Diarrhea, Maternal attitude, skill, knowledge a prospective study
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Transcript of Diarrhea, Maternal attitude, skill, knowledge a prospective study
ASK(Attitude, Skills, Knowledge) Mothers to prevent Diarrhea
Ajay AgadeJLN HOSPITAL & RESEARCH
CENTREBHILAI
1. Diarrhea known medically “Gastroenteritis” is a major killer of children in world.
2. One out of every four childhood death.3. Drains life out of 3 million infants & young children every year4. 99.6% children from Third World.5. One in ten children die of diarrhea before age 5
The ImpactLoosing precious childMalnutritionBurden health services Socioeconomic burden family society country
Ask mothers to prevent diarrhea-Introduction
Diarrhea is a disease of old civilizationBibliocas (25000 yrs old) first referencePacillus (1472) 1st printed book of pediatricsBroussais (1829) The term GastroenteritisH.E. Harrison (1954)The first ever ORSWHO (1970) standardize formula of ORSWHO (1978) promotion of formulaWHO,UNICEF(2001) low osmalarity ORS
ORS–The Magic Bullet for Child SurvivalSimple, effective, cheapReduces number of diarrheal deathsReduces hospitalization ratesPrevents adverse effects like malnutrition
EVIDENCE –Diarrheal mortality -5 million per year 1.5 million per year
Ask mothers to prevent diarrhea-Chronolgy
Incidence
Mortality
Ask mothers to prevent diarrhea - Global scenario
“Ask mothers to prevent diarrhea”-Indian scenario
NFHS-3 (2005-2006)
India Chattisgarh
Children with diarrhea who received ORS
26.2% 42%
Chldren with diarrhea taken to health facilities
58% 65.3%
Ask mothers to prevent diarrhea -Chattisgarh scenario
NFHS-2 (1998-1999)
India Chattisgarh
Children with diarrhea who received ORS
26.9% 29.7%
Chldren with diarrhea taken to health facilities
65.3 59.3%
1. To assess maternal knowledge of diarrhea : its definition and causes
2. To assess maternal attitude towards diarrhea management
3. To assess the maternal skills and practices related to ORS
Settings In patient department & out patient department of Jawaharlal
Nehru Hospital & Research Centre, Steel Plant Bhilai
Ask mothers to prevent diarrhea- Aims & Objectives
Type- cross sectional studyMaterial- The mother, of children 0-5 years age group who presented
with acute diarrhoea in the pediatric inpatient & outpatient department of the J.L.N.H. & R.C.
Period - June 2008-May 2009Method- 200 Mothers were questioned on a careful predesigned
questionnaire in local language. Proforma compramised of more than 30 questions. Exclusion & Inclusion criterias were set.
Proforma –Covered various aspect like definition, causes, symptoms, fluids given, use of ors, method of preparation of ors etc.
Analysis- Results of this study were compared & analyzed, by proportional method keeping in view the results & reports of various other investigators by reviewing all available literature
Ask mothers to prevent diarrhea- material & methods
knowledge about diarrhea & ORS
Ask mothers to prevent diarrhea-observations
KNOWLEDGE PERCENTAGE
Correct definition of diarrhea 62
Cause of diarrhea as contaminated food &
water
29.6
Both fluids & foods to be given in diarrhea 55
Extra feeds should be given in diarrhea 0
Knowledge about ORS 72
Correct method of reconstitution of ORS 8.9
Correct ammount 7.3
Practices regarding diarrhea & ORS
Ask mothers to prevent diarrhea-observations
WRONG PRACTICE percentage
Didn’t wash hands hygienically with soap 20
Didn’t practice exclusive breast feeds 91
Gave diluted milk 70
Gave bottle feeds 30
Restricted food during diarrhea 13.8
ORS not used 52
Attitude towards Diarrhea & ORS
Ask mothers to prevent diarrhea-observations
Attitude percentage
Delayed health seeking 46.5%
ORS not used despite its knowledge 13.6%
Didn’t think of maintaining clean water 37%
Indifferent attitude for prevention 17%
Ask mothers to prevent diarrhea-Discussion
k.An
and
(199
2)
Niyaz
(199
5)
Man
gala
S.(2
001)
Pres
ent s
tudy
24%15%
46%62%
CORRECT DEFINITION OF DIARRHEA
Correct def’n
Ask mothers to prevent diarrhea-Discussion
k.Anand (1992) Niyaz(1995) Mangala s.(2001)
Present study
11.00%27.40% 29.60%
36.00%
51.80%
31.10%
38.00%
0.36
0.42
KNOWLEDGE REGARDING DIARRHEA
Correct causes Danger signs consequences
Ask mothers to prevent diarrhea-Discussion
H.Vishwanathan(1990)
K.Anand(1992) Present study
24% 41%72%48%
38%
50%
81%79%
PRACTICES IN DIARRHEA
Huygenic handwashing Cont. normal diet during diarrhea
Use of liquid supplements
ORS-Knowledge & skills
Ask mothers to prevent diarrhea-Discussion
H.Vishwanthan(1990)
K.Anand(1992) S. Mangala Present study
24.00% 29.70%
68.10% 72.00%48% 38%
50%
3.30%
8.50% 8.90%
Know ORS Correct method of reconstitution Use of liquid supplements
Ask mothers to prevent diarrhea-observations
Ahmed F.(1996)
NFHS-2 (1998-1999)
NFHS-3 (2005-2006)
Present study
33.30%25.90%
42.00% 46.00%
PRACTICE REGARDING ORS
Of those having knowledge, ORS used by
Millennium Development Goal of decreasing childhood mortality can be achieved by effective management of diarrhea by mothers. Assessment of current maternal attitude, knowledge & practices of diarrhea & ORS is cornerstone to achieve success in the prevention of this major killing disease.
Mother is the person responsible for the care of her baby during illness. Her knowledge & practices during an episode of diarrhea are important factors which influence the course of the disease.
Ask mothers to prevent diarrhea-Conclusion
SIGNIFICANT IMPROVEMENTKnowledge of correct definition 4 fold increased awarenessPractice of giving excess fluidsReduction in practice of starvation Knowledge of ORSPractice of ORS
LESS SIGNIFICANT CHANGES & HENCE REQUIRING MORE FOCUS
Poor knowledge of causes (only 29.6% know correct causes)Correct method of reconstitution (only 8.9% of knowledgeable)Feeding practice (100% unaware of giving extra feeds)Exclusive breast feeding, bottle feeding practicesLack of preventive attitude(17% indifferent attitude)
Ask mothers to prevent diarrhea - Conclusions
Targeted efforts to fill up lacunas detected through study
Ask mothers to prevent diarrhea-Recommendation
Face to face demonstration-
danger sign, preparing ORS
etc.
Interaction in small group
Importance of hygiene
Nutritional educa-tion & rehabilita-
tion
Implentation of DDCP
Reinforcement through paramed-
ical sources
1.K. Anand et al. knowledge & practice regarding diarrhea in mother of haryana,Indian pediatrics,1992,29:915-916
2.P. Kapoor, knowledge attitude & practices in diarrhea ,Indian pediatrics, 1996,33:319-320
3.Niyaz A. et al. parental awareness & practices in acute diarrhea Indian pediatrics, 1995,32: 77-78
4.S. Mangala, educational intervention on knowledge of mother regarding home management of diarrhea, Indian journal of pediatrics, 2001,68:393-397
5.National Family and Health Survey-2 (1998-
1999)6.National Family and Health Survey-3 (2005-
2006)
Ask mothers to prevent diarrhea-Bibliography