed that the level of management. water and energy. The findings of I don’t know 67 16. Respondents’ knowledge of Diarrhoeal Home management: Use of ORS in under-five diarrhoea home management.6%) reporting that they do not know the 6. Discussions of Findings duration of zinc administration. having a high I don’t know 65 15. the largest proportion of disclosed the use of spoon and cup. 2017 43 proportion (75. Percentage information on child care during immunization visits as well Stop diarrhoea 114 27. The relatively low level of knowledge on commencement after three days of noticing watery stool. another the respondents (80.9%) rightly reported that children are 54% of the respondents correctly stated the timing of given ORS/SSS using cup and spoon. 0. and Ema [18] who reported an 117 28. only 43. Moralejo and Mathew [21] who administered frequently. before it starts Kamaldeen and Buhar [19] who also reported awareness Frequently 180 43. On the preparation of ORS. This of ORS/SSS high level of awareness can be attributable to exposures to Items Variables Freq. demonstrated incorrect knowledge of ORS preparation with . 15.5%) among mothers of Timing of ORS After vomiting 9 2. diarrhoea before its onset while 9.9 important as this awareness could trigger or stimulate By force feeding 20 4. Prevents diarrhoea 3 . findings showed that the largest proportion awareness on ORS did not translate to high knowledge level (51.

Otengah P. (2012). attitude. Nurs MidwiferyStud.J. K. 1: 8.Malawi Med J. preparation and use in under-five diarrhoea management at [7] El-Mohammady H. this diarrhoea in the Gambia: knowledge. Available from: is an alternative to ORS. Ovung.1371/journal.2008. Epub 2012 Nov 29. M. Pre-hospital management of diarrhoea among caregivers resenting at a tertiary health institution: implications for practice and health education. B. Fitzwater S.. The use of oral although under-five mothers in Ibadan have a high level of rehydration salt in managing children under 5 years old with awareness of ORS in diarrhoea home management. (2009). awareness level is not reflected in knowledge of ORS Nutrition. (2011). and Chao JC. and 4) The use of peer based diarrhoea management education Coppieters. (2013).pone. disseminating diarrhoea management information to Cameroon. [5] O'Reilly. New (2009). Retrieved 12th March 2016 necessary steps including timely hospital visit [10] Santosham M. Accessed: targeted health education to address knowledge gap rather April 2015 than mere creation of awareness on ORS use in diarrhoea home management. Oral Rehydration Therapy in Children [1] UNICEF/WHO. S. Mansour A. African Health Sciences 11(1):41-47. M.1371/journal.who. MasoudiAlavi N.org/content/early. H. Diarrhoeal disease fact sheet. Ochieng. it is concluded that [6] Sillah F.O. [3] WHO (2006). behaviour-change targeted interventions aimed at [9] WHO (2009). 376: 63–67. Based on this...pmed.I. (2012). U. sanitation and hygiene: interventions to York: UNICEF.com/coms2/summary_0286-31765 Children's Fund. 79(4):472-7.J. 2010. Indian Journal of efforts from mere awareness creation to Pediatricsr.. 2015 [2] UNICEF. Raji T. (2013). Limitation of the Study 158–62. combat childhood diarrhoea in developing countries. White. 5(3):142-146. Implementing the New Recommendations on the Clinical Management of Diarrhoea: Guidelines for Policy [17] Wessells.R... Attitude and Practice of Home Management 0050568.1%) demonstrating incorrect of Childhood Diarrhoea among Caregivers of Under-5 knowledge of preparation of salt-sugar solution (SSS) which Children with Diarrhoeal Disease in Northwestern Nigeria. Estimating the global Makers and Programme Managers.G. Knowledge. Geneva prevalence of zinc deficiency: results based on zinc availability in national food supplies and the prevalence of [4] Ogunrinde O. D. Talebian A.C. doi: 10. (2013) Progress and barriers for the mothers on technical know-how in under-five diarrhoea control of diarrhoeal disease. Snilstveit. Y. Pneumonia and Diarrhoea: Tackling the [16] Waddington.B et al. Lancet. Fischer-Walker C.. 2005-2007: a cohort study.. home.1001256.A and Anigo KM. stunting. The major limitation in this study is that it relied on [13] Othero D. Iran.oxfordjournals. Shaheen HI. (2015) Use of oral rehydration therapy in the might be considered as potent and effective in treatment of childhood diarrhoea in Douala. Deadliest Diseases for the World’s Poorest Children. Conclusion and Recommendations 2012. Ngwe. Health. Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya. recommended (2012).html. Increase in the detection 1) Target health educational programme aimed at rate of viral and parasitic enteric pathogens among Egyptian improving knowledge of mothers on diarrhea home children with acute diarrhea. Ho HJ. Koum. Mousavi GA. and Brown K. .. [14] Uchendu. H. Groenewegen T. management using ORS and SSS is strongly [8] Patel A. Black R. Tate. M.. PlosOne 7(11): e50568. 29(11-12): 1368-73. 27(2): 60–64 mothers of under-five.accesslibrary. 7.J Accessed July. and practice. Available from: dying and what can be done. Diarrhoea: Why children are still with Acute Gastroenteritis.E.B. 6(11):774-81. and Parsons. [Online] empowering mothers with requisite knowledge and Available at http://www. Owolabi O. 2012. [12] Ghasemi AA. NewYork:United Nations http://www. P. in Kashan. doi: 10.. Orago A. J. Adiogo. Chandran A. New Delhi: International Initiative for Impact Evaluation. Journal of Tropic Pediatric. Knowledge of mothers in management of diarrhoea in underfive children. REFERENCES [15] Melinda G. 453ITM. I. 2007. Corroborative observational data would perception and practices. Home management of diarrhoea among retrospective self-reported information given by the under-five in a rural community in Kenya: Household mothers/care givers. Jaron. R. Nyaguara. the following are recommended: Motawea MS and Raafat I (2012).B. (2006)..44 Awareness and Knowledge of Diarrhoeal Home Management among Mothers of Under-five in Ibadan..and Dibley M. This has great implication for http://tropej..Badhoniya. D. et al.E. 9(7):e1001256. PlosMed... . Risk factors for predicting diarrheal duration and 2) Health care providers must tilt health information morbidity in children with acute diarrhea. Epub 2012 Jul 3 From the outcome of the study.E. Henien NH. and Fewtrell L. A. and Emoli.int/mediacentre/factsheets/fs33 skill to identify diarrhea signs and symptoms and rake 0/en/index. C.H. East African Journal of Public have been useful for such things as ORS use. 3) The mass media could be put into good use in educating Baqui AH. Nigeria an even higher percentage (93. prevention and home management [11] Essomba N.O. Water. Kaseje D. B. N.

. 2017 45 [18] OsonwaKalu O. Kamaldeen A. and its influence on ORS use in Indonesia. Eko Jimmy E. M. (2016). U. D.G. 19 (1): 34 – 39. Asia-Pacific IJPRBS.. Journal of Public Health. (2016). Odili V. E. Universal Journal of Public Health 5(1): 40-45. 1(4): 168-184.. 4(1):28-37 4(1):58-64 [19] Olakunle J.K. and Mathews.C &Okeke. Assessment of mothers’ knowledge of home Maternal Understanding of Diarrhoea – Related Dehydration management of childhood diarrhoea in a Nigerian setting. and Buhari M.. Utilization of [20] Anyanwu. American Assessment. S. Moralejo. M.. F. Nigeria. (2012). [21] MacDonald. Universal Journal of Educational Research Journal of Public Health Research. Ema S. Retooling Assessment Oral Rehydration Therapy in the Management of Diarrhoea in Procedures for Skill-based Health Education for Young Children among Nursing Mothers in Odukpani Local People in Nigeria: Implications for 21st Century Educational Government Area of Cross River State..R. (2007).