Knowledge and Practices of Home Diarrhoea Management among Adolescent Mothers with under Five Children in Nyando SubCounty, Kisumu, Kenya

Introduction

Diarrhoea in childhood is a key public health problem in low- and middle-income countries (LMICs). The World Health Organization (WHO) has defined diarrhoeal disease as the passage of three or more loose or liquid stools per day [1]. This disease although preventable and treatable is the second leading cause of death in children under five. Annually, approximately 1.7 billion cases of childhood diarrhoeal diseases have been reported, leading to deaths of 525,000 under-five children, which accounts for 8% of all deaths worldwide [1]. It is estimated that 90% of diarrhoeal diseases happen in sub-Saharan and South Asian countries [2].

In Kenya, during the year 2018, 1,499,146 cases of diarrhoea were reported among children under five years. Among the cases of diarrhoea in 2018 in Kenya, Nairobi accounted for 136,028 cases [2, 3]. Two-week diarrhoeal prevalence in Kisumu is 18%, higher than neighbouring areas [4]. There is an association between diarrhoeal diseases and an increase in the risk of malnutrition in children [1] since diarrhoeal diseases have a detrimental impact on child growth and cognitive development [5].

Home-based oral therapy in the management of diarrhoea has been recognised and advocated by the World Health Organization (WHO through the Integrated Management of Childhood Illness to lower the effect of diarrhoea, particularly on children [6]. The best and first-line recommendations for this purpose continue to be reduced (low)-osmolarity oral rehydration salt formulations. In its absence, home-made salt-sugar solutions (SSS) made from clean, boiled, and cooled water in certain ratios are also advised, along with appropriate food-based solutions like pap, gruel, soup, or rice water to replenish lost fluids, energy, and electrolytes [7]. Continued feeding, increased fluids intake, and use of zinc supplements for 10–14 days to prevent dehydration has been recommended by the WHO as the first line management of diarrhoea among under-five children. Together with this, the WHO guidelines indicate that children presenting non-severe dehydration ought to “receive oral rehydration therapy (ORT) with ORS solution in a health facility”. Antimicrobials are only recommended for the treatment of suspected cholera or bloody diarrhea with severe dehydration [7].

Even though the knowledge and practices on early interventions for the management of diarrhoea is important in its prevention and the related complications Chiabi A, et al. [8], the caregivers’ information about diarrhea management is influenced by various factors for example the level of education, other exposures in diarrhea management and also the caretakers background [9, 10]. A study done by Masiha SA, et al. [11] indicates that there is prove showing that inappropriate practices such as food intake restriction, reduced breastfeeding and use of conventional medicine whose outcome is unknown in management of diarrhea at home.

Together with this, fewer programs have explicitly focused on the non-adherence to other recommended diarrhea management practices, such as the restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. These practices are linked with negative outcomes, and they conflict with the WHO treatment guidelines. Restriction of feeds and fluids curtailment during diarrhea episodes can lead to an increased risk in reduced nutritional intake, dehydration, which could potentially inhibit child growth and development [7, 12].

In underdeveloped nations, there is a greater chance of getting diarrhea [13]. This is brought on by insufficient access to water, poor hygiene, inadequate nursing, and deficiencies in zinc and vitamin A Walker FCL, et al. [14] Due to a lack of availability to effective treatments like oral rehydration solution (ORS) and zinc, vulnerable children in underdeveloped and underprivileged areas also experience greater fatality rates than children in wealthy nations [15]. Diarrheal diseases among under 5-year children can be tackled in at both primary and secondary prevention levels. The primary prevention and management would involve environmental aspects such as improvement of sanitation and water quality [16]. Environmental mediations for the reduction of diarrhoea have traditionally focused on the improvement of the quality and distribution of drinking water, excreta management through sanitation systems as well as promotion of handwashing with soap at critical times Mumma J, et al. [17] as well as exclusive breastfeeding up to the age of 6 months, and continued breastfeeding through 24 months Black RE, et al. [18, 19] In addition, maternal factors like mother’s age and education level have been seen to be significant in explaining child health outcomes [20]. This study therefore aimed at determining the knowledge and practices of home diarrhoea m that affect diarrhoea management practices among adolescent mothers.

Data Processing and Analysis

All completed questionnaires were reviewed for accuracy. STATA version 17 was used to clean, code, enter, and analyzed. Tables and bar charts were used to display socio-demographic information (categorical variables) such education level, child’s gender, marital status, and occupation. Triangulation of sources and analysts helped to assure the analytical rigor of the qualitative investigation. The researchers (JM and AW) matched the transcriptions to the notes they took during the focus groups. Additionally, preliminary codes and themes (by JM) were reviewed by a second researcher (AW), and any discrepancies were discussed before codes and themes were finalized.

Ethical Considerations

This study sought approval from the Board of Postgraduate Studies, JOOUST. Ethical clearance was obtained from Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review committee (JOOTRH ERC (IRRC/ JOOTRH/560/21)) and NACOSTI (NACOSTI/P/22/16717). Permission to conduct the study was sought from the Health Department of Kisumu County, (GN 133 VOL.XL (229)).

Results

A total of 285 adolescent mothers participated in the study for the quantitative section while 21 adolescent mothers participated in the qualitative arm of the study. These data were analysed and triangulated. The study revealed that 64 children (22.5%) had had diarrhoea in the past two weeks.

Discussion

Diarrhoea is a prominent cause of illness and mortality in children under the age of five particularly in underdeveloped countries. Before dehydration sets in, diarrhoea must be properly treated. If parents were educated how to give their children ORS, zinc, and good home care, millions of children’s lives might be saved [22]. However, this study indicates that there is a low level of knowledge in ORS preparation. This implies that there is a gap in the level of awareness on fluid replacement using oral rehydration therapy. According to the findings approximately 67% had good knowledge of ORS preparation, these findings are similar to those of a study conducted in Gondar, Ethiopia that found out that about 65% of the caregivers had good knowledge about ORS in home management of diarrhoea [23]. In addition to ORS, findings from this study indicated that continued feeding and breast feeding were practiced by the participants during diarrhoea episodes. This is an indication that participants practice the appropriate diarrhoea management, and this would be helpful in impeding malnutrition and dehydration. The findings concur with a study conducted in Ethiopia whose findings showed that, findings showed that continued breastfeeding and increased food intake were practiced by participants [24]. However, several patterns of suboptimal diarrhoea management practices such as withholding of food was noted among the study participants. This is inappropriate but it is also discouraged as it increases the child’s vulnerability to malnutrition. These findings concur with studies conducted in Nigeria in which participants mentioned withholding food during diarrhoea episodes [25, 26]. The use of banana and yoghurt during diarrhoea was low among the study participants. Although these two have been noted to be of great importance, banana helping with electrolyte balancing and yoghurt helping with probiotics there was little knowledge about them among the study participants. As study conducted on traditional diarrhoea management practices in found out that the use of banana, and yoghurt was common [27, 28]. This study also identified the use of conventional methods of diarrhoea management at home. There is a specific herb which is given to babies during diarrhoea episodes. This is not only a suboptimal practice in diarrhoea management but also inappropriate since it exposes the baby to sepsis and to other gastrointestinal infections. This has also been observed in other studies [11, 29] which highlighted the use of herbs and other traditional medicines to be used in the management of diarrhoea.

Some of the diarrhoea prevention methods identified in this study were hygiene practices such as handwashing, environmental hygiene as well as drinking treated or boiled. These findings are supported by literature that demonstrated that the use of proper sanitation, hygiene, and water practices can reduce mortality by 65% and diarrhoea incidence by 26%. [30]. The WHO also recommends that sanitation and hygiene are some of the key elements in diarrhoea prevention methods [31]. The study findings showed that continued feeding and breastfeeding during the diarrhoea episodes were appropriate practices I diarrhoea management. These were practices that would help reduce the risk of dehydration among the babies with diarrhoea. Immunization against rotavirus was however not mentioned as a method of diarrhoea management. Literature indicates that some of the strategies such as promotion of early and exclusive breastfeeding, vitamin A supplementation, and soap- washing were recommended as a means of community- wide sanitation. Together with this, rotavirus vaccination was also recently recommended for global introduction into routine schedules for immunization procedures [15]. This study showed that only 28.77% had had their babies receive rotavirus vaccine, which was below the previous reports by WHO/UNICEF Wandera EA, et al. [32, 33] report that only 38% of the national target Kenyan population received the rotavirus vaccine in 2014, and 66% in 2015. Such a gap in immunization might imply the lack health education on the vaccines that the child gets or the importance of immunization in the child’s wellbeing. There is therefore need to educate mothers on the appropriate home diarrhoea management practices, since diarrhoea is common among under-fives and if well managed, many deaths could be averted [34].

Conclusion

Continued feeding and breastfeeding during diarrhoea episodes were identified as appropriate management practices and were significant in preventing dehydration as well as increased vulnerability to malnutrition. The use of banana and yoghurt for diarrhoea management was low, even though the two are known for their electrolyte balance and probiotic production during diarrhoea evidence. There is low coverage of immunization generally and that of rotavirus among the study participant and therefore the need for immunization campaigns to improve the vaccine uptake. The use of water and sanitation strategy as methods in prevention and management of diarrhoea have been advocated and these are approaches that could help in averting the occurrence of diarrhoea among children.

Recommendation

Explore the knowledge of ORS, zinc solution and other treatments of diarrhoea among under five children.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author’s Contribution

JM, DO, DO, Conceptualized the idea, JM wrote the original manuscript, DO and DO review and gave their comments during the manuscript development stages and participated in the drafting of the paper JM, MK, and AW participated in data collection, analysis. All the authors read and approved the final manuscript.

Acknowledgement

We are grateful to Jaramogi Oginga Odinga University for the approval of the proposal and to all the study participants for voluntarily responding to the questionnaire and participating in the focus group discussions. To the supervisor and mentors in motivating us throughout the research journey and for their unending support and patience through my learning journey.

Significance Statement

The findings from this study will be used in informing the department of health on the diarrhoea management practices among adolescent mothers. This would therefore inform the development of possible interventions to curb the improper/inappropriate diarrhoea management practices.