Impact of knowledge and perception of caregivers on management practices of Diarrhoea among children under-five years of age in West Seme location, Kisumu county, Kenya

Abstract

Diarrhoea remains a major cause of morbidity and mortality among children aged under-five (< 5) years old worldwide. Of the five million annual deaths among this age group, one fifth is due to diarrhoea. Management of diarrhoea at home is one of the key household practices targeted for enhancement of community management of childhood diarrhoea that may result in substantial reduction in child mortality. Appropriate home management is critical in management of diarrhoea. In Seme Sub-County diarrhoea is the 4th leading cause of death among children < 5years old and the factors that influence this sad state is not known. Most studies in this Sub-County have focused on prevalence of diarrhoea rather than the possible causes of this high prevalence and mortality. The aim of this study therefore was to determine the impact of knowledge, perception and practice of caregivers on management of diarrhoea at home among children less than five years old. The specific objectives were; To determine knowledge of caregivers on causes of diarrhoea and signs of dehydration, to determine perception of caregivers on severity of diarrhoea, to determine home management practices of caregivers during diarrhoea and to determine association between knowledge and perception and home management practices. Data was collected from 394 caregivers with children under-five years of age. A cross-sectional design was employed. The respondents were sampled using systematic random sampling from villages in the study area. The caregivers were interviewed using structured questionnaire at the households. Four focus group discussions were held at Arito Health Centre to enhance the findings from the interviews. The data was analyzed using logistic regression and Chi square test to examine predictors of appropriate management of diarrhoea at home among children < 5 years. The strength of association is expressed as Odds ratio (OR) and 95% confidence interval (CI) with statistical significance set at p< 0.05. Out of the 394 caregivers, 79.9% knew the causes of diarrhoea while 89% had no knowledge on the danger signs of dehydration. On home management practices during diarrhoea, 240 (60.8%) had poor knowledge and 154 (39.2%) had good knowledge. Caregivers’ knowledge that diarrhoea is caused by germs was significantly associated with management of diarrhoea at home by giving water, OR=3.7 (95% CI= (1.283-11.100) p =0.042 or continued feeding OR=1.4 (95% CI= (1.264-1.297) p =0.04. The caregivers who reported that diarrhoea was caused by teething were 3.5 times more likely to continue feeding the child than those who thought that diarrhoea is caused by taboo. The caregivers’ knowledge on the signs of dehydration had influence on management of diarrhoea at home. Those who knew the signs of dehydration and gave ORS were; (68.2%; x =7.923, p value= 0.022), water, (65.1%; x= 10.672, p value=0.001), and continued feeding (73.3%; x=6.631, p value=0.038). Perception of caregivers about severity of diarrhoea was significantly associated with appropriate home management of diarrhoea. Those caregivers who perceived diarrhoea to be severe were 2.1 times more likely to manage the child using ORS (p =0.008) and 4.2 times more likely to manage diarrhoea by giving water (p =0.048). From the FGDs majority of caregivers expressed their feelings that the major cause of death among children < 5 years of age was diarrhoea and that diarrhoea management was dependent on the type and its perceived severity. The study concluded that most caregivers in West Seme have the right knowledge on causes of diarrhoea (79.9%). However, majority cannot recognize danger signs of dehydration (89.9%). The study found that right knowledge on the causes of diarrhoea and danger signs of dehydration, determine appropriate home management practices and caregivers whose perception on severity of diarrhoea is correct are more likely to manage diarrhoea at home appropriately. The significance of this result is that it can be used for planning and decision making at the ministry and at the local level to educate caregivers on appropriate management of diarrhoea at home in order to alleviate the consequences and mortality due to diarrhoea in the location. The study therefore recommends that; healthcare providers should educate caregivers on the risk factors of appropriate home management practices. Community based meetings with the local residents can be used to create awareness on the causes of diarrhoea and danger signs of dehydration. A further study is needed to determine the number of children < 5 years with dehydration who can be saved by practicing appropriate home management.