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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 127-131

Knowledge and perceptions of mothers of under-five children attending a tertiary care hospital about childhood diarrhea: A cross-sectional study


1 Department of Physiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Paediatrics, Agartala Government Medical College, GB Pant Hospital, Agartala, West Tripura, India

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. Nilratan Majumder
Department of Paediatrics, Agartala Government Medical College, GB Pant Hospital, Agartala - 799 001, West Tripura
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_43_19

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  Abstract 


CONTEXT: Diarrhea is a major cause of morbidity and mortality among young children. The incidence of diarrhea has remained almost unchanged over the years, highlighting the scope of prevention. A mother is the primary caregiver of a child. Her perceptions and knowledge of a disease determine her care-seeking behavior and health of the child by extension.
AIM: The aim of the present study was to assess the level of knowledge of mothers about different aspects of childhood diarrhea.
SETTINGS AND DESIGN: A hospital-based, descriptive cross-sectional study was carried out in the Department of Paediatrics, Agartala Government Medical College and G. B. Pant Hospital, Agartala, Tripura, over a period of 2 months.
MATERIALS AND METHODS: The sample size for the study was 700. Convenience sampling technique was used to interview 700 mothers of under-five children, using a predesigned structured interview format.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 13. Descriptive statistics and Chi-square test were used for analysis. P < 0.05 was considered as statistically significant.
RESULTS: Majority of the mothers had a correct perception of the symptoms and causes of diarrhea. Most of them also knew about the importance of handwashing and had also heard about oral rehydration solution (ORS). However, their awareness about the warning signs indicating severe dehydration and the role of ORS in diarrhea was very poor. Educational level was found to be significantly associated with the knowledge.
CONCLUSIONS: To bring down the mortality rate, mothers have to be made aware of the warning signs and the role of ORS because adequate knowledge is a critical component of the decision-making process.

Keywords: Childhood diarrhea, knowledge, mothers, under-fives


How to cite this article:
Dhar DK, Majumder N. Knowledge and perceptions of mothers of under-five children attending a tertiary care hospital about childhood diarrhea: A cross-sectional study. Indian J Health Sci Biomed Res 2019;12:127-31

How to cite this URL:
Dhar DK, Majumder N. Knowledge and perceptions of mothers of under-five children attending a tertiary care hospital about childhood diarrhea: A cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Aug 24];12:127-31. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/127/259643




  Introduction Top


Diarrhea is a major cause of morbidity and mortality among young children. Globally, an estimated 1.8 billion cases of childhood diarrhea are reported, and it is estimated that 17% of all deaths among the under-fives occur due to diarrhea. Most of these cases occur in the developing countries like India. Childhood diarrhea remains an important public health concern as well as a significant cause of visit to hospitals. It is known that death in diarrhea is caused due to dehydration and its consequent effects on the body's fluid and electrolyte homeostasis. It is estimated that 60%–70% of diarrhea-related deaths are caused by dehydration.[1] While global mortality may be declining, the overall incidence of diarrhea remains unchanged at about 3.2 episodes per child per year. The World Health Organization (WHO) suspects that there are >700 million episodes of diarrhea annually in children <5 years of age in developing countries.[2]

The occurrence of diarrhea can be prevented to a large extent if cleanliness and hygiene are adhered to in the household. The consequent deaths too can be avoided greatly if the primary caregiver, in most instances, the mother of the affected child is able to identify the signs of dehydration and initiates prompt rehydration measures with the help of oral rehydration solution (ORS) or any locally and culturally acceptable fluid even before transferring the patient to a health-care facility. The WHO and UNICEF recommend the use of low osmolarity ORS for the correction and prevention of dehydration and 10–20 mg of zinc for 10–14 days as treatment for all episodes of diarrhea.[3],[4]

In this regard, the levels of awareness and knowledge of the caregivers, mainly the mothers, regarding childhood diarrhea are very important because knowledge determines her attitude and practices about health seeking. Poor or delayed “health-care seeking” contributes to 70% of child deaths.[5],[6] Mothers' knowledge about diarrhea again depends on various factors such as educational status, occupation, and prior experience of managing the disease. The present study was, therefore, carried out to assess the level of knowledge and perceptions of mothers about different aspects of childhood diarrhea from causes to its prevention and management.


  Materials and Methods Top


A descriptive study was carried out in the pediatric outpatient department (OPD) of a government tertiary care hospital over a period of 2 months. Mothers of under-five children visiting the pediatric OPD were included as participants for the study. Those who were not willing to participate were excluded from the study.

A total of 700 mothers fulfilling the selection criteria were interviewed with the aid of a predesigned and structured interview schedule. Convenience sampling method was used while recording the data. The targeted sample size of 700 was covered over a 2-month (8 weeks) period by interviewing around 90 mothers per week. Considering the fact that OPD remains closed on Sundays, the first 15 registered mothers who met the selection criteria were interviewed in a one-by-one, face-to-face manner over the remaining 6 days of the week. This ensured uniformity of sampling. Approval was obtained from the institutional ethics committee before the study. Informed consent was obtained from every respondent before starting the interview, and information thus obtained was dealt with confidentiality. The data thus obtained were entered in computer using SPSS version 13 (SPSS Inc., Chicago, USA) software. Descriptive statistics and suitable statistical tests such as Chi-square test were applied. P < 0.05 was considered as statistically significant.


  Results Top


The perceptions of mothers about the symptoms of diarrhea are shown in [Figure 1], clearly highlighting that watery stools and increased frequency of stools were most commonly perceived as diarrhea. Knowledge and perceptions about the causes of diarrhea and warning signs of severe dehydration are indicated in [Table 1]. Knowledge of mothers regarding ORS and importance of handwashing and food hygiene in the prevention of diarrhea is depicted in [Table 2]. The level of education of mothers was found to be significantly associated with the level of awareness and proper knowledge on these issues. The sources from where mothers came to know about ORS are shown in [Figure 2].
Figure 1: Knowledge of mothers about the symptoms of diarrhea

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Table 1: Knowledge about causes of diarrhea and warning signs of severe dehydration

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Table 2: Knowledge of mothers regarding oral rehydration solution and handwashing in the prevention of diarrhea

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Figure 2: Sources of information about oral rehydration solution among mothers who had heard of it

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  Discussion Top


The findings of the present study showed similarities as well as certain points of discord when compared with other similar works. In the present study, majority of the mothers had a correct perception of the symptoms and causes of diarrhea. Most of them also knew about the importance of handwashing and had also heard about ORS, highlighting the good penetration of various health-care programs and proper dissemination of knowledge on the issue. However, their awareness about the warning signs indicating severe dehydration and the role of ORS in diarrhea was very poor. It was also observed that education level of the mother was found to be a significant determinant of her knowledge on diarrhea and by extension, the care that a sick child would receive.

In our study, we found that most of the mothers related to increased frequency or passage of watery stools as the common presentation of diarrhea. Padhy et al.[7] observed that nearly half of the mothers had good knowledge about what is diarrhea. However, in a similar study by Saunders N,[8] fever was recognized as a feature by 82% of mothers. With regard to signs by which mothers assessed the severity, our findings were similar to a study by UNICEF[9] where “Child was having too many stools” and “child was feeling very weak” were commonly associated with severe diarrhea. Kaur et al.[10] in their study had reported that mothers perceived eight or more watery stools per day (41.6%) and excessive sleepiness (54.1%) as the danger signs. Mukhtar et al.[11] in their study in Nepal reported that majority (about 79%) of the mothers viewed thin watery diarrhea being the most serious type. Padhy et al.[7] reported in their study that only one-third of the mothers had knowledge about the danger signs. A Mexico-based study by Pérez-Cuevas et al.,[12] however, found that clinical signs that were statistically associated with the decision of intervention were bloody diarrhea, vomiting, illness longer than 3 days, weight loss, and fever. As far as the cause of diarrhea is concerned, we found that the consumption of unhygienic food or leftover was the most prevalent opinion (29.9%). This is almost near to the findings of Kaur et al.[10] and Amare et al.[13]

It also came forward in the course of our study that 75% of the mothers had heard earlier about ORS, and among them, 55.05% knew about it from health-care facilities such as hospitals, primary health centers, subcenters, and dispensaries. It was very similar to studies conducted by Akhtaruzzaman et al.,[14] Raghu et al.,[15] and UNICEF.[9] Even higher level of awareness was reported in studies by Ashoka and Khatri[16] and Sultana et al.[17] A similar study in Lahore by Seyal and Hanif revealed that 27% of the mothers used ORS from their own knowledge where newspapers, television, neighbors, or previous consultation by the doctor acted as sources.[18] Saunders in their study found knowledge about ORS to be surprisingly very low (1.5%). With regard to how ORS helps in diarrhea, our findings were in near resonance with Mukhtar et al.[11] In contrast, a study by Rasania et al.[1] reported much higher levels of knowledge where 69.8% of the mothers knew about the role of ORS during diarrhea. With regard to the role of proper handwashing and food hygiene in the preventive aspects, the findings of our study were very reassuring with nearly 90% of the mothers being aware of it. A study from Jamaica[19] had concluded that children of caregivers with low knowledge scores about the prevention and treatment of diarrhea were at increased risk of presenting with gastroenteritis.

The few differences in the knowledge patterns that came up in light of this comparative discussion can be ascribed to the factors such as variation in the level of education in societies and communities, the absence or presence of prior experience of managing a child with diarrhea either directly or in the family, and locally prevalent sociocultural practices and misconceptions.

As the present study was conducted in a government tertiary care hospital, the findings reflect the pattern of awareness and perceptions about childhood diarrhea over a wide spectrum of the population in its catchment area. However, multicentric studies in different states need to be carried out to get a more holistic picture and consider suggestions at the administrative and policy level.


  Conclusions Top


Knowledge and awareness about a disease is one of the critical components of the management because it directly influences the practices and health-care seeking. Early identification of the danger signs indicating severe dehydration is very important because it directly influences the decision-making process of the mother about the type of intervention, whether home-based care would suffice or hospital-based medical assistance would be required. This is especially important as warning signs indicate impending worsening of the condition of the child and warrant immediate intervention. Hence, if mother fails to recognize them, the life of the affected child remains at jeopardy. Adequate knowledge on causes and prevention would, in the long run, reduce the incidence of childhood diarrhea; but, to bring down the mortality rate, mothers have to be made aware of the warning signs and the role of ORS. And in this context, education remains the single most important social element of this intervention.

Acknowledgment

The study was conducted as a part of the Short-Term Studentship program of the Indian Council of Medical Research (ICMR), New Delhi, in 2013 and the report accepted. The support offered by ICMR is gratefully acknowledged by the authors.

Financial support and sponsorship

This study was financially supported by the ICMR, New Delhi, as part of Short-Term Studentship program.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rasania SK, Singh D, Pathi S, Matta S, Singh S. Knowledge and attitude of mothers about oral rehydration solution in few urban slum of Delhi. Health and Population- Perspectives and issues 2005;28:100-7.  Back to cited text no. 1
    
2.
Pomerance HH. Nelson textbook of pediatrics. Arch Pediatr Adolesc Med 1997;151:324.  Back to cited text no. 2
    
3.
Chiabi A, Monebenimp F, Bogne JB, Takou V, Ndikontar R, Nankap M, et al. Current approach in the management of Diarrhoea in children: From theory and research to practice and pragmatism. Clin Mother Child Health 2010;7 (N°1):1243-51.  Back to cited text no. 3
    
4.
Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials. Zinc investigators' collaborative group. J Pediatr 1999;135:689-97.  Back to cited text no. 4
    
5.
Högberg U. The world health report 2005: “make every mother and child count” – Including Africans. Scand J Public Health 2005;33:409-11.  Back to cited text no. 5
    
6.
Umuhoza C, Karambizi AC, Tuyisenge L, Cartledge P. Caregiver delay in seeking healthcare during the acute phase of pediatric illness, Kigali, Rwanda. Pan Afr Med J 2018;30:160.  Back to cited text no. 6
    
7.
Padhy S, Sethi KR, Behera N. Mother's knowledge, attitude and practice regarding prevention and management of diarrhoea in children in Southern Odisha. Int J Contemp Pediatr 2017;4:966-71.  Back to cited text no. 7
    
8.
Saunders N. Maternal Knowledge, Attitudes and Practices Concerning Child Health among Mothers of Children Younger than 60 Months in Kep district, Kingdom of Cambodia. Final Report: 9; 2005.  Back to cited text no. 8
    
9.
UNICEF. Management Practices for Childhood Diarrhoea in India 2009. UNICEF; 2009. p. 4-7.  Back to cited text no. 9
    
10.
Kaur A, Chowdhury S, Kumar R. Mothers' beliefs and practices regarding prevention and management of diarrheal diseases. Indian Pediatr 1994;31:55-7.  Back to cited text no. 10
    
11.
Mukhtar A, Mohamed Izham MI, Pathiyil RS. A survey of mothers' knowledge about childhood diarrhoea and its management among a marginalised community of Morang, Nepal. Australas Med J 2011;4:474-9.  Back to cited text no. 11
    
12.
Pérez-Cuevas R, Guiscafré H, Romero G, Rodríguez L, Gutiérrez G. Mothers' health-seeking behaviour in acute diarrhoea in Tlaxcala, Mexico. J Diarrhoeal Dis Res 1996;14:260-8.  Back to cited text no. 12
    
13.
Amare D, Dereje B, Kassie B, Tessema M, Mullu G, Alene B, et al. Maternal knowledge and practice towards diarrhoea management in under five children in Fenote Selam Town, West Gojjam Zone, Amhara Regional State, Northwest Ethiopia, 2014. J Infect Dis Ther 2014;2:182. doi:10.4172/2332-0877.1000182.  Back to cited text no. 13
    
14.
Akhtaruzzaman M, Hossain MA, Khan RH, Karim MR, Choudhury AM, Islam MS, et al. Knowledge and practices of mothers on childhood diarrhoea and its management attended at a tertiary hospital in Bangladesh. Mymensingh Med J 2015;24:269-75.  Back to cited text no. 14
    
15.
Raghu MB, Balasubramanian S, Indumathy, Balasubrahmanyam G. Awareness of and attitude towards oral rehydration therapy. Indian J Pediatr 1995;62:439-43.  Back to cited text no. 15
    
16.
Ashoka BA, Khatri PC. Knowledge, attitude and practices of mothers in Rustaq district, Sultanate of Oman. Oman Medical Journal May 1996;12:12-7.  Back to cited text no. 16
    
17.
Sultana A, Riaz R, Ahmed R, Khurshid R. Knowledge and attitude of mothers regarding oral rehydration salt. J Rawalpindi Med Coll 2010;14:109-11.  Back to cited text no. 17
    
18.
Seyal T, Hanif A. Knowledge, attitude and practices of the mothers and doctors regarding feeding, oral rehydration solution (ORS) and use of drugs in children during acute diarrhoea. Annals 2009;15:38-41.  Back to cited text no. 18
    
19.
Bachrach LR, Gardner JM. Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica. Rev Panam Salud Publica 2002;12:37-44.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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