Diarrheas’ Accounts for High Levels of Morality in Young Children in Developing Countries in Nigeria

Diarrheas’ Accounts for High Levels of Morality in Young Children in Developing Countries in Nigeria

CHAPTER ONE

Purpose of the Study

The purpose of the study is to find out the knowledge and management practices of childhood diarrhea by mothers in Ezeagu LGA. Specifically, the study intends to find out:

1. level of knowledge of the concept of diarrhoea possessed by mothers in Ezeagu LGA;
2. level of knowledge of the signs and symptoms of childhood diarrhoea possessed by
3. level of knowledge of modes of spread or transmission of diarrhoea possessed by
4. level of knowledge of the dangers of childhood diarrhoea possessed by mothers in Ezeagu
5. level of knowledge of preventive measures against childhood diarrhoea possessed by
6. the management practices of childhood diarrhoea by mothers in Ezeagu LGA;
7. the difference in the knowledge of mothers about childhood diarrhoea according to level of education;
8. the difference in the management practices of mothers about childhood diarrhoea based on level of education;
9. the difference in the knowledge of mothers about childhood diarrhoea based on age;
10. the difference in management practices of mothers about childhood diarrhoea based on age;
11. the difference in the knowledge of mothers about childhood diarrhoea based on parity;
12. the difference in the management practices of mothers about childhood diarrhoea based on parity.

CHAPTER TWO

Review of Related Literature

Literature, of both local and foreign origin, abounds on childhood diarrhoea. However, literature considered pertinent to this study is hereby presented under the following headings:

1. Conceptual framework
   • Childhood and diarrhoea
   • Knowledge and practice
   • Management and management
   • Factors associated with knowledge and management practices of
2. Theoretical framework
   • Health action process approach
   • Systems management theory
   • Self efficacy theory
3. Empirical studies on childhood
4. Summary of literature review

Conceptual Framework Childhood and Diarrhoea.

This section presents childhood diarrhoea, knowledge and management practices of mothers. Under-five has been conceived as early childhood, a period roughly covering the first five years of life, prior to entry into school. According to Hodges (2001) childhood is a period of rapid physical growth, including the development of the brain almost to its full adult size, and is also a critical period for the development of cognitive functions. He further added that the key factors for child growth and development are adequate care, good health, nutrition and stimulation.

The importance of giving young children the quality care, nutrition and stimulation needed for their healthy growth and development has increasingly been receiving recognition, both nationally and internationally. This was prominent not only in the Convention on the Rights of a Child (CRC), but more recently in the Education For All – EFA (2000). Declaration of the Dakar World Education Forum, reaffirmed the goal of expanding and improving comprehensive early childhood care and education. Nigeria, not only endorsed this declaration, but has given prominence to the needs of pre-school children in the new universal Basic Education (UBE), Programme announced in 1999. One of the important features of childhood is the development of the brain. The brain is vulnerable during this initial growth spurt. Inadequate nutrition and care in the first few years of life can seriously interfere with brain development and lead to such neurological and behavioural disorders as learning disabilities (Bargley, 1996). The knowledge and practice of adequate and quality childhood care could lead to healthiness of the child in terms of prevention of early childhood diseases while lack of knowledge and poor practices increase the chances of prevalence of childhood diseases. There should be therefore, great emphasis in the importance of children getting a good start in life, for future growth and development in cognitive and pscho-social terms as well as physically.

The main concerns of mothers and other care givers with respect to feeding, hygiene in the home and the prevention, diagnosis and response to illness in young children should be adequate knowledge and quality practices. This is because, in spite of the rising rate of exclusive breast feeding, the practice is still very low in Nigeria, indicating that the great majority of mothers have little knowledge of nutritional value of breast milk or of the health risks of early exposure to other liquids and solids, leading to one of the main causes of diarrhoea in young children, which can set off a vicious cycle of illness and malnutrition (Park, 2009).

Diarrhoea disease refer to the disturbance of the gastro – intestinal tract comprising of changes in the intestinal motility and absorption, leading to an increase in the number of stools and changes in their consistency (Ballabriga, Hilpert & Ishiker, 2000). However, when the presumed or definite cause of these disturbances is infectious as expounded by Ballabriga et al (2000), it is referred to as infectious diarrhoea. FRN (2000) described diarrhoea disease manifestations as the passage of three or more watery stools in a day. Edge (1996) equally asserted that if a baby who has had steady weight gain over a period and who has been in a habit of passing one normal yellow stool a day begins to pass frequently loose and watery green stool that are of an unpleasant odour, he is probably suffering from diarrhoea disease.

Spradley and Allender (1998) also described childhood diarrhoea as food and water borne diseases whose intake by people, especially children results in symptoms relating to gastrointestinal problems. Onset of symptoms may occur within few hours of exposure or not until days and even weeks later, between exposure and organism. In a related conception, WHO (2000) described diarrhoea disease as one of the diseases leading to two out of three deaths among children and young adults in Africa and South-East Asia. The above assertion was further confirmed by a flow chart in which diarrhoeal disease accounted for 9 per cent of deaths of children in Africa and South East Asia. However, any passage of three or more watery stools within a day (24 hours) is referred to as diarrhoea. Childhood diarrhoea within the context of this study is any type of loose, watery stool that occurs more frequently than usual in a child. The consistency and the volume of stool constitute how to classify diarrhoea.

WHO (2000) classified diarrhoea into three clinical types which includes: Acute watery diarrhoea, dysentery and persistent diarrhoea. Acute watery diarrhoea refers to diarrhoea that begins acutely, last less than 14 days and involve passage of frequent stool without visible blood. Dysentery is diarrhoea with visible blood in the feaces, while persistent diarrhoea is the diarrhoea that begins acutely but is of usually long duration (at least 14 days). The episode may begin as watery diarrhoea or as dysentery, with frequent marked weight loss. Morley (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 lining. Osmotic diarrhoea is caused by the presence of osmotically active solutes in the intestinal linning 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 linning 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 causes.

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart

 

CHAPTER THREE

Methods

This chapter describes the research design, area of study, population for the study, sample and sampling techniques. It also presents the instrument for data collection, validity and reliability of the instrument, method of data collection and data analysis.

Research Design

In order to accomplish the purpose of the present study, the survey research design was used. Gay (1981) described survey research design as being useful for studying a variety of problems involving data collection for either testing hypotheses or answering pertinent research questions concerning the present status of subjects under study. He further stated that this design permits the description of conditions as they exist in their natural settings. Eboh (1998) asserted that a survey designs covers the physical characteristics of people, behaviour as well as their knowledge, attitudes, beliefs and opinions and practices that occurred or are occurring in the population.

The survey research design therefore was considered most appropriate for the present study as it has effectively been utilized in related studies by Raw, Mishra and Rutherford (1998) and Langston and Hill (2004). The successful application of the design by the aforementioned investigators in their respective studies suggests a possible success in its use for the present study.

Area of Study

The study location, Ezeagu LGA is one of the seventeen Local Government Areas of Enugu State. Ezeagu is located some 20 kilometers south west of Enugu, the Enugu state capital in Eastern Nigeria. It is bounded on the north by Uzo-Uwani Local Government Area, on the west by the Awka-North LGA. in Anambra state and on the east and south by parts of Udi L.G.A. Ezeagu LGA is made up of eight communities which include Imezi Owa, Agu obu owa, Mgbagbu Owa, Oghe, Olo, Awha, Umana and Umumba.

The inhabitants of the area are mainly farmers while some few hands are engaged in civil service and trading business. The possible source of water supply range from the use of stream, tanker water to the occasional use of tap water. They also use rain water during rainy season. General environmental sanitation is poor as there are no facilities for refuse disposal. They make use of open refuse dumps such as dumping them into nearby bushes, burn them or dumping by the roadside. They use pit latrines and nearby bushes for sewage disposal.

However, some well-to-do families make use of water closet system. These features make it possible for the spread of diarrhoea among children in Ezeagu LGA.

CHAPTER FOUR

Results and Discussions

This chapter presents and discusses the results of the study on the knowledge and management practices of childhood diarrhea by mothers in Ezeagu LGA of Enugu State, Nigeria. Three hundred copies of the questionnaire were distributed and all were collected back making one hundred per cent return rate. Out of this number, sixteen were discarded due to lack of completeness of information. The remaining two hundred and eighty four (284) copies were used for analysis.

CHAPTER FIVE

Summary, Conclusions and Recommendations

Summary

The purpose of the study was to investigate the knowledge and management practices of childhood diarrhea by mothers in Ezeagu LGA. In order to accomplish this purpose, twelve specific objectives and corresponding research questions were formulated. Six null hypotheses were postulated for verification. Three socio-demographic variables, namely: age, level of education and parity were investigated. Literature pertinent to the study was reviewed under the following headings: conceptual framework, factors associated with knowledge and management practices of childbearing mothers regarding childhood diarrhoea, theoretical framework and emperical studies on knowledge and management practices of mothers.

The survey research design was adopted for the study. The study population comprised of 3000 registered mothers attending MCH clinics in Ezeagu LGA at the time of the study. The multi stage sampling procedure was utilized to draw the sample. At each of the three stages employed, an appropriate sampling technique was adopted. This process produced a sample of 300 respondents which constituted ten per cent of the total number of registered mothers attending MCH clinics in Ezeagu LGA at the time of study.

Conclusions

Based on the findings and discussions of the study, the following conclusions were attained;

1. Mothers had high knowledge (71.21%) of the concept of childhood diarrhoea. Thisanswers research questions 1.
2. Mothers had very high knowledge (84.95%) of the signs and symptoms of childhood. this answers the research question 2.
3. Mothershad high knowledge (76.58%) of the modes of transmission childhood  This answers research question 3.
4. Mothers had high knowledge (77.82%) of the dangers of childhood diarrhoea. Thisanswers research question 4.
5. Mothershad high knowledge (71.21%) of the preventive measures of childhood  This answers research question 5.
6. Mothers adopted various childhood diarrhoea management practices such as promptlycleaning a baby who defecated (90.5%), continue breast feeding baby especially during diarrhoea (88.7%), boiled water used in making drinks for the children (85.6%), prepared food hygienically during diarrhoea episode (83.1%), washed hands with soap and water in preparing ORS (75.75), mixed ORS in the right proportion (73.65) and gave ORS as soon as diarrhoea starts (72.2%). Whereas lower proportion of the mothers gave their babies only breast milk during diarrhoea (42.35) and allowed their children who has diarrhoea to defecate in bushes or open spaces (35.6%). This answers research question 6.

Recommendations

Based on the finding and conclusion of this study, the following recommendations were drawn:

1. The healthworkers at the various MCH in Ezeagu LGA should strengthen their teachings on the management practices of mothers regarding childhood diarrhoea. Since these mothers varied in their responses in all the management practices.
2. More scientific research should be conducted in Ezeagu LGA on factors that hinderthe management of childhood diarrhoea by mothers. This is essential for developing rational and effective intervention to the
3. All methods of ORT should be uniformly taught to mothers so that they can have avariety of choice based on conveniences to them.
4. Since there was significant difference in the knowledge and management practiced ofmothers regarding childhood diarrhoea according to level of education. The state government should provide free and compulsory education for both younger and older mothers to enable then acquire education up to tertiary level so as to widen their scope in all spheres of life including health issues such as childhood diarrhoea.

References

• Abu Hijleh, S.M. (2003). Mothers knowledge, attitude and practices regarding diarrhoea management, in Palestine. Journal of Tropical Pediatrics 56(4) 180-182.
• Afolabi, B.M., Ekanem, E.E., Sodeinde J. & Randle S.A., (1995). Home, traditional and other remedies in childhood diarrhoea in coastal Lagos, Nigeria. Nigerian Journal of Paedictrics (21) 121-125.
• Ahmed, I.S, Eltom, A.R, Karrar, L.G, & Gibril, A.R. (2009). Knowledge, Attitude and practices of mothers regarding Diarrhoea among children in a Sudanese rural community. Department of community Health, Ministry of Health, Khartoum Sudan, East Africa medial Journal 71(11) 716-719.
• Akinsola, H.A. (2000). A-Z of community and Social Medicine in medical and Nursing practice with special reference to Nigeria. Ibadan: 3AM Communication Publishers.
• Akpede, G.O., Omotara, B.A, Webb, G.D, & Igene, J.O. (1997). Caretaker‟s knowledge and Preparation Abilities of Salt Sugar Solution in North Eastern Nigeria. Journal of diarrhoea disease research. 15(4) 232-240.
• Akuezuilo, E.O. (2000). Research Methodology and statistics for beginning research students. Lagos: Christen Printing and Publishing co.
• Ali, A. (1998). Fundamentals of research in education. Awka: Maks Publishers (Nig.). Anyakoha, E.U. (2007). Home management for schools and colleges. Onitsha. Africana First
• Publishers Ltd.
• Aristotle A. (384 – 322). Epistemology of knowledge Athens LYCEUM.
• Ashur, S.S. (1977). An evaluation plan for the development of updating of Nutrition Curriculum at Upper Elementary and Preparatory levels in Jordan. IVES/UNESCO International conference in Nutrition Education NE (Oxford) 207(2) 67-74.
• Babbie, E., (2003). The Practice of social Research (10^th ed.) Belmon: CA Thompson.
• Ballabriga, A, Hilpert H., & Ishiker H., (2000), Immunity of the infantile gastro intestinal tract and implications on modern Infant Feeding. Nestle Research News, Netherlands, Nestle Nutriton Services: 17-27.
• Bandura A. (1986). Self efficacy mechanism in human agency. American Psychologies. 37, 122 – 147.
• Bargley, S. (1996). “Your child’s brain”. Newsweek New York, 19^th February.
• Benenson, A.S. (1990). Control of Communicable diseases in man, (5^th.ed), Washington, DC: American Public Health Association.
• Best, J.W. (1981). Research in education. New Jersey: Prentice Hall Inc. Englewood Cliffs. Bethann, C., Gopel, S., Douglas, M., & Lynn, c. (1992). Knowledge and attitudes of pre-
• service education majors about AIDS: Implication for curriculum development,
• Health Education Journal, 3(1), 23 – 27.
• Britaninica student Library (2009). Dehydration. Encyclopaldia Britainica student and Home Edition. Chicago: Encyclopaedia Britannica.
• Britannica student library (2009). Malnutrition, Encyclopaedia Britannica student and Home Edition. Chicago: Encyclopaedia Britannica.
• Brown, R.N., Oke, F.E. & Brown, D.P., (1996). Curriculum and Instruction: An introduction to methods of teaching. London: Macmillan Publishers.
• Cameron, M., & Hofvander, Y., (1998). Manual on infant feeding, (3^rd ed). Oxford, Oxford University Press.
• Conforth, M. (1996). Dialectical materialism. An introduction. Longon: Lawrence & Wishert Ltd.

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart