CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
According to World Health Organization WHO (2014), Diarrhea occurs when stools contain more water than normal and are loose or watery. In some regions, diarrhea is defined as passage of three or more loose or watery stools in a 24-hour period. It is more common in settings of poor sanitation and hygiene including a lack of safe drinking. In Nigeria, diarrhea accounts for an estimated 150,000 deaths every year mainly among under-five children due to unsafe water, poor sanitation and hygiene practice. Oloruntoba, Folarin and Ayede (2014) added that diarrheal disease is part of the head causes of mortality and morbidity among young children in developing countries. Every year approximately 2.5 billion cases of diarrhea occur among children of under-five years and these appraisals suggest that the overall incidence has been stable over the past 20years. Africa and Asia account for more than half of the cases of childhood diarrhea which is uttered as the fourth leading cause of mortality among under five children in Nigeria. Each day Nigeria loses about 2,300 under five year old children and this makes her the second largest contributor to the under-five mortality rate in the world. (UNICEF, 2016).
Diarrhea in children is classified as acute diarrhea, persistent diarrhea and dysentery. Acute diarrhea is an episode of diarrhea that lasts for less than 14days. In acute diarrhea, the death of a child is usually due to dehydration. Persistent diarrhea is a type of diarrhea which lasts for about 14days or more. Almost 20 percent of episodes of diarrhea become repetitive which often lead to nutritional problems and therefore can cause death in children. Dysentery is a type of diarrhea with blood present in the stool and this could be with or without mucous. The most common cause of dysentery is known to be Shigella bacteria. (WHO, 2014)
An infant can have diarrhea if the stools have been altered from the normal pattern and are many and watery. This indicates that there is more water than fecal matter. When normal frequent or semi-solid stools occur in breastfed babies, it is not diarrhea. However, it is significant to be aware that the classification of diarrhea does not have an effect on the cause. The main repercussions of diarrhea are frequent loose or watery stools, risk of dehydration, damage to intestine and loss of appetite (which could be with or without vomiting). The signs of dehydration are not clearly seen until there is acute loss of fluid of about 4-5percent of body weight. The signs and symptoms of dehydration includes pallor, sunken eyes, poor skin turgor, unconsciousness (if dehydration continues), drinking poorly (due to unconsciousness), drinking eagerly and acts thirsty (WHO, 2014).
The preventive practices according WHO (2014) are giving extra fluid as much as the child can tolerate, giving zinc supplements (for full 14days), continuous feeding, follow up visit or immediately if danger signs develop. Raja (2017) opines that as a mother, she may have certain way of perceiving things relating to the child and have an entirely different view about how the child feels. She also added that the way a mother behaves to her child will have a long lasting effect on the child development throughout childhood. Therefore, knowledge of the mother is important in the care of the child because the mother is the first to be aware of the physical, cognitive and immunological development of the child in order to enable healthy growth.
This study is important in order to know the type of management mothers adopt in a particular area and also for mothers to have a good understanding of what causes diarrhea and how it is being treated. They should also be aware of the signs and symptoms in order to seek medical advice promptly (Gbasemi, Talebian, Alavi & Mousavi, 2015).
1.2 STATEMENT OF PROBLEM
The poor management of diarrhea among mothers of under-five children in particular areas of Lagos state have led to the depletion of water among under five children which is responsible for life. It is a disease that comes regularly and one of the major determining factors of childhood mortality and morbidity (Olaniyi & Oyerinde, 2016). There are signs that in some areas in Lagos state, knowledge and use of Oral Rehydration Therapy (ORT) to effectively treat diarrhea among under five children especially at home may be diminishing regardless of the fact that most mothers have been health educated on ORT (Tobin, Isah & Asogun, 2013). Most caregivers according to Onwukwe, Deventer & Omole (2016) still give unsafe hyper or hypo osmolar ORT mixtures to their children clearly because they do not know the correct preparation. Mothers’ knowledge on diarrhea is determined by factors like prior experience of managing the disease and the environment, educational status (Olaniyi & Oyerinde, 2016). On the basis of the above, the researcher is interested in evaluating the knowledge and practice of Oral Rehydration Therapy in the management of diarrhea disease among mothers of under-five children.
1.3 SIGNIFICANCE OF THE STUDY
The researcher hopes that the result obtained from this study will enhance the level of knowledge of mothers of under five children as it provides them with proper knowledge on the clinical manifestations of diarrhoeal disease, methods of treating and preventing childhood diarrhea thereby decreasing the prevalence of diarrhea among children. This will enable mothers make their different choices on the type of management to adopt in managing diarrheal diseases.
This study is also important because it will serve as a reference material for health workers especially nurses by educating mothers on the prevention of childhood diarrhea and adopt cost effective behavior in order to reduce childhood morbidity and mortality. This study will disclose some of the reasons why diarrhea occur among children in the selected health care center so also different methods of preventing infection among the children. Researchers can also profit from the study in such that it helps them build more on their own findings with this area of knowledge. The data pertaining to this study may also enhance supply of data for future study.
1.4 OBJECTIVES OF THE STUDY
The objective of this study is to assess the knowledge of mothers of under five year children on diarrheal disease and practice of Oral Rehydration Therapy in the management of diarrheal disease in Gbaja community. The specific objectives are to:
1. Determine the level of knowledge of mothers on diarrhea disease.
2. Ascertain the knowledge of mothers on oral rehydration therapy.
3. Ascertain the knowledge of mothers on the preventive measures against childhood diarrhea.
4. Determine the management of diarrheal disease among mothers of under-five.
1.5 RESEARCH QUESTIONS
Some research questions are formulated by the researcher and these research questions will be tested to assess mothers’ knowledge on diarrheal disease and practice of Oral Rehydration Therapy in the management of diarrheal disease among under-five children in Gbaja community. The research questions are as follows:
1. What is the level of knowledge of mothers on diarrhea disease?
2. What is the level of knowledge of mothers on oral rehydration therapy?
3. What is the level of knowledge of mothers on the preventive measures against childhood diarrhea?
4. How do mothers of under-five manage diarrheal disease?
1.6 RESEARCH HYPOTHESIS
Hypothesis One
H1= Mother’s knowledge on Diarrhea has no causal relationship with the use of Oral Rehydration Therapy (ORT)
H2= Mother’s knowledge on Diarrhea has causal relationship with the use of Oral Rehydration Therapy (ORT)
1.7 SCOPE OF STUDY
The study will be carried out among mothers of under-five children at the Randle General Hospital (maternal and child health care center) in Gbaja Surulere Lagos state to ascertain mothers’ knowledge on diarrheal disease and practice of oral rehydration therapy.
1.7 OPERATIONAL DEFINITION OF TERMS
Under-five children: Children that are under the age of five years or between the age of one month and five years.
Dehydration: This refers to the excessive loss of fluid from the body by persistent vomiting, diarrhea, sweating or from lack of intake.
Oral Rehydration Therapy (ORT): It is a type of fluid replacement used to prevent and treat dehydration especially that is due to diarrhea. It involves drinking water with modest amount of sugar and salts, specifically sodium and potassium
Diarrhea: This involves rapid movement of faecal matter through the intestine resulting in poor absorption of water, nutritive element and electrolytes.
Disease: This is described as a definite pathological process having a characteristic set of signs and symptoms. It may affect the whole body or any of its parts.