diarrhea, maternal attitude, skill, knowledge a prospective study

ASK(Attitude, Skills, Knowledge) Mothers to prevent Diarrhea

Ajay AgadeJLN HOSPITAL & RESEARCH

CENTREBHILAI

1. Diarrhea known medically “Gastroenteritis” is a major killer of children in world.

2. One out of every four childhood death.3. Drains life out of 3 million infants & young children every year4. 99.6% children from Third World.5. One in ten children die of diarrhea before age 5

The ImpactLoosing precious childMalnutritionBurden health services Socioeconomic burden family society country

Ask mothers to prevent diarrhea-Introduction

Diarrhea is a disease of old civilizationBibliocas (25000 yrs old) first referencePacillus (1472) 1st printed book of pediatricsBroussais (1829) The term GastroenteritisH.E. Harrison (1954)The first ever ORSWHO (1970) standardize formula of ORSWHO (1978) promotion of formulaWHO,UNICEF(2001) low osmalarity ORS

ORS–The Magic Bullet for Child SurvivalSimple, effective, cheapReduces number of diarrheal deathsReduces hospitalization ratesPrevents adverse effects like malnutrition

EVIDENCE –Diarrheal mortality -5 million per year 1.5 million per year

Ask mothers to prevent diarrhea-Chronolgy

Incidence

Mortality

Ask mothers to prevent diarrhea - Global scenario

“Ask mothers to prevent diarrhea”-Indian scenario

NFHS-3 (2005-2006)

India Chattisgarh

Children with diarrhea who received ORS

26.2% 42%

Chldren with diarrhea taken to health facilities

58% 65.3%

Ask mothers to prevent diarrhea -Chattisgarh scenario

NFHS-2 (1998-1999)

India Chattisgarh

Children with diarrhea who received ORS

26.9% 29.7%

Chldren with diarrhea taken to health facilities

65.3 59.3%

1. To assess maternal knowledge of diarrhea : its definition and causes

2. To assess maternal attitude towards diarrhea management

3. To assess the maternal skills and practices related to ORS

Settings In patient department & out patient department of Jawaharlal

Nehru Hospital & Research Centre, Steel Plant Bhilai

Ask mothers to prevent diarrhea- Aims & Objectives

Type- cross sectional studyMaterial- The mother, of children 0-5 years age group who presented

with acute diarrhoea in the pediatric inpatient & outpatient department of the J.L.N.H. & R.C.

Period - June 2008-May 2009Method- 200 Mothers were questioned on a careful predesigned

questionnaire in local language. Proforma compramised of more than 30 questions. Exclusion & Inclusion criterias were set.

Proforma –Covered various aspect like definition, causes, symptoms, fluids given, use of ors, method of preparation of ors etc.

Analysis- Results of this study were compared & analyzed, by proportional method keeping in view the results & reports of various other investigators by reviewing all available literature

Ask mothers to prevent diarrhea- material & methods

knowledge about diarrhea & ORS

Ask mothers to prevent diarrhea-observations

KNOWLEDGE PERCENTAGE

Correct definition of diarrhea 62

Cause of diarrhea as contaminated food &

water

29.6

Both fluids & foods to be given in diarrhea 55

Extra feeds should be given in diarrhea 0

Knowledge about ORS 72

Correct method of reconstitution of ORS 8.9

Correct ammount 7.3

Practices regarding diarrhea & ORS


WRONG PRACTICE percentage

Didn’t wash hands hygienically with soap 20

Didn’t practice exclusive breast feeds 91

Gave diluted milk 70

Gave bottle feeds 30

Restricted food during diarrhea 13.8

ORS not used 52

Attitude towards Diarrhea & ORS


Attitude percentage

Delayed health seeking 46.5%

ORS not used despite its knowledge 13.6%

Didn’t think of maintaining clean water 37%

Indifferent attitude for prevention 17%

Ask mothers to prevent diarrhea-Discussion

k.An

and

(199

2)

Niyaz

(199

5)

Man

gala

S.(2

001)

Pres

ent s

tudy

24%15%

46%62%

CORRECT DEFINITION OF DIARRHEA

Correct def’n


k.Anand (1992) Niyaz(1995) Mangala s.(2001)

Present study

11.00%27.40% 29.60%

36.00%

51.80%

31.10%

38.00%

0.36

0.42

KNOWLEDGE REGARDING DIARRHEA

Correct causes Danger signs consequences


H.Vishwanathan(1990)

K.Anand(1992) Present study

24% 41%72%48%

38%

50%

81%79%

PRACTICES IN DIARRHEA

Huygenic handwashing Cont. normal diet during diarrhea

Use of liquid supplements

ORS-Knowledge & skills


H.Vishwanthan(1990)

K.Anand(1992) S. Mangala Present study

24.00% 29.70%

68.10% 72.00%48% 38%

50%

3.30%

8.50% 8.90%

Know ORS Correct method of reconstitution Use of liquid supplements


Ahmed F.(1996)

NFHS-2 (1998-1999)

NFHS-3 (2005-2006)

Present study

33.30%25.90%

42.00% 46.00%

PRACTICE REGARDING ORS

Of those having knowledge, ORS used by

Millennium Development Goal of decreasing childhood mortality can be achieved by effective management of diarrhea by mothers. Assessment of current maternal attitude, knowledge & practices of diarrhea & ORS is cornerstone to achieve success in the prevention of this major killing disease.

Mother is the person responsible for the care of her baby during illness. Her knowledge & practices during an episode of diarrhea are important factors which influence the course of the disease.

Ask mothers to prevent diarrhea-Conclusion

SIGNIFICANT IMPROVEMENTKnowledge of correct definition 4 fold increased awarenessPractice of giving excess fluidsReduction in practice of starvation Knowledge of ORSPractice of ORS

LESS SIGNIFICANT CHANGES & HENCE REQUIRING MORE FOCUS

Poor knowledge of causes (only 29.6% know correct causes)Correct method of reconstitution (only 8.9% of knowledgeable)Feeding practice (100% unaware of giving extra feeds)Exclusive breast feeding, bottle feeding practicesLack of preventive attitude(17% indifferent attitude)

Ask mothers to prevent diarrhea - Conclusions

Targeted efforts to fill up lacunas detected through study

Ask mothers to prevent diarrhea-Recommendation

Face to face demonstration-

danger sign, preparing ORS

etc.

Interaction in small group

Importance of hygiene

Nutritional educa-tion & rehabilita-

tion

Implentation of DDCP

Reinforcement through paramed-

ical sources

1.K. Anand et al. knowledge & practice regarding diarrhea in mother of haryana,Indian pediatrics,1992,29:915-916

2.P. Kapoor, knowledge attitude & practices in diarrhea ,Indian pediatrics, 1996,33:319-320

3.Niyaz A. et al. parental awareness & practices in acute diarrhea Indian pediatrics, 1995,32: 77-78

4.S. Mangala, educational intervention on knowledge of mother regarding home management of diarrhea, Indian journal of pediatrics, 2001,68:393-397

5.National Family and Health Survey-2 (1998-

1999)6.National Family and Health Survey-3 (2005-

2006)

Ask mothers to prevent diarrhea-Bibliography

diarrhea, maternal attitude, skill, knowledge a prospective study

Health & Medicine