TABLE OF CONTENTS
DECLARATION………………………………………………………………………………………….. II
DEDICATION……………………………………………………………………………………………. III
ACKNOWLEDGEMENTS………………………………………………………………………….. IV
TABLE OF CONTENTS………………………………………………………………………………. V
LIST OF TABLES…………………………………………………………………………………….. VIII
LIST OF FIGURES…………………………………………………………………………………….. IX
OPERATIONAL DEFINITION OF TERMS………………………………………………….. X
ABBREVIATIONS AND ACRONYMS……………………………………………………… XII
ABSTRACT……………………………………………………………………………………………… XIII
CHAPTER ONE: INTRODUCTION………………………………………………………….. 1
CHAPTER TWO: LITERATURE REVIEW…………………………………………….. 13
- Overview……………………………………………………………………………………………. 13
CHAPTER THREE: METHODOLOGY……………………………………………………. 28
- Study Design………………………………………………………………………………………. 28
CHAPTER FOUR: RESULTS AND DISCUSSION…………………………………… 39
- Introduction……………………………………………………………………………………….. 39
- Specific Information based on the Objectives of the Study………………………. 43
CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS…………….. 72
REFERENCES……………………………………………………………………………………………. 75
APPENDICES…………………………………………………………………………………………….. 81
Appendix I: Participant Informed Consent:…………………………………………………. 81
Appendix II: Sample of Questionnaire………………………………………………………… 83
Appendix III: Interview Schedule for Health Officers………………………………….. 88
Appendix IV: UASIN GISHU COUNTY MAP………………………………………….. 90
LIST OF TABLES
Table 3.1: Target Population of Respondents……………………………………………….. 31
Table 3.2: Sample Size of Respondents………………………………………………………. 32
Table 4.1: Socio-Demographic Characteristics of Respondents (n=360)…………… 40
Table 4.2 Diarrhoea in Children a Serious Health Problem in this Region………… 44
Table 4.3: Specified Cause of Diarrhoea (n=360)…………………………………………. 45
Table 4.3: Signs and Symptoms Respondents are Aware of (n=360)………………. 46
Table 4.4: Measures to Prevent a Child from Diarrhoea (n=303)……………………. 49
Table 4.5: Association between Socio-Demographics Factors and Home Management of Diarrhoea (n=360)……………………………………………………………………………………. 56
Table 4.6: Socio-Demographics and Duration Taken Before Taking the Child for Medical Care 58
Table 4.7: Multiple Logistic Regression Analysis of Factor Influencing Home Management of Diarrhoea (n=360)…………………………………………………………………………………….. 60
Table 4.8: Multiple Logistic Regression Analysis of Factor Influencing Health Seeking Behaviour 61
LIST OF FIGURES
Fig 1.1: Conceptual framework………………………………………………………………………. 10
Fig 4.1: Transmission of Diarrhoea in Children………………………………………………… 48
Fig 4.2: Treatment Measures of Diarrhoea at Home (n=303)……………………………… 51
Fig 4.3: MOH First Line Recommended Drug for Diarrhoeal Diseases (n=153)…… 52
Fig 4.4: Time Taken To Seek Medical Care (n=360)…………………………………………. 53
OPERATIONAL DEFINITION OF TERMS
Appropriate Healthcare-seeking Practice: Care sought from skilled health care provider in government health facilities and private hospitals/clinic as well as use of Oral Rehydration Solution (ORS) and zinc supplements in the management of diarrhoea.
Caretaker: This is a person who is responsible of taking care of a child and providing a variety of services to care recipient (a child) such administering medications, assisting with daily tasks(including personal care, meal planning and preparation, and eating as well as walking, sitting down and standing up), meeting with health providers, daily supervision and activity.
Diarrhoea: Diarrhoea is the passage of three or more loose or watery stools per day, or more frequently than is normal for the child. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms (WHO, 2009).
Episode of Diarrhoea: An episode of diarrhoea begins with a 24-hour period when a child starts to diarrhoea and ends on the last day without three or more loose or watery stools.
Healthcare-seeking Practice: Any activity undertaken by individuals who perceive themselves or their children to have a health problem for the purpose of finding a remedy. This is based on the recognition of symptoms, which are interpreted by individuals who then proceed to address the problems.
Inappropriate Healthcare-seeking Practice: Other types of care which are not according to the definition of appropriate healthcare-seeking practice such as purchasing medicine from a pharmacy or shops without prescription, home remedies
and traditional healers. In the current study it also includes those who take no action for the perceived illness.
Under-five Children: Children from 59 months and below.
| ABBREVIATIONS AND ACRONYMS | |
| AIDS: | Acquired Immunodeficiency Syndrome |
| CBS: | Central Bureau of Statistics |
| CDC: | Centre for Disease Control |
| CI: | Confidence Interval |
| DHS: | Demographic and Health Survey |
| HF: | Health Facility |
| HIV: | Human Immunodeficiency Virus |
| HW: | Health Workers |
| IMCI: | Integrated Management of Childhood Illness |
| KDHS: | Kenya Demographic Health Survey |
| MCH: | Maternal and Child Health |
| MDG: | Millennium Development Goal |
| MOH: | Ministry of Health |
| NGO: | Non Governmental Organization |
| OR: | Odds Ratio |
| ORS: | Oral Rehydration Solution |
| SPSS: | Statistical Package for Social Sciences |
| UNICEF: | United Nations Children’s Education Fund |
| WHO: | World Health Organization |
ABSTRACT
Diarrhoea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behaviour for diarrhoea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The study examined how a diarrhoea episode is handled, as well as how other factors influence the home management and health seeking behaviour with regards to diarrhoea episodes in Langas and Huruma estates of Eldoret Municipality, Kenya. The objective of the study was to determine the factors influencing caretakers’ home management and health seeking behaviour with regards to diarrhoeal diseases among children under five years in Eldoret Municipality.The study employed a descriptive cross sectional research design. The study target population consisted of 1,256 adult home caretakers and 35officials from the Ministry of Health in Eldoret Municipality leading to total of 1,291 respondents. A sample of 377 households was selected through systematic sampling technique, where every 4th household was selected to participate. The researcher also employed systematic sampling technique to select the 11 county officials from the Ministry of Health. The researcher therefore selected the sample size of 388 respondents from the target population of 1,291 respondents. The study used both secondary and primary data. The secondary data was obtained from the records while the primary data was obtained from the respondents through questionnaires and interview schedule. Data collected was analyzed both quantitatively and qualitatively. The statistical package for social sciences (SPSS V.20) was used for data analysis. Descriptive statistics (frequencies, mean and percentages), chi square tests and regression were used in the analysis. P-value less than 0.05 were considered significant. The study yielded a response rate of 95.4% since out of 377 questionnaires that were given out, 360 (95.4%) were filled and returned. The study findings showed that majority of respondents 301(83.6%) agreed with the view that diarrhoea was a major problem among children under the age of five years in the region. It was found out that majority of the respondents 111(30.8%) identified poor hygiene and poorly disposed excreta-refuse as the main cause of diarrhoea among children in the region. It was also found from the study that all the respondents sampled were at least aware of the signs and symptoms of diarrhoea in children with majority of them correctly identifying the cardinal signs of diarrhoea. The study findings further showed that washing hands before eating/preparing food was the main measure to undertake when prevent children from contracting diarrhoeal diseases. The findings showed that a majority of respondents 107 (29.3%) use oral rehydration solution the immediate treatment measures for a sick child suffering from diarrhoea. The results indicated that there was a significant relationship between age (p=0.010) marital status (p=0.022), education level (p=0.011) and home management of diarrhoea as these were socio-demographic factors associated with home management of diarrhoea. Occupation, age and education level were socio-demographic factors significantly associated with health seeking behaviour. Education was a significant factor influencing home management of diarrhoea (p=0.013). Those with primary education were less likely to practice home management of diarrhoea compared to those with tertiary level (AOR; 1- 0.427= 57%). The researcher concluded that the prevalence of diarrhoea in the study areas is high and that it is a major problem among children under the age of five years. Efforts to educate the caretakers about the importance of seeking care and proper management of diarrhoeal and other childhood illnesses should be intensified.
CHAPTER ONE: INTRODUCTION
Background to the Study
According to WHO (2010), Diarrhoea is defined as the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. Diarrhoea is a common disorder of the gastrointestinal system experienced by most of the population sometime in their lives. Generally it is self-limiting and may not require any intervention. Intervention may be considered necessary by patient because of their beliefs and attitude towards normal bowel function (Hogue, 2010). The causes of diarrhoea include various diseases, medications, dietary changes, food or water contamination and psychological distress.
Diarrhoeal diseases remain the major cause of childhood morbidity and mortality in developing countries, especially in African countries. Each year at least 3 million children under the age of five years die in the developing world due to environmental related illnesses, inadequate water supply and poor sanitation (Kaseje et al., 2008). Diarrhoea continues to be a public health problem in many countries, particularly in developing ones. Despite the tremendous advances in medicine and technology over the last decades, diarrhoea diseases are still the main causes of deaths in children under the age of five years. On average, children below three years of age in developing countries experience three episodes of diarrhoea each year (WHO, 2009).
Caretakers’ home management and health seeking behavior refers to an act of taking care of a child and providing a variety of services to care recipient (a child) such administering medications, assisting with daily tasks (including personal care, meal planning and preparation, and eating as well as walking, sitting down and standing up), meeting with health providers, daily supervision and activity (especially when there is cognitive impairment such as Diarhoreal diseases) (Ahmed et al, 2009). Maternal practices regarding health care have been recognized as an important social and anthropological factor behind the high mortality rates among children aged less than five years. Maternal literacy and health education, socioeconomic status, practices, culture, beliefs, practices and access to health care are among factors contributing to the high mortality rates caused by diarrhoea (Negussie, 2008).
Globally, diarrhoeal diseases are also among the leading causes of morbidity and mortality in under-five children (WHO, 2003). Children of less than five years of age have over three diarrhoeic episodes per year, and more than one-third of their deaths are associated with diarrhoea. It is estimated that 1.5 billion diarrhoeic episodes and 2 million deaths in children less than five years old occur in the world each year (Widdoson, 2010).
In Africa, diarrhoeal diseases among under five years of age have been regarded as an epidemic that requires proper attention and good caretakers’ home management as well as early health seeking (UNICEF, 2000). In Tanzania for instance, diarrhoeal diseases are rank third after malaria and respiratory infections as a cause of death in less than five years children in Tanzania. In Tanzania, the main
aetiological agents for diarrhoea in children include Escherichia coli, Shigella spp, Giardia lamblia and rotavirus (Scheider et al., 2009).
In Kenya, as in other developing countries, diarrhoeal diseases are among the major causes of child deaths (KNBS and ICF Macro, 2010). According to the Kenya Demographic and Health Survey (KDHS) 2008/09, treatment and care-seeking for major illnesses for children remain poor in Kenya. The prevalence is even worse in the informal settlements, which are characterized by poor sanitary conditions among other problems (Magadi et al., 2008). In addition to lack of social amenities, informal settlements are also typified by overcrowding, insecurity and high levels of unemployment, thus they have turned out to be hubs of ill health (Kyobutungi et al., 2008)
Most of the deaths that occur in Kenya among children under the age of 5 years are due to illnesses that can be prevented or effectively treated using simple interventions (Gove, 2007; World Health Organization, 2009). Prompt and appropriate healthcare-seeking is one of the ways that can prevent many of these deaths. Studies have shown that practicing appropriate healthcare-seeking has great prospects of reducing morbidity and mortality due to childhood illnesses (Negussie, 2008). The poor access to formal health care services in the suburbs settlements in most towns in Kenya has led to the proliferation of a largely unregulated health care system with the high levels of morbidity and mortality as a result of diarrhoeal diseases in such areas being reported due to lack of access to safe water and
sanitation. It is also likely that inappropriate healthcare-seeking practice is rampant therein. Understanding health care practices in town suburb areas therefore is essential in improving the health care systems that serve the urban poor, through programs that target both users and suppliers (APHRC, 2000). This has the potential of ultimately reducing childhood mortality among the urban poor. Important aspects in the appropriate healthcare-seeking practice and management of childhood illnesses include early identification of disease, early treatment, diligence with treatment, and promptly opting for more effective treatment (D’ Souza, 2008).
Problem Statement
Ideally, the success of diarrhoeal diseases control strategies depends upon the appropriateness of caretakers’ home management and health seeking behavior, as well as general perceptions of diarrhoeal diseases. It is estimated that 1.5 billion diarrhoeic episodes and 2 million deaths in children less than five years old occur in the world each year, and worse still, it is said to cause more child deaths than malaria, measles and AIDS combined (WHO, 2009).
Currently, diarrhoea continues to be a major cause of death among young children and it has major economic impacts. Although it is a preventable disease, the incidence rates of diarrhoeal diseases continue to rise and it is currently the second- leading killer of under-five children in the world. In Kenya, it is also a leading cause of childhood morbidity and mortality estimated at 53.6% according to the study by the ministry of health in Kenya (KNBS and ICF Macro, 2010).
Delay in seeking health care or not seeking care at all, and ineffective treatment choices can compromise the outcome of a child’s health status. Improving the behavioral practice in the care of children in the homes therefore plays an important role in improving the health status of children. In addition Proper home management can reduce morbidity and mortality due to diarrhoea (WHO, 2002).
Justification of the Study
The rapid growth of urban centers in many sub-Saharan African countries has occurred largely in an environment of poor economic performance and lack of urban planning and regulation. This has resulted in an increase in the number and size of informal settlements or slums in many cities. There is a high mortality rate in urban slums and in rural farming communities, close association of diarrhoea to socio- economic conditions and poverty. Langas and Huruma estates in Eldoret Municipality where the study was carried out are urban slums in Eldoret town.
Research is needed to identify home management practices and health seeking behavior of Kenyan mothers in controlling their children’s diarrhoea. The results of the current study will help decision-makers in Kenya to take a holistic approach in dealing with problems such as improving the planning and implementing of more effective management of diarrhoeal problems to prevent diarrhoea diseases in the future.
It is hoped that the results of this study will provide relevant information on the healthcare-seeking practices of caretakers of under-five children in the slums, which will be useful in determining the type of intervention programmes that can be put in place to alleviate the myriad of health problems in the slums, with particular reference to diarrhoea. It will also assist in policy formulation that will improve healthcare-seeking and management practices and reduce child morbidity and mortality due to diarrhoeal diseases in Kenya. In addition, this will help in planning of diarrhoea prevention and control programs thus bringing the country closer to the achievement of the MDG 4 on reduction of child mortality.
Research Questions
- What is the level of knowledge and practices of the caretakers in home management of diarrhoea disease?
- What is the health seeking behaviour of caretakers in management of diarrhoeal diseases in children under-five years?
- What are the socio-demographic factors that influence the health seeking practices of caretakers in management of diarrhoea diseases in children under-five years?
Objectives of the Study
1.5.1 Broad Objective
To determine the factors influencing caretakers’ home management and health seeking behaviour with regards to diarrhoeal diseases among children under five years in Eldoret Municipality.
Specific objectives
- To determine caretakers knowledge and practices on home management of diarrhoea diseases.
- To determine the health seeking behaviour of caretakers in management of diarrhoeal diseases in children under-five years.
- To determine socio-demographic factors that influences the health seeking practices of caretakers in management of diarrhoea diseases in children under-five years.
Significance of the Study
The study will be useful to the Ministry of Health as it will provide it with the necessary information to help curb the problem of diarrhoeal diseases among children under-five years in order to reduce the rate of mortality and morbidity caused by diarrheal diseases.
The study will help in formulating workable strategies for responding to the needs and problems of diarrhoeal diseases among under-five children especially in rural and poor urban settlements. For example, the kind of medical services and preventive measures needed, and how and where the services should be offered. Assessments also help in monitoring whether services are producing the desired effect and whether there is a need for a change in strategies. Results from the assessments should be used to create awareness about the causes of diarrhoeal diseases.
The study will be able to unearth the underlying issues concerning the impediments to reducing mortality of under-five years in relation diarrhoeal diseases. It is also an initiating document for other researchers to further discuss and improve the status of healthcare service among children in Kenya and beyond.
Limitations of the Study
The study relied on retrospective self-reporting. Conversely, during the study period, the researcher faced some constraints such as lack of sufficient time and permission to access some data. This was managed through making prior visits to establish the exact time to be used as well as seeking permission from relevant authorities. Some respondents did not complete answering the questions, while others failed to give genuine responses. The researcher appealed to the respondents individually for their utmost cooperation.
Scope and Delimitation of the Study
The study purpose was to determine the factors influencing caretakers’ home management and the health seeking behavior with regard to diarrhoeal diseases among children under-five years in Eldoret Municipality, Uasin Gishu County with the aim of establishing caretakers knowledge and practices on home management of diarrhoea disease, the health seeking behaviour of caretakers in management of diarrhoeal diseases in children under-five years, and socio-demographic factors that influences the health seeking practices of caretakers in management of diarrhoea diseases in children under-five years. The study scope was limited to both primary and secondary methods of data collection. The study scope was further limited to
those factors that only influence diarrhoeal diseases such as poor sanitation, unhealthy water supply and inappropriate healthcare-seeking practices.
The study delimited itself to Langas and Huruma estates in Eldoret Municipality, Uasin Gishu County which was considered the most appropriate places to carry out the study due to high population and poor hygienic conditions which are the main cause of diarrhoeal diseases. The study further delimited itself to home caretakers and children under-five years in various households in Langas and Huruma estates.
Assumptions of the Study
The researcher assumed that respondents would cooperate and give honest responses to the questions in the research tools. The researcher also assumed that all the sampled population had a common understanding on the issues in the tools of data collection. It was also assumed that the sample size chosen was adequate to enable the researcher draw a valid conclusion about the study.
