MATERNAL KNOWLEDGE AND PRACTICE OF ORAL REHYDRATION THERAPY IN THE MANAGEMENT OF DIARRHEA AMONG INFANTS AND YOUNG CHILDREN IN NIGERIA

 

 

 

Diarrhea is the second leading cause of child morbidity and mortality, especially in the developing countries. Diarrhea is defined as passage of three or more loose or watery stools in a 24-hr period, a lose stool being one that would take the shape of the container. It is estimated that there are 2.5 billion episodes and 1.5 million deaths annually in children under-five years of age. This accounts for 21% of all the deaths in developing countries and the number has remained unacceptably high (Bryce 2005, Fischer 2013).About 80 per cent of these deaths are in the first two years of life (Lucas & Gilles, 2014) 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 diarrhoea 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, 2011). In Nigeria, it is one of the leading causes of infant and child mortality where it accounts for an estimated 250,000 deaths per annum (Iyun and Oke 2010). Although, the federal government has contributed appreciable resources towards the reduction of the disease in Nigeria, these efforts have not yielded significant results. 

Diarrhea kills young children more than Acquired Immuno Deficiency Syndrome (AIDS), malaria and measles combined (WHO, 2015). It also exposes children to secondary infection. Oral Rehydration Therapy (ORT) is a primary intervention for the management of diarrhea. It can be easily administered at home by the mothers/caregivers as soon as a diarrhea episode begins (WHO/UNICEF 2010, Adimoral 2013). ORT is simple, inexpensive and the most effective way to treat dehydration and reduce diarrhea mortality. Its use has been widely advocated mainly by World Health Organization (Jones, 2016).Several factors are likely to contribute to the very high diarrhoea morbidity and mortality rates, in children under-five years including poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services (Park, 2013).Socio economic, environmental and maternal practices related to hygiene, breastfeeding, sanitary food preparation and appropriate weaning practices are also potentially important determinants in the occurrence of diarrhea in children.  Malnutrition is another established risk factor for mortality among children with diarrhoea disease. This may be due to inadequate case management. The first line of management of diarrhoea, is therefore, the prevention of dehydration. This can be achieved at home using Oral Rehydration Therapy (ORT).

However, despite the extensive efforts made to promote ORT for the last several decades, its utilization by rural communities has remained unsatisfactory (Forsberg 2012, Ram 2013). A recent review of literature showed that only 39% of the children with diarrhea in developing countries receive ORT (UNICEF/WHO 2014). Some studies have found that maternal knowledge of the causes of diarrhea, attitude towards ORT usefulness, barriers regarding its preparation were associated with ORT use (Sodemann 2013, Asakitikpi 2013).

According to the report based on Demographic and health surveillance (DHS, 2018) data analysis in 34 countries in Sub-Saharan Africa and Asia, it was found out that there is no significant increase in the utilization of ORT in the last ten years, and this has created great concern among stakeholders hence the need to Investigating the knowledge, and practice of the use of this widely available and effective lifesaving intervention upon which this study is based. The use of ORS largely depends on the level of knowledge and attitude of mothers. Misconceptions are prevalent that prevent the use of ORS during diarrhea. The use of ORS largely depends on the level of knowledge and attitude of mothers. Misconceptions are prevalent that prevent the use of ORS during diarrhea.

The definition of oral rehydration therapy (ORT) has changed over time, broadening in scope and encompassing a definition of a specific therapy appropriate for dehydration initially in the early 1980s, ORT was defined only as the official solution prescribed by the World Health Organization. It was later changed in 1988, to also encompass recommended home fluids, as it was noted that access to the official preparation was not always readily available. It was amended once again in 1988 to include continued feeding as appropriate management. In 1991, the definition was changed to define ORT as any increase in administered fluid. The final change came in 1993, and is the definition used today, which states that ORT is an increase in administered fluids and continued feeding.

Prescription from the ancient physician dated back over 2500 years with treatment of acute diarrhea with rice water, coconut juice and carrot soup. However, the knowledge did not carry over to the western world, as dehydration was found to be major cause of death secondly to the 1892 cholera pandemic in Russia and Western Europe. In 1831, the loss of water and stool of cholera patients was noted and intravenous fluid (IVF) therapy was prescribed to compensate for fluid loss. The results were remarkable as patients who were on the blink of death from dehydration recovered. The mortality rate of cholera dropped from 70% to 40% with the hypotonic (IV) solution. 

ORT was introduced in 1979 and rapidly became the cornerstone of programme for the control of diarrheal diseases. The event surrounding the Bangladesh liberation war in 1971 convinced the world of the effectiveness of ORT as medical ran out of intravenous fluid to treat the spreading cholera epidemic; As Philip Mahalandis instructed his staff to distribute oral rehydration salt (ORS) to the 350,000 patients in refugee camps.

 Between 1980 and 2006, ORT decreased the world wide death from five million a year to three million a year. Death from diarrhea was the leading cause of infant mortality in the developing countries until ORT was introduced. Its remarkable success has led to the discovery of its underlying physiological basis as “potentially the most important medical advancement of the century”. Oral rehydration is part of United Nations Children Emergency Fund GOBI programme, a low cost programme to increase child survival in developing countries”.   

Diarrhoea remains a leading cause of childhood morbidity and mortality in developing countries. (NDHS, 2018). Dehydration caused by diarrhoea is a major cause of illness and death among young children, even though the condition can be easily treated with oral rehydration therapy (ORT) (NDHS, 2018). The world Health Organization (WHO) suspects that there are greater than 700 million episodes of diarrhea annually among children less than 5 years of age in developing countries. It is because of this that the oral rehydration therapy was introduced for management of diarrheal diseases. It is the most effective and least expensive way to manage diarrhea rehydration. While global mortality may be declining, the overall incidence of diarrhea remains unchanged at about 3.2 episodes per child per year (Abramson, 2014). 

The diarrhoea prevalence rate of children under the age of 5 in Nigeria is 10.2% in which nearly over 150,000 under 5 children dies of diarrhea and Nigeria accounts for 11% of all deaths worldwide (NDHS 2018). Diarrhoea was most common among children age 12–23 months (17 percent) and least common among those age 48-59 months (5 percent) and Children of mothers with no education were twice as likely as children of mothers with more than a secondary education to have had diarrhoea (NDHS, 2018). The diarrhoea prevalence rate of children under the age of 5 in Kaduna is 14.5% and it is one of the highest in North west Zone of Nigeria (NDHS, 2018). The diarrhoea prevalence rate of children under the age of 5 in Samaru is 2.3% and nearly over 722 children under the age of 5 suffers from diarrhea yearly (PHC Samaru, 2019).

Oral rehydration therapy is a critical intervention to save the lives of children during the episodes of diarrhea. However, millions of children die every year due to failure to replace fluid effectively.

This study is aimed at assessing mothers’ knowledge and practice of oral rehydration therapy in management of diarrhea in infants and young children among residents of Samaru community, SabonGari local government area Kaduna state.

The objectives of the study are:

For the purpose of this study to be achieved, the following research questions are constructed to guide the study.

The study will provide information on the knowledge and practice of Oral Rehydration Therapy in Samaru Community. The information provided will be of great significance to public health personnel as will guide the actions in designing strategies to improve prevention of diarrhea and dehydration in infants and young children using Oral Rehydration Therapy in Samaru Community. The finding of the study will serve as a motivation tool for government to take appropriate decision in ways of impacting knowledge and preventive measures of diarrhea disease.

It will also motivate the health workers to promote health of children and prevention of mortality and morbidity rate in Samaru community through health education of mothers and their families of ways to prevent diarrhea and use of Oral Rehydration Therapy.     

The scope of this study is on the assessment of mothers’ knowledge and practice of Oral Rehydration Therapy in management of diarrhea in infants and young children among Samaru community of SabonGari Local Government Kaduna State within 2019.

In the course of study some terms have been used which may need definition for the purpose of clarity. They include;

Knowledge: This is the understanding, awareness, and information possessed by mothers in Samaru community regarding oral rehydration therapy (ORT) for the management of diarrhea in children.

Practice: This refers to the specific actions, behaviors, and strategies employed by mothers in the Samaru community to administer oral rehydration therapy (ORT) for the management of diarrhea in their children.

Diarrhoea: Loose, watery bowel movements that may occur frequently and with a sense of urgency among infants and young children in Samaru Community.

Mother: A female parent or a woman who has a child in Samaru Community.

Infants: A very young child or baby under one year of age in Samaru Community.

Young child: A child who is between the ages of 24 to 36 months in Samaru Community. 

Oral rehydration therapy (ORT): The administration of fluid (Oral rehydration solution) by mouth to prevent or correct the dehydration that is a consequence of diarrhoea in Samaru Community.

Oral Rehydration Solution (ORS): A liquid preparation developed by the World Health Organization that can decrease fluid loss in persons with diarrhea.in Samaru community.

Management: Treatment with care using Oral Rehydration Solution in infants and young children in Samaru Community.