A study of maternal awareness of acute diarrhoeal disease

Objective To determine maternal awareness regarding acute diarrhoeal disease and use of oral rehydration solution (ORS). Method Study was carried out in a suburban family practice on mothers/carers of children, presenting with acute diarrhoea, using an interview-based questionnaire to collect data. Mother's/Carer's knowledge regarding causes and transmission of diarrhoea, use of ORS and its method of preparation, were assessed. Results Knowledge about causative factors and transmission of acute diarrhoea among mothers/carers was poor. Though aware of ORS, a majority prepared it incorrectly.


Introduction
Diarrhoeal disease is a global health problem and is estimated to cause about 4.6 million deaths per year, in children below 5 years of age, in developing countries 1 . A major obstacle to control and prevention of diarrhoea and dehydration in children may be lack of maternal knowledge about diarrhoea and use of oral rehydration solution (ORS). Oral rehydration is now an accepted therapy for prevention and treatment of dehydration resulting from diarrhoea and vomiting. In this study, maternal awareness of transmission of acute diarrhoea and use of ORS is analysed.

Method
Study was carried out in a family practice clinic at Ratmalana over a period of 24 months. A pre-tested interview based questionnaire was used. The study sample included mothers/carers of children below 15 years of age presenting with acute diarrhoea. As study was designed to test mother's knowledge and practices regarding acute diarrhoea, children seen only once during this period, were excluded. Following data were recorded -age and sex of children, educational level of _____________________________________________ 1 Senior Lecturer in Family Medicine, University of Sri Jayawardenapura, Nugegoda.
(Received on 10th July 2003) mothers/carers, their knowledge on causes and transmission of diarrhoea, awareness on ORS and its preparation.

Results
There were 377 children in study sample of whom 215 were boys. Age distribution of children presenting with acute diarrhoea is shown in Table 1.  Among the study population, 93% were mothers while the rest were carers comprising aunts, grand mothers and other relatives. Beliefs of mothers/carers regarding cause of diarrhoea are shown in Table 3. Only 51(13.5%) mothers/carers knew that diarrhoea was due to an infective organism. 8 mothers/ carers did not respond to this question. The 51 mothers/carers, who knew that the cause was due to infective organisms, had their educational standards above the GCE O/L. 90% of them knew that transmission was due to bad personal hygiene and/or contamination of food and water.
Mothers/Carers were questioned on awareness of ORS, its use and preparation. 361 (96.5%) were aware of ORS. Only 13 (3.5%) had not heard about ORS before. The main source of information regarding ORS is shown in Table 4.  Table 5. 226 mothers/carers said that they had prepared ORS recently and were questioned regarding the preparation and use of ORS. Following were taken as errors.
• Preparation of concentrated or diluted ORS by dissolving part/entire packet in a quantity of water less/more than 1 litre.
• Once prepared, using it, even after keeping it for >24 hours at room temperature.
Almost 50% of mothers/carers had prepared ORS incorrectly. Table 6 shows the comparison of their educational level with errors in preparing ORS. Out of the 111 who had prepared ORS correctly, 90 (81%) had studied up to GCE O/L and above. On the other hand, out of 106 who had prepared ORS incorrectly 58 (54%) had studied up to the same grade.

Discussion
In this study 155 (41%) mothers/carers thought that diarrhoea was due to a wrong type of food given to child e.g. cheese, butter, fruits etc. Only 51(14.6%) knew that it was due to an infective agent entering the gut. Over 50% mothers/carers considered teething a cause of diarrhoea and a substantial number regarded crawling, worm infestation and eating food that is difficult to digest as factors causing diarrhoea.

Conclusions and Recommendations
The study shows that mother's/carer's knowledge of transmission of diarrhoea and preparations of ORS was poor. The results indicate that the study population was aware of ORS through the electronic media and their family physicians. It will be important to educate the public that acute diarrhoea is caused by an infective organism entering via oral route, due to contamination of food or water. The family doctor should demonstrate the preparation of ORS in their clinics. Family doctors should take the main role in giving health education to the public through the electronic media.