ABSTRACT
Diarrhoea continues to remain one of the main and the second most significant cause of death globally in children under five years. The number of diarrhoea cases continues to increase every year and is estimated to be 1.7 billion annually. In 2018, in Nigeria, 1,499,146 cases of diarrhoea were reported among children under five years and Lagos state accounted for 136, 028 cases. A research in Lagos state Informal Settlements showed that 25.6% of children living in the Informal Settlement had diarrhoea. Caregivers in Ikorodu reported that their children contract diarrhoea at least once every two weeks. As diarrhoea is mostly managed at home by caregivers there is need to determine the management practices of diarrhoea by caregivers of children under five years. The main objective of the research was to determine the management practices of diarrhoea by caregivers of children under five years in Ikorodu. To achieve this objective, a cross-sectional study design was used. It was preferred because it is a one point of time study. Due to its pollution and diarrhoea frequency reported by caregivers, Ikorodu was purposively selected. For the choice of households and respondents, simple random sampling was used. Researcher administered questionnaire and observation checklist were completed appropriately. Fisher’s and exact test, Pearson Chi-square as well as Pearson correlation were utilized in the analysis. P < 0.05 was considered as statistically significant. Age of the caregivers ranged from 18-72 years old. The main age group of caregivers was 25-31 years old with 56.17%. The household size ranged from 2 to 15. Children under five years living in the selected households of the study ranged from 1 to 7 per household. Children who were 1 per household accounted for 49.4%. Mothers accounted for 83.6%. Prevalence of diarrhoea among children was 18.7%. Sex of the caregiver (p=0.008), relationship of the caregiver (p<0.001), number of household residents (p<0.001), and number of children under five years in the household (p<0.001) were found to be statistically significant with diarrhoea prevalence among children aged zero to less than five years. Knowledge level of caregivers regarding management practices of diarrhoea was found to be statistically significant with prevalence of diarrhoea in children under five years (p=0.020). Majority of the respondents (63.89%) used drugs from hospitals to manage diarrhoea. In 63.89%, water was given like any other day during diarrhoea. One hundred and seventy six caregivers breastfed the child during the survey. The majority of the respondents (52.78%) had no formal education. Faeces, flies and open garbage were present near or within the household in 37.72%, 59.26%, and 80.25% respectively. All the respondents washed their hands during the study. However 27.78% of the respondents did not wash their hands after disposing the child faeces. Caregivers disposed the child stool in garbage in 38.89 %. Fifty caregivers did not take their children for immunization. Statistical significance was observed between diarrhoea prevalence and the caregiver’s educational level (p<0.001), renting (p=0.024), existence of flies near or within the household (p<0.001), existence of faeces near or within the household (p<0.001), existence of open garbage near or within the household (p<0.001), immunization of children (p<0.001), age when the children start using latrine (p<0.001).In conclusion, low knowledge level was a predictor of diarrhoea among children under five years. Many factors such as existence of open garbage near or within the household and immunization practices were found to be associated with diarrhoeal prevalence among children under five years. It is therefore recommended that there is need for public health education and promotion in the study area.
CHAPTER ONE:
INTRODUCTION
1.1. Background information
Risk of diarrhoea is still high worldwide in children aged zero to less than five years. Diarrhoea continues to remain one of the most important causes of death. It is the second major cause of mortality globally in children aged zero to less than five years. Every year, the number of diarrhoea cases continues to increase and is estimated to be 1.7 billion annually. Diarrhoea accounts for up to 7.7% of deaths in Africa according to the World Health Organsition (WHO). In Africa, an estimated 5 episodes of diarrhoea are observed every year in each infant. Eight hundred thousand children under five years die from diarrhoea and dehydration each year in Africa (WHO, 2018). During the year 2018, in Nigeria, 1,499,146 cases of diarrhoea were reported among childrenunder the age of five. Among the cases of diarrhoea in 2018 in Nigeria, Lagos state accounted for 136, 028 cases (DHIS, 2019).
Diarrhoea leads to loss of electrolytes and fluids which will result in dehydration and malnutrition. Three main agents cause diarrhoea: bacteria, parasites, and viruses. In most of the cases, diarrhoea caused by bacterial infections, parasitological infections, and viral infections occurs after improper hygiene and sanitation conditions or unsafe drinking water (Mokomane et al., 2018). The main virus responsible for diarrhoea in children under five year is rotavirus (WHO, 2009).
Rotavirus accounted for about one third of deaths as a result of diarrhoea and 9,000,000 globally hospital admissions of children under the age of 5 years (Carmo et al., 2011, Troeger et al., 2018). Rotavirus is responsible for 41 percent of the burden of childhood diarrhea in Nigeria (Otieno et al., 2020). In a recent study led by Gikonyo et al., (2019) which aimed to estimate the post vaccine prevalence and seasonal distribution of rotavirus in children under five years in Lagos state, the hospital based prevalence of rotavirus was 15.2%. The WHO introduced rotavirus immunization in July 2009 into the national immunization programmes of all countries after finding that rotavirus is one of the main cause of diarrhoea among children (WHO, 2009). There are two types of rotavirus vaccine: the monovalent formulation (RotatrixTM) and the pentavalent formulation (RotaTeqTM). The routine immunization on rotavirus recommended by the WHO consists of two doses composed of the single-dose vaccine sequence which should be given for the monovalent formulation. The first dose will be given from 6 to 14 weeks, and the second from 14 to 24 weeks. The dosage period does not exceed 4 weeks. The pentavalent formulation consists of three doses. The very first dose must be taken at the age of 6-12 weeks, the two further doses at 4-10 weeks interval. All three doses must be finished before a child is 32 weeks old. Nigeria implemented the rotavirus vaccine into the national immunization programme in July 2014. Since then, in the framework of the routine child immunization programme, two doses of live attenuated rotavirus vaccine (Rotarix) are administered orally at 6 and 10 weeks of life. (Government of Nigeria, 2013, WHO, 2019).
Children aged between 0-59 months have several reasons for a higher death rate due to diarrhoea. Poverty is one of the primary causes of death from diarrhoea. Studies have demonstrated that poor families or families without funding are more risky than others. Illiteracy by caregivers or parents is also one of the primary causes of diarrhoea mortality in children aged between 0-59 months. Researches also illustrated that uneducated parents or caregivers have a greater frequency of diarrhoea than educated caregivers. In young mothers, knowledge on Oral Re-hydration Salts (ORS) is poor compared to in their older counterparts. Low knowledge on the management practices of diarrhoea by caregivers can also raise death rates and incidence of diarrhoea among children under five years (Ansari et al., 2009).
Improper prevention measures such as non-exclusive breastfeeding, improper hygiene and sanitation conditions, non-immunization, and unsafe drinking water are risk factors of diarrhoea. Consequently, proper domestic practice regarding diarrhoea management will reduce the death rate. Quick administration of ORS is one the proper home diarrhoea management strategies (Apa et al., 2015). Several studies also demonstrated that good practices reduce the burden of diarrhoea among children (Thiam et al., 2019, Hillow, 2018).
Certain sections of Lagos state, particularly informal settlements, the rate of illiteracy, poverty and costly health facilities will force caregivers to handle diarrhoea of their children at home. As healthcare systems focus less on diarrhoeal diseases, caregivers' awareness about prevention and clinical treatment of diarrhoea decreases (Apa et al., 2015). The research sensitized caregivers of children aged 0-59 months on therapeutic and preventive measures of diarrhoea. The aim was to establish knowledge level of caregivers on management of diarrhoea, establish their current practices and establish factors that influence management practices. Knowledge will have an effect on practice as well as attitude. Knowing knowledge of caregivers regarding diarrhoea management practices in children aged zero to five years may enable practitioners in public health to build educational strategies directed at the community. In the final stage of development or updating of diarrhoea policy, the recommendations made will benefit National Programme Managers (NPMs). This will also benefit the government and certain Nongovernmental Organisations (NGOs) to establish a behavioural change model.
1.2. Problem statement
Diarrhoea is the second most important cause of child mortality among children aged between 0-59 months. About 48 000 (8%) children die every year as a result of acute diarrhea. Roughly 80 % of these deaths arise in Africa and in Asia, with approximately 35% casualties in just 15 countries(UNICEF, 2019). Nigeria is 10th of those affected by childhood diarrhoea in the most extreme countries (Wardlaw et al., 2010).
In 2018, in Nigeria, nearly 1.5 million cases of diarrhoea were reported among children under the age of five and Lagos state accounted for 136, 028 cases (DHIS, 2019). In the urban areas , particularly in informal settling environments, the burden of diarrheal diseases in Nigeria has been investigated at higher rate for children than in other environments (Kawakatsu et al., 2017). Despite the implementation of the community-based programme on diarrhoea in Ikorodu, the burden of diarrhoea remains high. A research led by Concern Worldwide (2017) in Lagos state Informal Settlements showed that 25.6% of children living in the Informal Settlement had diarrhoea. Although in the same report, the exact prevalence of diarrhoea among children in Ikorodu was not mentioned, caregivers in Ikorodu reported that their children contract diarrhoea at least once every two weeks.
There are limited studies on the home-based management of diarrhoea by caregivers of children aged between 0-59 months in the informal settlement of Ikorodu. It is not also clearly known how the cases of diarrhoea are managed by caregivers of children under five years in Ikorodu. Therefore, this research fills in the gaps by analysing data from Ikorodu.
1.3. Research questions
It refers to questions that the study seeks to achieve. In this research, the questions are:
a. What is the knowledge level of caregivers on management practices of diarrhoea among children under five years in Ikorodu?
b. What are the current practices of caregivers in terms of management of diarrhoea among children under five years in Ikorodu?
c. What are the factors influencing management practices of diarrhoea among caregivers of children under five years in Ikorodu?
1.4. Hypotheses
The study adopted null hypotheses which state:
a. Knowledge level of caregivers on management practices of diarrhoea is not associated with prevalence of diarrhoea among children under five years in Ikorodu;
b. Current practices of caregivers concerning management of diarrhoea are not associated with prevalence of diarrhoea among children under five years in Ikorodu;
c. Socio-economic, environmental, and behavioural factors are not associated with prevalence of diarrhoea among children under five years in Ikorodu.
1.5. Objectives
1.6.1. General objective
The general objective of this research study was to determine the management practices of diarrhoea by caregivers of children under the age of five in Ikorodu.
1.6.2. Specific objectives
The specific objectives were:
a. To establish knowledge level of caregivers on management practices of diarrhoea among children under five years in Ikorodu;
b. To establish current management practices of diarrhoea by caregivers of children under five years in Ikorodu;
c. To establish factors influencing management practices of diarrhoea by caregivers of children under five years in Ikorodu.
1.6. Significance of the study
This research is essential in addressing poor health outcome of children living in informal settlements. The recommendations given at the end would benefit the government in formulation or revision of diarrhoea health policies. It would also enable some NGOs as well as the government to understand diarrhoea factors among children in Ikorodu in order to establish health strategies to minimize mortality and morbidity risk in the area. The research helped the studying community to recall hygiene practices, sanitation practices, food intake, vaccination, as well as the value of breastfeeding. The residents will benefit from the results of the study through health programme provided by local authorities which will help in improving their quality of life. This research will add onto the knowledge of academicians.
1.7. Limitation and delimitation
1.8.1. Limitation
Language barrier was a study issue because majority of people in this area understand only Kiswahili. This was however tackled by involving research assistants with experience in health and good in Kiswahili who helped in translating questions into Kiswahili.
Another limitation was security. The place is known to be an unsecure if you are not known by the residents. Assaults are frequent in the study area. The robbers target those who are new in the area. This challenge was addressed by involving research assistants who have background in health and who are familiar as well as known from the place.
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