Knowledge and Attitude towards prevention of Diarrhea among the mothers of under-five children: A cross-sectional approach

 

Shivaleela P. Upashe¹*, Rahul Shil²

¹Associate Professor, Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences,

Nitte Deemed to be University, Mangalore-575018, Karnataka, India.

²Assistant Professor Cum Ph.D. Scholar, Department of Medical and Surgical Nursing (Neuroscience),

College of Nursing and Health Sciences, Dayananda Sagar University,

Kumaraswamy Layout, Bengaluru-560078, Karnataka, India.

 

 

ABSTRACT:

In the globe, under-five children experience on average 3.2 episodes of diarrhea every year and consequently, 1.87 million children will die from dehydration associated with diarrheal disease. And in developing countries, diarrheal disease among under-five children accounts for about 21% of all deaths. Therefore, under-five children are susceptible to diarrhea-related death if proper measures are not taken. In India up to two-third of total pediatric admissions are due to diarrheal disease and, up to 17% of all deaths in indoor pediatric patients are associated with dehydration-related diarrhea. Thus the researchers conducted research on knowledge, and attitude on the prevention of diarrhea among the mothers of under-five children in selected hospitals at, Bengaluru. A total of 75 mothers were recruited randomly. A Descriptive research design with cross–sectional approach was used in this study. Structured knowledge questionnaire and 5 point attitude rating scales developed by the investigator were used to collect data. The study findings showed that 40 mothers (53.3) had inadequate knowledge, 30 (40.0%) had moderate knowledge and only 5 (6.7%) had adequate knowledge about diarrhea and regarding attitude12 mothers (16%) expressed a moderate level of attitude, 63 (84%) had inadequate attitude and none of them had a high level of attitude towards prevention of diarrhea.

 

 

INTRODUCTION:

Diarrhea is one among the foremost common manifestations of illness in infants and children. Each year 500 million episodes of diarrhea occur in India, five million of which may require treatment at health facilities.

 

An individual child suffers 10 to 15 episodes of diarrhea within the first 5 years of life¹. Diarrhea may cause inflammatory and mal-absorption disorders and impairment of the functional integrity of the gastro intestinal tract². Also besides, since the immune system and mucosal barrier continue to mature after birth, infectious diarrhea causes significant alternations in fluids and electrolyte balance in infants and children. In any disorder that involves gastrointestinal losses, particular a large amount of fluid dehydration poses a serious threat to life and demand immediate attention.³

 

Children under 5 years of age constitute 15 to 20 percent of the population in developing countries where 35 to 60 percent of all death occur in this age group is major because of diarrheal disease, malnutrition, and acute infectious disease while these are all preventable. The undernourished mothers can have increased life-threatening events during pregnancy and lactation resulting in low birth weight babies which can successively have a 3-4 times greater risk of dying due to diarrhea, acute respiratory infection, etc.^3,4

 

The two main risks of diarrhea is malnutrition and death. A child may lose almost the maximum amount of water and electrolytes from the body during an episode of diarrhea as an adult and one liter of fluid from the body of a child weighing 7kg approximately 50% of body loss. Significant dehydration disturbing the balance of electrolyte and acid-base status of the body occurs in about 2 to 5% of all cases of diarrhea. Such significant of these cases loss may prove fatal if fluids and electrolytes are not replaced to restore normal circulation and body functions.⁵

 

In India, diarrheal disease is a major public health concern among children under the age of 5 years. In health institutions up to two-third of total pediatric admissions are due to diarrheal disease and up to 17% of all deaths in indoor pediatric patients are related to dehydration related to diarrhea⁶ Fluid electrolyte imbalances related to diarrhea in under-five children is one of the chief problems in the early stage of life.

 

In most of the developing countries of the planet, there is increasing in the number of diarrheal cases due to lack of resistance to pathogenic agents, widespread prevalence of malnutrition, inadequate medical facilities, poverty, poor sanitization, lack of mother knowledge, and awareness of fluid-electrolyte imbalances. Therefore, the role of the health care workers is important to provide knowledge about the complications and their prevention. Diarrhea is still the most common cause of mortality in most of the tropical and subtropical countries,^7,8 and according to 2017 figures for every 1000 live births in India, up to nine babies die before celebrating their fifth birthday^9,10.

 

Therefore, this study was aimed to assess the knowledge and attitude of the mother of under–five children towards the prevention of diarrhea in selected hospitals at Bengaluru. The information obtained from this study will be used by policymakers and stakeholders to identify the awareness and attitude to provide information about diarrhea prevention in the study area.

 

HYPOTHESIS:

1.     There was a significant association between level of knowledge with demographic variables.

2.     There was a significant association between level of Attitude with demographic variables.

 

OBJECTIVES:

1.     To assess the knowledge on prevention of diarrhea among mothers of under five children.

2.     To assess the attitude of mothers on prevention of diarrhea.

3.     To find out the association between knowledge and attitude with selected demographic variables.

 

MATERIAL AND METHODS:

Descriptive research design with cross-sectional approach was used. A total of 75 mothers between the age group of 20 to 35 years who were having under-five children were randomly selected using simple random technique who were willing to participate in the study. The sample size was calculated by Standardize statistical formula considering population criteria in comparison with normal distribution theory. The data collection instrument was developed by the investigators. The reliability and validity of the tool were done with the help of nursing experts, pediatrician, and statistician. The reliability worked out using the split-half method developed by brown prophecy and was found to be 0.8926. Further validity coefficient worked out to be 0.9448. It had three sections such as (1) Demographic data, (2) Structured knowledge questionnaire, (3) and 5 point rating scale. The knowledge part included the questions on general knowledge, causes, sign and symptoms, diagnosis, complications, and prevention of diarrhea. Total 30 statements considered to assess the concept with the score one and zero for correct and incorrect responses with minimum score zero and maximum score 30. Ten statements were included regarding aspects of prevention of diarrhea and the response included (strongly agree, agree, uncertain, disagree, and strongly agree) to check the attitude. To complete the data a master data sheet was prepared by the investigator. Demographic data containing sample characteristics were analyzed using frequency and percentage, knowledge and attitude score was analyzed in terms of frequency, percentage and mean, and standard deviation. Chi-square test was computed for finding out the association between knowledge and attitude score with demographic variables and Karl Pearson’s coefficient of correlation was calculated to find out the relationship of knowledge and attitude score. Institutional research committee approval was taken. Formal approval was also obtained from the medical superintendent and hospital authority of the selected hospitals. The investigator introduced the self to the participants, written consent was obtained from the participants and the purpose of the study was explained to ensure better cooperation during the data collection period.

 

RESULTS AND DISCUSSION:

Section-A

Table1: Description of Socio demographic variables and its frequency and percentage

No	Demographic variables		No. of mothers	%
	Age of the mother	20 -25 years	25	33.3
1		26 -31 years	44	58.7
		31 -36 years	6	8.0
	Religion	Hindu	38	50.7
2		Muslim	22	29.3
		Christian	15	20.0
	Type of family	Joint	40	53.3
3		Nuclear	31	41.3
		Broken	4	5.3
	Location of family	Urban	11	14.7
4		Semi urban	33	44.0
		Rural	31	41.3
5	Father education	Secondary	18	24.0
		Higher Secondary	43	57.3
		Graduated	14	18.7
6	Mother education	Secondary	28	37.3
		Higher Secondary	39	52.0
		Graduated	8	10.7
	Occupation	Government service	26	34.7
7		Private service	20	26.7
		Agriculture	29	38.7
	Income	Rs.10000 -20000	2	2.7
8		Rs.5000 -10000	50	66.7
		<Rs.5000	23	30.7

 

Table-1 shows the frequency and percentage distribution of the demographic variables of mothers of under-five children and a majority of them are in the age group of 26-31 years. Most of them were Hindus (50.7%) and living in a joint family (53.3%) and they reside in semi-urban (44%) areas. The majority of them completed their higher secondary degree education and works in the agricultural sector with an income of 5000 – 10000/rupees per month (66.7%).

 

Table 2: Level of knowledge on prevention of diarrhea

Level of knowledge	No. of mothers	%
Inadequate	40	53.3
Moderate	30	40.0
Adequate	5	6.7
Total	75	100

 

Table-2 shows that the knowledge towards prevention of diarrhea among under-five children was assessed related to the general knowledge of diarrhea, causes, sign and symptoms, diagnosis, complications, and prevention of diarrhea. According to the total score obtained by each subject knowledge was classified into adequate knowledge (>75%), moderate knowledge (50–75%), and poor knowledge (>50%). Table-2 gives the distribution of knowledge level. Our study indicates that 53.3% had inadequate knowledge, 40% had moderate knowledge and 6.7% had adequate knowledge. The overall mean knowledge score of the mother of under-five children’s was 16.53 ± 2.90, Maximum score= 30 and overall knowledge is 55.1%.

 

Table 3: Percentage of attitude on prevention of diarrhea

ITEMS	Strongly		Agree		Uncertain		Disagree		Strongly Disagree
	n	%	n	%	n	%	n	%	n	%
Diarrhea is an infectious disease.	59	78.7	10	13.3	6	8.0	0	0.0	0	0.0
Diet plan change can lead to diarrhea Diarrhea in babies can be caused by a change in diet.	23	30.7	50	66.7	2	2.7	0	0.0	0	0.0
Normal baby stool is similar to adult’s diarrheal stool.	42	56.0	24	32.0	2	2.7	1	1.3	6	8.0
Breast feeding should be continued during diarrhea	23	30.7	25	33.3	19	25.3	7	9.3	1	1.3
Giving ORS supplementation during diarrhea can help to maintain fluids and electrolytes balance.	43	57.3	10	13.3	16	21.3	6	8.0	0	0.0
No urine output in 8 hours could be the sign of severe dehydration.	45	60.0	21	28.0	1	1.3	6	8.0	2	2.7
Diarrhea is the caused by malnutrition	35	46.7	28	37.3	1	1.3	11	14.7	0	0.0
Rotavirus vaccine can prevent diarrheal Disease.	54	72.0	12	16.0	7	9.3	0	0.0	2	2.7
Under five children are more vulnerable to diarrhea	16	21.3	37	49.3	11	14.7	11	14.7	0	0.0
Rehydration is one of the complications of diarrhea	33	44.0	7	9.3	18	24.0	12	16.0	5	6.7

 

Table 4: Association between level of knowledge and their demographic variables.

Sl No.	Characteristics	Category	Knowledge Level						N	Chi-square test
			Inadequate		Moderate		Adequate
			N	%	N	%	N	%
	Age (years)	20 -25	12	48.0	13	52.0	0	0.0	25	c2=21.58 (P=0.01) **
1		25 -30	26	59.1	16	36.3	2	4.5	44
		30 -35	2	33.3	1	16.7	3	50.0	6
2	Religion	Hindu	17	44.7	21	55.3	0	0.0	38	c2=12.59 (P=0.03) *
		Muslim	13	59.1	5	22.7	4	18.2	22
		Christian	10	66.7	4	26.7	1	6.7	15
3	Type of family	Joint	23	57.5	13	32.5	4	10.0	40	c2=4.23 (P=0.38)
		Nuclear	16	51.6	14	45.2	1	3.2	31
		Broken	1	25.0	3	75.0	0	0.0	4
4	Location of family	Urban	5	45.5	5	45.5	1	9.1	11	c2=0.68 ( P=0.95)
		Semi urban	17	51.5	14	42.4	2	6.1	33
		Rural	18	58.1	11	35.5	2	6.5	31
5	Father education	Secondary	13	72.2	5	27.8	0	0.0	18	c2=4.97 (P=0.29)
		Higher Secondary	21	48.8	19	44.2	3	7.0	43
		Graduated	6	42.9	6	42.9	2	14.3	14
6	Mother education	Secondary	13	46.4	14	50.0	1	3.6	28	c2=3.72 (P=0.44)
		Higher Secondary	24	61.5	12	30.8	3	7.7	39
		Graduated	3	37.5	4	50.0	1	12.5	8
7	Occupation	Government	12	46.2	14	53.8	0	0.0	26	c2=15.19 (P=0.01) **
		Private	14	70.0	2	10.0	4	20.0	20
		Agriculture	14	48.3	14	48.3	1	3.4	29
8	Family Income/month	Rs.10000 -20000	1	50.0	1	50.0	0	0.0	2	c2=4.05 (P=0.39)
		Rs.5000 -10000	28	56.0	17	34.0	5	10.0	50
		<Rs.5000	11	47.8	12	52.2	0	0.0	23

 

Table 5: Association between level of attitude and their demographic variables

	Characteristics	Category	Attitude Level				N	Chi-square Test
			Poor		Moderate
Sl No.			N	%	N	%
1	Age (years)	20 -25	23	92.0	2	8.0	25	c2=12.83 (P=0.01) **
		25 -30	38	86.4	6	13.6	44
		30 -35	2	33.3	4	66.7	6
2	Religion	Hindu	32	84.2	6	15.8	38	c2=0.16 (P=0.92)
		Muslim	18	81.8	4	18.2	22
		Christian	13	86.7	2	13.3	15
	Type of family	Joint	34	85.0	6	15.0	40	c2=1.05 (P=0.59)
3		Nuclear	25	80.6	6	19.4	31
		Broken	4	100.0	0	0.0	4
4	Location of family	Urban	8	72.7	3	27.3	11	c2=1.41 (P=0.49)
		Semi urban	29	87.9	4	12.1	33
		Rural	26	83.9	5	16.1	31
5	Father education	Secondary	14	77.8	4	22.2	18	c2=1.44 (P=0.48)
		Higher Secondary	38	88.4	5	11.6	43
		Graduated	11	78.6	3	21.4	14
6	Mother education	Secondary	26	92.8	2	7.2	28	c2=8.53 (P=0.01) **
		Higher Secondary	33	84.6	6	15.4	39
		Graduated	4	50.0	4	50.0	8
7	Occupation	Government	21	80.	5	19.2	26	c2=0.32 (P=0.82)
		Private	17	85.0	3	15.0	20
		Agriculture	25	86.2	4	13.8	29
8	Family Income/month	Rs.10000 -20000	2	100.0	0	0.0	2	c2=0.41 (P=0.81)
		Rs.5000 -10000	42	84.0	8	16.0	50
		< Rs.5000	19	82.6	4	17.4	23

 

Table-3 shows the percentage of attitude on prevention of Diarrhea among mothers of under-five year children. The majority of the mothers are having below-average attitude in all aspects. Our study indicated that 84% of the mothers had an inadequate level of attitude, 16% had moderate and 0% had adequate level of attitude and the mean score of overall attitude on the mothers is18.04 ± 3.80, and the percentage of attitude is 36.1%. Our study also found a healthy attitude and practice of exclusive breastfeeding for the first 6 months and continued breastfeeding during diarrheal illness by a majority of mothers (64%). Similar observations were found by Ranjan and Paswan in their study where majority of the mothers (52%) continued breastfeeding during diarrheal illness⁸. Our study showed that the majority of mothers regarded diarrhea as a serious illness (92%). Many of the mothers in our study were able to take care of the episodes of diarrhea by the household remedies like dal water and lemon drinks along with ORS (70%).

 

Table-4 depicts the association between knowledge level and their demographic variables. Higher respondents (52.0%) of 20-25 years of age noticed moderate knowledge as compared to 59.1 percent of 25-30 year of age respondents who had inadequate knowledge. Further, 50.0 percent of respondents of 30-35 years of age found with adequate knowledge level. However, the association between age and knowledge level was found statistically significant (c2 =21.58**, P=0.01). Regarding religion majority (55.3%) of Hindu, respondents had moderate knowledge as compared to 59.1 5 and 66.7 % of Muslim and Christian noticed inadequate knowledge. Further, the result established significant findings (c2 =12.59* P=0.03).

 

Almost slightly higher among joint (57.5%) and nuclear (51.6%) family respondents noticed inadequate knowledge as compared to a broken family with 75.0 percent as moderate knowledge. Regarding the location of the family, an almost similar response towards knowledge level was observed among all categories.

 

It is observed that the higher the education of both father and mother better is the knowledge level among the respondents. Respondents with government (53.8%) and agriculture (48.3%) background had moderate knowledge as compared to less among private service (10.0%) respondents. Further an association between occupation and knowledge level was found to be significant (c2 =15.19* P= 0.01). Almost equal response of moderate and adequate knowledge level observed among different income groups under study.

 

It can be concluded that the association between type of family, location of family, parent’s education, and family income was found to be statistically non-significant (p>0.05). Three variables i.e., age group, religion, and occupation with knowledge established highly significant (p<0.05).

 

Table–5 depicts the association between attitude level and their demographic variables. It shows that high respondents (92%) of 20-25 year of age with poor attitude as compared to (8.0%) of 20 – 25 year of age who are having a moderate attitude. However the association between age and attitude level was found statistically significant (c2=12.83, P=0.01).

 

Regarding religion majority (18.2%) of Muslims, respondents had a moderate attitude compared to 84.2% and 86.7% of Hindu and Christian noticed with a poor attitude. In family types, nuclear family has the moderate attitude of (19.4%) as compared to joint family (15.0) and broken family (0.0%) similarly urban people had moderate level attitude (27.3%) as compared to rural (16.1) and semi–urban (12.1). It is observed that mother education has a high impact on attitude than father education. Secondary (92.8%) and higher secondary (84.6%) had poor level of attitude as compared to graduated mothers (50.0%) further, an association between mother education and knowledge level found to be significant (c2=8.53,P=0.01) ). Responders with government (19.2%) and private (15.0%) had a moderate level of attitude as compared to agriculture background (13.8%) and it is found that moderate level of income had lower attitude level. Respondents with an income levels between 5000 to 10000 rupees (50%) had a lower attitudes when compared with high-income levels i.e. between 10000 to 20000 rupees per month.

 

It can be concluded that the association between religion, type of family, location of the family, father education, occupation, and family income was found to be statistically non-significant (p>0.05). Two variables i.e., age and mother education found to be highly significant (p>0.05). This result, is consistent with the study by Singh A, Dzeyie Ka, and Yilgwan CS et al^{, 11,12,13} The diarrheal diseases are more common in the lower educational status of the mother and lesser age of the mother with prevalence of overcrowding. Similar results on the educational status of the mother and the lower age group of the mother in the house were found in the studies.

 

Figure 1: Distribution of knowledge and attitude of the mother of under-five children towards prevention of diarrhea.

 

Figure–1showsthe majority (53.3%) of the participants had inadequate knowledge regarding the prevention of diarrhea, (40%) of the participants had moderate knowledge, and only (6.7%) reported with an adequate level of knowledge. Similarly (16%) of the participants had a moderate level of attitude, (84%) had an inadequate level of attitude and none of the study participants had an adequate level of attitude towards the prevention of diarrhea in the same setting.

 

Studies done in Kalburgi and other place on knowledge and practice of mothers of under‑. five children regarding management of diarrhea shows that, most of the mothers were ignorant about the causes of diarrhea^14,15. This difference may probably because their studies were conducted in urban slum areas with low literacy rates whereas our study was conducted in a city with a high literacy rate. In our study, most of the mothers (40%) had limited knowledge regarding signs of dehydration and danger signs. These results were similar to other studies conducted in rural part of Rajasthan India and Kingdom of Cambodia ^16,17. The difference in results may probably because their study was done in an area with a low literacy rate whereas our study was done in a city with a high literacy rate.

 

Despite having a good knowledge of diarrhea, the low- to-moderate level of attitude might be a contributory factor of the high prevalence of diarrhea-related death among under-five children. In our country, another study conducted in Wardha, Maharashtra showed that the 16% mothers had poor knowledge, 74% mothers had average knowledge, and 10% mother had good knowledge about the prevention of diarrhea.

 

CONCLUSION:

Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable. The findings of the present study show that the overall level of knowledge and attitude of the mothers were inadequate about the prevention of diarrhea among the mothers of under-five children. The level of knowledge was significantly associated with mother age group, religion, and occupation. Moreover, the level of attitude was significantly associated with the age and mother education about the prevention of diarrhea. Therefore, health education dissemination of information and community conversation should plan and implement to create a positive knowledge and attitude towards the better prevention of under-five diarrheal diseases in the community.

 

LIMITATION OF THE STUDY:

Since it was a cross-sectional study, it is difficult to know the cause and effect at the same time. In rare cases, there might be recalled bias among their respondents. There is a shortage of literature for factors associated with knowledge as well as attitude.

 

CONFLICTS OF INTEREST:

There is no conflicts of interest.

 

ACKNOWLEDGEMENT:

The authors would like to thank all the study participants and concerned departments for their kind support to carry out this study.

 

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Received on 26.05.2021           Modified on 25.10.2021

Accepted on 09.01.2022          © A&V Publications all right reserved