Maternal Knowledge and Practice of Oral Rehydration Therapy in the Management of Diarrhea among Infants and Young Children in Nigeria
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ABSTRACT
The study was carried out to find out mothers` knowledge and practice of oral rehydration therapy in management of diarrhea in infants and young children among residents of Samaru community, SabonGari Government Area, Kaduna State. The aim was to determine the level of awareness of mothers’ knowledge and practice of oral rehydration in management of diarrhea, the rate of use of oral rehydration therapy and to suggest possible ways of improving the mothers` knowledge and practice in management of diarrhea among infants and young children.
The study is a descriptive study; non-probability sampling technique was used in which Ninety-one questionnaires (91) were distributed among mothers of child bearing age of Samaru community. 80 questionnaires were filled and returned.
The findings of the study revealed that the level of mothers` knowledge and practice of oral rehydration was very high 70(87.5%) of respondents are aware of oral rehydration therapy Majority 72(83.7%) of respondents defined oral rehydration therapy as a solution to prevent or correct dehydration as a result of diarrhoea. Also, majority 80(95.2%) of the respondents practice oral rehydration therapy. However, 34(39.5%) of respondents don’t know the contents of oral rehydration solution and its preparation which is below average.
Based on these findings it was recommended that adequate program should be set up for proper and effective health education of the populace on the importance and advantages of oral rehydration in the management of diarrhea in infants and young children and oral rehydration should be emphasized and encouraged during ante-natal care to build the capacity of the mothers in management of diarrhea in their infants and young children.
TABLE OF CONTENTS
MATERNAL.. i
DECLARATION.. ii
CERTIFICATION.. iii
DEDICATION.. iv
ACKNOWLEGEMENT. v
ACRONYMS AND ABBREVIATION.. vi
ABSTRACT. vii
CHAPTER ONE. 1
1.0 INTRODUCTION.. 1
1.1 BACKGROUND OF THE STUDY. 1
1.1 STATEMENT OF THE PROBLEM.. 4
1.2 OBJECTIVES OF THE STUDY. 5
1.3 RESEARCH QUESTIONS. 6
1.4 SIGNIFICANCE OF THE STUDY. 6
1.5 SCOPE OF THE STUDY. 7
OPERATIONAL DEFINITION OF TERMS. 7
CHAPTER TWO.. 9
LITERATURE REVIEW.. 9
1.0 INTRODUCTION.. 9
1.1 CONCEPTUAL REVIEW.. 9
2.1.1 PREVENTION AND CONTROL OF DIARRHEA: 11
2.2 DEHYDRATION: 12
2.3 ORAL REHYDRATION THERAPY (ORT): 14
2.3.1 VOLUME OF ORS SOLUTION REQUIRED: 14
2.3.2 ADMINISTRATION OF ORS SOLUTION: 17
2.4 KNOWLEDGE AND PRACTICE. 18
2.5 EMPIRICAL REVIEW.. 23
2.6 THEORETICAL REVIEW.. 25
SELF CARE THEORY AND ORAL REHYDRATION THERAPY. 28
CHAPTER THREE. 31
RESEARCH METHODOLOGY. 31
3.0 INTRODUCTION.. 31
3.1 RESEARCH DESIGN.. 31
3.2 AREA OF STUDY. 31
3.3 TARGET POPULATION.. 32
3.4 SAMPLING TECHNIQUE. 32
3.5 INSTRUMENT FOR DATA COLLECTION.. 33
3.6 VALIDITY AND RELIABILITY OF THE INSTRUMENT. 33
3.7 INCLUSION AND EXCLUSION CRITERIA. 34
3.8 METHOD OF DATA COLLECTION.. 34
3.9 METHODS OF DATA ANALYSIS. 34
3.10 ETHICAL CONSIDERATION.. 36
CHAPTER FOUR. 37
DATA PRESENTATION.. 37
4.0 INTRODUCTION.. 37
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS. 37
4.2 KNOWLEDGE OF MOTHERS ABOUT ORAL REHYDRATION THERAPY. 39
- 3 MATERNAL PRACTICE OF ORAL REHYDRATION THERAPY. 40
TABLE 4.4 BARRIERS TO KNOWLEDGE AND PRACTICE OF ORT. 41
CHAPTER FIVE. 44
DISCUSSION, SUMMARY, CONCLUSION AND RECOMMENDATION.. 44
5.0 INTRODUCTION.. 44
5.1 DISCUSSION OF FINDINGS. 44
5.1.1 Maternal knowledge about Oral Rehydration Therapy. 44
5.1.2 Practice of Mothers of Oral Rehydration Therapy. 45
5.1.3 Barriers to knowledge and practice of ORT. 46
5.2 IMPLICATIONS FOR NURSING. 46
5.4 SUMMARY. 47
5.4 CONCLUSION.. 47
5.5 RECOMMENDATIONS. 48
5.6 Limitation of The Study. 48
5.7 Suggestion for Further Study. 48
REFERENCES. 49
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
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 percent 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”.
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