Home based management of acute diarrhoeal disease in an urban slum of Aligarh- an appraisal

N.Faizi,M.S.Shah1, A.Ahmad1, N.Khalique3,S.Afzal4,M.A.Ansari2, Z Khan3

Dr. M. Salman ShahAssistant Professor

Department of Community MedicineJawaharlal Nehru Medical College

Aligarh Muslim University, Aligarh.

Introduction Globally, Diarrhoeal diseases are a

major cause of morbidity and mortality accounting for 4 billion cases and 2 million deaths annually.

According to the recent estimates for 2004 diarrhoeal diseases accounted for about 17% of under-five mortality and 3% of neonatal deaths.

17%

19%

4%8%3%3%

10%

37% Diarrhoeal Diseases

ARI

Measles

Malaria

HIV/AIDS

Injuries

Non communicable ds

Neonatal causes

Causes of Death of Children under- five years of age

Source :WHO- 2003

Use of ORT became the highest priority in diarrheal disease control efforts.

1.07 million cases in 2005 . (4.07 m in 1980)

Objective To know the knowledge, attitude,

practice regarding diarrhoea in children under-five years of age.

Methodology

The study was undertaken in urban slum (Shahenshabad) of Aligarh District in June & July 2009.

Aligarh DistrictShahenshabad

Households 300

Total Population (2100)

Children (upto 60 months)

(280)

101

The mothers of all the 250 children uptill the age of 60 months, suffering from diarrhoea with atleast one episode in the last 2 weeks prior to the day of interview were included in the study.

Tool of Study: Information was gathered on a predesigned and pretested questionnaire.

Mothers of the child were interviewed for :

Danger Signs Home available fluids preparation of ORS feeding pattern health seeking behaviour during

diarrhoeal illness. Case of diarrhoea: Children up to the age

of 60 months having passed 3 or more loose stools in a day or passed blood or mucous even once over a period of 2 weeks preceding the date of interview.

Consent & Ethical Consideration Only those mothers who gave

consent were included in the study Wherever known that there is

deficiency in the knowledge and practice and the behaviour, it was overcome by behavioural change communication

Results

Socio-demographic profile of mothers

• Approximately 80% of the mothers were illiterate.

• Per capita income was less than Rs.1500.

• Availability of safe water was poor. • Water was stored in buckets which

remained open. • Practice of defecation in fields was

near universal.

Prevalence of Diarrhoea cases in under-five children

Age group No. of diarrhoea cases Prevalence (%)

0-365 days

(n=84)

37 44%

365dys – 60 months (n=196)

59 30%

Total

(280)

101 36%

Aware of Danger Signs?

Many watery stools

Repeated vomiting

Fever lethargy Blood in stools

Marked thirst/ Poor feeding

Reduced urine output

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

DO YOU KNOW ABOUT ORS? HOW TO PREPARE ORS?

46.5

53.5

Yes

No

Correct method Incorrect method0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

KNOWLEDGE ABOUT HAF ? WHAT CAN BE GIVEN ?

38.7

61.3

Present

Absent

Salt

suga

r sol

utio

n

Daal k

a pa

ni

Dalia

Khich

di

Rice

wat

er0.00

10.00

20.00

30.00

40.00

50.00

60.00

Feeding pattern during diarrhoea

Babies on exclusive breast feeding (n= 25)

Continued 18(72%)

Interrupted 7 (28%)

Feeding pattern during illness (n=225)

Continued 128(57%)

Withheld 97(43%)

Health Seeking BehaviorUse of Medical Services

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Types of Medical Services availed

Nearb

y che

mist

Vaidh

/ Hak

eem

Quack

Use o

f lef

t ove

r dru

gs p

resc

ribed

ear

lier

Gener

al p

ract

ition

er

Child

spe

cialis

t

Gover

nmen

t hea

lth w

orke

r (RHTC

)

No Tr

eatm

ent

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Conclusion &

Recommendations

The study highlights that the knowledge and practice of mothers is not adequate.

If health education is correctly provided to the specific target group (mothers and health care providers) regarding early home based case management of childhood diarrhoea, things would improve.

Serious analysis of the reasons for a this disappointing situation should be done, although the significant efforts made over the past 25 years to promote proper home base management of diarrhoea in children.

Thank You!