Awareness and Knowledge of Mothers Regarding Home Management of Diarrheal Disease for Children Less Than Five

Background: Diarrhea is the major cause of morbidity and mortality among children less than 5 years of age. Adequate rehydration therapy is the most important aspect of management. Home-based Oral Rehydration Therapy (ORT) prevents morbidity and mortality. In this study, our objective was to assess the awareness and knowledge of mothers regarding home management of the diarrheal disease for children less than five years in Gaffer Ibnauf specialized children's hospital. Methods: This study was descriptive cross-sectional in gaffer ibnauf specialized children hospital. A questionnaire was provided to all the mothers admitted by children under five. in gastroenteritis word. Results: A total of 50 mothers60% of mothers have an aware understanding of the term childhood diarrhea. 52% of mothers were aware of signs of diarrhea. 48.0% of mothers aware of the severe symptoms noticed in children with diarrhea. 40.0% of mothers identify the mode of diarrhea spread, and more than halve the mothers had poor knowledge. 52.0% of mothers are aware of the danger of diarrhea. 42.0% of respondents were aware that dehydration is associated with acute loss of water and salt from the body. 52.0% of responders had good knowledge about the management of diarrhea. 64.0% of the respondents were aware of the composition of oral rehydration therapy. 48.0% of the respondents had knowledge of how to avoid some diets (like fat and fiber) in order to prevent diarrhea. Conclusions:The study concluded that mothers had good knowledge about definition, signs, symptoms, main danger of diarrhea, the composition of ORT, importance of fluid and breastfeed continuation, and they had poor knowledge about the diet control types of diarrheal diseases and mode of its transmission.


Introduction
Diarrhea is defined as the passage of unusually loose or watery stool at least 3 times in a 24-hours period. The main problem with acute diarrhea is its ability to cause rapid fluid loss through stools in addition electrolytes [1]. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days [2]. Diarrhea is one of the commonest causes of morbidity among young children in developing countries as well as low income countries. Young children is most vulnerable especially under 5 years of age group. Annually 1.4 to 2.5 million deaths occurs in children under the age of 5 years [3].
According to the World Health Organization (WHO) and (UNICEF), there are about two billion cases of diarrheal disease worldwide every year, and 1.9 million children younger than 5 years of age perish from diarrhea each year, mostly in developing countries. Globally, acute diarrhea is the second leading cause of death (after pneumonia), and both the incidence and the risk of mortality from diarrheal diseases are greatest among children aged less than 5 years, particularly during infancy. Godana and Mengistie [4] WHO European region 12per 1000 live birth and African region 90 per 1000live birth Sudan has one of highest prevalence rates of diarrhea and global acute malnutrition. In one study by Karrar and Omer. (10) The incidence of diarrhea in village near Khartoum was 217 episodes Per100 children per year,28% of children below the age of 5 years in North Sudan had diarrhea in the two weeks prior to the survey, varying From 40% in blue Nile to19% in South Kordofan [1].
Most of the mortalities and morbidities due to diarrhea can be prevented by practicing primary preventive measures such as use of clean water, hand washing, good cooking , exclusive breast feeding, immunization, sanitary disposal of excreta, use of latrines and good sanitary and hygienic [5].
Secondary preventive measures include early recognition of dehydration due to diarrhea and prompt oral rehydration by ORT (oral rehydration therapy), increased & continued feeding of energy dense food in addition to breastfeeding, zinc therapy and the use of appropriate antibiotics for severe cases of diarrhea [6].
With reference to the pivotal role mothers play in management of diarrhea, a joint statement of WHO/UNICEF stressed the need to understand their present attitudes, perceptions and regarding diarrhea [6].
Information on factors playing role in diarrheal disease management, preventive measures and control strategies need to be understood for better planning, organization and implementation of health services within the community In this context, the present study was undertaken to assess the knowledge and awareness of mothers regarding management of diarrhea and to give health education to mothers [7].

Study Design
This study was descriptive cross-sectional hospital bases study

Study Setting
This study was conducted In Gaffaribnauf Specialized Children' Hospital Which Is Located In Khartoum State. The hospital is the one of the well-established in references hospital health in Sudan with large catchments where many patients. The hospital has about 500 beds for different units including out patients, general word (GIT) word, pharmacy, blood bank and laboratory, ultra-sound, (NICU) ,(PICU) unit ,Nursery, pediatric hemodialysis and department of dietitian.

Study Population
The focused groups of the study were all mothers admitted with child in ward of gastrointestinal disease In Gaffaribnauf specialized children' hospital.

Inclusion Criteria
All mothers with their different qualifications (illiteracy ,primary school ,secondary school and university) during the period of the study and were accepted to participate in the study.

Exclusion Criteria
-All mothers who were not accept to participate in the study.

Sample Size and Technique
Total coverage was taken and there number was (5o).

Data Collection Tool
Structured self-administrative questionnaire was being designed by utilization of two purposes as follows: First: to find out the general characteristics of the study sample, it contains basic data related to their general characteristics such as age, qualification, number of children. Second: to examine mother's awareness and knowledge regarding variables which includes questions about knowledge related to management of diarrheal disease at home.

Ethical Consideration
Ethical consideration was approval by Faculty of postgraduate studies and scientific research, Shendi University , then Permission was taken from ministry of health and Gaffaribnauf specialized children' hospital. Verbal consent was taken from participants after explanation the purposes ofstudy.

Data Management and Analysis
The data was coded then analyzed manually by simple statistic technique (master sheet) then used software program (SPSS) version 20 different statistical measure was used (frequency, percentage ,and rate ) then presented form tables.

Abbreviations and Acronyms
World

Discussion
Diarrhea is one of the most common manifestations of illness in infants and children. It is characterized by an increased in fluidity, frequency, volume as well as possible changes in color of faces in comparison with the usual stool pattern of the individual [8]. The treatment based on degree of dehydration. The treatment of acute diarrhea is determined by extent of the illness and the cause, with attention to hydration and dietary needs as appropriate and with prevention as a priority. Initially the priority is to restore and maintain hydration. Oral rehydration is generally attempted before intravenous hydration. The focus is on correcting the fluid and electrolyte imbalances and treating the underlying cause [9]. The current study conducted 50.0 mothers in Gaffaribnauf specialized children hospital and aimed to assess the home management of diarrheal disease for children less than five years.
Baseline data of mothers awareness and knowledge regarding home management of diarrheal diseases for children under five years in this current study indicated that,(42%) of participants are with age between (20-25 years), (36%) of them are more than 37 years , (14%) aged between (26-31years) and only (8%) are between (32-37 years) . According to the qualification, (28%) of mothers were illiterate, (36%) have a primary school degree, about (14%) are secondary school graduate and only (22%) of them graduated from university.
The study revealed that more than halve of participants (60.0%) had a good knowledge regarding understanding the term of diarrhea. Compared with previous study, GabrielOfikwuOgbeyi from Opialu Benue state in Nigeria, only one hundred and twenty six respondents (42.7%) could define diarrhea correctly. more than halve (52.0%) of mothers in this study had a good knowledge in management of acute diarrhea , compared with the previous study, AdanechEshete ,Assela town The study findings revealed that ,out of 390 caregivers, 182 (46.7%) had good knowledge about ORS utilization for acute watery diarrheal disease while 208 (53.3%) of care givers had poor knowledge. Other study Mr.TerefeDodichoDosha in Mareka district, Dawuro zone, SNNPR, Ethiopia level of practice on home management of diarrhea, among respondents knowledge was good in 309 (47.2%) of respondents and poor in 345 of them.
The study revealed that mothers' identification of diarrhea spread is poorly known in about (40.0%) of participants. Compared to previous study Dr. Kiran Kumar Rokkappanavar from House to house survey More than halve of participants lacked adequate knowledge regarding spread of diarrhea .
The study also Showed that the attribution of drinking contaminated water , eating food prepared by unwashed hands in a dirty environment in diarrheal diseases , only knowed about (44.0%) of mothers, compared with the previous study, Dr.SadasibaPadhy ,from M.K.C.G. Medical College (33%) of mothers had good knowledge on sanitary latrine and safe drinking water uses in prevention of diarrheal disease. Other previous study Gabriel OfikwuOgbeyi in Opialu, a rural community in Benue State, Nigeria, More than halve (61.1%) of the respondents had correct knowledge of hand washing after using the toilet.
According to respondents awareness of mean danger of diarrhea, (52.0%) of mothers had good knowledge ,comparied to previous study Dr.SadasibaPadhy in M.K.C.G. Medical College study (34%) of mothers were aware of assessment signs of dehydration.
(42.0%) of the respondents have a good knowledge that dehydration associated with acute loss of water, salt from the body, backache, thirst and acute loss of blood .
The study showed that about (52.0%) (More than halve mothers) had good knowledge about management of diarrhea, compared with previous study Mr.TerefeDodichoDosha from March to April, 2015. inMareka district, Dawuro zone, SNNPR, Ethiopia was used to select 390 households, (46.7%) had good knowledge about ORS utilization for acute watery diarrheal disease management , while 208 (53.3%) of care givers had poor knowledge.
The study showed that majority of the respondents (64.0%) know the composition of oral rehydration therapy , compared with previous study Mr.TerefeDodichoDosha in Mareka district, Dawuro zone, SNNPR, Ethiopia, Only 50 (37.6%) of respondents were aware about the correct amount of ingredients of home-made ORS (salt-sugar solution).
The study showed that majority of respondents (about 48.0%) have a good knowledge that during diarrhea they should modify the diet of child, compared with previous study Mr.TerefeDodichoDosha from Mareka district, Dawuro zone, SNNPR, Ethiopia Most of the mothers, caregivers (70.3%) were in favor of sustained feeding (breast milk, solid and liquid food) during episodes of diarrhea in their children.

Conclusions
Based on the results of current study concluded that most of the mothers had good knowledge regarding understanding term of diarrhea .signs, symptoms, composition of oral rehydration therapy and important of fluid continuation ,Mothers was poor knowledge about the spread, route of transmission of diarrhea and food avoiding during diarrheal diseases.

Conflicts of Interest
There is no conflict of interest regarding the publication of this article.