CHAPTER ONE

1.1 INTRODUCTION

Effort to improve childhood mortality and morbidity associated with diarrhea disease have seen the emergency of large multinational studies to characterize disease burdens, regional differences and success of various interventions. Despite significant advances in management of childhood diarrhea and into the etiology and comorbidities, mortality remains excessive in children, particularly affecting children less than five years of age. Advance molecular diagnostic approaches have resulted in considerable progress in identifying etiological key cause of malnutrition and stunting in developing countries. Childhood diarrhea, even though it is preventable and treatable disease, remains a major cause of consultation, hospitalization, emergency care and deaths in children under five years old. It is estimated that 2.5 billion cases in children of this age group occur annually, leading to 57 deaths per 100, the second largest cause of global morbidity and mortality in children in developing countries (UNICEF 2018). Globally, there are nearly 1.7billion cases diseases that accounts for one in nine child deaths, it kills 525,000 children under five years old each year, and it’s the leading cause of malnutrition in children under five years World Health Organization(WHO) UNICEF 2017. The majority (42%) of deaths due to diarrhea due to diarrheal disease were concentrated in sub-Sahara Africa, including Ethiopia (88 per 1000 live births), where hygiene and sanitation are poor World Health Organization (WHO) 2014.

Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for an individual) World Health Organization (WHO 2017). Acute diarrhea disease is associated with multiple factors related to socioeconomic, health, cultural and behavioral conditions (Amaechi EC and Anye KS 2017 2019). In low income countries, children up to three years old experience, on average, three diarrhea episodes each year. Each episode deprives them of the necessary nutrition for growth, in addition leading dehydration, becoming a cycle of, since malnourished children are more likely to get sick from diarrhea (World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) 2019). Most causes of result from infection in the intestinal tract, several organisms are responsible for the infection. They include bacteria, viruses and parasites. The child gets infected through contaminated food and drinking water from person to person due to poor hygiene World Health Organization (WHO 2016). Lack of environmental hygiene accounts for 88% of diarrhea disease (Environmental Health Project 2015). In Ethiopia over 75- 80 of community disease are caused due to poor environmental health conditions arising from unsafe and inadequate water supply and poor hygienic and sanitation practices (WHO 2014).

 The vast majority of these is preventable through improvements in water sanitation, hygiene, nutrition, breast feeding, rotavirus vaccine, maternal behavior (Sabino LM et Al 2018). It is important to also note that more than 90% of diarrhea can be treated effectively with oral rehydration solution World Health Organization (WHO 2015). Other effective treatments include zinc intravenous fluids and antibiotics.

In Cameroon, paucity of data on diarrhea morbidity and mortality exists and these epidemiological studies have indicated community based prevalence of acute diarrhea to range from 16% to 23% among under five (Bilal NK et AL 2016). The main reason why the number of children dying from diarrhea are increasing due to associated risk factors and the lack of access to essential treatment. Children in household with lower socioeconomic status receive oral rehydration therapy (fluid taken by mouth to prevent or treat dehydration) less often than children in household with higher socioeconomic status (Tsinuel G et AL 2017).

Diarrhea case management can be divided into; Assessment, Treatment and Follow up. The assessment to classify patient’s levels of dehydration and determine the type of diarrhea illness (acute, dysentery or persistent diarrhea). Follow up may range from hourly observations of severely dehydrated patients to reassessment after 4hours for a patient with such dehydration. A patient may require follow up after a number of days of treatment if they present with persistent bloody diarrhea (CDC 2019).

Strategies to optimize the management of diarrhea need to focus on improving the communication between staff and ensuring effective treatment is implementation; Nurses find some challenges while managing childhood condition (UNICEF committee 2018). Despite all these management diarrheas still remains a prevent childhood disease.

1.2    PROBLEM STATEMENT

According to WORLD HEALTH ORGANISATION WHO 2017, diarrhea is one of the leading causes of death in children under five in the world. Each year diarrhea kills 525000 children under five years and nearly 1.7 billion of childhood cases of diarrhea World Health Organization WHO 2018. In Africa and South America diarrhea accounts for one in eight deaths among children younger than five years (Kedd et al 2016, Kotloff 2017) and an estimated 16% of child death in Nigeria annually (Charyeva et al 2015). In Cameroon, was reported that 17.4% of deaths and dehydration was due to diarrhea (World Bank Collection of Development Indicators 2018). A study carried out in Minawao in the Farnorth region, reported that 66% of dehydration and death cases were due to diarrhea (Maternal and Child Epidemiology Estimation, MCEE 2016). Also the investigator during one of her clinical placement at the Tiko Holforth Health Center in 2021, most of the patients at the children’s ward were under five years and came in severely dehydrated due to diarrhea, also other cases witnessed from classmates, neighbor and friends’ children which were all under five years experiencing diarrheal episodes leading to severe dehydration and possibly death.

In Cameroon efforts to reduce the mortality rate of children under five due to diarrhea depend on the management of patients by medical personnel’s (nurses, midwives) in hospitals (WORLD HEALTH ORGANIZATION WHO 2019). In spite the WHO guidelines of treatment of childhood diarrhea in all hospitals facilities, very little has been achieved in rolling back the rising number of care of childhood diarrhea and related complications in one health setting. The aim of this study is to understand the challenges faced by nurses and midwives in the implementation of the prescribed treatment guidelines in the management of childhood diarrhea. Hence the need to know the knowledge of nurses and midwives on the management of childhood diarrhea.

1.3 RESEARCH OBJECTIVES

1.3.1 General objectives

Nurses and midwives’ knowledge and practices on the management of childhood diarrhea

1.3.2 Specific objectives

1. Nurses knowledge and practices on the management of childhood diarrhea
2. Identify the different challenges nurses face in the management of childhood diarrhea patients

1.4       RESEARCH QUESTIONS

1. How do nurses and midwives of CMA down beach manage childhood diarrhea?
2. What is the level of knowledge of nurses and midwives of CMA on the management of childhood diarrhea?
3. What are the challenges faced by nurses and midwives on the practices and management of childhood diarrhea?