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A STUDY TO ASSESS THE KNOWLEDGE OF

MOTHERS OF UNDERFIVE CHILDREN REGARDING

HOME MANAGEMENT OF DIARRHOEAL DISEASES

IN SELECTED AREAS OF HASSERGHATTA-PHC,

BANGALORE

by

SARAMMA T. T.

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment

Of the requirements of the degree of

Master of Science in Nursing

in

Community Health Nursing

Under the guidance of

Prof. Arul Mani Esther Rani. TP M.Sc (N)

DEPARTMENT OF COMMUNITY HEALTH NURSING

EAST WEST COLLEGE OF NURSING

AFFLIATED TO RAJIV GANDHI UNIVERSITY

OF HEALTH SCIENCES, KARNATAKA

BANGALORE

2006

i
DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management

of diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore

is a bonafide and genuine research work carried out by me under the

guidance of Pro. Arul Mani Esther Rani, Head of Department of

Community Health Nursing, East West College of Nursing, Bangalore.

Date: Saramma T. T.

Pace: Bangalore East West College Of Nursing

Bangalore

ii
CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management of

diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore a bonafide

research work done by Saramma T. T. in partial fulfillment of the requirement for

the degree of Master of Science in Nursing (Community Health Nursing).

Date: Signature of the guide

Place: Bangalore Name: Prof. Arul Mani Esther Rani

Designation and Department

Head of the Department

Community Health Nursing

iii
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE

INSTITUTION

This is to certify that the dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management of

diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore is a

bonafide research work done by Saramma T. T. under the guidance of

Prof. Arul Mani Esther Rani, Head of Community Health Nursing Department.

Seal and Signature of HOD Seal and signature of the Principal

Name: Prof. Arul Mani Esther Rani Name: S. Chitra

Date: Date:

Place: Bangalore Place: Bangalore

iv
COPYRIGHT

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation/thesis in

print or electronic format for academic/research prupose.

Date: Signature of the Candidate

Place: Bangalore Name

Rajiv Gandhi University of Health Sciences, Karnataka

v
ACKNOWLEDGEMENT

This study was undertaken and completed under the guidance of

Prof. Arul Mani Esther Rani. M.Sc (N) I am grateful to her for the constant

guidance, support, and encouragement provided for the successful completion of

this study.

I am grateful to Prof. S. Chitra, Principal of East West College of Nursing

for the guidance, support, and expertise suggestions contributed throughout the

conduction of this study.

My sincere thanks go to Ms. Prabavathy. M. Sc (N) for her valuable

suggestions and support rendered for the completion of this study.

My sincere thanks go to Prof. Vimalakumari P. G. M.Sc (N) for providing

expertise suggestions and support for the completion of this study.

I thank Dr. Dinesh for the guidance and valuable suggestions provided

during the conduction of the study.

I am extremely grateful to Prof. H.S. Surendra (statistician) for his

valuable suggestions, constant guidance and support rendered throughout the

conduction of the study.

I express my gratitude and thanks to all the experts who have validated the

tool and for providing expertise suggestions and remarks.

I also thank all my friends and the members of my family for the

cooperation and help rendered for the completion of this study.

Date: Signature of the Candidate

Place: Name: Saramma T.T.

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LIST OF ABBREVIATIONS USED

(In alphabetical order)

HAF: Home Available Fluids

HRS: Home made Recommended Solution

ORS: Oral Rehydration Solution

ORT: Oral Rehydration Therapy

SSS: Sugar-Salt Solution

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ABSTRACT

A study to assess the knowledge of mothers of underfive children regarding home

management of diarrheal diseases in selected areas of Hasserghatta-PHC,

Bangalore.

Objectives of the study

1. To assess the knowledge of mothers of underfive children regarding home

management of diarrhea.

2. To compare the knowledge of mothers of underfive children between rural

and urban slum area.

3. To associate the knowledge of mothers of underfive children regarding

home management of diarrhea with selected demographic variables.

4. To develop a health information material based on study findings.

The tool selected for data collection was structured interview schedule. Eleven

experts validated the tool. Reliability of the tool established by using split half

technique. The reliability coefficient of the test for knowledge scale was found to

be r11 = 0.9235 and validity coefficient as 0.9610.

The research approach adopted for the study was a descriptive study. The

study was conducted on a total of 100 mothers comprising 50 from Hassarghatta

rural area and 50 from Dasarahalli urban slum, Bangalore. Data was collected

from 19th September 2005 to 15th October 2005. A pretest on knowledge of

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mothers regarding diarrhea was also administered on the first and second day for

both the groups.

The data obtained were analyzed based on the set of objectives of the study

using descriptive and inferential statistics.

Major findings of the study

Findings related to sample characteristics.

Majority of mothers 50% belonged to the age group of 21-24 years, 52%

illiterates, 86% housewives, 97% of mothers were Hindus, 49% belonged to

nuclear family, 53% had income less than rupees 1500 per month, 40% of

mothers belonged to a family size of five and above. A majority 41.7% of the

families had two under-five children. A majority of the subjects 61% did not have

any previous exposure to any media. Nearly one-fourth of the underfive children

were infants 24.7% and 51.4% were males.

Findings related to demographic variables.

The mean knowledge score of rural area mothers was 38.33%, which was
higher than in urban slum area of 14.82%.
Mothers more than 25 years of age had higher mean knowledge score of

33.12% than mothers aged 17-20 years 18.61%.

Mothers belonging to nuclear family had a slightly higher mean


knowledge score of 29.13% than joint family 24.12%, but was found to be
non significant at 5% level.
The mean knowledge score of literate mothers 37.42% was higher than
that of illiterate mothers 16.56%.
The mean knowledge score of housewives 28.31% was found to be higher
than labourers 15.91%.

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The mean knowledge score of mothers having one underfive children was
found to be slightly high 26.92% than having two underfive children
26.13%, but was found to be non significant at 5% level.
Families having a monthly income of more than rupees 2500 per month
had a mean knowledge score of 35.43%, which was higher than having
income of less than rupees 1500 per month 22.64%.
The mean knowledge score of mothers exposed to media was higher

(36.44%) than that of not exposed to any media (19.88%).

Findings on knowledge assessment related to home management of

diarrhea

Findings related to causes, signs and symptoms, and complications:

On the whole mothers had a highest mean knowledge score regarding

meaning of diarrhea 57% (i.e. at least 3 watery stools per day) (rural 82%,

urban32%) followed by causes of food contamination 32.5% (rural 42%, urban

23%). The knowledge on the exact cause of diarrhea i.e. microorganisms was

only 7%.

The mean knowledge score on diarrhea transmission including contaminated

water, contaminated food, and poor environmental sanitation was 28% (rural

34%, urban 22%).

The mean score on reason for developing diarrhea including bottle-feeding

was 26% and water storage in a wide mouthed container was 8%.

Regarding dangerous signs of diarrhea the overall mean score was 30%

(rural 42%, urban 18%). The mean knowledge score of the main signs were

dehydration 16%, at least 8 watery stools was 39%, and fever 19%. Regarding

complications of diarrhea the overall mean score was 21.3% (rural 37.3%, urban

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5.3%). Urban slum mothers had poor knowledge regarding death 0%,

malnutrition 10% and anemia 6% as the complications of diarrhea, while rural

mothers had a better knowledge. Mothers had the least score on followed by

meaning of dehydration i.e. loss of water and salts from the body 3.5% (rural 6%,

urban 1.0%). All these datas were subjected to statistical tests and it indicates the

mean knowledge score of mothers were found to be significant at 5% level.

Findings related to oral fluid and food intake during diarrhea.

Regarding the management of diarrhea at home the overall mean

knowledge score of mothers was 23.3% (use of Home Available Fluids 39%,

ORS 15%, and SSS 7%. The mean score of rural mothers were 26.7% and urban

14%.

Regarding the use of home based foods, mothers had the highest overall

mean knowledge score regarding the foods to be avoided during diarrhea 54.3%

(rural 97%, urban 11.5%), followed by the knowledge on the foods to be given

during diarrhea was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural

29%, urban 17.5%). The mean knowledge score regarding increasing the quantity

of food during and after diarrhea was very negligible 5% (rural 10%, urban 1%).

On the whole the knowledge on giving usual amounts 24% but 71% restricted

solid foods during diarrheal episodes, which indicates a limited knowledge on use

of home based foods.

Regarding ORS, the overall mean knowledge score of mothers on

availability of ORS packets was high 50.7% (rural 25.4%, urban 18.3%) followed

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by advantages of using ORS 26% (rural 36.7%, urban 16%), correct method of

preparation of ORS 11% (rural 20%, urban 2%), usage of ORS within 24 hours

8% (rural 14%, urban 2%), correct frequency of giving ORS 7.3% (rural 12%,

urban 2.7%), and precautions to be followed while preparing ORS was 1.0%

(rural 2%, urban 1%). On the whole knowledge on precautions and preparations

of ORS was found to be very low in both the areas.

Regarding knowledge on various home available fluids that can be during

diarrhea the overall mean knowledge score was 21.9% (rural 25.4%, urban

15.4%)and on increasing the quantity of oral fluids during diarrhea was found to

be only 19% (rural 28%, urban 10%). Regarding breastfeeding the overall mean

score on increasing the frequency of breastfeeding 23% (rural 30%, urban 16%).

However, a few mothers mentioned about giving usual amounts 60%.

All these findings indicate that rural mothers had more knowledge than urban

mothers. All these datas were subjected to statistical tests and it indicates the

mean knowledge score of mothers were found to be significant at 5% level.

Findings related to prevention and control measures of diarrhea.

The overall mean knowledge score of mothers regarding boiling of infants

feeding utensils was found to be higher 64% (rural 94%, urban 20%) followed by

when the child requires medical aid 34.7% (rural 43.3%, urban 26%), prevention

of occurrences of diarrhea 32.5% (rural 50.5%, urban 14.5%), prevention of feco-

oral contamination 27% (rural 52%, urban 2%), use of boiled cooled water for

drinking 26% (rural 50%, urban 2%), frequency of hand washing with soap and

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water 25% (rural 48%, urban 2%), and knowledge on use of clean water was 23%

(rural 40%, urban 6%). However, these findings indicate that rural mothers had

more knowledge than urban mothers. All these datas were subjected to statistical

tests and it indicates the mean knowledge score of mothers were found to be

significant at 5% level.

On the basis of the study following recommendations were made.

This study could be replicated in a larger sample to generalize the

findings.

A similar study can be carried out to find out the effectiveness of planned

teaching programme using the health information material developed for

the present study.

A study can be conducted on attitude, beliefs and practice regarding oral

fluids and food intake during and after diarrhea at home.

A study can be carried out to find out the attitude and actual practices of

mothers regarding prevention of diarrhea.

A study can be conducted to find out the knowledge and practices of

health care providers regarding diarrhea.

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TABLE OF CONTENTS

1. Introduction Page No 1-8

2. Objective Page No 9-14

3. Review of Literature Page No 15-27

4. Methodology Page No 28-34

5. Results Page No 35-71

6. Discussion Page No 72-82

7. Conclusion Page No 83

8. Summary Page No 84-93

9. Bibliography Page No 94-99

10. Annexure Page No 100

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LIST OF TABLES

Sl. No Tables Pages

1. Personal characteristics of respondents. 37

2. Family related characteristics of respondents. 37

3. Child related characteristics of respondents. 38

4. Diarrheal episodes and media of exposure on 40

management of diarrhea.

5. Aspect wise knowledge on Home management 41

of diarrheal diseases among mothers.

6. Statement wise over all assessment of Knowledge 43

on meaning, etiology and manifestations, and

complications.

7. Statement wise over all assessment of Knowledge 45

on home management using oral fluids and foods.

8. Statement wise over all assessment of knowledge 47

on control measures and prevention of diarrhea.

9. Residence wise Knowledge on home management 49

of diarrheal diseases among mothers.

10. Statement wise over all assessment of knowledge 51

on etiology and manifestations among mothers

(rural, urban).

11. Statement wise overall assessment of 54

knowledge on home management using

oral fluids and foods among mothers (rural, urban).

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12. Statement wise over all assessment of knowledge 57

on control measures and prevention of

diarrhea among mothers (rural, urban).

13. Impact of residence on knowledge of home 59

management of diarrheal diseases.

14. Impact of age on knowledge of children on home 59

management of diarrheal diseases among mothers.

15. Impact of education on knowledge of home 65

management of diarrheal diseases.

16. Impact of occupation on knowledge of home 66

management of diarrheal diseases among mothers.

17. Impact of type of family on knowledge of home 67

management of diarrheal diseases.

18. Impact of family income on knowledge of home 67

management of diarrheal diseases among mothers.

19. Impact of number of living children on knowledge 68

of home management of diarrheal diseases.

20. Impact of family size on knowledge of home 69

management of diarrheal diseases.

21. Impact of number of episodes on knowledge of home 70

management of diarrheal diseases.

22. Impact of previous exposure to media on knowledge 70

of home management of diarrhea among mothers.

23. Comparison of literacy rate between urban and 71

rural area.

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LIST OF FIGURES

Sl. No Tables Pages

Figure. 1: Personal characteristics of Respondents 39

Figure. 2: Aspect wise knowledge on Home management 42

of Diarrheal diseases among mothers

Figure.3: Residence wise knowledge on Home management 50

of diarrheal diseases of among mothers

Figure 4: Impact of Residence and Age on knowledge of 60

mothers on home management of diarrheal diseases.

Figure. 5: Impact of Education on knowledge of Home 61

management of Diarrheal diseases

Figure. 6: Impact of Occupation and Type of Family on 62

knowledge of Home management of diarrheal

diseases

Figure .7: Impact of Family size on knowledge of Home 63

management of Diarrheal diseases

Figure . 8: Impact of Family income on knowledge of Home 64

management of Diarrheal diseases

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1. INTRODUCTION

The countrys children is a supremely important asset.

-National Health Policy

"Health is not everything, but without health you have nothing."

Health is both a responsibility as well as right. Protecting the health and

development of children is a long-term contribution to the growth and development of the

country as a whole. Children under five years of age constitute to 15-20% of the Indias

population. Their protection is a greatest investment for countrys economic prosperity

and political stability (Basavanthappa, 2003) [1].

Worldwide, almost 30,000 children under age 5 are dying every day that's more

than 10 million children a year nearly all from preventable or treatable conditions like

diarrhea, pneumonia, measles and malaria. Malnutrition contributes to half of these

deaths. Oral rehydration therapy currently helps save one million children's lives from

diarrhea-related diseases each year. Yet, more than two million diarrhea-related deaths

still occur each year (David Oot, 2004) [2]. Diarrhea is responsible for about one in five

deaths of children in the world (Margaret Kosek, 2003) [3].

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More than 1.5 million children under five continue to die each year as a result of

acute diarrhea in developing countries (UNICEF/WHO, 2004) [4]. Eighty percentage of

underfive deaths due to diarrhea occur in the first 2 years of their life [3] and as many as

10% of infant deaths in India result from diarrhea (Tejal Baraj-Jaitly, 2002) [5].

The problem of childhood diarrhea is severe in India 550,000 deaths per year and

is the second-leading cause of death for children under the age of five [6] (Christian

Science Monitor, 2005). The global report (March, 2004) [7] released on World Water

Day, more than five lakh (500,000) Indian children die each year based on diarrheal

disease rates. Nearly half of all children aged underfive are not growing normally and the

mortality rate for this group is 93 per one thousand live births.

In India, 50% of all deaths occur below 5 years, 33% below 1 year, 20% below 1

month, and 10% below 1 week. Almost 500 million children suffer from acute diarrhea

annually. Of them 5 million die every year. In India alone 1.5 million children become a

casualty due to diarrhea every year (Suraj Gupte, 2001) [8]. In India, diarrhea accounts

for 21.2% and neonatal factors 21.2% as the major cause of mortality followed by

pneumonia 18.2% and malnutrition were the major killers in children between 1-5 years.

Mortality in females was higher than males in infancy (Khalique N, 1993) [9]. In

Karnataka, it is estimated that 24,800 children die every year due to acute diarrheal

diseases (CSSM review, 1995) [10].

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Diarrheal diseases refer to a group of diseases in which the predominant symptom

is diarrhea. (Mazingrira, 1984) [11], the episodes are generally associated with other

infectious diseases making treatment and prevention more difficult. Diarrhea kills 8 or 9

children under the age of 5 every minute, often simply draining out the water and salts

the body needs to keep functioning. (Wishvas Rane, 2004) [12], acute diarrhea is often a

self-limiting condition. If dehydration is prevented or corrected with oral rehydration

therapy, no specific treatment is recommended even if the diarrhea is due to infection.

There is little evidence that antibiotics are useful in shortening illness or reducing fluid

loss, exceptions being cholera and acute bacillary dysentery.

NEED FOR THE STUDY

In India, diarrheal disease is a major public health problem among children under

the age of five years. (UNICEF/WHO, 2004) [4], diarrhea accounts for 15% of global

deaths among underfive children. Diarrhea claims the lives of 32 million children in the

underfive-age group in developing countries. The number can be dramatically reduced

through critical therapies such as prevention and treatment of dehydration with ORS and

fluids available in the home, breastfeeding, and continued feeding.

Diarrheal diseases cause a heavy economic burden for health services and as well

as to the country. (Jayaram A, 2001) [13], The Hindu News paper report states that nearly

seven lakh children died in India every year owing to diarrhea, which was easily

preventable. The country should promote preventive and community-based quality

healthcare. It also encourages private practioners to carry a significant share of the burden

of public health care.

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Various aspects of home management of diarrhea are:

(i) Recognition of dangerous signs of diarrhea.

(ii) Use of home available fluids.

(iii) Correct method of preparation of ORS and initiation of ORS.

(iv) Continued feeding during diarrheal attacks.

(v) Modification of diet and use of home available foods.

(vi) Increasing the quantity and frequency of feeding during after diarrheal

attacks.

(viii) Exclusive breast-feeding at least up to six months of age.

(ix) Following mainly hygienic practices to combat infection.

(x) Seeking medial aid when needed.

(Mangala, 2003) [14], the global communication efforts have concentrated on assisting

national programmes to promote the three rules of case management at home:

(1) Increase fluid intake.

(2) Continue feeding.

(3) Seek medical care when needed.

Thus, maternal knowledge and appropriate diarrheal management at home are of great

importance in the reduction of complication of dehydration and malnutrition.

4
Based on survey of India (2001), the total 0-6 years population of Bangalore rural

is 12% and Bangalore urban is 12.0%. The data obtained from Ministry Of Home Affairs,

Bangalore (2001), states the young dependency ratio of Karnataka is 532. In India, the

women between the age group of 15-34 years constitute 33.37% (Census of India, 2001)

[15], and in Karnataka, they constitute 35.3% of the total population who are the core

caretakers of underfive children.

Various strategies and programmes including GOBI, RCH, CSSM, and UNICEF

are focusing their efforts in averting the deaths of underfive children due to diarrhea. In

spite of so many interventions, the situation is still dismal.

The goal of World Summit for Children 1990, to be attained by the year 2000 was

to reduce the underfive deaths to one-third and halving the child deaths caused by

diarrhea and 25% reduction in the diarrheal incidence rate. A priority is to increase the

proportion of patients receiving ORT and continued feeding to 80 percent by the end of

1995, but currently only 38% of the diarrheal dehydration sufferers are treated with ORT,

(WHO, 2003) [16].

National Diarrheal Disease Control Programme was started during the Sixth plan

to bring down diarrhea-related mortality. The key element of the WHO Diarrheal Disease

Control Programme was implementation of oral rehydration therapy. The objective is to

educate mothers to enable them to take care of children suffering from diarrhea by home

made fluids, continued feeding during diarrhea, and to recognize early signs of

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dehydration. The other strategy of diarrhea prevention is to promote exclusive

breastfeeding for the first 4-6 months of life and proper weaning. Ultimately, it aims at

improving knowledge and practice of appropriate home management among caretakers of

young children (Park K, 2001) [17].

A study conducted by Anand K, et al. (1992), [18] on knowledge-regarding

diarrhea in rural mothers of Haryana revealed that diarrheal incidence stood at 2.88

episodes/child/year, just 24.1% defined diarrhea accurately. Only 29.7% knew about

sugar-salt solution or commercial ORS, only 9.7% could correctly prepare it, 38% gave

weak tea or curd, 81.4% continued to feed a child during a diarrheal episode,

breastfeeding was continued, and 64% did not know the dangerous signs of diarrhea. The

most reported danger signs were duration of at least 3 days (17%) and at least 6 stools per

day (14%). These findings showed limited knowledge about diarrhea and diarrheal

management by mothers.

Most of the diarrheal deaths are caused due to dehydration. Many of the millions

of children who die every year in developing countries from diarrhea could be saved if

mothers knew how to give ORT promptly. (Dua, et al. (1999), [19], The National Family

Health Survey 1992-1993 revealed that 42.7% of mothers knew about ORS packets and

25.9% had ever used them. According to UNICEF (1988), 70% of 4 million deaths could

have been prevented if the knowledge of the use of the low-cost ORT was universal.

Early administration of ORS leads to fewer office, clinic, and emergency department

(ED) visits and to potentially fewer hospitalizations and deaths.

6
A study conducted by Bhandari N, et al. (1995) [20] on patterns of use of oral

rehydration therapy in an urban slum community of Tigri, New Delhi, in 200 households.

In the 291 episodes occurring among 108 enrolled children, home available fluids in not

more than the usual amounts were used in 8.2 episodes, sugar-salt solution (SSS) in

14.7% of cases, oral rehydration salt solution (ORS) in 7.9% of cases and either of these

in 29.4% of cases. The amount of ORS administered to children was inadequate at all

ages, with majority consuming only spoonfuls or sips.

Diarrhea is a major cause for malnutrition. [14] In India, diarrhea accounts for

22% of the child mortality and malnutrition accounts for 60% of diarrheal deaths. The

episodes of diarrhea are more prolonged and severe in malnourished child, thereby

raising the risk of the death. Maternal knowledge regarding modification of diet,

increasing the quantity and frequency of feeding and continued breastfeeding during and

after diarrheal episodes plays a significant role in the prevention of malnutrition among

underfive children.

Knowledge on preventive aspects has the greatest impact on health often related

to improving of hygienic practices at household level. A large percentage of hygienic

activities take place in home or close to the home. Feco-oral transmission accounts for

most diarrheas. Knowledge on optimum utilization of the available health facilities needs

to be focused in the preventive aspect of diarrhea.

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Mothers still lack knowledge on actual cause of the disease and some of the basic

underlying hygienic principles including washing hands with soap and water after

defecation, safe disposal of feces, use of sanitary latrines, and use of safe food and safe

drinking water (Melanie Nielse, 2001) [21]. Mothers knowledge regarding domestic

hygiene, food hygiene, personal hygiene, and environmental sanitation are important in

reducing the prevalence of childhood diarrhea (Sheth Mini, 2004) [22].

The present underfive population of Hasserghatta-PHC, Bangalore, is 23,831. The

records revealed that 615 under five children in the year 2002-2003, and 710 underfive

children in the year 2003-2004 came to the PHC with acute diarrheal episodes. An

increase in the incidence of 100 more children having diarrheal episodes were found in

the year 2004. As a community health nurse, there was a felt need to assess the actual

knowledge of mothers of underfive children regarding home management of diarrhea.

These findings and the above supportive studies and its recommendations have

influenced the investigator to undertake this study.

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2. OBJECTIVES

Statement of the problem

A study to assess the knowledge of mothers of underfive children regarding home

management of diarrheal diseases in selected areas of Hasserghatta-PHC, Bangalore.

Objectives of the study

1. To assess the knowledge of mothers of underfive children regarding home

management of diarrhea.

2. To compare the knowledge of mothers of underfive children between rural and

urban slum area.

3. To associate the knowledge of mothers of underfive children regarding home

management of diarrhea with selected demographic variables.

4. To develop a health information material based on study findings.

Hypotheses

The following hypotheses were formulated based on the objectives of the study.

H0 (1): There is less knowledge among mothers of underfive children regarding home

management of diarrhea.

H0 (2): There is no difference in the knowledge among rural and urban mothers regarding

home management of diarrhea.

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H0 (3): There is no impact of demographic variables on knowledge of mother regarding

home management of diarrhea.

Assumptions

1. Mothers have some knowledge regarding the causes, signs and symptoms, and

prevention and control measures of diarrhea.

2. Mothers have limited knowledge regarding preparation and initiation of oral

rehydration therapy including use of ORS, home available fluids and foods during

diarrhea.

3. Knowledge of mothers is influenced by variables such as age, literacy, occupation,

type of the family, number of underfive children, family size, family income, residential

area, and previous exposure to media.

Operational definition

Diarrhea: It is the passage of three or more loose stools per day in children.

Under five: Children belonging to the age group of 0-5 years.

Mothers: Mothers having underfive children.

Knowledge: Knowledge refers to the mothers correct verbal response to the prepared

structured interview schedule regarding home management of diarrhea in children.

Assessment: Refers to the process used to identify the levels of knowledge on home

management of diarrhea.

Home management: The mothers ability to recognize the signs and symptoms of

diarrhea, prepare and use home available fluids and ORS, modify the diet, follow

10
hygienic practices and be alert to seek medical aid when needed to combat diarrhea at

home.

Home available fluids: Any recommended fluid available at home, which can be given

during diarrhea.

Health information material

It is an instruction regarding prevention and control of diarrhea at home, designed

and organized systematically for mothers as per the findings of the present study.

Delimitation

The study was limited to:

1. Hassarghatta rural and Dasarahalli urban area of Bangalore District.

2. Mothers who have underfive children.

3. Mothers who were willing to participate in the study only were considered as

sample.

4. Verbal statements of the mothers knowledge were considered as response.

Conceptual framework of the study

A theory is a conceptual system or framework invented for some purpose

(Dickoff and James, 1968). A theory is a set of interrelated constructs (concepts adapted

for a scientific purpose), definitions and propositions that present a systematic view of

phenomena by specifying relations among variables, with the purpose of explaining and

predicting the phenomena (Kerlinger, 1986) [23].

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The framework of the present study is based on Orems self care theory. Orem

presents three theoretical constructs (1) self care construct, (2) self care deficit construct,

and (3) the nursing systems construct.

She states that self-care is the practice of activities that individuals initiate and

perform on their own behalf in maintaining life, health, and well being. In the present

study, mothers are the dependent self-care agents (self care agency), as they provide care

to the children.

Self-care deficit is a health-related criterion for identifying one who needs nursing

care. Assessing the knowledge of mothers regarding home management of diarrhea

identifies the self-care deficits. It is conceptualized that mothers have some knowledge

regarding home management of diarrhea. Moreover, the knowledge of the mothers will

also vary according to the demographic variables such as age, education, occupation,

family income, number of underfive children, family size, previous exposure to media,

and residential area. This is done by the nursing care agency.

She also states that persons are able, or can and should learn to perform self-care

measure, but cannot do with assistance. The way an individual meets his self-care

demands is not an instinct but is a learned behavior. Mothers have the ability to meet the

self-care needs of her children with guidance, support and teaching. She also

conceptualizes that mothers have the capacity to reflect upon themselves and

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environment, symbolize what they experience. They can use symbolic creations in

thinking and communicating. By guiding mothers, she can be beneficial for themselves

and for others. Thus, mothers belong to a supportive educative system as per

classification of patient care by nursing care construct. As per the findings of the study in

order to meet her therapeutic self-care demands regarding diarrhea, an information

material was developed focusing on illustrations for the use of mothers.

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Conceptual framework based on Orems self care theory

Self care agency


(Mothers of under
five children)

Assessment on Knowledge on
therapeutic self-
care demands of diarrhea.
mothers.
Meaning of diarrhea
Factors Etiology
Manifestations
Residence Complications
Age of the mother
Religion
Mothers occupation (Nursing care
Education of mother agency)
Use of HAF
Family income Data collection
Use of ORS
Type of family
Breast-feeding
Family size
Home-based foods
Exposure to media
Previous experience
Child related
characteristics
Prevention and control
Knowledge measures of diarrhea
score of
mothers

Development of health
information material.

Meeting
m the self care
deficits of dependent
care agents
(Mothers)

14
3. REVIEW OF LITERATURE

The review of literature is organized under the following headings:

1. The underfive mortality and morbidity due to diarrhea.

2. The incidence and prevalence of diarrhea.

3. The home management of diarrhea.

The under-five mortality and morbidity due to diarrhea

Borooah Vani K (2004) [24], carried out a study that states Haryana (one of the

richest states in terms of mean household income) more than 9 out of 10 households had

diarrhea among under-three children 92.3%, while neighboring Punjab (as rich as

Haryana), the incidence was just over one in two, and in a relatively poor West Bengal

the incidence was about one in three.

Victoria, et al. (1993) [25], carried out a multi-centric study revealed the

population-based data on deaths due to diarrhea among children less than 5 years of age

were obtained from areas of Brazil (227 deaths), Senegal (531), Bangladesh (236) and

India (146). Persistent diarrheal episodes were more common in India and Senegal

between 1-4 years.

Aswathi, et al. (1993) [26], conducted a study in urban slums of Lucknow in 28

randomly selected slums revealed the annual underfive mortality was 71 deaths among

2796 children; pneumonia in 19.7%, diarrhea in 18.35% and measles in 11.4% and high

fever in 21.1%.

15
Khalique, et al. (1993) [9] conducted a study in 9 villages of Rural Health

Training Center, Jawan, Aligarh, India, having 1792 registered families. The infant

mortality rate was 79.3 per 1000 live births. Higher mortality in children between 1-2

years (29.6/1000) in comparison to 2-5 years (16.2/100) reflected higher vulnerability of

children below 2 years. Diarrhea 21.2% and neonatal factors 21.2% were the major cause

of mortality followed by pneumonia 18.2% and malnutrition were the major killers in

children between 1-5 years. Mortality in females was higher than males in infancy.

The incidence and prevalence of diarrhea

Banerjee, et al. [27] (2002) conducted a combination of retrospective and

prospective study in an urban area in West Bengal among underfive children of different

socioeconomic status; the overall prevalence was 31.67%. This implies that the

prevalence among under-fives ranges from 26.4% to 37% with 95% confidence, highest

in the lower socioeconomic class 41%.

Bhandari N, et al. (1992), [28] in a longitudinally followed cohort children under

six years of age in rural India revealed 1663 episodes of diarrhea and 23 related deaths

were recorded in 1467 children followed up in 20 months. The diarrheal attack rates were

24 times higher in children with severe malnutrition. The case fatality rate was 0.64% and

0.8% in episodes of one and two weeks duration and increased to 13.95 for persistent

episodes.

16
Guerrant RL, et al. (1990) [29] in a study done in Cleveland, Ohio from 1948-

1957, researchers learned that people had diarrhea an average of 1.52 times annually. The

age specific rates climbed from 1 episode/child 1-year old/years to 2-2.2 episodes/child

1-10 years old/year. In a similar study done in Charlottesville Virginia between August

1975-July 1977, the overall diarrhea attack rate stood for children 3 years old, it was 2.5

episodes/year. In developing countries, attack rates range from 5-12 episodes/child/year

with the highest rates in the first 2 years of life (e.g., in India, among the urban poor, 18.6

episodes/child/per year).

Causes of diarrhea and hygiene

Melanie Nielse (2001) [21] conducted a study on Childhood diarrhea and

hygiene: Mothers perceptions and practices in the Punjab, Pakistan. 200 households

from 10 villages were selected by random sampling. The mothers revealed that causes of

diarrhea were too much food 66%, too little food 4%, hot and cold food 7%, cold or hot

environment 16%, bad breast milk 2%, contaminated food 26%, contaminated water 4%,

insects or flies 2%, dirtiness 8%, soil eating 6%, others teething 6%, other causes 16%,

and do not know the causes 2%. Fecal contamination was never presented as a direct

cause of diarrhea and the feces of infants were not associated with germs. Only a few

mothers mentioned bacteria or germs in association with flies. Only 5 (2.5%) of the

surveyed mothers mentioned the need for a toilet for hygienic purposes. Lack of fuel or

resources for fuel were not found to be a primary reason for not boiling the water.

Another argument for not boiling the water was the change of taste. This indicates a lack

of knowledge regarding causes of diarrhea.

17
Home management of diarrhea

Sheth Mini and Obrah Monika (2004) [22] conducted a study in Gujarat, India

regarding feeding practices was conducted on mothers (n=200) of underprivileged

children in Anganwadi Centers. It revealed that contaminated water, contamination of

food also play an important role in the etiology of diarrhea. Most of the households

(50.5%) had poor ratings for environmental sanitation. The personal hygiene (PH) rating

for the mothers at the baseline were poor (38.5%) to average (30.5%). Poor

environmental sanitation and personal hygiene of mothers continues to be the leading

etiological factor for diarrhea. Behaviors such as child defecation on the floor, water or

rag being used to cleanse the child after defecation and mother not washing the child's

hand or her hands with soap and water after defecation or cleansing child's perineum

were directly related to high incidence of diarrhea. Food safety education package

incorporated three messages: washing hands with soap and water, avoid feeding leftover

food and keep surrounding clean reduces the prevalence of diarrhea.

Agarwal, et al. (2002) [30] conducted a study in New Delhi, showed a reduction

in diarrheal morbidity episodes by 40% when Actimel was started in a 3-month followup.

It reduces the duration of diarrhea in children.

Pandey A, et al. (2002) [31] conducted a study on gender differences among

underfive children (263 boys and 267 girls) in seeking health care among rural

community of West Bengal revealed that at the household level girls were less likely to

get home fluids and ORS during diarrhea. Qualified professionals were consulted more

18
often and sooner for boys than girls. The boys were 4.9 times more likely to be taken

early for medical care and 2.6 times more likely to be seen by qualified allopathic doctors

compared to girls.

Datta V, et al. (2001) [32] conducted a study on maternal knowledge and

practices towards diarrhea and ORT in rural Maharastra among 75 mothers revealed that

69.3% of them had per capita income less than Rs. 500. 68% of the mothers knew correct

definition of diarrhea but only 5.3% of them were aware that diarrhea leads to

dehydration. 90.7% of the mothers were aware of ORT and ORS was easily available to

the majority, but only 60% practiced ORT. Nearly 1/3rd of the mothers were mixing ORS

in wrong fluid. Nearly half of the mothers were not practicing adequate hand washing,

32% were using feeding bottles. The maternal knowledge towards diarrhea and ORS was

inadequate in the population and there was big gap between actual and desired practices.

Zodepy, et al. (1999) [33] conducted a case control study in 387 cases in a

Government Medical College Hospital, Nagpur, India, for a prediction model for

moderate or severe dehydration in children. It revealed that frequency of stools more than

8 per day, frequency of vomiting of more than 2 per day, not giving ORS, under nutrition,

not washing hands by mother, withdrawal of breast feeding, not giving home available

fluids, or both, during mild to moderate dehydration were found to be the significant risk

factors causing diarrheal mortality.

19
Bhatia, V. et al. (1999) [34] conducted a study on attitude and practices regarding

diarrhea in rural community, Chandigarh in 120 randomly selected samples revealed that

majority of the underfive children 88.1% had treatment for diarrhea whereas only 54.8%

of children were given oral rehydration solution. 86.7% of the mothers were aware of

ORS but only 18.7% could tell the correct method of preparation. A large number

restricted food during the episodes.

Mercy Thomas (1999) [35] conducted a study in Mangalore regarding oral fluid

and food intake in an urban area revealed that most of the mothers were of low

socioeconomic status and belonging to joint family. Mothers had only 50% of the

knowledge on diet and oral fluid to be given to underfive children. Most of the mothers

had knowledge on continuation of breastfeeding during diarrhea, but the mothers had

poor knowledge regarding foods that are to be given and the foods that are to be avoided.

Poor knowledge was found in the areas regarding the amount of fluid to be given 44.8%

and frequency of administering oral fluid 42.76%, but knowledge on preparation of ORS

package was severely lacking.

Rao KV, et al. (1998) [36], the government of India identified ORT promotion as

a priority child survival strategy. The effects of exposure to electronic media messages on

the mothers knowledge about use of ORT were investigated in 1992-3. 43% of mothers

were aware of ORS. Only 18% of infants received ORS and 19% were given

recommended homemade solution during the episode of diarrhea; 69% received neither

ORS nor RHS. Children with diarrhea were twice likely to receive decreased amount of

20
breast milk and other fluids than to be given increased amounts. The low use of ORS is

especially alarming since 61% of children with diarrhea in the previous 2 weeks were

taken to health facility for treatment. 94% of these were given antibiotics. These findings

indicate a need to strengthen education programs in this area for both mothers and health

care providers.

Bhal, et al. (1997) [37] a clinical trial study conducted at Shimla, Himachal

Pradesh regarding the cost effectiveness of oral rehydration therapy revealed that 47.6%

were infants and 58% came from rural areas. 87% had acute diarrhea, 10.4% had

dysentery and 2.6% had persistent diarrhea. Diarrhea was most prevalent during April to

September. 41.9% of presenting children had received ORT before coming to DTU; as a

result severe dehydration was seen only in 10.7% cases. Comparison of data on 166

children admitted to a study hospital in 1986-87 revealed a significant decline in

admission rate due to dehydration and associated illness (100% vs 26.8), use of

antimicrobials (66.2% vs 15.3%). 84.6% children in 1993-1994 were treated with ORT

alone. The average cost of ORT per child was 4.49% compared with Rs. 40.29 for

intravenous fluids. The study recommends health education campaigns aimed at

promoting even more widespread use ORT by mothers and health workers are needed.

Taneja, et al. (1996) [38] a study conducted on 6285 persons of Jhuggi clusters of

New Delhi to identify the diarrhea management at home and at a health facility to

determine knowledge levels about oral rehydration solution revealed that only 31.3%

received ORS or home available fluids. Only 11.5% could correctly measure the water

21
needed to make 1 liter of ORS. The study recommends that families need training in

correct preparation and use of ORS.

Mehta M (1996) [39], a comment on a nutritional management of diarrheal

diseases, states that nutritional management of acute infant and child diarrhea included

continued small feedings during acute illness and compensatory increase in feeding

during convalescence. A dietary intake of at least 125% of the recommended diet should

be attempted until the child gains the previous-illness weight. Continued breastfeeding

reduces the severity and complications of diarrhea. Full strength milk can be

administered as soon as dehydration is corrected. However, with persistent diarrhea total

elimination of artificial milk is necessary. Breast milk or animal milk should be

administered every 3-4 hours with staple foods enriched with oil and sugar.

Buch, et al. (1995) [40] conducted a study in Srinagar, Kashmir, in the Pediatrics

Outpatient Department interviewed 1600 parents of infants with acute diarrhea divided

into two groups. Group A (physicians, engineers, teachers, professors, lawyers, clerks,

educated business professionals: N=660) and Group B all others and uneducated parents:

N=940). Most infants were boys (66.2%)with acute diarrhea and aged 6 to 9 months

58.7%. Only 15% of all parents knew the definition of diarrhea (3 loose stools per day)

with Group B more likely to know it more than Group A parents 18.5% vs; p.001). 81.9%

of all parents incorrectly considered frequent stools as constituting diarrhea. The parents

considered weaning, maternal diet, and teething to be the major cause of diarrhea (58.1%,

42.5%, and 34.4%, respectively). Group A parents were more likely to report infections

22
while Group B parents were more likely to treat diarrhea with antidiarrhoeals and

antispasmodic drugs. Group A parents were most likely to use both these drugs and oral

dehydration therapy than Group B parents 62.5% vs 7.9%; p 001). Few parents 6.6%

administered only ORT. Group A parents were much more likely than Group B parents to

know the composition of various ORT brands, reconstitution of the solution, and their

utility in diarrhea (65.6% vs 7.7%). Group B parents preferred dietary restrictions during

diarrhoeal episode than group A parents 28.7% vs 6.2%. These finding reflect limited

parental knowledge about diarrhea and its treatment.

Bhandari N, et al. (1995) [20] conducted a study on patterns of use of oral

rehydration therapy in an urban slum community of Tigri, New Delhi, in 200 households

with at least one child under age five were interviewed to assess their knowledge,

attitudes and reported practices regarding management of diarrhea in children. In the 291

episodes occurring among 108 enrolled children, home available fluids in more than the

usual amounts were used in 8.2 episodes, sugar salt solution (SSS) in 14.7% of cases, oral

rehydration salt solution (ORS) in 7.9% of cases and either of these in 29.4% of cases.

The amount of ORS administered to children was inadequate at all ages, with majority

consuming only spoonfuls or sips.

Kaur P and Singh G (1994) [41] conducted a study to determine the food and

fluid practices during diarrhea among 2,160 children under five in rural area of Varanasi.

Most of the families 82% obtained water from wells. There were 2198 diarrhea episodes.

The prevalence of diarrhea was 72.2%. Families who kept their water covered had lower

23
prevalence of diarrhea than those who did not cover their water (84% vs 49.4%). Families

who washed with ash had a lower prevalence of diarrhea than those who washed them

mud or both 60.07% vs. 80.02% and 68.1% respectively. Families who washed their

hands with soap before meals suffered diarrhea less often those who did not 59% vs 73%.

Anand K, et al. (1992) [18] conducted a study on knowledge and practices

regarding diarrhea in rural mothers of Haryana. The findings revealed that diarrheal

incidence stood at 2.88 episodes/child/year. Just 24.1% defined diarrhea accurately (i.e.

WHO definition = 3 loose stools per day). Only 40% defined diarrhea to b e more than 6

stools/day). Only 29.7% knew about sugar salt solution or commercial ORS only 9.7%

could correctly prepare it and 38% gave weak tea or curd. 81.4% continued to feed a

child during a diarrheal episode. Breastfeeding was continued. 64% did not know the

dangerous signs of (duration of at least 3 days, at least 6 stools per day, blood in stools,

and lethargy), indicating a need to seek medical care. The most reported danger signs

were duration of at least 3 days (17% and at least 6 stools per day (14%). These findings

showed limited knowledge about diarrhea and diarrhea management.

Reddiah VP and Kapoor SK. (1991) [42] conducted a study in New Delhi, among

children under the age of 4 years for a period of one year by domiciliary visits revealed

more than 2/3 gave mainly home made ORS. 69.9% restricted food intake during attack.

Family with more than one child had more attacks. All the age groups were similarly

affected. 42.2% were shown to R.M.P.s. and 33% consulted friends or relatives.

24
Mahendraker. A.G, et al. (1991) [43] conducted a study on medico social profile

of underfive children suffering from diarrheal diseases in Pune. Diarrheal illness was

more common in low socioeconomic status than upper classes (65.81% for social class III

and 22.37% for social class IV vs 3.94-7.88 for social class I-II. The incidence of

diarrhea was inversely proportional to maternal literacy status (42.1% for illiteracy,

32.89% for primary school, 10.53% for middle school, 9.21% for secondary school, and

5.27% for higher education). A family size of more than 4 was associated with higher

incidence of diarrhea and more common in overcrowded households than in non-crowded

households. 73.68% vs 26.32%). Children younger than 24 months who were exclusively

breastfed made up a smaller proportion of diarrhea cases than their counterparts who

were not exclusively breastfed. 50% of the mothers did not know about ORT. Of the

mothers who did know about it, only 26.32% were using it.

Chowdhury, et al. (1991) [44] conducted a field trial in Bangladesh, although the

mothers agreed that rice based solutions stopped diarrhea more quickly, they used sugar-

based solutions twice as often in 40% of severe watery episodes as the rice-based

solutions in 18% because rice ORT was time consuming and difficult to prepare.

Mishra CP, et al. (1990) [45] conducted a study in urban Mirzapur among 350-

410 underfive children were selected from 200 urban families of 3 slums revealed that

prevalence of diarrhea varied between 8.7% to 33%. Breastfeeding was not restricted

while other forms of feeding was continued in 57.1% to 66.3% of cases. Use of ORT

increased from 0% to 39.62% possibly as a result of health education.

25
Huffman SL, et al. (1990) [46] conducted a case control study in Brazil has shown

that young infants who are not breast fed have a 25 time greater risk of dying of diarrhea

than those who are exclusively breastfed. A longitudinal study in urban slums of Lima,

Peru found that exclusively breastfed infants have a reduced risk of diarrheal morbidity

when compared with infants receiving only water in addition to breast milk.

Breastfeeding helps maintain hydration status during diarrheal episodes.

Kothari G (1987) [47] conducted a study on Diarrhea in urban slums Bombay,

revealed that almost half of them had diarrhea. Yet nearly half of the population live in

the slums characterized by unhygienic living conditions, overcrowding, poor housing,

and lack of basic amenities. People living in slums are more vulnerable to communicable

diseases and malnutrition. Children under age 3 suffer from diarrhea and dysentery. It

was a common practice to withhold breast milk and food during diarrhea to give

unsuitable remedies. The incidence of diarrhea is greatest at the time of weaning. The

infants were bottle-fed with formula milk. Most of the families did not use ORT for

diarrhea. Nearly 50% believed it was due to ignorance about hygiene, 18% gave reasons

such as artificial milk or teething, and 34% had no idea about etiology. For correct

diarrhea treatment, drugs and ORT were favored by 63, drugs alone by 29, and ORT

alone by 5. When asked about ORT, 55 said that they would use oral rehydration salts

(ORS), and 13 stated that they would use sugar salt solution.

26
According to report in Mazingira (1984) [10], a study has proved that rice water

to be effective treatment by investigators at International Center for Diarrheal Disease

Research, Bangladesh (ICDDR, B), who have shown that cereal based solutions are even

more effective than the much publicized mixtures of water, sugar, and salts. Tests have

shown that 80-86% of the rice powder is converted to glucose and absorbed. Dr. A. Majid

Molla (ICDDR, B) who pioneered the use of powder in ORT, 1 liter of rice powder

solution is twice as effective as 2 liters of sugar salt solution.

27
4. METHODOLOGY

This chapter deals with the description of the methodology selected for this

study. It includes description of the research approach, research design, setting, sample

and sampling technique, development of the tool, description of the tool, validity, pilot

study, data collection and plan for analysis.

Research Approach

A descriptive survey was considered to be the most appropriate research

approach for this study. In view of the nature of the problem and the objectives to be

achieved, an epidemiological approach was used for assessing and comparing the

knowledge of the mothers in the selected areas regarding home management of diarrhea.

Research design

The research design selected for the present study was descriptive design to

assess the knowledge of mothers regarding home management of diarrhea. A purposive

random sampling technique was used to select 100 mothers comprising of 50 from rural

and 50 from urban slum area.

Attribute variable

Age, educational qualification, occupation, number of underfive children,

family size, religion, family income per month, gender of the child, exposure to media,

and residential area.

28
Setting of the study

The study was conducted in Hassarghatta rural area and Dasarahalli urban slum,

covered by Hasserghatta-Primary Health Center, Bangalore. Hassarghatta-PHC has a

total underfive population of 23,831.

Population

The accessible population for the study was mothers having children underfive

years of age in Hassarghatta rural and Dasarahalli urban slum of Bangalore, Karnataka.

Sample and Sampling Technique

A purposive random sampling technique was used to select the sample. A 100

sample of mothers having children under the age of five years were selected; 50 from

rural and 50 from urban slum.

Criteria for selection of sample

Inclusion criteria:

The mothers having under-five children.

The mothers residing in Hasserghatta rural area and Dasarahalli urban slum of

Hassarghatta-PHC, Bangalore.

The mothers who give consent for the study.

29
Exclusion criteria

Mothers who were not having underfive children.

Mothers who were not present during the data collection.

Mothers who had not given consent for the study.

Selection of the tool

A structured interview schedule was used where the investigator asked questions

orally to the participants in a face-to-face meeting. It is considered as the most

appropriate instrument to elicit the responses from illiterate mothers and from those who

needed additional clarification regarding questions related to diarrheal aspects.

Development of the tool

Based on the theoretical framework of the study, a structured interview schedule

was developed to assess the knowledge of mothers regarding home management of

diarrhea.

The following steps were carried out in preparing the tool:

a. Literature review.

b. Preparation of blue print.

c. Consultation of experts in the field.

30
Preparation of blue prints

A blue print consisting of items pertaining to the knowledge of mothers regarding

home management of diarrhea was prepared. There were 29 items on the knowledge

regarding various aspects of diarrhea.

Description of the tool

A structured interview schedule comprised of four parts:

Part-A: Demographic data consisting of 15 items seeking information about the

background data such as age, gender, educational status, occupation, family income, type

of family, number under five children, family size, religion, and residential area.

Part B: Consists of 8 items on knowledge on meaning, etiology, signs and symptoms,

and complications.

Part C: Consists of 14 items on use of oral fluids and oral foods during diarrhea.

Part D: Consists of 9 items on prevention and control measures. It consisted of a total of

29 objective type items with choosing the most appropriate responses for each item. Each

item had one or more correct answers all of which were scored. Each correct answer was

given a score of one and wrong answer zero. The total score was 80.

Validity of the tool

Eleven experts comprising nurse, educators and one doctor established the

validity of the tool. After the expert suggestion, the tool was modified and the final tool

consisted of:

Background data 15 items

31
Knowledge 29 items

Persons proficient in Kannada computed the validity of the tool.

Pre-testing

Pre-testing of the structured interview schedule was done to check clarity of the

item, ambiguity of the language, and feasibility of the tool. The tool was administered to

12 samples residing outside the project area of Hassarghatta. The tool was found feasible,

items were clear and language was found unambiguous. It took about 35-40 minutes to

interview each mother.

Reliability

Reliability of the tool was established by using split half technique. The reliability

coefficient of the test for the knowledge scale was found to be rII = 0.9235 and validity

coefficient as 0.9610. Since the knowledge reliability coefficient for scale rII>0.70 tool

was found to be reliable.

Development of criteria checklist

A criteria checklist was prepared for the assessment of knowledge of mothers

regarding diarrhea. It was based on the literature review and opinion of experts. The

checklist consisted of criterion statements under the broad headings of content, items

relevant/relevant to some extent/not relevant and suggestion and remarks.

32
Content validity

The tool was given to the experts along with criteria checklist. The experts were

requested to validate the content of the tool and asked to indicate suitable suggestion.

There was 70 percent agreement on meets of the criteria and 30 percent on partial meets

on the criteria. These suggestions were accepted and this ensured the clarity and validity

of the tool.

Procedure for data collection

Data was collected from 19th September, 2005 to 15th October, 2005.

Data analysis plan

The data obtained were analyzed based on the set of objectives of the study using

descriptive and inferential statistics. The plan for data analysis was as follows:

Organize the data in a master sheet.

Frequencies and percentage for the analysis of the background data. Further,

students t-test was employed to compare the significant difference in the mean

knowledge score between rural and urban areas. Analysis of variance technique is

used (F-test) to know the impact of demographic characteristics on the knowledge

of mothers on management of diarrheal diseases.

Pilot study

A pilot study was conducted during the month of 17th to 27th August 2005 at

Hassarghatta rural and Dasarahalli urban slum area of Bangalore, Karnataka. The purpose

33
of the study was (1) to assess the knowledge of mothers of underfive children regarding

home management of diarrhea (2) to plan for data analysis and (3) to find out the

feasibility of conducting the research study.

Twelve mothers who were having children underfive years of age were selected

from two selected areas, six from each area. The overall mean knowledge score was

36.28% with a SD of 13.8. The mean knowledge score of mothers of urban slums

(47.53%) was found to be higher than rural area (25.03%) on establishing statistical

significant results. Hence, the study was found to be feasible.

34
5. RESULTS

This chapter deals with the analysis and interpretation of the data collected on

knowledge of mothers of underfive children regarding home management of diarrheal

diseases from urban slum and rural area of Bangalore. A structured interview schedule

was used for data collection and analysis was done using descriptive and inferential

statistics.

The objectives of the study were

1. To assess the knowledge of mothers of underfive children regarding home

management of diarrhea.

2. To compare the knowledge of mothers of underfive children between rural and

urban slum areas.

3. To associate the knowledge of mothers of underfive children regarding home

management of diarrhea with selected demographic variables.

4. To develop a health information material based on study findings.

Hypotheses

The following hypotheses were formulated based on the objectives of the study.

H0 (1): There is less knowledge among mothers of underfive children regarding home

management of diarrhea.

35
H0 (2): There is no difference in the knowledge among rural and urban mothers regarding

home management of diarrhea.

H0 (3): There is no impact of demographic variables on knowledge of mother regarding

home management of diarrhea.

Presentation of the data

The data collected were coded and entered in a master sheet for tabulation and

statistical processing. The analysis of data is categorized and organized in the following

heading:

Sample characteristics.

Knowledge of mothers of underfive children regarding home management of

diarrheal diseases.

Comparison of knowledge of mothers of underfive children between rural and

urban slum area.

Association between the knowledge of mothers regarding home management

of diarrhea with selected variables.

Analysis of sample description

The sample characteristics are described in terms of residential area, age,

educational qualification, occupation, type of the family, number of underfive children,

size of the family, family income and religion.

36
TABLE 1

Personal characteristics of Respondents

Respondents
Characteristics Category
Number Percent
Urban 50 50.0
Area
Rural 50 50.0
17-20 years 29 29.0
Age group 21-24 years 50 50.0
25-29 years 21 21.0
Illiterate 52 52.0
Primary 7 7.0
Education Middle 11 11.0
High school 25 25.0
PUC 5 5.0
Laborer 14 14.0
Occupation
Housewife 86 86.0
Total 100 100

Table-1 identifies the data of mothers by residential area, age, education and

occupation. 50% of them belonged to urban slum and 50% belonged to rural area. A

majority 50% belonged to the age group of 21-24 years. A majority of them 52% was

illiterate, rest 48% were literates out of whom 25% educated up to high school, 11%

educated up to middle school, 5% up to PUC, and 7% up to primary school. A majority

of them 86% were housewives and only 14% were laborers (Figure-1).

TABLE 2

Family related characteristics of Respondents

Respondents
Characteristics Category
Number Percent
Hindu 97 97.0
Religion
Muslim 3 3.0
Nuclear 49 49.0
Type of Family Joint 39 39.0
Extended 12 12.0

37
< Rs. 1500 53 53.0
Family Income/m Rs. 1500-2500 34 34.0
> Rs. 2500 13 13.0
22.0
Three 22
20.0
Family Size Four 20
18.0
(members) Five 18
40.0
Five& above 40
Total 100 100

Table-2 shows family related characteristics of mothers. Majority were Hindus

(97%), and only a negligible percentage (3%) was Muslims. Nearly half of the mothers

(49%) of them belonged to nuclear family, followed by joint family (39%), and extended

family (12%). More than half of the mothers (53%) had a family income of less than

Rs.1500. Only 13% had income more than Rs. 2500 per month. A majority (40%)

belonged to a family size of five and above followed by a family size of three (22%).

TABLE 3

Child related characteristics of Respondents

N=100
Respondents
Characteristics Category
Number Percent
< 1 year 36 24.7
1 year 28 19.2
2 years 30 20.5
Age of the Child (n=146)
3 years 27 18.5
4 years 19 13.0
5 years 6 4.1
Male 75 51.4
Sex of the Child (n=146)
Female 71 48.6
First 74 74.0
Birth order of the Child
Second 51 51.0
(n=146)
Third 21 21.0
One 56 56.0
Number of under 5 children in
Two 41 41.0
the Family
Three+ 3 3.0

38
Fig 1

39
Table-3 shows data on underfive children by age, sex, order of birth, and number

of under five children in the family. A majority 24.7% belonged to less than 1 year of age

followed by 20.5% of 2 years, 19.2% of 1 year, and, 18.5% of 3 years, 13% of 4 years

and only 4.1% of 5 years of age. A majority of them (51.4%) were male children and the

rest (48.6%) were females. A majority 74% was first child, 51% second child, and 21%

third child. A majority of the families (56.3%) had one underfive child, 41% had two

underfive children and 3% had three+ underfive children in the family.

TABLE 4

Diarrheal episodes and Media of Exposure on management of diarrhea at home.

N=100
Respondents
Aspects Category
Number Percent
No 28 28.0
0 1 year 39 39.0
Diarrheal episodes in past 3
1-2 years 20 20.0
months
2-3 years 8 8.0
3-5 years 5 5.0
Media of Exposure @
Television 19 19.0
Relatives/Friends 5 5.0
Medical personals 26 26.0
No response 61 61.0
Yes 20 20.0
Previous use of ORS
No 80 80.0
@ Multiple Response

Table-4 shows data regarding diarrheal episodes and exposure to media regarding

diarrheal management. Regarding occurrences of diarrheal episodes when asked to

mothers by recall method it was found that the number of episodes in the past 3 months

was highest in the age group of 0 to 1 year (39 episodes) followed by 20 episodes in the

40
age group of 1 to 2 years and the least between 3 to 5 years (5 episodes). These findings

indicate that the number of episodes decreases as the age increases.

A majority of them 61% were not exposed to any media regarding diarrhea, 26%

were exposed to medical personnels, 19% to television, and only 5% received

information from friends/relatives. Only 20% used ORS at home for treating diarrhea in

the past. These findings emphasize on the need for health education using mass media.

Analysis on knowledge of mothers regarding home management of diarrhea of total

population

TABLE - 5

Aspect wise Knowledge on Home management of Diarrheal diseases among mothers

Knowledge Score
Stateme Max.
Mean
Knowledge Aspects nts Score SD
Mean (%)
(%)

Meaning, Etiology, Manifestations


8 27 7.11 26.33 16.4
and complications
Home management using oral fluids
14 39 9.48 24.31 14.1
and foods
Control measures and prevention of
7 14 4.50 32.12 23.7
Diarrhea
Over all 29 80 21.26 26.58 12.0

Table 5 shows data on knowledge aspects of home management of diarrhea. It

reveals that the mean knowledge score of mothers on meaning etiology and

41
Fig 2 knowledge

42
manifestations of diarrhea was 26.33%, home management using oral fluids and oral

foods was 24.31%, control measures and prevention of diarrhea 32.12%. The overall

mean percentage of the knowledge aspect regarding diarrheal management was 26.58%

with a SD of 12% (Figure-2). These findings reveal that there is less knowledge among

mothers of underfive children regarding home management of diarrhea. Thus, null

hypotheses H0(1) is accepted.

TABLE 6

Statement wise over all assessment of Knowledge on meaning, etiology and

manifestations, and complications.

N=100
Statements Knowledge (%)
Max
No Score
Mean SD
Meaning of Diarrhea
1 1 57.0 50.0
The causes for Diarrhea
2 1 7.0 3.0
Main reason for developing diarrhea
3 4 21.3 25.7
Diarrheal transmission
4 4 28.0 26.2
Causes of food contamination
5 4 32.5 29.8
The dangerous signs of diarrhea
6 9 30.0 22.5
Meaning of dehydration
7 1 30.0 20.0
Complications of Diarrhea
8 3 21.3 27.8

From Table 6 and Annexure-A, it is clear that mothers had a highest overall mean

knowledge score regarding meaning of diarrhea 57% (passage of three or more loose

watery stools per day), followed by causes of food contamination 32.5% (open kept foods

43
30%, Dirty fingers 47%, unclean nipples 20%, flies 33%), followed by meaning of

dehydration 30% (loss of water and salts).

The overall mean score on dangerous signs of diarrhea was 30% (at least 8 watery

stools per day 39%, dehydration 16%, fever 19%, dry and sunken eyes 42%, loose skin

21%, frequent vomiting 40%, noisy breathing 11%, sunken fontenelle 24%, lethargy

58%).

The overall mean knowledge score on diarrhea transmission was 28%

(contaminated water 24%, contaminated food 63%, poor environmental sanitation 12%,

poor personal hygiene 13%). Regarding the reasons for developing diarrhea the mean

score was 21.3% (bottle feeding 26%, water storage in a wide mouth container 8%,

indiscriminate disposal of children stools 18%, non use of soap for washing feeding

containers 33%).

The mean score for complications of diarrhea was 21.3% (shock and death 22%,

malnutrition 27%, and anemia 12%). However, mothers had a poor knowledge regarding

the exact etiology of diarrhea i.e. microorganisms 7%.

TABLE 7

Statement wise over all assessment of Knowledge on Home management using

oral fluids and foods

44
N=100
Statements Max Knowledge (%)
No Score
Mean SD
9 Initial management of Diarrhea at home 3 20.3 28.8

10 Increasing Oral fluid intake during diarrhea 1 19.0 4.0

11 Advantages of using Oral rehydration solution 3 26.3 30.4

12 Method of preparation of Oral rehydration 1 11.0 3.0


salt solution

13 Frequency of giving Oral rehydration salt 3 7.3 1.1


solution
14 Usage of Oral rehydration solution within 24 1 8.0 1.3
hours.

15 Precautions to be taken while using Oral 2 1.5 0.7


rehydration solution
16 Availability of Oral rehydration salt packets 3 50.7 35.9

17 Home available Fluids that can be given 7 21.9 15.0


during diarrhea
18 Increasing of breast feeding during diarrhea 1 23.0 4.0

19 Increase of Oral food intake during and after 1 5.5 1.2


diarrheal episodes
20 Home based foods that can be given during 5 26.6 17.5
diarrhea
21 Fruits that have been given during diarrhea 4 23.3 21.1

22 Home based foods to be avoided during 4 54.3 45.4


diarrhea

Table 7 and Annexure-B describes the knowledge of mothers regarding use of oral

fluids and foods during and after diarrhea.

Regarding the initial management of diarrhea at home the overall mean

knowledge score of mothers was 23.3% (use of home available fluids 39%, ORS 15%,

45
and SSS 7%). However, 36% of mothers mentioned of giving only drugs and 34%

mentioned consulting a physician immediately during diarrheal episodes. This indicates

limited knowledge of mothers regarding early initiation of home management using

fluids.

Regarding the use of home based foods; mothers had the highest overall mean

knowledge score on foods to be avoided during diarrhea 54.3%, while the knowledge on

the foods to be given during diarrhea was only 26.6% (well cooked vegetables 15%,

bread/biscuits 32%, steamed foods/bland diet 40%, double boiled rice gruel/kanji 20%,

other foods 26%). Regarding fruits the means score was 23.3% (apple 50%, pineapple

9%, Banana 25%, Mangoes 9%). The mean knowledge score on giving usual amounts

was 24% while on increasing the quantity of food during and after diarrhea was very

negligible 5%. However, a majority of them 71% mentioned about restriction of solid

foods during diarrheal episodes indicating a limited knowledge regarding use of home-

based foods.

Regarding ORS, mothers overall mean knowledge score on availability of ORS

packets was 50.7% which was higher than advantages of using ORS (26.3%), method of

preparation of ORS 11%, usage of ORS within 24 hours (8%), the correct frequency of

giving ORS (7.3%), and precautions to be followed while preparing ORS was only 1.0%

which was very poor.

46
Regarding knowledge on various home available fluids that can be given during

diarrhea the mean knowledge score was 21.9% (curds 24%, rice water with salt 17%,

tender coconut water 53%, tea 12%, vegetable soups 5%, boiled cooled water 23%, other

fluids 19%).

Regarding increasing the quantity of oral fluids during diarrhea was found to be

only 19%, usual amounts 27%. However, a few mothers (46%) mentioned about

restriction of fluid during diarrhea and 3% stopping oral fluids completely.

Regarding breastfeeding the score on increasing the frequency of breastfeeding

23% and usual amounts 60%. However, a few mothers mentioned about decreasing the

frequency of breastfeeding 9% and discontinuing the feeding 8%.

TABLE 8

Statement wise over all assessment of knowledge on control measures and prevention of

Diarrhea

N=100
Statements Knowledge (%)
Max
No Score
Mean SD
Child requires medical aid when there is
23 3 34.7 24.1
Occurrence of diarrhea can be prevented
24 4 32.5 28.3
Water used for drinking at home
25 1 26.0 4.0
Clean water type
26 1 23.0 4.0
Frequency of hand washing with soap and water
27 2 25.0 41.7

47
Method of cleaning of infants feeding utensils at
28 1 64.0 5.0
home
Measures used to prevent feco oral contamination
29 2 27.0 29.7

Table-8 and Annexure-C shows data regarding the knowledge of mothers regarding

control and prevention of diarrhea.

The overall mean knowledge score of mothers regarding boiling of infants

feeding utensils was found to be higher 64%, followed by the mean score on when the

child requires medical aid 34.7% (presence of several loose stools within 1 or 2 hours

with or without blood and mucus 10%, diarrhea lasting more than 3 days 72%, and

failure of home treatment 22%). However, 23% did not know when to seek medical aid

during diarrhea.

Regarding prevention of occurrences of diarrhea the mean knowledge score was

32.5% (keeping foods covered 24%, exclusive breastfeeding 36%, Good weaning

practices 42%, and hand washing with soap and water 28%).

Regarding prevention of feco-oral contamination the overall mean knowledge

score was 27% (use of sanitary latrines 49%, covering human excreta with saw dust or

mud 5%).

The mean knowledge score on usage of boiled drinking water 26% and knowledge about

use of clean water was 23%.

48
Regarding adequate hand washing with soap and water the mean score was 25%.

Knowledge on washing hands with soap and water after defecation or cleaning the baby

28% and before preparing/eating food/feeding the child 22%).

Analysis on comparison of knowledge of mothers regarding home management of

diarrhea between urban an rural area

TABLE-9

Residence wise knowledge on home management of diarrheal diseases among mothers


(rural, urban)
Knowledge Score (%)
Knowledge Aspects Rural (n=50) Urban (n=50)
t-
Mean SD Mean SD Test
Meaning, Etiology and Manifestations
36.16 15.2 16.50 10.7 7.48 *
Home management using oral fluids
34.46 10.8 14.16 8.5 10.44 *
and foods
Control measures and prevention of
51.17 17.6 13.07 9.3 13.53 *
Diarrhea
Over all
38.33 11.0 14.82 7.1 12.70 *
* significant at 5 % Level

Table-9 shows the mean percentage of knowledge score in accordance with the

residential area.

In rural area the mean knowledge score on mothers meaning, etiology,

manifestations, and complications was 36.16% which was much higher than urban area

of 16.50%, the mean knowledge score on home management using oral fluids and foods

in rural was higher 34.46% and lower in urban area which was 14.16% (Figure-3). The

mean knowledge score of mothers on control measures and prevention was higher in

49
Fig -3

50
rural 51.17% and lower in urban area 13.07%. The overall mean knowledge score of

mothers in rural area was 38.33%, which was higher than urban area of 14.82% with a

mean SD of 7.1. However, the data subjected to statistical test indicates the mean

knowledge score between the rural and urban area were found to be significant at 5%

level (t=12.70). Hence, the null hypotheses H0 (2) i.e. there is no difference in the

knowledge among rural and urban mothers regarding home management of diarrhea is

rejected.

TABLE 10

Statement wise over all assessment of knowledge on etiology and manifestations among

mothers (rural, urban)

Knowledge (%)
t-
No Statement Rural Urban
Test
Mean SD Mean SD
Meaning of Diarrhea
1 82.0 40.0 32.0 50.0 5.52 *
The causes for Diarrhea are
2 8.0 3.0 6.0 2.0 3.92 *
Main reason for developing diarrhea
3 30.0 27.7 12.5 20.4 3.60 *
Diarrhea is transmitted through
4 34.0 26.1 22.0 25.1 2.34 *
Causes of food contamination
5 42.0 30.1 23.0 26.6 3.34 *
The dangerous signs of diarrhea
6 42.0 22.0 18.0 15.5 6.31 *
Loss during dehydration (loss of salt
7 and water) 6.0 2.0 1.0 0.8 16.41 *

Complications of Diarrhea are


8 37.3 29.8 5.3 12.3 7.02 *
Significant at 5 % Level

51
Table-10 and Annexure-A shows data regarding overall assessment of knowledge on

meaning, etiology, manifestation, and complications between urban and rural mothers.

The mean knowledge score of mothers regarding meaning of diarrhea in rural area

was 82%, which was much higher than urban area, which was only 32%.

The mean knowledge score of mothers regarding the exact cause of diarrhea

(microorganisms) in rural area was 8%, which was slightly higher than urban area, which

was very poor 6%.

The mean knowledge score of mothers regarding reasons for developing diarrhea

in rural area was 30% (bottle feeding 36%, water storage in a wide mouth container 10%,

indiscriminate disposal of children stools 26%, non use of soap for washing feeding

containers 48%), which was higher than urban area of only 12.5% (bottle feeding 16%,

water storage in a wide mouth container 6%, indiscriminate disposal of children stools

10%, non use of soap for washing feeding containers 18%).

The mean knowledge score of mothers regarding transmission of diarrhea in rural

area was 34% (contaminated water 26%, contaminated food 80%, poor environmental

sanitation 14%, poor personal hygiene 16%), which was much higher than urban area of

22% (contaminated water 22%, contaminated food 46%, poor environmental sanitation

52
10%, poor personal hygiene 10%). However, the knowledge scores on environmental

sanitation and personal hygiene were poor in both the groups.

The mean knowledge score of mothers regarding causes of food contamination in

rural area was 42% (open kept foods 38%, dirty fingers 54%, unclean nipples 30%, flies

46%), which was much higher than urban area of only 23% (open kept foods 22%, dirty

fingers 40%, unclean nipples 10%, flies 26%).

The mean knowledge score of mothers regarding dangerous signs of diarrhea in

rural area was 42% (at least 8 watery stools per day 48%, dehydration 22%, fever 34%,

dry and sunken eyes 54%, loose skin 36%, frequent vomiting 56%, noisy breathing 20%,

sunken fontenelle 38 %, lethargy 70%), which was much higher than urban area of 18%

(at least 8 watery stools per day 30%, dehydration 10%, fever 4%, dry and sunken eyes

30%, loose skin 6%, frequent vomiting 24%, noisy breathing 2%, sunken fontenelle 10%,

lethargy 46%).

The mean knowledge score of mothers regarding meaning of dehydration (loss of

water and salt) in rural area was 6%, while none of the mothers in urban area could

mention it (0%).

The mean knowledge score of mothers regarding complications of diarrhea in

rural area was 37.3% (shock and death 44%, malnutrition 44%, anemia 18%), which was

much higher than urban area of 5.3% (shock and death 0%, malnutrition 10%, anemia

53
6%). These findings indicate that urban mothers had very limited knowledge regarding

the complications of diarrhea.

On the whole regarding meaning, etiology, manifestation, and complications, the

knowledge of mothers in rural area was found to be higher than urban area. The data

subjected to statistical tests indicate the mean knowledge score of the mothers was found

to be significant at 5% level.

TABLE 11

Statement wise overall assessment of knowledge on home management using oral fluids
and foods among mothers (rural, urban)
No Statement Knowledge (%)
t-
Rural Urban
Test
Mean SD Mean SD
9 Initial management of Diarrhea at
26.7 31.6 14.0 24.4 2.25 *
home
10 Increased oral fluid intake during
diarrhea 28.0 5.0 10.0 3.0 21.83 *

11 Advantages of using Oral


36.7 33.8 16.0 22.6 3.60 *
rehydration solution
12 Method of oral rehydration salt
20.0 4.0 2.0 1.0 30.87 *
solution is prepared
13 Frequency of giving Oral
12.0 22.1 2.7 1.1 2.97 *
rehydration salt solution
14 Oral rehydration solution should be
14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using
12.0 9.9 1.0 0.2 7.86 *
Oral rehydration solution
16 Oral rehydration salt packets are
70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be
25.4 15.4 18.3 13.9 2.42 *
given during diarrhea
18 Increase of breast feeding during
diarrhea 30.0 5.0 16.0 4.0 15.46 *

19 Increase of oral food intake during


10.0 3.0 1.0 0.2 21.17 *
and after diarrheal episodes
20 Home based foods that can be given 33.2 19.6 20.0 12.1 4.05 *

54
during diarrhea
21 Fruits that have been given during
29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during
97.0 12.0 11.5 16.9 29.17 *
diarrhea
* Significant at 5 % Level

Table 11 and Annexure- B describes the knowledge of mothers regarding use of oral

fluids and foods during and after diarrhea in the urban and rural area.

Regarding the mean score on initial management of diarrhea at home in rural area

was 26.7%, (using home available fluids 48%, ORS 20%, and SSS 12%, which was

higher than urban area of 14% (using home available fluids 30%, ORS 10%, and SSS

2%).

Regarding the use of home based foods during diarrhea, the knowledge scores of

mothers both in rural area and urban area are home based foods to be avoided 97.0% and

11.5%, foods that can be given during diarrhea 33.2% and 20%, increasing oral food

intake during diarrhea 10% and 1%, fruits 29% and 17.5% respectively. It is clear from

this data that rural mothers had more knowledge than urban mothers.

Regarding ORS, mothers mean knowledge scores in rural and urban areas are

availability of ORS packets 70.7% and 30.7%, advantages of using ORS 36.7% and 16%,

method of preparation of ORS 20% and 2%, usage of ORS within 24 hours 14%, and 2%,

frequency of giving ORS 12% and 2.7%, and precautions to be followed while preparing

55
ORS was 12% and 1% respectively. On the whole the knowledge of rural mothers was

found to be higher than urban mothers.

Regarding intake of oral fluids during diarrhea at home the mean knowledge score

on home available fluids in rural area was 25.4% (curds 34%, rice water with salt 4%,

tender coconut water 80%, tea 4%, vegetable soups 8%, boiled cooled water 36%, other

fluids 12%) which was higher than urban area 18.3% (curds 14%, rice water with salt

30%, tender coconut water 26%, tea 20%, vegetable soups 2%, boiled cooled water 10%,

other fluids 26%). Regarding increasing the quantity of oral fluids during diarrhea rural

10% and urban was 1% respectively. These findings reflect inadequate knowledge on use

of home available fluids.

Regarding breastfeeding mothers knowledge on increasing the frequency of

breastfeeding in rural was 30% and in urban was 16%.

On the whole, regarding knowledge of mothers about the intake of oral fluids and

foods during diarrhea in rural area was found to be higher than urban slum area. The data

subjected to statistical tests indicate the mean knowledge score of the mothers was found

to be significant at 5% level. However, the knowledge level was found to be less in both

the areas.

56
TABLE 12

Statement wise over all assessment of knowledge on control measures and prevention of

diarrhea among mothers (rural, urban)

No Statement Knowledge (%)


t-
Rural Urban
Test
Mean SD Mean SD
23 Child requires medical aid when
43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be
50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home
50.0 5.0 2.0 1.0 66.56 *
26 Clean water type
40.0 5.0 6.0 2.0 44.64 *
27 Frequency of hand washing with
48.0 47.3 2.0 1.4 6.87 *
soap and water is done
28 Cleaning of infants feeding utensils
94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral
52.0 20.1 2.0 0.9 17.57 *
contamination
* Significant at 5 % Level

Table 12 and Annexure-C shows the data regarding the knowledge scores of

mothers regarding control and prevention of diarrhea among urban and rural areas

The mean knowledge score of mothers regarding boiling of infants feeding utensils was

found to be higher in rural 94% than urban 34%.

Regarding knowledge prevention of feco-oral contamination the mean score in

rural area was 52% (covering human excreta with mud 10% and use of sanitary latrines

94%), which was low in urban area 2%(covering human excreta with mud 0% and use of

sanitary latrines 2%).

57
Regarding prevention of occurrences of diarrhea the mean knowledge score in

rural area was 50.5% (keeping the foods covered 44%, exclusive breastfeeding 48%,

good weaning practices 58%, hand washing with soap and water 52%), which higher than

urban slum 14.5% (keeping the foods covered 4%, exclusive breastfeeding 24%, good

weaning practices 26%, hand washing with soap and water 4%).

Regarding usage of boiled cooled water for drinking at home the mean score in

rural area was 50% and urban 2%. Knowledge about adequate hand washing with soap

and water rural 48% and urban 2%, and knowledge about use of clean water rural 40%

and urban 6%.

Regarding knowledge on when to seek medical aid the mean score of rural

mothers was 43.3% and urban 26.0%.

On the whole, regarding knowledge of mothers about control and prevention of

diarrhea in rural mothers was found to be much higher than urban mothers. The data

subjected to statistical tests indicate the mean knowledge score of the mothers was found

to be significant at 5% level.

Association of knowledge of mothers of underfive children regarding home

management of diarrhea based on baseline data.

58
TABLE 13

Impact of residence on knowledge of home management of diarrheal diseases (rural,


urban)
Knowledge Score (%)
Sample F
Residence Mean (%)
(n) Mean SD (%) Value
Rural
50 30.66 38.33 11.0
Urban 160.16 *
50 11.86 14.82 7.1
Combined
100 21.26 26.58 15.0
NS : Non-Significant. * Significant at 5 % Level

Table-13 shows the mean knowledge score in accordance with the residential

area. In rural it was 38.33%, which was higher than urban area, which was 14.82%

(figure-4). The overall mean knowledge score of both urban slum and rural area was

26.58% with mean SD of 15.0% The data subjected to statistical test indicate the mean

knowledge score according to residence wise was found to be significant at 5% level

(F =160.16).

TABLE 14

Impact of age on knowledge of home management of diarrheal diseases among mothers


Knowledge Score (%)
Age group Sample F
Mean (%)
(n) Mean SD (%) Value
17 20 years
29 14.89 18.61 13.1
7.30 *
21 24 years
50 22.76 28.45 14.8

59
25-29 years
21 26.50 33.12 13.89
Combined
100 21.26 26.58 15.0
* Significant at 5 % Level

fig-4

60
Fig-5

61
Fig-6

62
Fig-7

63
Fig-8

64
Table-14 shows mean knowledge score of mothers belonging to the age group of 25 and

above had a slightly high score 33.12% followed by mothers belonging to the age group

of 21-24 years of 28.45% and the least scores between the age group of 17-20 years of

18.61% (Figure-4). The data subjected to statistical test indicate the mean knowledge

score according to age wise was found to be significant at 5% level (F =7.30).

TABLE 15

Impact of education on knowledge of home management of diarrheal diseases among


mothers
Knowledge Score (%)
Education Sample F
Mean (%)
(n) Mean SD (%) Value
Illiterate
52 12.45 16.56 8.7
Primary/Secondary
18 26.80 33.50 13.5
50.07 *
High school/PUC
30 31.82 39.78 11.7
Combined
100 21.26 26.58 15.0
Significant at 5 % Level

Table 15 shows the mean knowledge score of mothers educated up to high school/PUC

had a higher score of 39.78% followed by mothers educated up to primary/secondary

33.50%, and illiterates had the lowest score of 16.56% (Figure-5). The data subjected to

65
statistical test indicate the mean knowledge score according to education was found to be

significant at 5% level (F =50.07). Thus, null hypotheses H0 (3) i.e. there is no impact of

demographic variables on knowledge of mothers regarding home management of

diarrhea is rejected.

TABLE 16

Impact of occupation on knowledge of home management of diarrheal diseases among


mothers
Occupation Knowledge Score (%)
Sample F
(n) Mean Mean (%) SD (%) Value

Labourer 14 12.73 15.91 7.1


8.88 *
House wife 86 22.65 28.31 15.2

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level

Table-16 shows the mean knowledge scores of housewives were found to be higher

(28.31%) than labourers (15.91%) (Figure-6). The data subjected to statistical test

indicate the mean knowledge score according to occupation of the mother was found to

be significant at 5% level (F =8.88). Thus, null hypotheses H0 (3) i.e. there is no impact

of demographic variables on knowledge of mothers regarding home management of

diarrhea is rejected.

TABLE 17

Impact of type of family on knowledge of home management of Diarrheal diseases


among mothers

66
Type of Knowledge Score (%)
Family Sample F
(n) Mean Mean (%) SD (%) Value

Nuclear 49 23.30 29.13 15.8


2.85 NS
Joint 51 19.30 24.12 13.9

Combined 100 21.26 26.58 15.0

NS : Non-Significant

Table 17 shows the mean knowledge score of mothers belonging to nuclear

family was found to be slightly higher (29.13%) compared to joint family (24.12%)

(Figure-6). The data subjected to statistical test indicates the mean knowledge score

according to the type of the family was found to be non significant at 5% level

(F =2.85)NS. Thus, null hypotheses H0 (3) i.e. there is no impact of demographic

variables on knowledge of mothers regarding home management of diarrhea is accepted.

TABLE 18

Impact of family income on knowledge of home management of Diarrheal diseases


among mothers

Family Income Knowledge Score (%)


Sample F
Mean (%)
(n) Mean SD (%) Value
< Rs. 1500
53 18.11 22.64 14.8
Rs. 1500-2500
34 23.46 29.32 14.5
5.04 *
> Rs.2500
13 28.34 35.43 12.4
Combined
100 21.26 26.58 15.0

67
* Significant at 5 % Level

Table 18 shows that the mean knowledge score of mothers having income more than Rs.

2500 per month had a slightly higher knowledge of 35.43% followed by mothers having

income between Rs. 1500-2500 per month of 29.32%, and the least knowledge 22.64%

by mothers having income of less than Rs. 1500 per month (Figure-8). The data subjected

to statistical test indicate the mean knowledge score according to monthly income of the

family was found to be significant at 5% level (F =5.04). Thus, null hypotheses H0 (3)

i.e. there is no impact of demographic variables on knowledge of mothers regarding

home management of diarrhea is rejected.

TABLE 19

Impact of number of underfive living children on knowledge of home management of

diarrheal diseases among mothers.

Living children Knowledge Score (%)


under 5 years
Sample F
Mean (%)
(n) Mean SD (%) Value
One
56 21.54 26.92 15.9
Two+ 0.07 NS
44 20.90 26.13 13.8
Combined
100 21.26 26.58 15.0
NS :Non-Significant

Table-19 shows the mean knowledge score of mothers having one underfive child

had a slightly higher 26.92 than with more than two underfive children of 26.13%. The

overall mean knowledge score was 26.58%. The data subjected to statistical test indicate

68
the mean knowledge score according to monthly income of the family was found to be

non significant at 5% level (F =0.07) NS.

TABLE 20

Impact of family size on knowledge of home management of diarrheal diseases among

mothers

Knowledge Score (%)


Family Size Sample F
Mean (%)
(n) Mean SD (%) Value
Three/Four
42 24.28 30.35 16.1
Five and above 4.77 *
58 19.07 23.84 13.6
Combined
100 21.26 26.58 15.0
* Significant at 5 % Level

Table-20 (Figure-7) shows the mean knowledge score of mothers belonging to a

family size of three/four was higher (30.35%) than mothers belonging to a family size of

five and above (23.84%). The data subjected to statistical test indicate the mean

knowledge score according to family size was found to be significant at 5% level.

(F =4.77). Thus, null hypotheses H0 (3) i.e. there is no impact of demographic variables

on knowledge of mothers regarding home management of diarrhea is rejected.

TABLE 21

Impact of number of episodes on knowledge of home management of diarrheal diseases

69
Number of Knowledge Score (%)
Diarrheal
Sample F
episodes Mean (%)
(n) Mean SD (%) Value
Nil 28 22.70 28.37 15.2
One time 39 21.05 26.31 16.5
1-2 times 20 20.87 26.09 14.0 0.24NS
Above 2 times 13 19.41 24.26 12.1
Combined
100 21.26 26.58 15.0
NS :Non-Significant

Table 21 shows that out of 100 mothers 72 of them had experience with

managing with diarrheal episodes of their children. However, the data subjected to

statistical test indicate the mean knowledge score according to previous experience with
NS
diarrheal episodes was found to be non significant. (F =0.24) . These findings also

indicate a need for health education.

Table -22

Impact of previous exposure to media on knowledge of home management of diarrhea

among mothers

Knowledge Score (%)


Exposure to
t-test
media Urban Rural
Value
n Mean SD N Mean SD
Yes 4.82*
10 23.41 8.7 24 40.93 12.8
No 13.39*
40 12.68 4.8 21 34.74 6.7
Combined
50 14.82 7.1 50 38.33 11.0
F-test 28.21* 4.08*
* Significant at 5 % Level

70
Table-22 identifies the data regarding impact of knowledge of mothers with regard to

exposure to media. Only one-fifth (10) of the urban mothers and more than half of the

rural mothers (29) were exposed to media. The mean knowledge score of those who were

exposed to media (urban 23.41% and rural 40.93%) was higher than that not exposed to

any media previously. However, the data subjected to statistical test indicates a

significant difference of knowledge between rural and urban. The result indicates

significant findings for urban (F = 28.21*) and rural (F=4.08*). These findings indicate

null hypothesis H0 (3) was rejected. These findings also emphasize the need for health

education regarding home management of diarrhea.

Table 23
Comparison of literacy rate between urban and rural area.

Education Rural Urban


N % N %
Illiterate 8 16 44 88
Primary 4 8 3 6
Middle School 9 18 2 4
High School 24 48 1 2
PUC 5 10 0 0
Total 50 100 50 100

From the above table it is clear that majority of urban mothers (88%) were illiterates

when compared to rural mothers where only 16% were illiterates.

71
6. DISCUSSION

The study was designed to assess the knowledge of mothers of under five children

regarding home management of diarrhea. Fifty mothers of Dasarahalli urban slum and

fifty mothers of Hassarghatta rural area were selected for the study. The total sample size

was 100. The content areas included; meaning, etiology, manifestations, complications,

usage of oral rehydration salt solution, home available fluids and foods, prevention and

control measures of diarrhea.

In this study, nearly half of the mothers 50% belonged to the age group of 21-24

years. In this study, majority of the mothers were Hindus 97%.

A majority of mothers 52% were illiterate and 25% educated up to high school,

11% educated up to middle school, 5% up to PUC, and 7% up to primary school. A

majority of them (86%) were housewives. These findings are similar to the study done by

Mahendraker AG, (1991) [43] which revealed 42.1% for illiteracy, 32.89% for primary

school, 10.53% for middle school, 9.21% for secondary school, and 5.27% for higher

education.

In this study, nearly half of the mothers (49%) belonged to nuclear family,

followed by joint family (39%). These findings are similar to a study conducted by

Mercy Thomas (1999) [35] that revealed most of the mothers belonged to joint family.

72
In this study, more than half of the mothers 53% had a monthly family income of

less than Rs.1500. Only 34% had income more than Rs. 2500 per month. These findings

are close to a similar study conducted by Datta V (2001) [32] that revealed 69.3% of

them had per capita income less than Rs. 500.

In this study, a majority of mothers 40% belonged to a family size of five and

above followed by a family size of three (22%). These findings are in conformity with the

study conducted by Kothari G (1987) [47] on diarrhea in urban slums of Bombay, which

revealed that nearly half of the population living in the slums is overcrowded.

In this study, a majority of children (24.7%) belonged to less than 1 year of age

followed by 20.5% of 2 years, 19.2% of 1 year, 18.5% of 3 years, and 13% of 4 years. A

majority of them 51.4% were male children and the rest 48.6% were females.

In the present study, a majority of children 74% was first child, 51% second child,

and 21% third child. A majority of mothers 56.3% had one underfive child, 41% had two

underfive children and 3% still had three underfive children in the family indicating the

need for family planning.

In this study, regarding occurrences of diarrheal episodes, when asked to mothers

by recall method, it was found that the number of episodes in the past 3 months was

highest in the age group of 0-1 year (39 episodes) followed by 20 episodes in the age

73
group of 1 to 2 years and the least between 3 to 5 years (5 episodes). These findings

indicate that the number of episodes decreases as the age increases.

In this study, a majority of them 61% were not exposed to any media regarding

diarrhea, 26% were exposed to medical personnels, 19% to television, and only 5%

received information from friends/relatives. The findings of the study are in conformity

of studies conducted by Rao KV, et al. (1998) [36] and Kothari G (1987) [47] and

Reddiah VP, et al. (1991) [42] that states 33% consulted relatives/friends.

Analysis on knowledge of mothers regarding home management of diarrhea of total

population

In the present study, the overall mean knowledge score of total mothers regarding

etiology and manifestations of diarrhea was 26.33%, home management using oral fluids

and oral food was 24.31%, control measures and prevention of diarrhea 32.12%. The

overall mean score of the knowledge aspect regarding diarrheal management was 26.58%

with SD of 12%. This finding is supported by a study done by Datta V, et al (2001) [32].

In this study, knowledge of mothers regarding meaning of diarrhea 57% (at least 3

watery stools per day) (urban 82%, rural 32%). This is similar to a study conducted by

Anand K, et al. (1992) [18], which states just 24.1% could correctly define diarrhea.

74
In this study, regarding causes of food contamination, the mean knowledge score

was 32.5% (rural 42%, urban 23%), which is almost similar to a study conducted by

Melanie Nielse (2001) [21] and Sheth Mini and Obrah Monika. (2004) [22], which states

that only 26% mentioned that contaminated food is the cause of diarrhea.

In this study, regarding the reasons for diarrhea, the mean score was 21.3%(rural

30%, urban 12.5%), and complications of diarrhea 21.3% (rural 37.3%, urban 5.3%).

Regarding meaning of dehydration, the mean knowledge score was 3.5% (rural 6%,

urban 1.0%) and dangerous signs of diarrhea 30% (rural 42%, urban 18%). These

findings are much low when compared with the study conducted by Anand K, et al.

(1992) [18], which indicates that 60% of mothers knew about the dangerous signs of

diarrhea.

The mean knowledge score on diarrhea transmission including contaminated

water, contaminated food, poor personal hygiene and environmental sanitation was

28%(rural 34%, urban 22%). Similar findings found in a study conducted by Sheth Mini

and Obrah Monika (2004) [22], which indicate that ratings were poor on these areas.

All these datas were subjected to statistical tests and it indicates the mean

knowledge score of mothers were found to be significant at 5% level.

75
Findings related to oral fluid and food intake during diarrhea.

In this study, regarding the initial management of diarrhea at home, the mean

knowledge score of all mothers was 20.3% (home available fluids 39%, ORS 15%, and

SSS 7%). The mean knowledge score in rural 26.7% and urban14%. These findings are

similar to a study conducted by Bhandari N (1995) which states that sugar salt solution

(SSS) in 14.7% of cases, oral rehydration salt solution (ORS) in 7.9% and Taneja et al.

(1996) which states the knowledge levels about oral rehydration solution revealed that

only 31.3% received ORS or home available fluids and Anand K, et al. (1992) [18] states

that only 29.7% knew about sugar salt solution. A study conducted by Mahendraker. A.G

(1991) also reveals that 50% of the mothers did not know about ORT.

In this study, regarding the use of home based foods, mothers had, the highest

mean knowledge score regarding the foods to be avoided during diarrhea 54.3% (rural

97%, urban 11.5%), followed by the knowledge on the foods to be given during diarrhea

was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural 29%, urban 17.5%).

The mean knowledge score regarding increasing the quantity of food during and after

diarrhea was very negligible 5.5% (rural 10%, urban1%). These findings are of support to

the studies conducted by Agarwal, et al. (2002) [30] and Mercy Thomas (1999) [35],

which states that mothers had poor knowledge regarding foods that are to be given and

the foods that are to be avoided.

In this study regarding ORS, mothers mean knowledge score on availability of

ORS packets was 50.7% (rural 70.7%, urban 30.7%), which was higher than advantages

76
of using ORS 26.3% (rural 36.7%, urban 16%), correct method of preparation of ORS

using 1 liter of water 11% (rural 20%, urban 2%), usage of ORS within 24 hours 8%

(rural 14%, urban 2%), correct frequency of giving ORS 7.3% (rural 12%, urban 2.7%),

and precautions to be followed while preparing ORS was 1.5% (rural 2%, urban 1%)

which was very poor. These findings are similar to studies conducted by Taneja, et al.

(1996) [38], which states that only 11.5% could correctly measure the water needed to

make 1 liter of ORS and Bhandari N (1995) [20] which states that the amount of ORS

administered to children was inadequate at all ages, with majority consuming only

spoonfuls or sips. A study conducted by Mercy Thomas (1999) [35] also reveals that

knowledge on preparation of ORS package was severely lacking among the mothers.

In this study regarding knowledge on various home available fluids that can be

given during diarrhea the mean knowledge score was 21.9% (rural 25.4%, urban18.3%).

These findings are similar to a study conducted by Anand K, et al. (1992) [18], which

states that 38% gave weak tea or curd.

In this study regarding increasing the quantity of oral fluids during diarrhea, the

overall mean score was found to be only 19%, usual amounts 27%, and 46% restricted

fluid intake during diarrhea for their children, and 3% stopped oral fluids completely.

This is similar to a study conducted by Mercy Thomas (1999) [35], which states that only

50% of the mothers had knowledge regarding oral fluid intake during diarrhea.

77
In this study regarding breastfeeding the score on increasing, the frequency of

breastfeeding 23% and usual amounts 60%, discontinued 8%, and 9% decreased in

frequency of breastfeeding during diarrhea. Only illiterate mothers restricted

Breastfeeding. The mean knowledge score of urban was 30% and rural 16%. These

finding is in contrast to a study conducted by Bhatia V (1996) and Mishra CP (1990)

[45], which states that breastfeeding, was not restricted.

However, all these findings indicate that rural mothers had more knowledge than

urban slum mothers. All these datas were subjected to statistical tests and it indicates the

mean knowledge score of mothers were found to be significant at 5% level.

Findings related to prevention and control measures of diarrhea.

In this study regarding knowledge of mothers regarding control and prevention of

diarrhea the mean knowledge score of mothers regarding boiling of infants feeding

utensils was found to be the highest 64% (rural 94%, urban 20%). High literacy rate in

rural areas was found to be a major contributing factor for this finding as observed by the

investigator during the survey.

In this study regarding, the usage of boiled cooled water for drinking 26% (rural

50%, urban 2%) and use of clean water was 23% (rural 40%, urban 6%). These findings

are similar to a study conducted by Melanie Nielse (2001) [21], which states that lack of

fuel or resources for fuel were not found to be a primary reason for not boiling the water.

78
In this study regarding prevention of occurrences of diarrhea, the mean

knowledge score of total subjects was 32.5% (keeping foods covered 24%, exclusive

breastfeeding at least 4 to 6 months 36%, Good weaning practices 42%, and hand

washing with soap and water 28%). The mean knowledge score of rural was 50.5% and

urban 14.5%. These findings are supported by studies conducted by Sheth Mini and

Obrah Monika (2004) [22], Datta V et al (2001) [32] and Kaur P (1994) [41], which

states that mothers had poor knowledge on washing hands with soap and water and other

hygienic activities.

In this study regarding prevention of feco-oral contamination, the mean score was

27% (use of sanitary latrines 49%, covering human excreta with saw dust or mud 5%).

The mean score in rural area was 52% (covering human excreta with mud 10% and use of

sanitary latrines 94%) and urban area 2%. Knowledge on use of sanitary latrines of urban

mothers was only 4% and none of the mothers had knowledge on covering the human

excreta with mud or saw dust though majority of them used open field defecation.

In this study, the mean score on when the child requires medical aid 34.7%

(presence of several loose stools within 1 or 2 hours with or without blood and mucus

10%, diarrhea lasting more than 3 days 72%, and failure of home treatment 22%). The

mean knowledge score of rural was 43.3% and urban 26%. This finding indicates that

mothers had poor knowledge on presence of blood in the stool as a dangerous sign.

However, 23% did not know when to seek medical aid during diarrhea. These findings

are also supported by Anand K, et al. (1992) [18], which states that only 62% knew the

79
dangerous signs of diarrhea. All these datas were subjected to statistical tests and it

indicates the mean knowledge score of mothers were found to be significant at 5% level.

In this study, the overall mean knowledge score of mothers regarding all the

knowledge aspects of diarrhea in rural was 38.33%, which was higher than urban area of

14.82% with SD of 7.1. However, the data subjected to statistical test indicates the mean

knowledge score between the rural and urban area were found to be significant at 5%

level (t=12.7*).

In rural area, the mean knowledge score on meaning, etiology, manifestations,

and complications was 36.16% which was higher than urban area which was 16.50%, the

mean knowledge score on home management using oral fluids and foods in rural area

was higher 34.46% and lower in urban area which was 10.8%. The mean knowledge

score of mothers on control measures and prevention was higher in rural area 51.17% and

lower in urban 11.0%.

Association of knowledge of mothers of underfive children regarding home

management of diarrhea based on baseline data.

In this study, it shows the overall mean knowledge score based on residential area

indicates that rural area had higher knowledge 38.33% than urban area 14.82%. The

overall mean knowledge score of both urban slum and rural area was 26.58%. The data

80
subjected to statistical test indicate the mean knowledge score according to residence

wise was found to be significant (F =160.16) at 5% level.

In this study, the mean knowledge score of mothers belonging to the age group of

25 and above had a slightly high score 33.12% followed by mothers belonging to the age

group of 21-24 years of 28.45% and the least scores between the age group of 17-20

years of 18.61%. The data subjected to statistical test indicate the mean knowledge score

according to age wise was found to be significant (F =7.30) at 5% level.

In this study, the mean knowledge score of mothers educated up to high

school/PUC had a higher score of 39.8% followed by mothers educated up to

primary/secondary 33.50%, and illiterates had the lowest score of 16.56%. The data

subjected to statistical test indicate the mean knowledge score according to education was

found to be significant (F =50.07) at 5% level.

With regard to occupation in this, study the mean knowledge scores of

housewives were found to be higher 28.31% than laborers, which was 15.91%. The data

subjected to statistical test indicate the mean knowledge score according to occupation of

the mother was found to be significant (F =8.88) at 5% level.

In this study, the overall mean knowledge score of mothers belonging to nuclear

family was found to be slightly higher 29.13% than joint family, which was 24.12%. The

81
data subjected to statistical test indicate the mean knowledge score according to the type

of the family was found to be non significant (F =2.85) at 5% level.

In this study, the overall mean knowledge score of mothers having income more

than Rs. 2500 per month had a slightly higher knowledge of 35.43% followed by having

mothers having income between Rs. 1500-2500 per month of 29.32%, and the least

knowledge 22.64% by mothers having income of less than Rs. 1500 per month. The data

subjected to statistical test indicate the mean knowledge score according to monthly

income of the family was found to be significant (F =5.04%) at 5% level.

In this study, the mean knowledge score of mothers having one underfive child

had a slightly higher 26.92% than with more than two underfive children of 26.13%. The

overall mean knowledge score was 26.58%. The data subjected to statistical test indicate

the mean knowledge score according to monthly income of the family was found to be

significant (F =0.07%) at 5% level.

In this study that out of 100 mothers 72 of them had experience with managing

with diarrheal episodes of their children. However, the data subjected to statistical test

indicate the mean knowledge score according to previous experience with diarrheal

episodes was found to be non significant. (F =0.24%).

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7. CONCLUSION

The following conclusions were drawn from the study:

Majority of subjects 50% were in the age group of 21-24 years and 86% were

Hindus, and majority of them were illiterates (52%).

Rural mothers had higher knowledge than urban slum mothers.

All mothers had inadequate knowledge in all content areas regarding causes, signs

and symptoms, complications of diarrhea, use of oral fluids and food intake

during and after diarrhea, and prevention and control measures.

Only 39% of the subjects had previous exposure to media regarding management

of diarrhea.

There was significant difference in the knowledge of mothers with regard to age,

occupation, family size, family income, residence, literacy and previous exposure

to media.

There was no significant difference in the knowledge of mothers with regard to

family type, number of underfive children in the family, or previous experience

with managing diarrhea episodes at home.

83
8. SUMMARY

This chapter deals with the summary, findings, implications, limitations and

recommendations of the study.

SUMMARY OF THE STUDY

The primary aim of the study was to assess the knowledge of mothers of

underfive children on home management of diarrheal diseases. The assessment included

specific content areas like definition, etiology, manifestations, complications, use of oral

fluids and home based foods, prevention and control measures of diarrhea.

The objectives of the study were:

1. To assess the knowledge of mothers of underfive children regarding home

management of diarrhea.

2. To compare the knowledge of mothers of underfive children between rural and

urban slum area.

3. To associate the knowledge of mothers of underfive children regarding home

management of diarrhea with selected demographic variables.

4. To develop a health information material based on study findings.

The study attempted to examine the following hypotheses and assumptions

Hypotheses

84
The following hypotheses were formulated based on the objectives of the study:

H0 (1): There is less knowledge among mothers of underfive children regarding home

management of diarrhea.

H0 (2): There is no difference in the knowledge among rural and urban mother regarding

home management of diarrhea.

H0 (2): There is no impact of demographic variables on knowledge of mother regarding

home management of diarrhea.

Assumptions

1. Mothers have some knowledge regarding the causes, signs and symptoms, and

prevention and control measures of diarrhea.

2. Mothers have limited knowledge regarding preparation and initiation of oral

rehydration therapy including use of ORS, home available fluids and foods during

diarrhea.

3. Knowledge of mothers is influenced by variables such as age, literacy, occupation,

type of the family, number of underfive children, family size, family income, residential

area, and previous exposure to media.

The theoretical framework adopted for the study was based on Orems self care

deficit theory. A review of related literature helped the investigator to develop the tool

regarding home management of diarrhea, conceptual framework, and in planning for data

analysis. The review of literature further helped in developing a health information

material.

85
The research approach adopted for the study was a descriptive study. The

independent variables are home management of diarrhea. The dependent variable was

score on knowledge test. The extraneous variables are demographic variables.

The study was conducted in Dasarahalli urban slum and Hassarghatta rural area of

Bangalore Karnataka State. Purposive random sampling was used to select the sample

respondents. The samples consisted of 100 mothers having under five children (urban

slum n = 50 and rural area n = 50).

The tool used for data collection was a structured interview schedule. It had four

sections. Part-A; consists of 15 items related to demographic characteristics, Part-B;

consists of 8 items related to etiology and manifestations of diarrhea, Part-C; consists of

14 items related to usage of oral fluids and oral foods, and Part-D; consists of 9 items

related to prevention and control measures of diarrhea. Ten experts established the

content validity of the tool. The tool was found to be reliable and feasible. The reliability

of the tool was established by split half method. The reliability coefficient of knowledge

test was r = 0.96 (p < 0.05).

Pilot study was conducted during the period of 17th August 2005 to 27th August

2005 in Hasserghatta rural area and Dasarahalli urban slum of Karnataka state. The

purpose of the pilot study was to find out the feasibility of the study and to determine

86
strategy for statistical analysis. Purposive random sampling was done from these areas

for conducting pilot study.

The final study was conducted during the period of 19th September 2005 to 15th

October 2005 in Hassarghatta rural area and Dasarahalli urban slum of Bangalore,

Karnataka State. The sample consisted of 50 mothers of under five children residing in

Hassarghatta rural area and 50 mothers of underfive children residing in Dasarahalli

urban slum area.

The data gathered were analyzed and interpreted based on the set objectives of the

study. Descriptive and inferential statistics were used for data analysis. Students t-test

employed in testing the main knowledge between urban and rural mothers. Further F-test

is used in testing the impact of demographic variables on knowledge of mothers

regarding home management of diarrhea.

FINDINGS

The major findings of the study are summarized as follows:

Findings related to sample characteristics.

Majority of mothers (50%) belonged to the age group of 21-24 years.

Majority (52%) of mothers were illiterate and house wives (86%)

Majority (97%) of mothers were Hindus and (49%) belongs to nuclear family.

A majority (53%) of mothers had income less than Rs. 1500 per month.

Majority (40%) of mothers belonged to a family size of five and above.

87
Nearly one-fourth (24.7%) of the children were less than one year of age and

more than half of underfive children 51.4% were males.

A majority (41%) of the families had two underfive children and 3% of families

had 3+ underfive children.

A majority of the subjects (61%) were not exposed to any media regarding

management of diarrhea.

Findings related to demographic variables.

The mean knowledge score of rural area mothers was 38.33%, which was higher

than in urban area (14.82%).

Mothers more than 25 years of age had higher mean knowledge score of 33.12%

than mothers aged 17-20 years (18.61%).

Mothers belonging to nuclear family had a slightly higher mean knowledge score

of 29.13% than joint family (24.12%), but no significant difference.

The mean knowledge score of literate mothers was higher (37.42%) than that of

illiterate mothers (16.56%).

The mean knowledge score of housewives 28.31% was found to be higher than

labourers (15.91%).

The mean knowledge score of mothers having one underfive children was found

to be slightly higher (26.92%) than having two underfive children (26.13%), but

no significant difference.

88
Families having a monthly income of more than Rs. 2500 per month had a mean

knowledge score of 35.43%, which was higher than having income of less than

Rs. 1500 per month (22.64%).

The mean knowledge score of mothers exposed to media was higher (36.44%)

than that of not exposed to any media (19.88%).

Findings on knowledge assessment related to home management of diarrhea

Findings related to cause, signs and symptoms, and complications:

On the whole mothers had a highest mean knowledge score regarding meaning of

diarrhea 57% (i.e. at least 3 watery stools per day) (rural 82%, urban 32%) followed

by causes of food contamination 32.5% (rural 42%, urban 23%), followed by

meaning of dehydration 3.5% (rural 6%, urban 1.0%) and dangerous signs of diarrhea

30% (rural 42%, urban 18%). The mean knowledge score on diarrhea transmission

was 28% (rural 34%, urban 22%), reasons for developing diarrhea was 21.3% (rural

30%, urban 12.5%), and complications of diarrhea 21.3% (rural 37.3%, urban 5.3%).

All these datas were subjected to statistical tests and it indicates the mean knowledge

score of mothers were found to be significant at 5% level.

Findings related to oral fluid and food intake during diarrhea.

Regarding the initial management of diarrhea at home the mean knowledge score

of all mothers were 20.3% (home available fluids 39%, ORS 15%, and SSS 7%). Among

rural mothers it was 26.7%, (using Home Available Fluids 48%, ORS 20%, and SSS

12%, which was higher than urban mothers of 14% (using Home available fluids 30%,

89
ORS 10%, and SSS 2%). The overall knowledge score of total subjects was 20.3% (rural

26.7%, urban 14%).

Regarding the use of home based foods, mothers had the highest overall mean

knowledge score regarding the home based foods to be avoided during diarrhea 54.3%

(rural 97%, urban 11.5%), followed by the knowledge on the foods to be given during

diarrhea was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural 29%, urban

17.5%). The mean score on increasing the quantity of food during and after diarrhea was

very negligible 5.5% (rural 10%, urban 1%). On the whole the knowledge on giving

usual amounts 24%, but 71% mentioned about restricting solid foods during diarrheal

episodes, which indicates a limited knowledge on use of home based foods.

Regarding ORS, the overall mean knowledge score of mothers on availability of

ORS packets was high 50.7% (rural 70%, urban 30.7%) followed by advantages of using

ORS 26% (rural 36.7%, urban 16%), correct method of preparation of ORS 11% (rural

20%, urban 2%), usage of ORS within 24 hours 8% (rural 14%, urban 2%), correct

frequency of giving ORS 7.3% (rural 12%, urban 2.7%), and precautions to be followed

while preparing ORS was 1.5% (rural 2%, urban 1%). On the whole knowledge on

precautions and preparations of ORS was found to be very low or negligible in both the

areas.

Regarding knowledge on various home available fluids that can be given during

diarrhea the overall mean knowledge score was 21.9% (rural 25.4%, urban 18.3%)and on

90
increasing the quantity of oral fluids during diarrhea was found to be only 19% (rural

28%, urban 10%). Regarding breastfeeding the overall mean score on increasing the

frequency of breastfeeding 23% (rural 30%, urban 16%) and usual amounts 60%. Others

discontinued 8%, and 9% decreased the frequency of breastfeeding. These findings

indicate a limited knowledge on this sub area.

However, all these findings indicate that rural mothers had more knowledge than

urban mothers. All these datas were subjected to statistical tests and it indicates the mean

knowledge score of mothers were found to be significant at 5% level.

Findings related to prevention and control measures of diarrhea.

The mean knowledge score of mothers regarding boiling of infants feeding

utensils was found to be higher 64% (rural 94%, urban 34%) followed by when the child

requires medical aid 34.7% (rural 43.3%, urban 26%), prevention of occurrences of

diarrhea 32.5% (rural 50.5%, urban 14.5%), prevention of feco-oral contamination 27%

(rural 52%, urban 2%), usage of boiled drinking water 26% (rural 50%, urban 2%),

frequency of hand washing with soap and water 25% (rural 48%, urban 2%), and

knowledge on use of clean water was 23% (rural 40%, urban 6%).

However, these findings indicate that rural mothers had more knowledge than

urban mothers. All these datas were subjected to statistical tests and it indicates the mean

knowledge score of mothers were found to be significant at 5% level.

91
IMPLICATION

Nursing service/Administration

Nurses play an important role in prevention of disease and promotion of health.

The findings of the present study indicate a deficit in the knowledge of mothers regarding

home management of diarrhea. Thus, this study will enable the nurse as a member of the

multidisciplinary team to understand and assess the level of knowledge of mothers,

expand their knowledge for planning effective in-service and health education

programmes for specific communities and hospitals. Further, this will enable them to

prioritize and focus their nursing care activities based on the needs of the society.

Nursing education

These findings will help the student nurses to identify the deficits of knowledge

on various sub areas of home management of diarrhea. They should be able to recognize

the major health problems and focus on improving their knowledge and practice in the

prevention and control of diseases in the field.

Nurses as educationists can plan health education programmes for various nursing

personnels in the hospital as well as community. This study will enable them to identify

the learning needs of the mothers. Further, they can adapt to different teaching-learning

strategies for various nursing personnels for effectiveness of home management of

diarrhea by mothers. This will also enable nurses to identify the changing learning needs

of the society as an educationist and contribute for the curriculum development and

preparation in nursing as well as non-nursing field.

92
Nursing research

The researchers can carry out studies to identify cost effective ways for dissemination of

health information to the public and test its effectiveness regarding reduction and

mortality and morbidity due to diarrhea. This study will also enable them to identify and

focus on specific areas for conduction of further studies.

RECOMMENDATIONS

This study could be replicated in a larger sample to generalize the findings.

A similar study can be carried out to find out the effectiveness of planned

teaching programme using health information material developed for the present

study.

A study can be conducted regarding on attitude, beliefs and practice regarding

oral fluids and food intake during and after diarrhea at home.

A study can be carried out to find out the attitude and actual practices of mothers

regarding prevention of diarrhea.

A study can be conducted to find out the knowledge and practices of health care

providers regarding diarrhea.

LIMITATIONS

The size of the sample was small which imposes limitations generalization.

Mothers who could understand Kannada and English only were included in

the study.

Mothers were limited to only those who were having underfive years of age.

93
9. BIBLIOGRAPHY

1. Basavanthappa BT. Community health nursing. 1st ed. New Delhi: Medical

Publishers (P) LTD; 2003. p. 298.

2. David Oot. Saving children. Washington times. 2004; January 18.

3. Margaret Kosek, Caryn Bern, Guerrant RL. The global burden of diarrheal

disease, as estimated from studies published between 1992 and 2000. Bulletin of

the World Health Organization 2003; 81:197-204.

4. Clinical management of acute diarrhea. WHO/UNICEF Joint statement. Geneva.

Switzerland. 2004; May. (www. who.int) (www. Unicef.org)

5. Tejal Baraj-jaitly. Health status of children in India. Health For The Millions

2002; October-November. p. 19.

6. India's Popular Soap Operas Become a National Soapbox. Christian Science

Monitor. 2005; June 10.

7. Poor Hygiene Kills 500,000 Children Each Year in India. Asia Pacific disease

outbreak/surveillance reports. India: Week of Mar 22, 2004. (http://timesofIndia.

Indiatimes.com/articleshow/580688.cms) access date 9/7/2005

8. Suraj Gupte. A short textbook of pediatrics. 9th ed. New Delhi: Medical

publishers; 2001. p. 4-5.

9. Khalique N, Sinha SN, Yunus M, Malik A. Early childhood mortality- a rural

study. J R Soc Health 1993 Oct; 113(95): 247-9.

10. A newsletter on child survival and safe motherhood program. New Delhi.

Government of India. CSSM review 1995. p.26.

94
11. No author. Cereal aids fight against diarrhea. Mazingira 1984 July; 8 (3): 9.

12. Wishvas Rane. Nitromidazole-Quninoline Anti-diarrhoeals neither rationale nor

necessary. Health Action 2004 Jan; p. 25-26.

13. Jayaram A. Vajpayeee hits out the cost of medicare. Online edition of Indias

National Newspaper. The Hindu January 20, 2001. (Vajpayee hits out at high cost

of medicare.htm) access date 10/12/2004)

14. Mangala S, Gopinath D, Narasimhamurthy NS, Shivaram C. Feeding practices in

Under-Fives during diarrhea before and after educational intervention. Indian

Pediatrics 2003; 37: 312-314 (http://www.indianpediatrics.net/march-312-

314.htm) access date 9/7/2005.

15. Census of India, 2001. Karnataka State PLCN:29. p.10, 31, 62. (http:// www.

Censusindia. Net)

16. Environmental sanitation conditions and health impact: a case-control study

(2003). Prevelance of diarrhea Bulletin of the World Health Organization 2003;

81 (3)

17. Park K. Textbook of social and preventive medicine. 17th ed. Jabalpur:

Bhanarsidas Bhanot Publishers; 2001. p. 81-96.

18. Anand K, Lobo J, Sundaram KR, Kapoor SK. Knowledge and practice regarding

diarrhea in rural mothers of Haryana. Indian Pediatr. 1992 Jul; 29 (7): 914-7.

19. Dua T, Bhal R, Bhan MK. Lessons learnt from Diarrheal Disease Control

program and implications for the future. Indian J Pediatrics 1999 Jan-Feb; 66(1): 55-

61.

95
20. Bhandari N, Qadeer I, Bhan MK. Patterns of use of oral rehydration therapy in

urban slum community. J Indian Med Assoc. 1995 Jun; 93(6): 239-42.

21. Melanie Nielsen, Anneke Hoogvorst, Flemming Konradsen, Muhammed

Mudasser and Wim van der Hoek. Childhood diarrhea and hygiene: Mothers

perceptions and practices in the Punjab, Pakistan: 2001 Working Paper 25.

Colombo, Sri Lanka: International Water Management Institute. (www.iwmi.org)

Access date 14/11/2005.

22. Sheth Mini and Obrah Monika. Diarrhea prevention through food safety

education. The Indian J of pediatrics 2004; 71 (10): 879-82.

23. BT Basavanthappa Nursing Research. 1st ed. New Delhi: Medical Publishers

(P) LTD; 2005. p. 67.

24. Borooah Vani K. On the incidence of diarrhea among young children.

Ecconomics and Human Biology 2 (2004) 119-38 (www.sciencedirect.com)

25. Victoria CG, Huttly SR, Fuchs SC, Barros FC, Garenne M, Leroy O, et al.

International differences in clinical patterns of diarrheal deaths: a comparison

of children from Brazil, Snegal, Bangladesh, and India. J Diarrheal Dis Res

1993, Mar; (1): 25-9

26. Aswathi S, Pande VK, Glick H. Underfive mortality in the urban slums of

Lucknow. Indian J of Pediatrics 1996 May-Jun; 63(3): 363-8.

27. B. Banerjee, S. Hazra, and D. Bandyopadhyay. Diarrhea Management Among

Under Fives. Indian Pediatrics 2004 mar; 17(41): 259

96
28. Bhandari N, Bhan MK, Sazawal S. Mortality associated with acute watery

diarrhea, dysentery, and persistent diarrhea in rural India. Acta pediatric

Supplement 1992 Sep; 381: 3-6

29. Guerrant RL, Hughes JM, Lima NL, Crane J. Diarrhea in developed and

developing countries: magnitude, special settings, and etiologies. Rev Infect

Dis. 1990 Jan-Feb; 12 Suppl 1:S41-50

30. Agarwal KN and Bhasin SK. Feasiblity studies to control acute diarrhea in

children by feeding fermented milk preparations Actimel and Indian Dahi, Eur

J Clin Nutri 2002 Dec; 56 Suppl 4:S 56-9.

31. Pandey A, et al. gender differences in health care seeking during common

illness in a rural community of west Bengal, India. J Health Popul Nutr. 2002

Dec; 20 (4): 306-11.

32. Datta V, John R, Singh VP, Chaturvedi P. Maternal knowledge, attitude and

practices towards diarrhea and oral rehydration therapy in rural Maharastra.

Indian J Pediatr. 2001 Nov; 68 (11): 1035-7

33. Zodepy SP, Despande SG, Ughade SN, Kulkarni SW, Shrikhande SN, Hinge

AV. A predication model for moderate or sever dehydration in children with

diarrhea. J Diarrheal Dis Res 1999 Mar; 17 (1): 10-6.

34. Bhatia V, Swami HM, Bhatia M, Bhatia SP. Attitude and practice in rural

community in chandigarh. Indian J Pediatr 1999 Jul-Aug; 66(4): 499-503.

35. Mercy Thomas. Mothers knowledge on the diet and oral fluid intake during

diarrheal diseases of the children below five years of age in a selected urban

community in Mangalore. 1999. Unpublished thesis.

97
36. Rao KV, Mishra VK, Retherford RD. Mass media can help improve treatment

of childhood diarrhea. Natal Fam Health Surv Bull 1998 August; (11): 1-4

37. Bhal L, Sharma VK, Kaushal RK. Experience with diarrhea training and

treatment unit in Shimla. Indian Pediatr 1997 Jun; 34 (6): 527-34.

38. Taneja DK, Lal P, Aggarwal CS, Bansal A, Gogia V. Diarrhea management in

some Jhuggi clusters in Delhi. Indian pediatric 1996 Feb; 33(2): 117-9

39. Mehta M. Nutritional management of diarrheal diseases. Indian Peadiatr. 1996

Jun; 33 (6): 524-5; author reply 525.

40. Buch NA, Hassan M, Bhat IA. Parental awareness and practices in acute

diarrhea. Indian Pediatr. 1995 Jan; 32 (1): 76-9

41. Kaur P, Singh G. Food Practices during diarrhea. Indian J Public Health 1994

April-Jun; 38(2): 58-61.

42. Reddiah VP and Kapoor SK., Epidemiology of diarrhea and its implications

for providing services. Indian J pediatrics 1991 Mar-Apr; 58(2): 205-8

43. Mahendraker AG, Dutta PK, Urmil AC, Moorth TS. A study on medico social

profile of under five children suffering from diarrheal diseases. Indian J

Matern Child Health 1991; 2(4): 127-30.

44. Chowdhury AM, Karim F, Rhode JE, Ahmed J, Abed FH. Oral rehydration

therapy: a community trial comparing the acceptability of homemade sucrose

and cereal based solutions. Bull World health organ 1991; 69 (2): 229-34

45. Mishra CP, Kumar S, Tiwari IC, Prasad DN. A study on some diarrhea related

practices in urban Mirzapur. India J Public health 1990 Jan-Mar; 34 (1): 6-10

98
46. Huffman SL and Combest C. Role of breastfeeding in the prevention and

treatment of diarrhea. J Diarrhoeal Disease Res. 1990 Sep: 8 (3): 68-81.

47. Kothari G. Diarrhea in urban slums. Bombay. Dialogue Diarrhea 1987 Dec;

(31): 4-5.

99
ANNEXURE A

Statement wise over all assessment of Knowledge on Etiology and Manifestations


N=100
Statements Response (%)
No
Urban Rural Combined
1 Meaning of Diarrhea 32 82 57
2 The causes for Diarrhea are 6 8 7
3 Main reason for developing diarrhea
a Bottle feeding 16 36 26
b Water storage in a wide mouthed container 6 10 8
c Indiscriminate disposal of children stool 10 26 18
d Non use of soap for washing feeding containers 18 48 33
4 Diarrhea is transmitted through
a Contaminated water 22 26 24
b Contaminated food 46 80 63
c Poor environmental sanitation 10 14 12
d Poor personal hygiene 10 16 13
5 Causes of food contamination
a Open kept food \s 22 38 30
b Dirty fingers 40 54 47
c Unclean nipples 10 30 20
d Flies 20 46 33
6 The dangerous signs of diarrhea
a At least 8 watery stools per day 30 48 39
b Dehydration 10 22 16
C Fever 4 34 19
d Dry and sunken eyes 30 54 42
e Loose skin 6 36 21
f Frequent vomiting 24 56 40
g Noisy breathing 2 20 11
h Sunken Fontenelle 10 38 24
i Lethargy 46 70 58
7 During dehydration there is loss of 0 6 3
b Water and salts
8 Complications of Diarrhea are
a Shock and death 0 44 22
b Malnutrition 10 44 27
c Anemia 6 18 12

100
ANNEXURE -B

Statement wise over all assessment of Knowledge on Home management using


oral fluids and foods

N=100
Statements Response (%)
No
Urban Rural Combined
9 Initial management of Diarrhea at home
a Home available fluids 30 48 39
bOral rehydration salt solution 10 20 15
c Sugar Salt solution 2 12 7
10 Oral fluid intake during diarrhea to be 10 28 19
b increased
11 Advantages of using Oral rehydration solution
a Readily available as powder in packets 36 62 49
bContinued when there is vomiting 2 14 8
c Replaces electrolytes and water 0 6 3
12 Oral rehydration salt solution is prepared 2 20 11
a 1 liter of boiled cooled water
13 Frequency of giving Oral rehydration salt
solution
a After each loose stool 6 16 11
b Quarter glass after each stool for below 2 years 0 0 0
c 1 glass after each loose stool for above 2 years 0 0 0
14 Oral rehydration solution should be used 2 14 8
Within 24 hours
15 Precautions to be taken while using Oral
rehydration solution
a Store in a cool dry place in a closed container 0 4 2
c Avoid soft drinks and sweetened drinks 0 0 0
16 Oral rehydration salt packets are available
a Subcenters/Hospitals 20 82 51
b Provisional stores 0 54 27
c Medical shops 72 76 74
17 Home available Fluids that can be given during
diarrhea
a Curds 14 34 24
b Rice water with salt 30 4 17
c Tender coconut water 26 80 53
d Tea 20 4 12

101
eVegetable soups 2 8 5
fBoiled cooled water 10 36 23
g Other fluids 26 12 19
18 Breast feeding during diarrhea to be 16 30 23
b increased
19 Oral food intake during and after diarrheal 0 10 5
b episodes
Increased
20 Home based foods that can be given during
diarrhea
a Well cooked smashed vegetables 0 30 15
b Bread/Biscuits 22 42 32
c Steamed foods/bland diet 28 52 40
d Double boiled rice gruel/kanji 18 22 20
e Any other 32 20 26
21 Fruits that have been given during diarrhea
a Apple 28 72 50
b Pineapple 10 8 9
c Bannana 24 26 25
d Mangoes 8 10 9
22 Home based foods avoided during diarrhea
a Raw vegetables 12 100 56
b Chocolates and sweets 0 92 46
c Animal fats 4 98 51
d High fiber foods 30 98 64

102
ANNEXURE-C

Statement wise over all assessment of Knowledge on Control measures


and prevention of Diarrhea
N=100
Statements Response (%)
No
Urban Rural Combined
23 Child requires medical aid when there is
a Presence of several stools in 1 or 2 hours with or 4 16 10
without blood and mucus
b Diarrhea lasting at least more than 3 days and 60 84 72
lethargy
c Failure of home treatment 14 30 22
24 Occurrence of diarrhea can be prevented
b Keeping the foods covered 4 44 24
c Exclusive breast feeding 24 48 36
D Good weaning practices 26 58 42
f Hand washing with soap and water 4 52 28
25 Water used for drinking at home 2 50 26
d Boiled cooled water
26 Clean water type 6 40 23
b Bhore water
27 Frequency of hand washing with soap and
water
b After defecation or cleaning the baby 2 54 28
c Before preparing/eating food/feeding the child 2 42 22
28 Cleaning of infants feeding utensils is done at 34 94 64
home
d. Soap and water and boiling b efore each feed
29 Measures used to prevent feco oral
contamination
b Covering human excreta with saw dust 0 10 5
c Use of sanitary latrines 4 94 49

103
ANNEXURE -D

LETTER SEEKING PERMISSION TO CONDUCT STUDY

Reference: No. EWCON/648/2004 Date: 30/09/2004

From,

The Principal

East West College of Nursing

Rajajinagar

Bangalore.

To,

The Medical Officer

Hassarghatta PHC

Bangalore.

Sub: Permission to conduct study.

Ms. Saramma T. T. is a M.Sc Nursing student (Community Health Nursing) of

East West College of Nursing, Bangalore. She has selected a topic assess the knowledge

of mothers of underfive children regarding home management of diarrhea in selected

areas of Bangalore. Kindly give her permission to conduct this study in Hassarghatta-

PHC and help her by giving needed details regarding her study.

Thanking you,

Prof. S. Chitra

Principal

104
ANNEXURE - E

Permission letter

105
ANNEXURE-F

BLUE PRINT FOR CONTENT OF THE TOOL

KNOWLEDGE QUESTIONNAIRE

S. No Questions Total Total score Score


number of percentage
questions
27 33.75%
Part-B
1, 2,3,4,5,6,7,8 8
Knowledge
regarding
recognition of
diarrhea

Part-C 39 48.75%
9, 10, 11, 12,
Home management 13, 14, 15, 16, 14
of diarrhea using 17, 18, 19, 20,
oral fluids and 21, 22.
foods

4.Part D 23, 24,25, 26, 14 17.5%


27, 28,29. 9
Control measures
and prevention

Grand Total 29 80 100%

106
ANNEXURE - G

LETTER SEEKING EXPERT OPINION IN VALIDATING THE TOOL USED


TO ASSES THE KNOWLEDGE OF MOTHERS REGARDING HOME
MANAGEMENT OF DIARRHEA.

From,

Ms. Saramma T. T.

MSc (N) II year

East West College of Nursing

Bangalore.

To,

Sir/Madam,

Sub: Seeking validation of tool.

I am a student of Masters in Nursing (Community Health Nursing) studying in

East West College of Nursing, Bangalore, working on thesis. This thesis is to be

submitted to RGUHS as a partial fulfillment of the requirement of Masters degree in

Nursing. The title of my study is to assess the knowledge of mothers of underfive

children regarding home management of diarrhoeal diseases in selected areas of

Bangalore.

Objectives of the study:

1. To assess the knowledge of mothers of underfive children regarding home

management of diarrhea.

107
2. To compare the knowledge of mothers of underfive children between rural and

urban slum area.

3. To associate the knowledge of mothers of underfive children regarding home

management of diarrhea with selected demographic variables.

4. To develop a health information material based on study findings.

I am herewith enclosing

1. Questionnaire.

2. Blue Print of questionnaire.

3. Criteria for content validity.

4. Content validity certificate.

I kindly request you to give your valuable suggestions and expert comments

regarding the content of the tool.

Thanking you,

Yours sincerely,

Saramma T. T.

M.Sc (N) student

108
ANNEXURE-H

TOOL IN ENGLISH

STRCTURED INTERVIEW SCHEDULE

INSTRUCTIONS

Please read the following items carefully and place a tick mark Tot

against the most appropriate responses. Scores 80

PART A

BASELINE DATA

Serial Number

Code Number

1. Area

a. Urban slum

b. Rural

2. Age of the mother in years __________

3. Education of the mother

a. Illiterate

109
b. Primary school

c. Middle school

d. High school

e. PUC

f. Graduate

g. Post graduate

4.Occupation of the mother

a. Employee/government/private

b. Labourer

c. Business

d. Housewife

e. Professional/medical/engineer/others

5. Monthly income of the family per month in rupees _________

6. Type of family

a. Nuclear

b. Joint

c. Extended

7. Religion

a. Hindu

110
b. Muslim

c. Christian

d. Others

8. Age of the child in years

a. < 1

b. 1

c. 2

d. 3

e. 4

f. 5

9. Sex of the child

a. Male

b. Female

10. Birth order of the child

a. First

b. Second

c. Third

d. Fourth

e. Fifth

f. Fifth and above

111
11. Number of underfive children in the family

a. One

b. Two

c. Three

d. Four

12. Number of diarrheal episodes of diarrhea within the past 3 months age wise

a. 0-1 year _________

b. 1-2 year _________

c. 2-3 year _________

d. 3-4 year ________

d. 4-5 year ________

13. Family size

a. Three

b. Four

c. Five

d. Five and above

14. Previous exposure to media regarding management of diarrhea were

a. TV

b. Radio

112
c. News paper/magazines

d. Friends

e. Relatives

f. Medical personnels

g. None of the above

15. Have you ever used ORS ? Yes/NO

PART B

KNOWLEDGE REGARDING ETIOLOGY AND MANIFESTATIONS

1. Diarrhea means passage of

a. Frequent formed stools per day 0

b. Three or more loose watery stools per day 1

c. Less than three loose stools per day 0

d. Do not know 0

2. The exact causes of diarrhea are

a. Microorganisms 1

b. Curse 0

c. Evil eye 0

d. Do not know 0

3. The main reasons for developing diarrhea are

113
a. Bottle feeding 1

b. Water storage in a wide mouth container 1

c. Indiscriminate disposal of childrens stool 1

d. Non use of soap for washing feeding containers 1

e. Do not know 0

4. Diarrhea is transmitted through

a. Contaminated water 1

b. Contaminated food 1

c. Poor environmental sanitation 1

d. Poor personal hygiene 1

e . Do not know 0

5. The causes of food contamination are

a. Open kept foods 1

b. Dirty fingers 1

c. Unclean nipples 1

d. Flies 1

e. Do not know 0

6. The dangerous signs of diarrhea

a. At least 8 watery stools per day 1

b. Dehydration 1

114
c. Fever 1

d. Dry and sunken eyes 1

e. Loose skin 1

f. Frequent vomiting 1

g. Noisy breathing 1

h. Sunken fontenelle 1

I. Lethargy 1

J. Do not know 0

7. During dehydration there is loss of

a. Excess water from the body 0

b. Excess water and salts 1

c. Salts 0

d. Do not know 0

8. Complications of diarrhea are

a. Death 1

b. Malnutrition 1

c. Anemia 1

d. Do not know 0

PART C

KNOWLEDGE ON HOME MANAGEMENT OF DIARRHEA USING ORAL

115
FLUIDS AND FOODS

9. Initial management of diarrhea at home includes

a. Home available fluids

b. Oral rehydration salt solution 1

c. Sugar Salt solution 1

d. Only drugs 1

e. Consulting a physician immediately 0

10. The oral fluid intake during diarrhea to be

a. Restricted

b. Increased 0

c. Stopped completely 1

d. Usual amounts 0

e. Do not know 0

11.The advantages of using Oral Rehydration Solution are

a. Readily available as powder in packets

b. Continued when there is vomiting 1

c. Replaces electrolytes and water lost from the body 1

d. Do not know 1

12.Oral rehydration salt solution is prepared by mixing

one standard packet (WHO) in

116
a. l liter of boiled cooled water

b. 1 glass of boiled cooled water 1

c. 5oo ml of clean water 0

d. Do not know 0

13. The frequency of giving Oral Rehydration Salt solution are

a. After each loose stool

b. Quarter to half glass after each loose stool for children below 2 years 1

c. 1 glass after each loose stool for children above 2 years of age 1

d. Do not know 1

14. Oral rehydration salt solution should be used within

a. 6 hours

b. 12 hours 0

c. 24 hours 0

d. Do not know 1

15. Precautions to be taken while using Oral rehydration solution are

a. Store it in a cool dry place in a closed container

b. Prepare fresh solution each time 1

c. Avoid soft drinks and sweetened drinks 0

d. Do not know 1

117
16. Oral Rehydration Salt Packets are available at

a. Sub centers/Hospitals

b. Provisional stores 1

c. Medical shops 1

d. Do not know 1

17. The home available fluids that can be given during diarrhea are

a. Curds

b. Rice water with salt 1

c. Tender coconut water 1

d. Tea 1

e. Soups 1

f. Boiled cooled water 1

g. Any other 1

h. Do not know 1

18. Breastfeeding during diarrhea to be

a. Discontinued

b. Increased in frequency 0

c. Decreased in frequency 1

d. Usual amounts 0

19. The oral food intake during and after diarrheal episodes

118
a. Restricted

b. Increased till the child gains the previous weight 0

c. Usual amounts 1

d. Stopped 0

e. Do not know 0

20. The home based foods that can be given during diarrhea are

a. Well cooked smashed vegetables

b. Bread/Biscuits 1

c. Steamed foods/bland diet 1

d. Double boiled rice gruel/kanji 1

e. Any other 1

f. Do not know 1

21. Fruits that can be given during diarrhea are

a. Apple

b. Pineapple 1

c. Banana 1

d. Mangoes 1

e. Do not know 1

22. Home based foods to be avoided during diarrhea are

a. Raw vegetables

119
b. Chocolates and sweets 1

c. Animal fats 1

d. High fiber foods 1

e. Do not know 1

PART D

KNOWLEDGE REGARDING CONTROL MEASURES

AND PREVENTION OF DIARRHEA

23. The child requires medical aid when there is

a. Presence of several loose stools in 1 or 2 hours with or without blood and

mucus

b. Diarrhea lasting at least more than 3 days and lethargy 1

c. Failure of home treatment 1

d. Do not know 1

24. The occurrences of diarrhea can be prevented by

a. Using left over food

b. Keeping the foods covered 0

c. Exclusive breast feeding 1

d. Good weaning practices 1

120
e. Keeping dirty clothes uncovered 1

f. Hand washing with soap and water 0

g. Do not know 1

25. Water used for drinking at home is

a. Non boiled water from any source

b. Filtered by cloth 0

c. Sometimes boiled or filtered water 0

d. Boiled cooled water 0

26. Clean water is

a. Tap water

b. Bhore water 0

c. Well water 1

d. Do not know 0

27. Frequency of hand washing with soap and water is

a. Sometimes

b. After defecation or cleaning the baby 0

c. Before preparing/eating food/feeding the child 1

d. Not required 1

28. Cleaning of infants feeding utensils is done at home using

121
a. Plain water alone

b. Mud/sand 0

c. Soap and water 0

d. Soap and water and boiling before each feed 0

29. Measures used for prevent feco oral contamination are

a. Open field defecation

b. Covering human excreta with saw dust or mud 0

c. Use of sanitary latrines 1

d. Do not know 1

122
ANNEXURE I

EVALUATION CRITERIA CHECKLIST FOR VALIDITATION OF TOOL


INSTRUCTIONS
The expert is requested to go through the following evaluative criteria checklist prepared for

validating the tool for assessing the knowledge.

Specific Content Item

Areas Numbers Criteria Suggestion and remarks

Relevant

Relevant to

some extent

Not relevant

123
ANNEXURE-J

LISTS OF EXPERTS FOR CONTENT VALIDATION OF THE

TOOL

1. Vimalakumari P.G.

Principal

Indira Nursing College

Managalore.

2. Dr. T.M. Krishnaveni

Professor

Mallige College of Nursing

Bangalore-13

3. Dr. Ms. K.P. Neeraja

Principal

Navodhya College of nursing

Raichur

4. Mrs. Sunitha

Principal

Rajiv Gandhi College of Nursing

Bangalore

124
5. Dr. Jayanth Kumar K.

Proffessor and Head

Dept of community Medicine

M.S. Ramiaha Medical College

Bangalore.

6. Mrs. Saroja Jayakumar

Principal

Manipal School of Nursing

Bangalore

7. Ms. R. Prabavathy

Principal

Hosmat College of Nursing

Bangalore

8. Mr. H. S. Surendra

Associate Professor of Statistics

College of B S &H.

University of Agricultural Sciences

GKVK. Bangalore-55

125
9. Ms. M. Naveenatha

Lecture

Manipal College Of Nursing

MAHE, Manipal.

10. Mrs. Prema. P

Lecturer

Navodaya College of Nursing

Raichur

11. Mrs. Gangabai.B. Kulkarni

Professor and HOD

Community Health Nursing

MSRINER, Bangalore-54

126
ANNEXURE-K

TOOL IN KANNADA VERSION

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8. vuS quS.

H)
)yNS Nq EgSu.
)N wq
m)Sr.

S -

9. vw w xqo
luu AS.

H) w Sq N
uoSu.
)RN ywdNou Ezw
uoSu.
)N q Ezw uoSu.
m)MvSu q.
C) qqT u ylu.

132
10. vS u qSuN
RN uoS S CN.

H) qlN.
)Yw you
)yoT xrN.
m)u you
C) Sr.

11. RN ywdNou uow


EyTuu
BS ycwS u.

H) u yNg S
uou ym Squ.
)xq rS uu
Nlu.
)uvu dh N bN
NoSw q xw q
uN qu.
m)Sr.

12. RN ywdNou Ezw uo


Ku you yNg. (l.HX.K)
N quTu.

H) Ku h Nv Bu xw.
)Ku h Nv Bu xw.
)500 ..h u xw.
m)Sr.

13. RN ywdNou Ezw


uow Nluu w
qS uu.

133
H) vu yr .
)N Svu BuS huS
vu yr 2
Oq Nm w NS
NluTu.
)3 h NS yr
vu wq Ku h
NluTu.
m)Sr.

14. RN ywdNou Ezw


uow C uS
EyTN.

H) B SgS KS
)wl SgS KS.
)Cyqw SgS KS.
m)Sr.

15. RN ywdNou Ezw


uow EyTS As S
ASqT AwNu AO AS.

A)qow KoT bSu X


Y yq
As l SN.
)yr uT uow
qN.
)qy yx, q yxS
ww xrN.
m)Sr.

16. RN ywdNou Ezw uo


S bSS.

134
H) Ey SS.
)vw ASmS.
)BqS.
m) Mv ASmS.
C) Sr.

17. vS uu Nluu
w Sq uoS,
u.

H)
)Ey u Awu Sd.
)H x.
m)X
C) qN u x.
Cy)Nv Bu x.
d) uu.

18. v uu
puw.

H) qlShN As xN.
)Yw you.
)Nm you
m)wu r.

19. vS uu w
Bw
H) xrN.
)Aru you N.
)w you N.
m)xN.
C) Sr.

135
20. vS uu w
quq q Nluuq
B yusS u.

H) XwT u qNS.
)l As q.
) u B yusS.
As y A.
m)Hl u Awu Sd.
C) uu.
Hy)Sr.

21. vS uu
Nluuq oS.

H)
)Aww
)o.
m) uu
C) Sr.

22. vS uu uu
B yusS
H) qNS.
)XNg q rxS.
)Hn Nu yusS.
m)ww yusS.
C) Sr.

S - 4

23. SS NT uO YOq
Nl uS.

136
H) 1 Sg As 3 Sg S AwN
N
q Nmu v uS.
)3 vwS Bu Aru vu xO
uS.
)ww MvSu SoSu
uS.
m)Sr.

24. vu BS Nw
qluu AS.

H) N vwS u qh
Bw rwu.
)B yusSw Ylu.
)QlT 6 rS N q
Epu.
m)3 rS wq SS yN
Bw Nlu.
C) Nu gSw S
qSu Ylvu.
Hy) NSw y q xxu
qu.
d) Sr.

25. Nm w uN
x.

H) u Nvu xw
EyTu.
)gu vNh x.
)N Nvu As vNu x.
m)Nvu x.

26. uu x Hu.

137
H) w x
)N x
) x.
m)Sr.

27. y q x EyT
Nquw lNuu.

H) N AwSoT.
) cw mu N As
Sw X
mu .
)B q q rw u
As SS
B rx u.
m)ANq C.

28. S B yqSw X
l w
uuS.

H) w xxu.
)o / .
)y q x.
m)y q x q yr
u
Nu.

29. RNT l v Nw
xru S.

H) qu w cw.
)u h As pxu ww
du

138
w Xu.
)yqNu cw
XSw u.
m)Sr.

139
TABLE 1

Personal characteristics of Respondents

Characteristics Category Respondents


Number Percent
Area Urban 50 50.0
Rural 50 50.0
Age group 17-20 years 29 29.0
21-24 years 50 50.0
25-35 years 21 21.0
Education Illiterate 52 52.0
Primary 7 7.0
Middle 11 11.0
High school 25 25.0
PUC 5 5.0
Occupation Labourer 14 14.0
Housewife 86 86.0
Total 100 100

TABLE 2

Family related characteristics of Respondents

Characteristics Category Respondents


Number Percent
Religion Hindu 97 97.0
Muslim 3 3.0
Type of Family Nuclear 49 49.0
Joint 39 39.0
Extended 12 12.0
Family Income/m < Rs. 1500 53 53.0
Rs. 1500-2500 34 34.0
> Rs. 2500 13 13.0
Family Size Three 22 22.0
(members) Four 20 20.0
Five 18 18.0
Five& above 40 40.0

Total 100 100


TABLE 3

Child related characteristics of Respondents

N=100
Characteristics Category Respondents
Number Percent
Age of the Child (n=146) < 1 year 36 24.7
1 year 28 19.2
2 years 30 20.5
3 years 27 18.5
4 years 19 13.0
5 years 6 4.1
Sex of the Child (n=146) Male 75 51.4
Female 71 48.6
Birth order of the Child (n=146) First 74 74.0
Second 51 51.0
Third 21 21.0
Under 5 children in the Family One 56 56.0
Two 41 41.0
Three+ 3 3.0

TABLE 4

Diarrheal episodes and Media of Exposure on management of diarrhea

N=100
Aspects Category Respondents
Number Percent
Diarrheal episodes in past 3 No 28 28.0
months 0 1 year 39 39.0
1-2 years 20 20.0
2-3 years 8 8.0
3-5 years 5 5.0
Media of Exposure @ Television 19 19.0
Relatives/Friends 5 5.0
Medical personals 26 26.0
No response 61 61.0
@ Multiple Response
TABLE 5

Aspect wise Knowledge on Home management of Diarrheal diseases among mothers

Stateme Max. Knowledge Score


Knowledge Aspects nts Score
Mean Mean SD
(%) (%)

Etiology and Manifestations 7 27 7.11 26.33 16.4

Home management using oral fluids 15 39 9.48 24.31 14.1


and foods
Control measures and prevention of 7 14 4.50 32.12 23.7
Diarrhea
Over all 29 80 21.26 26.58 12.0

TABLE 6

Residence wise Knowledge on Home management of Diarrheal diseases among mothers

Knowledge Score ( % )
Knowledge Aspects Urban (n=50) Rural (n=50) t-
Mean SD Mean SD Test

Etiology and Manifestations 36.16 15.2 16.50 10.7 7.48 *

Home management using oral fluids 34.46 10.8 14.16 8.5 10.44 *
and foods
Control measures and prevention of 51.17 17.6 13.07 9.3 13.53 *
Diarrhea
Over all 38.33 11.0 14.82 7.1 12.70 *

* significant at 5 % Level
TABLE 7

Impact of Residence on Knowledge of Home management of Diarrheal diseases

Knowledge Score (%)


Residence Sample F
(n) Mean Mean (%) SD (%) Value

Urban 50 30.66 38.33 11.0

Rural 50 11.86 14.82 7.1 160.16 *

Combined 100 21.26 26.58 15.0

NS : Non-Significant. * Significant at 5 % Level

TABLE 8

Impact of Age on Knowledge of children on in prevention of dental carries

Age group Knowledge Score (%)


Sample F
(n) Mean Mean (%) SD (%) Value

17 20 years 29 14.89 18.61 13.1


7.30 *
21 24 years 50 22.76 28.45 14.8

25 35 years 21 26.50 33.12 13.89

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level
TABLE 9

Impact of Education on Knowledge of Home management of Diarrheal diseases

Education Knowledge Score (%)


Sample F
(n) Mean Mean (%) SD (%) Value

Illiterate 52 12.45 16.56 8.7

Primary/Secondary 18 26.80 33.50 13.5 50.07 *

High school/PUC 30 31.82 39.78 11.7

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level

TABLE 10

Impact of Occupation on Knowledge of Home management of Diarrheal diseases

Occupation Knowledge Score (%)


Sample F
(n) Mean Mean (%) SD (%) Value

Labourer 14 12.73 15.91 7.1


8.88 *
House wife 86 22.65 28.31 15.2

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level
TABLE 11

Impact of Type of Family on Knowledge of Home management of Diarrheal diseases

Type of Knowledge Score (%)


Family Sample F
(n) Mean Mean (%) SD (%) Value

Nuclear 49 23.30 29.13 15.8


2.85 NS
Joint 51 19.30 24.12 13.9

Combined 100 21.26 26.58 15.0

NS : Non-Significant

TABLE 12

Impact of Family Income on Knowledge of Home management of Diarrheal diseases

Family Income Knowledge Score (%)


Sample F
(n) Mean Mean (%) SD (%) Value

< Rs. 1500 53 18.11 22.64 14.8

Rs. 1500-2500 34 23.46 29.32 14.5 5.04 *

> Rs.2500 13 28.34 35.43 12.4

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level
TABLE 13

Impact of Living children on Knowledge of Home management of Diarrheal diseases

Living children Knowledge Score (%)


under 5 years Sample F
(n) Mean Mean (%) SD (%) Value

One 56 21.54 26.92 15.9


0.07 NS
Two+ 44 20.90 26.13 13.8

Combined 100 21.26 26.58 15.0

NS :Non-Significant

TABLE 14

Impact of Family type on Knowledge of Home management of Diarrheal diseases

Family Type Knowledge Score (%)


Sample F
(n) Mean Mean (%) SD (%) Value

Nuclear 42 24.28 30.35 16.1


4.77 *
Joint 58 19.07 23.84 13.6

Combined 100 21.26 26.58 15.0

* Significant at 5 % Level
TABLE 15

Impact of Number of episodes on Knowledge of Home management of


Diarrheal diseases

Number of Knowledge Score (%)


Diarrheal Sample F
episodes (n) Mean Mean (%) SD (%) Value

Nil 28 22.70 28.37 15.2


One time 39 21.05 26.31 16.5 0.24NS
1-2 times 20 20.87 26.09 14.0
Above 2 times 13 19.41 24.26 12.1
Combined 100 21.26 26.58 15.0

NS :Non-Significant

TABLE 16

Statement wise over all assessment of Knowledge on Etiology and Manifestations


N=100
Statements Max Knowledge (%)
No Score
Mean SD
1 Meaning of Diarrhea 1 57.0 50.0

2 The causes for Diarrhea are 1 7.0 3.0

3 Main reason for developing diarrhea 4 21.3 25.7

4 Diarrhea is transmitted through 4 28.0 26.2

5 Causes of food contamination 4 32.5 29.8

6 The dangerous signs of diarrhea 9 30.0 22.5

7 Loss during dehydration 1 30.0 20.0

8 Complications of Diarrhea are 3 21.3 27.8


TABLE 17

Statement wise over all assessment of Knowledge on Home management using


oral fluids and foods

N=100
Statements Max Knowledge (%)
No Score
Mean SD
9 Initial management of Diarrhea at home 3 20.3 28.8

10 Oral fluid intake during diarrhea 1 19.0 4.0

11 Advantages of using Oral rehydration solution 3 26.3 30.4

12 Oral rehydration salt solution is prepared 1 11.0 3.0

13 Frequency of giving Oral rehydration salt 3 7.3 1.1


solution
14 Oral rehydration solution should be used 1 8.0 1.3

15 Precautions to be taken while using Oral 2 1.0 0.7


rehydration solution
16 Oral rehydration salt packets are available 3 50.7 35.9

17 Home available Fluids that can be given 7 21.9 15.0


during diarrhea
18 Breast feeding during diarrhea 1 23.0 4.0

19 Oral food intake during and after diarrheal 1 5.0 1.2


episodes
20 Home based foods that can be given during 5 26.6 17.5
diarrhea
21 Fruits that have been given during diarrhea 4 23.3 21.1

22 Home based foods avoided during diarrhea 4 54.3 45.4


TABLE 18
Statement wise over all assessment of Knowledge on Control measures
and prevention of Diarrhea
N=100
Statements Max Knowledge (%)
No Score
Mean SD
23 Child requires medical aid when there is 3 34.7 24.1

24 Occurrence of diarrhea can be prevented 4 32.5 28.3

25 Water used for drinking at home 1 26.0 4.0

26 Clean water type 1 23.0 4.0

27 Hand washing with soap and water is done 2 25.0 41.7

28 Cleaning of infants feeding utensils is done at 1 64.0 5.0


home
29 Measures used to prevent feco oral contamination 2 27.0 29.7

TABLE 19

Statement wise over all assessment of Knowledge on Etiology and Manifestations

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
1 Meaning of Diarrhea 82.0 40.0 32.0 50.0 5.52 *

2 The causes for Diarrhea are 8.0 3.0 6.0 2.0 3.92 *

3 Main reason for developing diarrhea 30.0 27.7 12.5 20.4 3.60 *

4 Diarrhea is transmitted through 34.0 26.1 22.0 25.1 2.34 *

5 Causes of food contamination 42.0 30.1 23.0 26.6 3.34 *

6 The dangerous signs of diarrhea 42.0 22.0 18.0 15.5 6.31 *

7 Loss during dehydration 6.0 2.0 1.0 0.8 16.41 *

8 Complications of Diarrhea are 37.3 29.8 5.3 12.3 7.02 *

* Significant at 5 % Level
TABLE 20

Statement wise over all assessment of Knowledge on Home management using


oral fluids and foods

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
9 Initial management of Diarrhea at 26.7 31.6 14.0 24.4 2.25 *
home
10 Oral fluid intake during diarrhea 28.0 5.0 10.0 3.0 21.83 *

11 Advantages of using Oral 36.7 33.8 16.0 22.6 3.60 *


rehydration solution
12 Oral rehydration salt solution is 20.0 4.0 2.0 1.0 30.87 *
prepared
13 Frequency of giving Oral 12.0 22.1 2.7 1.1 2.97 *
rehydration salt solution
14 Oral rehydration solution should be 14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using 12.0 9.9 1.0 0.2 7.86 *
Oral rehydration solution
16 Oral rehydration salt packets are 70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be 25.4 15.4 18.3 13.9 2.42 *
given during diarrhea
18 Breast feeding during diarrhea 30.0 5.0 16.0 4.0 15.46 *

19 Oral food intake during and after 10.0 3.0 1.0 0.2 21.17 *
diarrheal episodes
20 Home based foods that can be given 33.2 19.6 20.0 12.1 4.05 *
during diarrhea
21 Fruits that have been given during 29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during 97.0 12.0 11.5 16.9 29.17 *
diarrhea
* Significant at 5 % Level
TABLE 21

Statement wise over all assessment of Knowledge on Control measures


and prevention of Diarrhea

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
23 Child requires medical aid when 43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be 50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home 50.0 5.0 2.0 1.0 66.56 *

26 Clean water type 40.0 5.0 6.0 2.0 44.64 *

27 Hand washing with soap and water 48.0 47.3 2.0 1.4 6.87 *
is done
28 Cleaning of infants feeding utensils 94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral 52.0 20.1 2.0 0.9 17.57 *
contamination
* Significant at 5 % Level
TABLE 22

Statement wise over all assessment of Knowledge on Etiology and Manifestations

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
1 Meaning of Diarrhea 82.0 40.0 32.0 50.0 5.52 *

2 The causes for Diarrhea are 8.0 3.0 6.0 2.0 3.92 *

3 Main reason for developing diarrhea 30.0 27.7 12.5 20.4 3.60 *

4 Diarrhea is transmitted through 34.0 26.1 22.0 25.1 2.34 *

5 Causes of food contamination 42.0 30.1 23.0 26.6 3.34 *

6 The dangerous signs of diarrhea 42.0 22.0 18.0 15.5 6.31 *

7 Loss during dehydration 6.0 2.0 1.0 0.8 16.41 *

8 Complications of Diarrhea are 37.3 29.8 5.3 12.3 7.02 *

* Significant at 5 % Level
TABLE 23

Statement wise over all assessment of Knowledge on Home management using


oral fluids and foods

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
9 Initial management of Diarrhea at 26.7 31.6 14.0 24.4 2.25 *
home
10 Oral fluid intake during diarrhea 28.0 5.0 10.0 3.0 21.83 *

11 Advantages of using Oral 36.7 33.8 16.0 22.6 3.60 *


rehydration solution
12 Oral rehydration salt solution is 20.0 4.0 2.0 1.0 30.87 *
prepared
13 Frequency of giving Oral 12.0 22.1 2.7 1.1 2.97 *
rehydration salt solution
14 Oral rehydration solution should be 14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using 12.0 9.9 1.0 0.2 7.86 *
Oral rehydration solution
16 Oral rehydration salt packets are 70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be 25.4 15.4 18.3 13.9 2.42 *
given during diarrhea
18 Breast feeding during diarrhea 30.0 5.0 16.0 4.0 15.46 *

19 Oral food intake during and after 10.0 3.0 1.0 0.2 21.17 *
diarrheal episodes
20 Home based foods that can be given 33.2 19.6 20.0 12.1 4.05 *
during diarrhea
21 Fruits that have been given during 29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during 97.0 12.0 11.5 16.9 29.17 *
diarrhea
* Significant at 5 % Level

TABLE 24

Statement wise over all assessment of Knowledge on Control measures


and prevention of Diarrhea

No Statement Knowledge (%) t-


Urban Rural Test
Mean SD Mean SD
23 Child requires medical aid when 43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be 50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home 50.0 5.0 2.0 1.0 66.56 *

26 Clean water type 40.0 5.0 6.0 2.0 44.64 *

27 Hand washing with soap and water 48.0 47.3 2.0 1.4 6.87 *
is done
28 Cleaning of infants feeding utensils 94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral 52.0 20.1 2.0 0.9 17.57 *
contamination
* Significant at 5 % Level
Respondents (%)

0
10
20
30
40
50
60
70
80
90
Ur
ba
n

50

Area
Ru
ral

50
17
-2 0

29
21
-2 4

50

Age (yrs)
25
-3 5

21
Illit
e ra
te

52
Pr
im
a ry

Education
7
TABLE 25

Mi
dd
le
Hig

11
hs
ch
oo
l

25
PU
C

5
La
bo
ure
r

Occupation
Ho

14
us
ew
ife
86
Knowledge Score (%)

0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
Etiology and
manifestations

26.33
Home management
using oral fluids and
goods

24.31
Controlmeasures and

Knowledge Aspects
prevention of diarrhea
32.12

Over all
26.58
Figure . 1 : Personal characteristic of Respondents
Urban Rural

51.17
60.00

50.00

36.16
34.46
Knowledge score (%)

40.00

30.00

16.50 13.07
20.00 14.16

10.00

0.00
Etiology and Home management Controlmeasures
manifestations using oral fluids and and prevention of
goods diarrhea

Knowledge aspects

Figure . 3 : Residence wise knowledge on Home management of


Diarrheal diseases among mothers
38.33

33.12
40.00

28.45
35.00

30.00

18.61
Knowledge score (%)

25.00

14.82
20.00

15.00

10.00

5.00

0.00
n l 0 4 5
Urba Rura 17-2 21-2 25-3

Residence Age (years)

Figure . 4 : Impact of Residence and Age on knowledge of children on


in prevention of dental carries
39.78
40.00
33.50
35.00
Knowledge Score

30.00 26.58
25.00 16.56
(%)

20.00
15.00
10.00
5.00
0.00

Illiterate
Primary /
Secondary High school /
PUC Combined
EDUCATION

Figure . 5 : Impact of Education on knowledge of Home management


of Diarrheal diseases
29.1
28.3

30.0
24.1
Knowledge score (%)

25.0 15.9

20.0

15.0

10.0

5.0

0.0
Labourer
House wife
Nuclear
Joint
Occupation Type of family

Figure . 6 : Impact of Occupation and Type of Family on knowledge of


Home management of Diarrheal diseases
40.00
35.43

35.00

29.32
30.00
26.58

25.00 22.64
Knowledge Score (%)

20.00

15.00

10.00

5.00

0.00
< Rs.1500 Rs.1500-2500 > Rs.2500 Combined

Family income per month

Figure . 7 : Impact of Family income on knowledge of Home management


of Diarrheal diseases
35.00
30.35

26.58
30.00
23.84

25.00
Knowledge Score (%)

20.00

15.00

10.00

5.00

0.00
Three / Four Five and above Combined

Family size

Figure . 8 : Impact of Family size on knowledge of Home management of


Diarrheal diseases