TABLE
OF CONTENTS
CHAPTER
ONE
1.1 BACKGROUND OF THE STUDY
1.2 Problem Statement
1.3 Justification
1.4 Research Objective
1.4.1 General Objective
1.4.2 Specific Objective
1.5 Research Questions
1.6 Scope of the Study
1.7 Operational Definition
CHAPTER
TWO
2.0 LITERATURE REVIEW
CHAPTER
THREE
METHODOLOGY
3.1 Study Design
3.2 Study
Setting
3.3 Data
Analyses
3.4 METHOD
OF DATA ANALYSIS
3.5 LIMITATION
OF THE STUDY
CHAPTER
FOUR
PRESENTATION
OF RESULTS AND ANALYSIS OF DATA
4.0 Introduction
4.1 Data Presentation
CHAPTER
FIVE
Discussion
of Findings
5.0 Introduction
5.1 Discussion of findings
5.2 Summary of findings
5.3 Limitation of the Study
5.4 Implication for Community Health
5.5 Conclusion
5.6 Recommendation
5.7 Suggestion for Further Study
REFERENCES
CHAPTER
ONE
1.1 BACKGROUND OF THE STUDY
Diarrheal
disease is highly preventable, yet accounts for nine percent of all deaths
among children under age five worldwide [Liu, 2013]. In 2013, this translated
into about 580,000 child deaths, or, on average, 1,600 children dying each day
due to preventable diarrhea [WHO, 2014].
Diarrhoea 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 [Ballabriga, et al 2000]. In diarrhoea, stool contains more water
than normal stool and is often called loose or watery stool. In certain cases,
they may contain blood in which case the diarrhoea is called dysentery [Obionu,
2007]. Any passage of three or more watery stools within a day [24 hours] is
referred to as diarrhoea [Cairncross et al, 2010].
Diarrhoea accounts for high levels of
mortality in young children in developing countries like Nigeria, despite
worldwide efforts to improve overall child health levels. Each year,third world
countries of Asia, Africa and Latin America, record approximately five million
deaths of children under five years of age from acute diarrhoea. About 80 per
cent of these deaths are in the first two years of life [Lucas & Gilles,
2009]. In the developing world as a whole, about one-third of infant and child
deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal 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 [Gupta & Mahajan, 2005]. UNICEF [2002] summated that in
Nigeria, infant mortality rates are twice as high in rural settings as they are
in urban ones due to poor hygiene and poor sanitation. About three million
infant births in Nigeria, approximately 170,000 result in deaths that are
mainly due to poor knowledge and management practices of childhood diarrhoea.
Several factors are likely to contribute to the high rate of diarrhoea
morbidity and mortality in children under-five years these include poverty,
female illiteracy, poor water supply and sanitation, poor hygiene practices and
inadequate health services [Park, 2009]. Malnutrition is another established
risk factor for mortality among children with diarrhoea disease. This may be
due to inadequate case management. In 2004, WHO and
UNICEF issued a joint statement on clinical treatment of acute diarrhea,
recommending the use of low-osmolarity oral rehydration salts [ORS], zinc
supplementation, increased amounts of appropriate fluids, and continued feeding
[WHO; 2014]. Treatment of diarrhea with ORS is a simple, proven, high-impact
intervention that can be provided in home settings by caretakers or by health
care providers at community and facility levels to prevent dehydration due to
diarrhea and decrease related deaths. The first line of management of diarrhoea is
therefore, the prevention of dehydration. This can also be achieved at home
using Oral Rehydration Therapy [ORT].
The consistency and the volume of stool
constitute how to classify diarrhoea. World Health Organization – WHO [2014]
classified diarrhoea as acute or persistent based on its duration. An episode
of diarrhoea that lasts less than two weeks is acute diarrhoea, while diarrhoea
that lasts more than two weeks is persistent. Calogero
et al[2000]
further classified diarrhoea according to its typology: Secretary Diarrhoea,
osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from
active process in the intestinal epithelium stimulated by the presence of
toxin, chemical or nutritional product in the intestinal linning. Osmotic
diarrhoea is caused by the presence in the intestinal linning of osmotically
active solutes that are poorly absorbed by the injection of laxatives such as
magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated
with damage to the mucosa lining leading to outpouring of mucus, blood and
plasma protein among other substances. However, it is important to note that
the classification of diarrhoea does not influence the cause.
Diarrhoea is a symptom of infection caused
by a host of bacterial, viral and parasitic organisms most of which can be
spread by contaminated water. Diarrhoea in most cases is caused by three major
groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites
[Lucas & Gilles, 2009]. The main agents of diarrhoea are enteroviruses
[e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera,
salmonella [non typhoid], entamoeba histolytica, giardia lamblia,
cryptosporidium]. These are further grouped in the following ways: Viruses
[e.g. Rota virus]; Bacteria [e.g. shigella, escherichia coli, vibrio cholerae,
salmonella non typhoid, campylobacter spp]. Parasites [e.g. entamoeba
histolytica, crytosporidium and giardia lamblia]. All over the world, viruses
especially rotavirus has been identified as the major cause of acute diarrhoea
in children. Studies in Nigeria also found viruses as the major causes of
diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20
per cent. Most of these pathogens are transmitted by faeco-oral route.
Childhood diarrhoea within the context of this study refers to any type of
loose, watery stool that occurs more frequently than usual in a child. The
various causative agents vary according to the signs and symptoms manifesting
from the disease.
The main
consequence of diarrhoea are frequent loose or watery stools, the risk of
dehydration, damage to intestine [especially when there is bloody diarrhoea]
and loss of appetite with or without vomiting. However, Victoria, Bryce,
Fountaine and Monasch [2000] asserted that signs of dehydration are not evident
until there is acute fluid loss of approximately 4-5 per cent of body weight.
The signs and symptoms of dehydration include sunken fontanels, dry mouth and
throat, fast and weak pulse, loss of skin elasticity and reduced amount of
urine. This loss leads to shock and untimely death of under-five. Werner [2001]
noted that dehydration takes its heaviest toll on infants and children
under-five. The signs and symptoms according to Longmach, Wilkinson and
Rajagopalan [2004] are passage of frequent loose watery stools, abdominal
cramps or pain, fever particularly if there is an infectious cause and
bleeding. Bacteria and parasites often can produce bloody diarrhoea
[dysentary]. In addition, inflammatory bowel disease, polyps and colorectal
cancer can cause blood and mucus in the stools, nausea and vomiting may also be
present in the case of infection.
1.2 Problem Statement
The diarrhea prevalence rate in Nigeria
is 18.8% and is one of the worst in sub-sahara Africa and above the average of
16%. Diarrhoea accounts for over 16% of child death in Nigeria and estimated
150,000 deaths mainly amongst children under five year occur annually due to
this disease mainly caused by poor sanitation and hygiene practice. Various
literature suggest 2.7% of prevalence
rate in Jos representing north central which include Nasarawa, Benue, Kogi
and Kwara State. (WHO Global Report for
research in infection diseases of poverty 2012 Geneva)
In Nigeria diarrhoea is responsible for
almost all child’s death in every year, Nigeria was estimated to have a total
number of annual child death due to diarrhoea to be 151,700 (WHO, 2009).
Diarrhoea was the most commonly reported cause of water borne infection in the
North West in Nigeria which include Kano, Jigawa, Katsina, Sokoto, Kebbi,
Zamfara and Kaduna with prevalence rate of 10%. (Unicef State of World Children
2013)
According to the manufacture instruction
using G zard generation Rida Screen Elisa kit (R Biopharm AG Germany) and
demographic data were collected via questionnaire to administered to
parent/guardians of the subject and analysis was done using online easy
chi-square (P<0.05) statistical package, show the prevalence rate of
diarrhoeal in north east state including Borno, Bauchi, Adamawa, Gombe, Taraba
and Yobe State is between 6.7% (40/600) and 5.0% (30/600) respectively across
the north east region (2013-2014). An hospital base study in Lagos reported a
prevalence rate of diarrhoea in South-West region of Nigeria that include
Lagos, Oyo, Ondo, Osun, Ogun and Ekiti State was found in 4/50 (8% 2010-2015).
(Unicef at glance Nigeria http//www.unicef.org/inferby conty)
Through World Health Organisation (WHO)
Research International (2015-2017) at University of Nsukka on prevalence rate
of diarrhoea across southeast which include Abia, Anambra, Ebonyi, Imo and
Enugu which present with prevalence rate of 57% and the prevalence rate for
diarrhoea in South South region of the country which include Akwa Ibom, Cross
river, Bayelsa, Rivers and Delta states has prevalent rate of 15.6%. (WHO
Geneva report for research on infection of disease of poverty 2012 Geneva).
Despite the several studies highlighted above cutting across most or all of the
geopolitical zones, diarroeal disease seem yet to be effectively controlled
within the Nigerian society.
1.3 Justification
Community-based strategy for
prevention and management of diarrhea disease among under five children
appeared not to have received adequate research attention. Finding out these,
certainly, will represent a positive step forward in the effort to promote the
childhood diarrhoea knowledge and management practices. Following from these
therefore, one is then inclined to ask, what are the community-based strategy
adopted for prevention and management of diarrhea diseases among under five
children in Oko-Erin community of Ilorin West local government? How effective
are these strategy adopted by the community? What are the factors influencing
the strategy towards achieving the desire goal?
1.5 Research Objective
1.4.1 General Objective
To investigate strategies put in place
by the community for prevention and management of diarrhoea among under five
children.
1.4.2 Specific Objective
1.
To assess the level of
knowledge of mothers on diarrhoeal; methods of prevention and treatment.
2.
To assess different
indigenous methods or strategies adopted for the prevention and management of
diarrhoea in the study area.
3.
To assess the
effectiveness of the strategies put in place by the Oko-Erin community towards
the management and prevention of diarrhoea among under five children.
4.
To investigate the
ability of such strategies to reduce morbidity and mortality due to diarrhoea
among under five children in the study area.
1.5 Research Questions
This
research work aims at providing answer to the following questions;
1.
What is the level of
knowledge of mothers on diarrhoeal; methods of prevention and treatment?
2.
What are different
indigenous methods or strategies adopted for the prevention and management of
diarrhoea in the study area?
3.
How effective are the
strategies put in place by the Oko-Erin community towards the management and
prevention of diarrhoea among under five children?
4.
What is the ability of
such strategies to reduce morbidity and mortality due to diarrhoea among under
five children in the study area?
1.6 Scope of the Study
This study covers the
community-based strategies in the prevention and management of diarrhoea among
under five in rural Nigeria using the study location as a case study. It
therefore, examines various home remedies in the treatment and management of
diarrhoea. This study gives attention to mothers and care givers who are directly
involved in the subject matter, that is, those whose child or children are
within the age bracket of this study and care givers including community health
workers/practitioners. Little attention is given to hospital diagnosis and
treatment of diarrhoea. The scope of this study is limited to children of under
five years of age while the data collection is also limited to Oko-Erin
community of Ilorin West local government of Kwara State.
1.7 Operational Definition
WHO: The World Health Organization (WHO) is a specialized agency of the
United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered
in Geneva, Switzerland.
Ø ORS : Oral Rehydration Solution (ORS) A liquid preparation developed by the World
Health Organization that can decrease fluid loss in persons with diarrhea
Ø ORT: Oral rehydration therapy (ORT) is a type of fluid replacement
used to prevent and treat dehydration, especially that due to diarrhea. It
involves drinking water with modest amounts of sugar and salts, specifically sodium and
potassium. Oral rehydration
therapy can also be given by
a nasogastric tube
Ø SSS: A solution of glucose-based salt solution used in oral rehydration therapy. WHO and UNICEF recommend a
single formulation of glucose-based ORS to treat or prevent dehydration from
diarrhea from any cause, including cholera, and in individuals of any age.
Ø VHW:Village Health Workers
those are people who volunteer themselves to the health services in a village
Ø RCH: Reproductive
and Child Health is a state of complete physical, mental and social well-being, and
not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes and functions.
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