TABLE OF CONTENTS
DECLARATION…………………………………………………………………………………………….. ii
DEDICATION………………………………………………………………………………………………… ii
ACKNOWLEDGMENT…………………………………………………………………………………. iv
TABLE OF CONTENTS………………………………………………………………………………… v
LIST OF TABLES………………………………………………………………………………………….. ix
LIST OF FIGURES………………………………………………………………………………………… x
ABBREVIATIONS AND ACRONYMS………………………………………………………….. xi
OPERATIONAL DEFINITION OF TERMS………………………………………………….. xii
ABSTRACT………………………………………………………………………………………………….. xiii
CHAPTER 1 INTRODUCTION……………………………………………………………………… 1
- Background to the study……………………………………………………………………………. 1
CHAPTER 2 LITERATURE REVIEW………………………………………………………….. 9
- Introduction…………………………………………………………………………………………….. 9
CHAPTER 3 MATERIALS ANDMETHODS………………………………………………… 19
- Research Design………………………………………………………………………………………. 19
CHAPTER FOUR FINDINGS……………………………………………………………………….. 27
- Introduction……………………………………………………………………………………………. 27
- “Caregivers” level of knowledge on diarrhea……………………………………………… 30
CHAPTER FIVE: DISCUSSION, CONCLUSION & RECOMMENDATION… 46
- Discussion………………………………………………………………………………………………. 46
REFERENCES………………………………………………………………………………………………. 63
APPENDICES……………………………………………………………………………………………….. 69
Kiambatishi I: Hatifa hamivu ya Ridhaa…………………………………………………………… 69
Appendix I: Informed Consent Document……………………………………………………….. 72
Kiambatisho II: Cheti cha Kuridhia…………………………………………………………………. 75
Appendix II: Certificate of Consent………………………………………………………………… 76
Appendix III: Map of Busia County……………………………………………………………….. 77
Appendix IV: Questionnaire…………………………………………………………………………… 78
Appendix V: Community Focus Group Discussion Guide………………………………….. 82
Appendix VI: Research Approval……………………………………………………………………. 83
Appendix VII: Research Authorization……………………………………………………………. 84
Appendix VIII: Ethical Approval……………………………………………………………………. 85
Appendix IX: Research Authorization, NACOSTI……………………………………………. 86
LIST OF TABLES
Table 3.1 Sampling technique……………………………………………………………………………… 21
Table 3.2 Knowledge classification……………………………………………………………………… 24
Table 4. 1 Caregivers characteristics…………………………………………………………………….. 28
Table 4. 2 Characteristics of the children………………………………………………………………. 29
Table 4. 3 Common causes of diarrhea………………………………………………………………… 31
Table 4. 4 Types of Oral fluids preferred to be given to children during diarrhea N=335 33
Table 4. 5 Use of ORS/SSS in diarrhea management………………………………………………. 35
Table 4. 6 ZINC use in management of diarrhea……………………………………………………. 36
Table 4. 7 Classification of knowledge levels……………………………………………………….. 38
Table 4. 8 Practices on the home-based management of diarrhea……………………………… 39
Table 4. 9 Caregivers practices in the home-based management of diarrhea using ORS/SSS 40
Table 4. 10 Classification of home-based practices……………………………………………….. 41
Table 4. 11 Socio-Demographic and economic influence on home base practices………. 43
Table 4. 12 Cross tabulations: knowledge levels……………………………………………………. 44
Table 4. 13 Logistic regression analysis………………………………………………………………… 45
LIST OF FIGURES
Figure 1.1 Conception framework……………………………………………………………………….. 8
Figure 4.1 Cause of childhood diarrhea……………………………………………………………….. 31
Figure 4.2 Preventive measures of diarrhea………………………………………………………….. 32
Figure 4.3 Danger signs of diarrhea……………………………………………………………………. 37
ABBREVIATIONS AND ACRONYMS
| AIDS: | Acquired Immune Deficiency Syndrome |
| CHW: | Community Health Worker |
| HFS: | Health Facility Survey |
| HIV: | Human Immunodeficiency Virus |
| IMCI: | Integrated Management of Childhood Illnesses |
| KDHS: | Kenya Demographic Health Survey |
| MDGs: | Millennium Development Goals |
| MOPHS: | Ministry of Public Health and Sanitation |
| ReSoMal: | Rehydration Solution for Malnutrition |
| ORS: | Oral Rehydration Solution |
| ORT: | Oral Rehydration Therapy |
| UNICEF: | United Nations International Children Emergency Fund |
| WHO: | World Health Organization |
| SSS: | Salt Sugar Solution |
| HBC: | Home Based Care |
OPERATIONAL DEFINITION OF TERMS
Diarrhea: The passage of three or more frequent loose stools than usual to the child
Dehydration: State of insufficient water in the body that can be caused by diarrhea and may lead to death.
Young Children: This study defines young children as those aged 0-5 years. These include both males and females
Caregivers: Persons, who take care of young children, may not necessarily be their parents.
Community Health Workers: Lay persons trained on certain health aspects and reside in the community. They may treat certain illnesses and refer sick people to health facilities when need be.
Malnutrition: Refers to deficiencies, excesses, or imbalances in a child’s intake of energy and/or nutrients.
Oral Rehydration Therapy: The administration of low osmolarity oral rehydration solution or fluids to correct dehydration.
Home management of diarrhea: This refers to practices undertaken for treatment of diarrhea at home.
Facility management of diarrhea: This refers to the treatment of diarrhea provided at a health facility.
Fluid replacement: This is giving a child with diarrhea additional fluids like soups, water, and milk, among others, to prevent or cure dehydration.
Water and sanitation: Refers to the provision of clean and safe drinking water and use of other hygienic practices like hand washing with soap and water, and proper waste disposal that is essential in the prevention of diarrhea.
ABSTRACT
Globally, diarrhea remains the second leading cause of reported mortalities among children (0-59 months) and a cause of significant morbidity, especially in developing countries. In Kenya, diarrhea accounts for 16% of deaths among children (0-59 months). It’s a major cause of mortality in children below five years after malaria and pneumonia in Busia County. Many of the children die due to poor home-based management of diarrhea. The main aim of the study was to explore the different interventions care givers use to manage diarrhea among children (0-59 months) in Busia County and factors associated with home-based management of diarrhea. This was a facility-based descriptive cross-sectional study done in Busia County. Multistage sampling was used to obtain the study sample and a sample size of 389 was used. Both inferential and descriptive statistics were used for quantitative data. Chi-square was used to test relationships between dependent and independent variables at 95% confidence interval. Logistic regression was used to examine the associations between socio-demographic and economic factors, level of knowledge and practices adopted for home-based care. A p-value of less than 0.05 was considered significant. The general knowledge of caregivers on home-based care was unsatisfactory. Out of the 389 caregivers interviewed, only 114(29.3%) had good knowledge level of knowledge on home-based management of diarrhea. Specifically, only 62(20.6%) could mention more than 1 acceptable cause of diarrhea while less than half of the caregivers (48%) thought diarrhea could be prevented. Knowledge of diarrhea management was also not sufficient. Despite all (389 caregivers) having practiced home-based management of diarrhea in the in the last 2 weeks, the study revealed that the overall home-based care practices were inappropriate 280(72%). Socio-demographic and economic factors like education, occupation, distance to the health facility, source of information and number of household members were significantly associated with appropriate home-based management of diarrhea at <0.001*, <0.001*, 0.044*, 0.003 and 0.001 respectively. Good level of caregivers knowledge was also significant to appropriate home-based management of diarrhea (<0.001*). When other factors had been adjusted, caregivers education p=0111 and care givers level of knowledge p= 0.0021 were found to be significantly associated with appropriate home-based care of diarrhea in children (0-59 months). The general conclusion of the study was that the caregivers’ level of knowledge about diarrhea was unsatisfactory and measures adopted by caregivers for home-based management of diarrhea were inappropriate. There is, therefore, need for extensive educational interventions such as health education and promotion activities on diarrheal diseases in the study area, together with emphasize on teaching caregivers about the “germ theory” of disease causation, effects, dangers as well as appropriate home management practices and prevention of diarrheal diseases.
CHAPTER 1 INTRODUCTION
Background to the study
Diarrhea is referred to as passage of loose or watery stools at least three times in 24 hours or more often than normal for an individual (WHO, 2016). Most incidents of diarrhea are normally mild, however, when it’s acute, diarrhea is likely to cause dehydration as a result of the fluid loss, which can be fetal even causing deaths, especially when fluids are delayed or not replaced at initial episodes of diarrhea. Most mortalities reported in children (0-59 months) are due to dehydration, often associated with loss of major electrolytes like sodium, potassium and bicarbonates and large quantities of water from the body in liquid stools during these episodes of diarrhea (Onyango and Angienda, 2010).
Worldwide, diarrhea among children remains one of the leading causes of reported mortalities and hospitalization. Approximately 1.7 billion cases of diarrhea are reported every year. Among children under the age of five, diarrhea accounts for 7.6 million lives every year Shridevi et al., (2015). Notably, overall global mortality cases have reduced, but general occurrences of diarrheahave never changed, with more than 700 episodes every year. This burden is not only in developing countries, but also in developed countries. For example, in the United States of America, there are 220,000 hospitalizations for gastroenteritis and 300 reported mortality cases every year (Aviner et al., 2013).
Diarrhea is viewed as a leading cause of diseases and deaths, especially among children under five years in developing counties, (Onyango and Angienda 2010). The disease has various adverse effects causing dehydration, inappropriate nutrient absorption; retardate growth and chronic gut disorders among others. Dehydration is as well considered danger to the health of a child. A larger percentage (68%) of the total diarrheal burden is borne by young children, especially those less than five years
It is a common belief in Africa that no child reach the age of five without having had experienced any diarrheal episode, others even experiencing as much as three episodes in a year. This is even likely to be even high since most of these research findings are mostly reported by developed countries, having it as a possible proxy to some social- related factors like poverty, malnutrition, ignorance among others (Adimora et al., 2011). According to WHO, 2016, Sub-Saharan Africa countries account for over 37% of diarrheal cases in the world and only half of them benefit from Oral Rehydration Therapy. In Cameroon alone, diarrhea is considered a key public health menace that causes excess deaths and diseases among children. It is responsible for estimated 93,000 under five deaths yearly UNCEF, (2016).
In Kenya, diarrhea is ranked as the second leading cause of deaths among children with a recorded prevalence of 17%. It accounts for 21% of under-five reported cases of deaths, KDHS (2014). Moreover, diarrhea is key to causing malnutrition among children. For over 10 years now, disease patterns in the country have placed diarrhea as one priority area that leads to stunting and other malnutrition disorders in children.
Countrywide, diarrhea has been recorded as one of the leading causes of outpatient attendance in many of the public hospitals. In 2010, the ministry of health and sanitation reported that from all the hospital’s attendances, 80% of the cases are preventable while half of these cases and related to water, sanitation and hygiene. Njuguna and Muruka, (2011).
Diarrhea is classified as the top 3 major reasons for hospitalization and admissions among children of years less than five in Busia County. Estimated 2,293 under-five children in the County have diarrhea with 9.7% reported deaths. Busia work plan 2015 rank diarrhea as top 10 major courses of outpatients among adults (Onyango and Angienda, 2010). Complex emergencies and natural disasters like floods are highly associated with destruction and contaminations that leads to diarrhea. Budalangi is a sub-county in Busia County, low-lying area and often affected by recurrent flooding disasters whenever river Nzoia overflows during the seasons of rain. Recurrent floods have hit the area resultingto contamination of mostly water and food in the area.
Studies carried out on home management of diarrhea in Busia have shown an unsatisfactory level of knowledge and poor methods like stopping to give food and use of inappropriate fluids during episodes of diarrhea. With the scarcity of treatment facilities, high costs of treatment, high poverty index, very few children with diarrhea in the area are treated at the heath facility. For there to be a significant reduction in morbidity and mortality due to diarrhea, there has to be an improvement in thehome-
based management of diarrhea like ORS, increase in fluid intake (ORT), continued breastfeeding, zinc and WASH activities.
This study sought to assess caregivers knowledge levels on home-based management of diarrhea among children (0-59 months), determine the extent to which caregivers manage diarrhea at home and determine the socio-demographic and economic factors associated with appropriate home-based management of diarrhea among children under the age of five in Busia County.
Statement of the Problem
Busia County is classified among those with the highest mortality rates in Kenya. According to KNOEMA, (2017), the mortality rate among children under the age of five is 210 deaths per 1000 live births while the mortality rate among the infants is at
125.9 per 1000 live births. These rates are relatively high compared with the national mortality rates (U5MR 49.2 while infant MR 36.5). During rainy heavy rainy seasons, the county is hit by natural calamities like floods, which causes destructions, deaths and displacement of families located along river Nzoia. These have led to increased cases of diarrheal cases, especially among children under the age of five. Various interventions put in place by the county and the national government have been short term. Families continue to suffer and forced to move to make shifts camps. Poverty has increased because of life disruption. Food security is of concern leading to malnutrition. Many families have reverted to home-based care approaches which involve the use of locally
available fluids. Unfortunately, inaccessibility and affordability of these fluids are not universal in this disaster-stricken region. Besides other factors influence caregivers choice of replacement fluids.
Justification
Integrated Global Action Plan for Pneumonia and Diarrhea aims to reduce deaths from diarrhea to fewer than 1 per 1000 live births and incidence of severe diarrhea by 75% in children less than 5 years of age compared to 2010 levels (UNICEF, 2016). Home- based management of diarrhea is essential in meeting these targets. However, it is imperative to evaluate the practice to ensure it is done appropriately. When done correctly, home-based care is lifesaving, as well as a mean of reducing unnecessary diseases related to diarrhea. Not much has been done however on diarrhea management at home in Busia. This study aimed atassessing the knowledge levels of caregivers regarding home-based care and sort the practices employed during home management of diarrhea. Findings from this study will be key to policymakers concerns measures to put in place to address this menace of diarrhea that comes along with floorings in the area.
Research Questions
- What’s the level of knowledge on causes, danger signs, prevention and management of diarrhea among caregivers of children under-five year in Busia County?
- What practices do caregivers of children under-five years adopt for home-based management of diarrhea in Busia County?
- What factors influence practices adopted by caregivers of children under-five years for home management of diarrhea in Busia County?
