ABSTRACT

According to WHO, diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual) (WHO, 2017).  In the last decade, global diarrhea was responsible for 1.7 million deaths per year among children under 5 years (Walker et al., 2013). In addition, UNICEF (2016) reported that global diarrhea mortality in children under five years old accounted for 9% in 2015. The aim of this study was to assess mothers’ knowledge on the predisposing factor of diarrhea among children 0-5years in the Mile 16 Community. This was a community based cross-sectional study conducted among 100 mothers having or leaving with children 0 – 5 years. Participants who met the inclusion criteria were sampled using a convenient sampling technique. Data was collected using a well-structured questionnaire based on the objectives of the study. Data collected from the field was analyzed using Microsoft Excel 2013 and presented on tables and charts. Findings from the study revealed that, of the 100 participants, 38 said the child had experience diarrhea in the last 2 weeks. The prevalence of acute diarrhea in children 0 – 5 years old was 38.0%. Based on the frequency of diarrhea, majority 20 (52.6%) of the children with diarrhea passed out stool twice a day. With regards to knowledge of participants on the risk factors of diarrhea, overall proportion of mothers with adequate knowledge on the predisposing factors of childhood diarrhea was 75.0%. Regarding participants’ knowledge on the preventive measures of diarrhea, the overall proportion of mothers with adequate knowledge on the preventive measures against childhood diarrhea was 64.0%. Findings from the study revealed that, majority (93%) of the participants mentioned scarcity and lack of good drinking water as a major challenge. Findings from the study revealed that the prevalence of diarrhea in under-five children was high. The mean frequency and duration of the diarrhea episodes were average. A majority of the participants had adequate knowledge on the risk factors and preventive measures of diarrhea in children. However, majority of the participants cited lack of adequate and safe drinking water as the measure challenge they face in the prevention of diarrhea among under-five children. Thus, portable water systems should be constructed in the community to reduce the prevalence of diarrhea in children.

CHAPTER ONE

INTRODUCTION

1.1 Background

Diarrhea is among top ten killers worldwide and causes 11% of child deaths globally (WHO, 2013). In addition, UNICEF (2016) reported that global diarrhea mortality in children under five years old accounted for 9% in 2015. According to WHO (2017) diarrhea deaths in children under five reach 525,000 and children global diarrhea cases was 1.7 billion every year. In the last decade, global diarrhea was responsible for 1.7 million deaths per year among children under 5 years (Walker et al., 2013). Many cases are from low and middle income countries (Ejemot-Nwadiaro et al., 2015) of Africa and part of Asia (Murray et al., 2012). 

For example, a study conducted in Tanzania indicated that the incidence of the diarrheal disease was estimated at 6.1% and affected mostly children aged between 12 to 23 months (11.6% to 15.8%) (Mashoto et al., 2014). A study conducted in Burundi found that diarrhea episodes affected 32.6% of children under 5 years old (Diouf et al., 2014). In Uganda, diarrhea affected 32 to 48% of children under 5 years in the two weeks preceding Uganda Demographic and Health Survey (UDHS, 2011).

The situation in Cameroon was documented in the recent Demographic and Health Survey 2018 according to the report, 12% of children under age five had diarrhea in the two weeks before the survey (CDHS, 2018).  Diarrhea was most common among those 6-23 months (about 20%).  Among children with diarrhea, 56% had advice or treatment sought. Numerous cases were identified among those fitting into 12-23 months of age and 6-11 months 22% (CDHS, 2018). Reports from 2018 DHS stated that the under-5 mortality rate was 80 deaths per 1,000 live births. 

This means that 1 in every 12 children dies before his or her 5^th birthday. Under-5 mortality increased in Cameroon between 1991 and 1998, but has been declining steadily since 2004.

Diarrheal diseases have many different consequences to childhood development, beside morbidity and death, diarrhea affects the nutritional status of children through different mechanisms ranging from poor nutrients intake, poor nutrients absorption, and forced micronutrients excretion (Ferdous et al., 2013). Poor absorption of nutrients lead to malnutrition which adds to childhood low immunity and this makes the child more prone to complex infectious diseases and inhibits the natural childhood growth (Ngure et al., 2014). Several concomitant infections in African children cause permanent immunological damage.

Different pathogens like viruses, bacteria, parasites can cause diarrhea. But many of them are mostly transmitted via faecal-oral route (Ejemot-Nwadiaro et al., 2015). Diarrhea pathogens that are transmitted through the fecal-oral channel, involve consumption of unsafe food, drinking contaminated water, or interpersonal contact, or through getting in touch with fecal matter. For the water-borne-diarrhea, people are affected when in-house water storage or/and source of water are contaminated with one of the causative agents. The last is transmitted in at least one of the following channels: either it is person to person, environmental contact, animal to human or vice versa via environment (Van-den-Bold, 2012).

In the efforts to prevent diarrhea, governments are struggling to implement effective therapy by establishing treatment guideline (Löfgren et al., 2012). Most of the available guidelines are base on rehydration. This strategy is aiming at preventing the serious consequences of diarrhea including death, but it does little in the primary prevention (Lassi et al., 2014).

Researchers believe that around 90% of diarrheal diseases among children under five result from inadequate sanitation and poor hygiene (Montgomery et al., 2007). Consequently, to address the root causes of the diarrhea problem there is a need to understand the environmental and behavioral issues that result in diarrheic diseases. From that perspective, it is true that diarrhea has a multi factorial cause and addressing one cause is at risk of registering a little gain. Studies in Rwanda identified biological-socioeconomic and environmental factors that might offer a conducive environment to biological cause’s development (Ngabo et al., 2016). In many cases, human contact with faecal matters happens through behavioral factors that include: type of stool disposal, open defecation and inadequate hand washing (Mattioli et al., 2015). The mentioned connection chain can be broken down through effective hand washing and the adequate use of toilettes. However, the gain from hand washing and hygiene cannot happen when people do not have access to safe water and adequate sanitation.

Currently, Cameroon is attempting to address all the potential risk factors. The Ministry of health has been working hard to control diarrheal diseases among children under five and policies have been implemented. For example, the Ministry of Public Health, through a process of task shifting principles, have enabled Community Health Workers (CHWs) to play a pivotal role in identifying cases in early stages, treat them or refer them to health facilities as before it becomes late (Haver et al., 2015). Additionally, the same Ministry initiated further preventive measures by establishing new diarrhea vaccines (rotarix) (Ngabo et al,. 2016). Researchers found that Rotavirus accounts for more than a third of diarrhea deaths in children younger than 5 years worldwide, with more than half of these deaths happening in sub-Saharan Africa (Nguyen et al., 2005). Aware of that, the Government of Cameroon introduced pentavalent rotavirus vaccine to curb diarrhea burden in the country.

In relation to access to safe water and sanitation, Cameroon has made tremendous progress. For example, the CDHS 2018 demonstrated that almost 4 in 5 (79.0%) households have an improved water source.  Improved water is almost universal in urban areas (96%) while only 57% of households in rural areas have improved water.  Nationally, 3 in 5 households have an improved sanitation facility, such as a toilet that flushes to a sewer system. One-third of households have an unimproved facility and 5% of households use open defecation.  Rural households are much more likely than urban households to have an unimproved toilet facility (57% versus 15%) and to use open defecation (12% versus 1%) (CDHS, 2018). However, despite these efforts, diarrheal diseases continue to be among the top ten leading causes of mortality and morbidity for children under 5 years in Cameroon (MoPH, 2020).

1.2 Problem Statement

Diarrheal diseases continue to be a public health issue in developing countries, especially in Sub-Saharan Africa. The diseases have many consequences that include high morbidity/mortality especially among young children (Ejemot-Nwadiaro et al., 2015) and can lead to childhood malnutrition which leaves children vulnerable to infections and delayed growth (Ferdous et al., 2013). Many competing factors might explain the vulnerability of sub-Saharan Africa. These include poverty, socio-political instability and lack of resources, all of these factors constitute an open ground for pathogens to develop (Stewart et al., 2013). Finally, the transmission from infected feces to people through poorly prepared food and unsafe drinking water, interpersonal contact, or manipulation of faecal matter, constitutes a major danger in relation to controlling diarrheal diseases. 

Despite the  efforts made by Government of Cameroon including availing water and sanitation  from 79% (CDHS, 2018), diarrheal diseases continue to be among the top ten leading causes of mortality and morbidity for children under 5 years in Cameroon (MoPH, 2013).  Cameroon demographic and health survey conducted a survey in 2018 to update the information related to burden of disease revealed that diarrhea prevalence among children under five years of age is 12% (CDHS, 2018). This population based survey targeted households of children five years of age. However, though CDHS indicated the prevalence of diarrhea among children under five, it did not identify the factors associated with this health condition as it was not its focus. It is important to perform a secondary data analysis from the available data in order to identify factors which are associated with diarrhea diseases among children under five. 

1.3 Rationale

Despite the many studies previously conducted in Cameroon on diarrhea, very few studies have been done on the knowledge of mothers on the predisposing factors to childhood diarrhea in the Mile 16 Community. Therefore, this is to the best of my knowledge the first study to assess the knowledge of mothers on the predisposing factors to childhood diarrhea in the Mile 16 Community.

1.4 Research Questions

1.      What is the level of knowledge of mothers on diarrhea among children 0-5 years?

2. What is the level of knowledge of mothers on the predisposing factors of diarrhea among children 0-5 years?

3.      What are the challenges faced by mothers in the prevention of diarrhea among children 0-5 years?

1.5 Research Objectives

1.5.1 General objective

To assess mothers’ knowledge on the predisposing factor of diarrhea among children 0-5years in the Mile 16 Community.

1.5 Specific Objectives of the study

1.      To determine the level of knowledge of mothers on diarrhea among children 0-5 years

2. To assess the level of knowledge of mothers on the predisposing factors of diarrhea among children 0-5 years

3.      To identify the challenges faced by mothers in the prevention of diarrhea among children 0-5 years