Research Article
Open Access
Awareness of Mothers about Diarrhea; A Cross
Sectional Comparative Study Focusing on
Consciousness of Diarrhea among Different
Socioeconomic Classes in Pakistan
Sana Noor1, Hira Nawaz2, Zarghoona Wajid3, Fatima Qaiser4, Hamza Jamal5, Anila Abdullah6, Samreen Farrukh7, Muhammad Abdul Waasey8, Neeta Maheshwary9*, Adnan Anwar10
1Assistant Professor, Department of Community Medicine, Avicenna Medical College, Lahore, Pakistan.
2FCPS Resident, National Institute of Child Health, Pakistan.
3Managing Assistant, Musavvir Stem cell clinic and pathology laboratory.
4Medical officer, Civil hospital.
5Medical Officer, Hamdard University Hospital, Pakistan.
6Medical Officer.
7Medical officer, Jinnah Sindh Medical University, Pakistan.
8Memon Hospital, Karachi, Pakistan.
9Manager Medical Affairs & Clinical Research, Hilton Pharma PVT Ltd.
10Senior Lecturer, Department of Physiology, Altibri Medical College, Karachi, Pakistan.
*Corresponding author: Neeta Maheshwary, Manager Medical Affairs & Clinical Research, Hilton Pharma PVT Ltd, E-mail:
@
Received: September 26, 2017; Accepted: November 22, 2017; Published: November 24, 2017
Citation: Sana Noor, Hira N, et al. (2017) Awareness of Mothers about Diarrhea; A Cross Sectional Comparative Study Focusing on Consciousness of Diarrhea among Different Socioeconomic Classes in Pakistan. Int J Pediatr Child Care: Open Access 2(1): 1-6.
Abstract
Objective: The objective of this study was to access the knowledge of mothers belonging to low and middle socio economic groupsconcerning diarrheal disease in Pakistan.
Methodology: This was an observational, comparative study done for three months using convenient sampling technique. The mothers of the
admitted children in paediatric wards or coming to the paediatric OPD of Sheikh Zayed Hospital, Lahore having at least one child under the age of
5 years and the presenting complaint of the child was diarrhea were included in the study.The duration of study was from 19 April 2015 to 28 July
2015. The calculated sample size was 268.The mothers who did not give consent were excluded from the study.The demographics data includedage
of the child, sex, number of sibling, residence (urban / rural), education and profession of father and mother and socioeconomic status. The family
having monthly income between ten to twenty thousand rupees in a month was classified to have low socioeconomic status and with twenty to
thirty thousand as middle socioeconomic status. They were divided into equal groups according to the socio economic status having 138 mothers
in each group. Awareness about diarrhea and its causes, signs of dehydration, importance and preparation of ORS were also documented. Data was
analyzed through SPSS version 20. Chi square test was used to evaluate the significance.
Results: In total of 268 mothers the mean age of their children that belong to low socioeconomic class was 2.2±1.34 years, and mean weight
recorded was 11.7±3.93kg while those that belong to middle socioeconomic class it was 2.4±1.53 years and 12.9±4.33 kg. Our study showed that
81(60.4%) of mothers in group A prefer ORS to give their child, 25(18.7%) give boiled rice, 28(20.9%) prefer to give other soft diet to their children.
However, mothers from group B, 90(67%) prefer to give ORS, 25(18.7%) give boiled rice while 19(14.2%) mother prefer to give other soft diet. The
adequate level of knowledge regarding ORS was found to be present in 123(91.8%) in group A and 134(100%) in group B, with a significant p-value
of 0.001. However it was found that the knowledge about the causes of diarrhea was similar in both the groups.
Conclusion: This study concluded that knowledge about control of diarrheal disease is quite unappreciative especially in mothers of low
socioeconomic group. Poverty, illiteracy, improper sanitation facilities, unhygienic practices and use of impure water is dragging the health indicators
down and increasing the burden of diarrheal diseases on health resources.
Keywords: Awareness of Mothers; Diarrhea;
Introduction
Globally, diarrhea is a one of the main cause of morbidity and
mortality among all age groups [1]. Diarrhea could be stated as the
passage of loose or watery stools. The World Health Organization
(WHO) describes a case of diarrhea as the passage of three or more
loose or watery stools per day. However, abnormality from the
usual pattern of child should arouse some fear irrespective of the
definite quantity of stools or their water content [2]. According to
the World Health Organization (WHO) and UNICEF, globally every
year diarrhea affects 2 billion people and every year 1.9 million
children younger than 5 years of age die from diarrhea mostly in
developing countries [3]. Around 25,000 deaths occur annually
in Pakistan because of diarrhea and is rated as the main cause of
death in children [4]. In Pakistan approximately 1,100 children of
less than 5 years die every day because of diarrhea and diseases
related to water, sanitation and hygiene [5]. Diarrheal ailment
could involve acute watery diarrhea, invasive (bloody) diarrhea,
or chronic diarrhea (persistent greater or equal to fourteen
days). This classification facilitates the approach to management
of childhood diarrhea. Maximum patients of acute diarrhea in
evolving countries are because of infectious gastroenteritis.
The etiologies of childhood diarrhea depend upon the type of
diarrhea. Acute watery diarrhea is because of rotavirus in newborn
and young kids; in older children, it is most often due to
Escherichia coli [6]. Severe diarrhea in childhood can caused
malnutrition, impaired cognitive development and growth failure
which are more common in developing countries. However, the
changes in personal hygiene, sanitation and water supply during
the past three decades have decreased the mortality in developing
countries [3,7]. Diarrhea exerts the economic burden on health
services leading to as one-third of total pediatric admissions in
hospitals [8]. Although the programs sponsored by World Health
Organization (WHO) have played significant role in decreasing
mortality rates but in children younger than 5 years the incidence
of diarrhea disease remains high [9]. The mortality of diarrhea is
because of fluid loss leading to sever dehydration [10]. Morbidity
and mortality of diarrheal disease can be reduced with oral
rehydrating solution (ORS) at appropriate time [11]. There are
various programs conducting throughout the world like WHO
diarrheal control program whose main objective is to delivered
the appropriate knowledge regarding diarrheal disease and the
use of ORS [12].
On the basis of accurate understanding of prevailing
knowledge and awareness of community, effective health
education can be provided. The objective of our study was to
accesses the knowledge of mothers belonging to two different
socio economic groups (low and middle socio economic
groups) regarding diarrheal disease. Therefore, for successful
implementation of control activities in the management of
diarrheal diseases in children of five years of age, the information
of awareness of mothers is essential.
Material and Methods
The study design was cross sectional comparative study with
non-probability convenient sampling technique. The study was
conducted in Sheikh Zayed Hospital, Lahore. Prior permission
was obtained from hospital concerned authorities to conduct the
study. Verbal and the written consent were taken from selected
mothers with confidentially of data. The duration of study was
from 19 April 2015 to 28 July 2015. The calculated sample size
was 268. Sample size was estimated using WHO software. It
was calculated under the assumption that the proportion of
mother appropriately treating their children with acute diarrhea
was 55% (p = 0.55) with an expected 5% margin of error and
90% confidence interval. The mothers of the admitted children
in paediatric wards or coming to the paediatric OPD of Sheikh
Zayed Hospital, Lahore having at least one child under the age of
5 years and the presenting complaint of the child was diarrhea
were included in the study. The mothers of children who did not
give consent for participation in the study were excluded from
the study. Mothers were interviewed by structured Performa.
The demographics data include age of the child, sex, number of
sibling, residence (urban / rural), education and profession of
father and mother and socioeconomic status. The family having
monthly income of between ten to twenty thousand rupees in
a month was classified to have low socioeconomic status and
with twenty to thirty thousand as middle socioeconomic status.
They were divided into equal groups according to the socio
economic status having 138 mothers in each group. The question
regarding diarrhea were asked from mothers including definition
of diarrhea, signs of dehydration, when they visit doctor to seek
treatment, food offer during diarrhea, either they educate their
children regarding hand washing or not and the causes and
consequences of diarrhea. The awareness about preparation and
importance of ORS was also documented.
Data Analysis
Data was entered and analyzed through SPSS version 20.
Quantitative data like age was presented by mean and standard
deviation while qualitative data like Study group, education
and socioeconomic status were presented by frequency and
percentages. Chi square test was used to evaluate the significance.
P-value of less than or equal to 0.05 was taken as substantial.
Results
In total of 268 mothers the mean age of their children that
belong to low socioeconomic class was 2.2±1.34 years, and mean
weight recorded was 11.7±3.93 kg while those that belong to
middle socioeconomic class it was 2.4±1.53 years and 12.9±4.33
kg .The gender of children in group A was male in 105 (78.4%)
and female in 29 (21.6%) while in group B males were 114
(85.1%), and females were 20 (14.9%). Number of sibling of age
range 0-4 years in group A was 101 (75.3%) % and in group B
was 105 (78.3%) while from 5-8 y in group A was 33 (24.6%) and
in group B was 29 (21.6%).The education of mothers from group
A was primary in 52 (38.8%), metric in 67 (50%), intermediate
in 12 ( 9%) and graduation in (2.2%), whereas from group
B primary in 10 (7.5%), metric in 19 (14.2%), intermediate in
40 (29.9%), graduation in 48 (35.8%), higher education in 17
(12.7%).The education of father from group A was primary in
14 (10.4%), metric in 50 (37.3%), intermediate in 70 (52.2%)
while from group B it was primary in 7 (5.2%), metric in 14
(10.4%), intermediate in 34 (25.4%), graduation in 59 (44%),
higher in 20 (14.9%). 103 (76.9%) mothers were housewives,
28 (20.9%) were maids and only 3 (2.2%) were doing private
job like teaching from group A, while from group B 82 (61.2%)
mothers were housewives, 7 (5.2%) were maids and 45 (32.6%)
were private job. The fathers belonging to low socioeconomic
group, 72 (53.7%) were doing private job, 41 (30.5%) were
shopkeepers, 21 (15.6%) were jobless. Among fathers belonging
to middle socioeconomic group 87 (65%) were doing private job,
shopkeepers were about 36 (26.8%), 5 (3.7%) were jobless while
only 6 (4.5%) were government employee (Table 1).
Table 1: General Analysis (n= 288)
Variables |
Group A
(n=134) |
Group B
(n=134) |
Age(years) |
2.2±1.34 |
2.4±1.53 |
Present weight of child (kg) |
11.7±3.93 |
12.9±4.33 |
Gender |
Male |
105 (78.4%) |
114 (85.1%) |
Female |
29 (21.6%) |
20 (14.9%) |
No. of siblings |
0-4 |
101 (75.3%) |
105 (78.3%) |
5-8 |
33 (24.6%) |
29 (21.6%) |
Education of mother |
Primary |
52 (38.8%) |
10 (7.5%) |
Matric |
67 (50%) |
19 (14.2%) |
Inter |
12 (9%) |
40 (29.9%) |
Graduation |
3 (2.2%) |
48 (35.8%) |
Higher |
0 |
17 (12.7%) |
Education of father |
Primary |
14 (10.4%) |
7 (5.2%) |
Matric |
50 (37.3%) |
14 (10.4%) |
Inter |
70 (52.2%) |
34 (25.4%) |
Graduation |
0 |
59 (44%) |
Higher |
0 |
20 (14.9%) |
Profession of Mother |
house wife |
103 (76.9%) |
82 (61.2%) |
maid |
28 (20.9%) |
7 (5.2%) |
Private Job/Teacher |
3 (2.2%) |
45 (32.6%) |
Profession of Father |
Private Job |
72 (53.7%) |
87 (65%) |
Business/Shop |
41 (30.5%) |
36 (26.8%) |
Jobless |
21 (15.6%) |
5 (3.7%) |
Govt. Job |
0 |
6 (4.5%) |
Out of the 134 mothers belonging to group A, 64 (47.8%)
quoted diarrhea as watery stools, 45 (33.6%) as increased
frequency of stools and 25 (18.7%) mothers were unaware.
While, out of 134 mothers from group B, 75 (56%) stated
diarrhea is watery stools, 31 (23%) as increased frequency of
stools and 28 (20.9%) mothers were unaware. Mothers from
group A have satisfactory knowledge about signs of dehydration
as 61 (45.5%) answered sunken eyes, thirsty and dry skin quoted
by 49 (36.6%) and 24 (17.9%) mother had no idea about it.
Similarly, 48 (35.8%) mothers from group B reported sunken
eyes, 59 (44%) thirsty and dry skin and 27 (20.1%) had no
awareness about it. An enormous number of mothers ,71 (53%)
from group A said that they should visit the doctor immediately
when their child have diarrhea, 51 (38.1%) reported within 48
hours of illness, only 12 (9%) mothers do not visit. Likewise, from
group B 45 (33.6%) mother were aware that they should visit
immediately, 59 (44%) visit within 48 hours and 30 (22.4%) do
not visit. Our study showed that 81 (60.4%) of mothers in group
A prefer ORS to give their child, 25 (18.7%) give boiled rice, 28
(20.9%) prefer to give other soft diet to their children. However,
mothers from group B, 90 (67%) prefer to give ORS, 25 (18.7%)
give boiled rice while 19 (14.2%) mother prefer to give other
soft diet. The adequate level of knowledge regarding ORS was
found to be present in 123 (91.8%) in group A and 134 (100%) in
group B, with a significant p-value of 0.001. Mothers that showed
adequate level of knowledge regarding preparation of ORS were
107 (79.9%) from group A and from group B they were 100
(74.6%). 103 (76.9%) from group A and 102 (76.1%) from group
B educate their children about frequent hand washing (Table 2).
Table 2: Accessing Knowledge Regarding Diarrhea (n= 288)
Comparison of Knowledge with Socio economic Status (n=268) |
Variables |
Group A |
Group B |
P-value |
Do you know what is diarrhea |
Watery stool |
64 (47.8%) |
75 (56%) |
0.164 |
Increase Frequency |
45 (33.6%) |
31 (23.1%) |
Don’t Know |
25 (18.7%) |
28 (20.9%) |
Do you know what are the signs of dehydration |
Sunken Eyes |
61 (45.5%) |
48 (35.8%) |
0.729 |
Thirsty and dry skin |
49 (36.6%) |
59 (44%) |
Don’t Know |
24 (17.9%) |
27 (20.1%) |
Do you visit the doctor when your child is having episode of diarrhea |
Immediately |
71 (53%) |
45 (33.6%) |
0.265 |
Within 48 Hours |
51 (38.1%) |
59 (44%) |
Don’t Visit |
12 (9%) |
30 (22.4%) |
Which diet do you offer during diarrhea |
ORS |
81 (60.4%) |
90 (67.2%) |
0.08 |
Khichri only |
25 (18.7%) |
25 (18.7%) |
(Banana, Borage, Khichri) |
28 (20.9%) |
19 (14.2%) |
Do you educate your child to wash his or her hands frequently |
Yes most often time |
103(76.9%) |
102 (76.1%) |
0.855 |
Sometimes |
31 (23.1%) |
32 (23.9%) |
Do you know what is ORS |
Yes |
123 (91.8%) |
131(97.7%) |
0.001 |
No |
11 (8.2%) |
3(2.3%) |
Our study recorded the knowledge of mothers regarding
causes of diarrhea and fount that from group A and B, 62 (46%)
and 64 (47%) mothers respectively consider use of contaminated
water as a cause of diarrhea. 29 (22%) and 24 (18%) mothers
of group A and B respectively consider teething as a cause of
diarrhea while equal number of mothers that is 32 (24%) of
mothers of both group believe that diarrhea is because of eating
mud by their children. 3 (2%) and 2 (1%) mothers of group A and
B respectively suppose evil eye to be the cause of diarrhea while
7 (5%) and 12 (9%) mothers of group A and B respectively do not
know the cause of diarrhea (Figure 1).
Our study recorded the knowledge of mothers regarding
consequences of diarrhea in the mothers of groups A as lethargy,
loss of weight, unconsciousness and death in 65 (49%), 42 (31%),
20 (15%) and 7 (5%) respectively. Similarly it was noted to be
47 (35%), 56 (43%), 27 (20%) and 4 (3%) respectively in the
mothers categorized in group B (Figure 2).
Discussion
The development of a country primary health care is very
important. The proper treatment of child by following the
instructions advised by doctor and practicing of oral rehydration
therapy is possible if mother is educated. The previous studies
revealed that literacy rate of mothers was higher in urban areas
Figure 1: Causes Of Diarrhea (n=288)
than the rural areas [13,14]. While our study showed that the
education of mothers from group A (low socio economic group)
was primary in 38.8%, matric in 50%, intermediate in 9%,
graduation in 2.2% and from group B(middle socioeconomic
group): primary in 7.5%, matric in 14.2%, intermediate in 29.9%,
graduation in 35.8%, higher in 12.7%. This showed the marked
difference in the educational status of the mothers in group B.
Figure 2: Showing the awareness about Consequences of Diarrhea (n=
288)
Existing literature showed that 86.7% and 75% of the
mothers living in urban and rural regions respectively had
reasonable information about diarrhea [14]. Results of another
study specified that knowledge of the most of women (64.3%)
concerning diarrhea and nutrition was modest and there were
only 3.7% had reasonable information [15]. Another study
documented the awareness in mothers regarding features of
dehydration, 26% mothers were aware about sunken eye as
the only clinical feature and 40% mothers reported unclear
signs whereas 35% answered two features including thirst
and dry skin and there were 80% Mothers who knew about
the preparation of ORS [16]. In one of the study the knowledge
about increase fluid intake during diarrhea was noted and it
was found that 81% and 49% mothers of urban and rural areas
respectively were aware about it. As revealed by the study these
fluids (ORS and other fluids) were locally acceptable. So, the child
can be treated at home if mothers are educated. Their study also
showed that 92% and 90% mothers from urban and rural areas
had knowledge regarding ORS solution [13]. In our study, it was
revealed that, among mothers belonging to low socioeconomic
group 47.8% documented diarrhea as watery stools, 33.6% as
increase frequency of stools and 18.7% mother did not know
about it. While, mothers from middle socioeconomic group stated
diarrhea is watery stools by 56% of mothers, increased frequency
by 23% and 20.9% mother were unaware. Mothers from group
A have acceptable knowledge about signs of dehydration, 45.5%
said sunken eyes, thirsty and dry skin quoted by 36.6% and
17.9% mother had no idea about it. Similarly, 48% mothers from
group B declared sunken eyes, 44% said thirsty and dry skin and
20.1% had no idea about it. An enormous number of mothers
71% from group A said that they visit the doctor immediately
when their child have diarrhea, 38.1% visit within 48 hours of
illness, only 9% mothers do not visit. Likewise, from group B
45% mother visit immediately, 44% visit within 48 hours and
22.4% do visit doctor. Our study showed that 60.4% of mothers
group A prefer ORS to give their child, 18.7% give khichri, 20.9%
prefer to give other soft diet to their children. However, mothers
from group B, 67.2% prefer to give ORS, 18.7% give khichri while
14.2% mother prefer to give other soft diet. Our study shows
Statistics that in both the groups the adequate level of knowledge
regarding ORS was found to be present in 91.8% in group A,
100% in group B, with a significant p-value of 0.001. Mothers
that showed adequate level of knowledge regarding preparation
of ORS were from group A 79.9% and from group B 74.6%. Our
research also recorded that 76.9% from group A and 76.1% from
group B educate their children about frequent hand washing with
a insignificant p-value 0.08.
One of the study recorded that those children were more
prone to have diarrheal disease who are using well or river water
and hand pump [17]. Our study documented that the source of
water used to drink and cook was tap water by 11.2% and by
storage tank by 88.8% from group A, and in group B tap water
used by 10.4% whereas 89.9% used from storage tank. It was
found that 91.8% of mothers from group A use water from tap
and only 8.2% used boil water to drink and for cooking purpose.
One of the study documented that the morbidity and
mortality of diarrheal disease was dependent on multiple factors
like female literacy, poor sanitation, inadequate health services,
poor hygiene, poverty and the lack of breast feeding [18]. Another
study showed that because of diarrhea and diseases stemming
because of poor hygiene, impure water usage and improper
sanitation techniques 1100 children under 5 years lose life daily
[19]. Another study documented that from 200 cases, mother’s
knowledge concerning the causes of diarrhea; eating mud (14%),
contaminated water (17%), teething (10%) [20]. Our study
recorded the knowledge of mothers regarding causes of diarrhea
that from group A and B, 62% and 64% mothers respectively
consider use of contaminated water as a cause of diarrhea. 29%
and 24% mothers of group A and B respectively consider teething
as a cause of diarrhea while equal number of mothers that is
32% of mothers of both group believe that diarrhea is because of
eating mud by their children. 3% and 2% mothers of group A and
B respectively suppose evil eye to be the cause of diarrhea while
7% and 12% mothers of group A and B respectively do not know
the cause of diarrhea.
The qualitative approach of our study has warranted that we
have considered the awareness of extensive range of mothers
from lower and middle socioeconomic classes in Pakistan.
However, the study might not be immune from subjective and
observer bias. Creating the awareness of the diarrhea among the
different classes of mothers would be revealing and beneficial to
regulate the prevention of diarrhea at initial level.
Conclusions
It can be concluded that knowledge of mothers regarding
control of diarrheal disease is quite unappreciative especially
in mothers of low socio economic groups. Poverty, illiteracy,
improper sanitation facilities, unhygienic practice and use of
impure water is reducing the quality of health. Therefore, with
the help of awareness programs, radio transitions and health care
camps case management of diarrheal disease at preliminary level
can be improved.
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