ABSTRACT

 Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year. Diarrhoea is a leading cause of malnutrition in children under five years old (WHO, 2021). In developing countries such as Cameroon, it has been estimated that 1.8 million people die annually due to diarrhoeal diseases and more than 80% of them are children aged less than five years (Bakiret al., 2017; Hodge et al., 2016). Diarrhoea is not lethal itself, the improper knowledge, poor practice and negative attitudes of mothers and their misdirected approach towards its management and prevention leads to high degree of severe dehydration and lastly death (Hackett et al., 2015; Mumtaz et al., 2014). A community based cross-sectional study was used where 100 participants were recruited for the study using a simple random technique. Questionnaires were used to collect the data. Results obtained indicated that; majority (68.75%) of participants in the Muea Community of Buea had poor knowledge on diarrheal out of the 26 questions that was used to evaluate the participants’ knowledge. Also, most (67.50%) of the participants had poor attitude on diarrheal and lastly, a poor practice in the management of diarrheal in children (0-5years) was perceived in a majority .

Based on the above 68.75% of participants in the Muea community had poor knowledge attitudes on diarrheal and 58.78% had poor  practice on the management of diarrheal because they decided to seek help from friends than going to hospitals.

CHAPTER ONE

INTRODUCTION

1.1 Background

According to the World Health Organization (WHO), Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable. Each year diarrhoea kills around 525 000 children under five. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year. Diarrhoea is a leading cause of malnutrition in children under five years old (WHO, 2021). Diarrhoea can last several days, and can leave the body without the water and salts that are necessary for survival. In the past, for most people, severe dehydration and fluid loss were the main causes of diarrhoea deaths. Now, other causes such as septic bacterial infections are likely to account for an increasing proportion of all diarrhoea-associated deaths. Children who are malnourished or have impaired immunity as well as people living with HIV are most at risk of life-threatening diarrhoea (WHO, 2021).

 According to the WHO Diarrhoea 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). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose, “pasty” stools by breastfed babies. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce disease risk. Diarrhoea should be treated with oral rehydration solution (ORS), a solution of clean water, sugar and salt (WHO, 2021).

In developing countries such as Cameroon, it has been estimated that 1.8 million people die annually due to diarrhoeal diseases and more than 80% of them are children aged less than five years (Bakiret al., 2017; Hodge et al., 2016). Diarrhoea is responsible for the death of more than 90% of under-five years of age in low and lower-middle income countries, and regionally, South Asia and sub-Saharan Africa (SSA) accounted for 88% of deaths for the same age group (UNICEF, 2019).Children with diarrhoea will face many problems including loss of appetite, electrolyte deficit, malnutrition, increased risk of developing other infectious diseases and delayed physical growth and mental development (WHO,2005; UNICEF, 1998). Because of its negative impact on the physical and cognitive development, diarrhoea is also associated with multiple problems; causing for 72.8 million disability and adjusted life years (DALYs), and it worsens the economic situation of families and the healthcare system (Aikins et al., 2010; Gakidou et al.,2017).

Inadequate quantities and quality of drinking water and lack of sanitation facilities cause the death of millions of the world’s poorest people through diarrhoeal diseases each year (Bartlett et al., 2003; Fewtrell et al.,2004).Furthermore, studies revealed that age of child (Nasir et al.,2020; Escobar et al.,2015;Atnafu et al.,2020;Bado et al.,2016; Danny VC et al.,2016), maternal education (Nasir et al.,2020;Atnafuet al.,2020;Hajara  et al.,2017), lack of awareness of mothers/caregivers (Agegnehu et al.,2019;Tambeet al.,2016), lower socio-economic status (Escobar et al.,2015),distance and source of drinking water (Nasir et al.,2020, Hussien H,2017, Moon et al.,2019), latrine and hand washing facilities (Dagnew et al.,2019;Gedamu  et al.,2017) , breast feeding(Dagnew et al.,2019, Fetensa et al.,2020), place of residence ( Badoet al.,2016, Gedamu et al.,2017, Mengistie et al.,2013 ), disposal of children’s stool (Mengistie et al.,2013;Desalegn  et al.,2011Medirattaet al.,2010), family size (Agegnehu et al.,2019;Kunii  et al.,2002),number of under-five children in the household (Atnafu et al.,2020, Tambe et al.,2016), maternal age (Hussien et al.,2017, Moon  et al.,2019) and maternal employment status (Atnafu.,2020, Agegnehu., 2019 , Hussien et al.,2017,Hatt L and Waters H.,2006) as the determinant factors of diarrhoea among under-five children.

According to WHO, Passage of 3 or more than 3 loose  stool or watery stools per day or considers as abnormal by the mothers or stools more frequent than normal for a
child is considered as diarrhoea (UNICEF,2004;WHO,2013). Diarrhoeal disease remains the second leading cause of death among under 5 children globally (WHO,2005; Wardlaw et al., 2010; Kosek et al.,2003;Black et al.,2003). Nearly one in five deaths of a child – about 1.5 million each year – is due to the disease of diarrhoea (Wardlaw et al., 2010; Walker et al., 2012). It kills more young children than malaria, HIV/AIDS, and measles together (WHO and UNICEF, 2004;Wardlaw et  al., 2010).Diarrhoeal disease is one of the commonest illnesses that has the greatest negative impact on the growth and development of infants and young children ( Motarjemi et al.,1993).

Worldwide, children whose age is less than 5 years’ experience, on average, 3.2 episodes of diarrhoea every year and consequently 1.87 million children will die from dehydration associated with diarrhoeal disease, particularly in the countries of Asia, Africa and Latin America (WHO, 2005). Rotavirus is among the commonest diarrhoeal pathogen in children worldwide that causes about one-third of diarrhoea-associated hospitalizations and 800,000 deaths per year (Parashar et al., 1998; Parashar et al., 2006; Walker et al., 2013). Children in the poorest countries like Cameroon account for 82% of rotavirus deaths of under-five children (Parashar et al., 2003). Rotavirus can cause intestinal losses of fluid, electrolyte and nutritional deficiency which relatively progresses rapidly to cause dehydration and death (King et al.,2003;O’Ryan et al.,2010).

Contaminated weaning food, inappropriate feeding practice, lack of clean water, poor hand washing, limited sanitary disposal of waste, poor housing conditions, and lack of access to adequate and affordable health care are aggravated factors of the under 5 diarrhoeal disease (Black et al., 2003,Motarjemi et al.,1993;Prüsset al.,2002; Keusch et al.,2006).Diarrhoeal diseases among under 5-year children can be tackled in at both primary and secondary prevention levels. The former about the improvement of sanitation and water quality but the latter is about early recognition of dehydration due to diarrhoea and prompt oral rehydration using ORS (oral rehydration solution) or appropriate home available fluids. Oral rehydration solution has been proven to be effective in preventing diarrhoea mortality in the community while varying degree of evidence favours the use of home available fluid (Munos et al., 2010).

Optimal infant and young child feeding practices could prevent more than 10% of deaths from diarrhoea. On the other hand, better hygiene practices, particularly hand washing with soap and the safe disposal of excreta can reduce the incidence of diarrhoea by 35% (WHO, 2004;Benenson et al., 1995).Diarrhoea is not lethal itself, the improper knowledge, poor practice and negative attitudes of mothers and their misdirected approach towards its management and prevention leads to high degree of severe dehydration and lastly death (Hackett et al., 2015; Mumtaz et al., 2014). Therefore, the main objective of this study was  the assessment of mothers’ knowledge, attitude, and practice on home-based management of diarrhoea amongst children under-five years in the Muea Community, Buea south West Region of Cameroon.

1.2 Problem Statement

Diarrhoea is the second leading cause of death among children under five years old in the world, affecting approximately 1.5 million children per year (Masukawa et al., 2014) with
more than 800000 under-fives kicking the bucket each year (Tambe et al., 2015; Acharya
et al., 2018). It actually contributes approximately 8% of deaths among children
between one and 59 months which is more than numbers recorded for Acquired Immune
Deficiency Syndrome (AIDS), malaria and measles combined (UNIGME, 2017). In many
developing countries such as Cameroon, diarrhoea is the major cause of morbidity and
mortality among children. Every child aged below five years of age in these developing
countries experiences five incidents of diarrhoea each year (Tambe et al., 2015).The Muea community , just like many other communities in the South West Region of the country , is haunted by an inadequate water supply. The already bad situation is compounded by poor sanitation and hygiene that has characterized literally the whole country. Due to fast growing urbanization, this phenomenon has become a health problem in this community. It is against this background the researcher resolved to find out how knowledgeable are the mothers on the management of diarrhoea in children 0-5 years in the Muea community.

1.3 Rationale 

Diarrhoea remains the second leading cause of death among children under 5 globally. It kills more young children than AIDS. It would have been prevented by simple home management using oral rehydration therapy. Mothers play a central role in the management and prevention of this condition.

1.4 Research Questions 

What is the level of knowledge mothers in the Muea Community have on diarrhoea

What attitudes do mothers in the Muea Community show towards the management of diarrhoea

What are the practices these mothers carry out in   the management of diarrhoea

1.5 Research Objectives 

1.5.1 General Objective 

Assessment of mothers’ knowledge, attitude and practice on home-based
management of diarrhoeal among children age 0-5years in the Muea Community, South West Region Buea.

1.5.2        Specific Objectives 

1. To assess the level of knowledge of these mothers on diarrhoea
2. To determine the attitudes of these mothers on the management of diarrhoea
3. To assess the practice of mother in the management of diarrhoea