Original Article
Indian J Pediatr 1999; 66 : 499-503
I
Attitude and Practices Regarding Diarrhoea in Rural Community in Chandigarh V. Bhatia, H.M. Swami, M. Bhatia and S.P.S. Bhatia
Department of Community Medicine, Government Medical College, Sector 32, Chandigarh Abstract. The present study on diarrhoea, its prevalence, practices and awareness of mothers was conducted in 120 randomly selected households in the rural area of Chandigarh during monsoons in 1996. Inspite of access to safe drinking water and latrines in 83% and 74% of the households in the village respectively, the prevalence rate of diarrhoea in 181 under five children was observed to be 23.2%. Majority (88.1%) of children had treatment for diarrhoea whereas only half (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 its preparation. A large number of respondents implicated a variety of food items responsible for diarrhoea and restricted them during the episodes. (Indian J Pediatr 1999; 66 : 499-503)
Key words: Diarrhoea; Treatment; Prevalence. Diarrhoea is a major cause of morbidity and mortality in children, accounting for about 4 million deaths worldwide and responsible for nearly 28% of mortality in underfives1. Oral rehydration therapy (ORT) is a boon to mankind and is hailed as the single most important medical advancement of this century2. However, ORT is able to prevent only I million deaths |. Various socio-economic factors like illiteracy & poverty, environmental factors like hygiene & safe water, faulty feeding practices and lack of availability & utilisation of health facilities continue to be major hurdles in reducing the prevalence of diarrhoeal diseases. Besides these factors, indiscriminate drug management during episodes of diarReprint requests : H.M. Swami, Prof & Head, Department of Community College Sarai Building, Sector32B, Chandigarh-110047.
rhoea by health care providers, and poor knowledge of mothers regarding prevention of diarrhoea contributes to the high prevalence of diarrhoea. Therefore, a study was conducted in a rural community of Chandigarh to find out the prevalence and practices regarding diarrhoea in underfive children. METHODS AND MATERIALS The study was conducted in rural area of Chandigarh over a period of three months during the rainy season of 1996. The surveyed village was the field practice area of the recently established Department of Community Medicine. The village had a sub-centre, two doctors of indigenous system and two unqualified practicing doctors. The population & literacy rate of the
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village was 8000 & 39% respectively1. A list of households having children under 60 months of age was prepared and 120 households were selected randomly. Information was recorded on a pretested & predesigned questionnaire. Mothers of the underfive children were interviewed regarding any episode of diarrhoea in past two w,eeks, treatment given to the suffering child and ORT. Knowledge of the mothers regarding the causation and prevention of diarrhoea, preparation of O1KS and m a n agement of diarrhoea was also assessed. A case of diarrhoea was a child upto the age of 60 months having passed 3 or more loose stools in a d a y or passed blood or mucus even once over a period of 2 weeks preceding the date of interview.
RESULTS Most (83%) of the households had access to drinking water through taps and provision of sanitary latrines (72%). Out of 181 children upto the age of 60 m o n t h s in the study, 42 (23.2%) had atleast one episode of diarrhoea in the 2 weeks preceding the day of interview. Nearly one-third of infants were suffering from diarrhoea (Table 1). As far as medical advice was concerned 37 (88.1%) were taken to a doctor. Nearly three-fourth were prescribed one or the other medicine to control diarrhoea while ORS was given to only 54.8% of the suffering children (Table 2). Half of the children h a d d u r a t i o n of diarrhoea between 3-5 days. Five children (11.9%) were suffering on the day of the interview (Table 3). The study observed that 78 (65%) mothers were aware about different reasons such as dirty food (51.30/o) and flies (43.3%) as the major factors causing diarrhoea. Coverage of food items, proper storage of
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water, washing hands were known to them to prevent the occurrence of diarrhoea. They were also aware that diarrhoea can be dangerous and can lead to death (81.7%) and the cause of death is loss of fluid from TABLE1. Prevalence of Diarrhoea Cases in Under Five Children Age group of children (n = 181) 1-12 months (n = 54) 12-60 months (n = I27) Total
Total no. of Prevalence children suffering (%) from diarrhoea 18
33.3
24
18.9
42
23.2
TABLE2. Management of Diarrhoea in Under Five Children Diarrhoeal management (n = 42) (a) Medical advice taken (b) Drugs given to child (c) ORT taken
Yes
No
37
7
(88.1)
(11.9)
31 (73.8) 23 (54.8)
6 (26.2) 19 (45.2)
( ) Parenthesis denotes percentages TABLE3. Duration of Diarrhoea No of diarrhoea cases
Percentage
<2 3-5 6-10 Not recorded at time of study
10 21 6 5
23.8 50.O 14.3 11.9
Total
42
100.0
Duration (days)
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501
TAsL~ 4. Knowledge of Mothers Regarding Occurrences of Diarrhoea Diarrhoea
No. of respondents
% age
78 40 13 12 13 11
65.0 51.3 16.7 15.4 16.7 14.1
(11=120) (n=74)
74 45 22 2 5
61.7 60.8 29.7 2.7 6.7
(3) Affects growth & development : Yes (n=120)
49
40.8
(4) Can cause death
(n=120)
98
81.7
(n=120)
59 30 48 26 18 17
49.2 50.8 81.3 44.1 30.5 28.8
(1) Reasons of diarrhoea : Aware Dirty food Flies Dirty water Dirty hands\nails Others (2) Relationship with season : Yes Summer Rainy season Winter Summer & rainy season
(5) Preventive measures against diarrhoea : Aware (a) Proper storage of water (b) Proper covering of food (c) Washing of hands (d) Proper disposal of waste (c) Others
(n=120)
(n=78)
(n--59)
the body (64.2%) or weakness (2.5%) Table 4. Fruits, pulses, and sweets were considered to be c o m m o n food items that cause diarrhoea and 56 (46.7%) mothers emphasised the n e e d to restrict food items like chapari, milk and pulses during diarrhoeal episodes. (Table 5). Mothers preferred to continue breast feeding d u r i n g episodes of diarrhoea in 88.3% of the cases. Awareness of mothers regarding ORS was observed in 86.7% but only 22 (18.3%) could tell the correct method of its preparation. Major source of informarion of ORS was health workers (51.9%) and television (20.2%). Majority (50.8%) knew about salt sugar solution but only 36
(30.0%) knew the correct method of preparation. In the present survey, 41.7% mothers said that diarrhoea can be m a n a g e d at home, whereas, one-third of them responded that health care provider should be contacted immediately when diarrhoea occurs b u t in practice, 50.8% contacted health workers w h e n the condition of the child w o r s e n e d (Table 6) after the initial selfmanagement.
DISCUSSION In the present study among under five children in the rural areas, prevalence of diarrhoeal diseases d u r i n g the rainy months was recorded as 23.2%. A higher preva-
502
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Ience of 49.1% in Varanasi 4 and 33% in Mirzapur 5 d u r i n g rainy m o n t h s was also reported among children. Although, Chandigarh has a strong health infrastructure at all the three levels of health care 6yet almost every fourth child was suffering from diarrhoea. It could be due to lack of awareness among mothers regarding hygienic conditions, incorrect feeding practices and inap-
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propriate storage of drinking water. A higher prevalence during infancy as observed in the study, m a y be due to factors like teething, initiation of crawling & walking and introduction to bottle feeding. In the present study, 86.7% mothers started breast feeding behaviour during episodes of diarrhoea. In another nation-wide study, 81% of the mothers desired to continue
TABLE5. Beliefs and Practices of Mothers in Relation to Diarrhoea Beliefs and practices
No. of respondents
% age
(n=120) (n-=49)
49 7 14 17 6 9
40.8 14.3 28.6 34.7 12.2 18.4
(2) Foods restricted during diarrhoea : Yes (n=120) Chapati (n=56) Pulses Milk Egg Fruits Others
56 20 7 7 5 5 15
46.7 35.7 12.5 12.5 8.9 8.9 26.7
104 63 65 14 6 27
86.7 60.6 62.5 13.5 5.8 26.0
(1) Foods responsible for diarrhoea : Yes Sweets Pulses Fruits Heavy foods Others
(3) More fluids during diarrhoea : Yes Lemon water PuL~s\ rice water Light tea Lassi Others
(n=120) (n=104)
Txm.E6. Awareness Regarding ORS Amongst Mothers Awareness (1) Aware about ORS
Total no. of respondents (n = 120)
% age
104
86.7
(2) Correct preparation of ORS
22
18.3
(3) Preparation of Salt Sugar Solution Correctly known
36
30.0
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breast feeding after the onset of diarrhoea 7. The s t u d y also revealed that a n u m b e r of mothers (42%) were aware regarding management of diarrhoea at home, yet almost all took treatment from a doctor. Tendency to use medicines indiscriminately b y the doctors in the village was also observed in the study. In Mirzapur district, 97.6% of diarrhoea cases were treated with capsules, tablets and mixtures s. Little stress is given on oral rehydration therapy (ORT) b y the health care providers. Majority of diarrhoea cases in underfives are caused b y viruses s and they d o not require any drug therapy except ORS. Drugs have a very limited role to play in the management of diarrhoea 9. Inspire of a g o o d k n o w l e d g e of mothers a b o u t ORS, less than one-fifth of them could prepare ORS correctly. Similarly, majority of mothers k n e w about salt sugar solution b u t less than a third could tell its correct preparation. Implicating a n u m b e r of food items like sweets, pulses, fruits etc. in diarrhoea and restricting items like chapati, pulses, milk etc. during the episodes was also reported b y the mothers in the study. Restriction of milk and other feeds besides complete restriction were also reported in the Srinagar study 1~ A sound knowledge about appropriate feeding practices is essential to break the vicious cycle of diarrhoea and malnutrition. Majority of mothers in the present study were unaware about the measures required to prevent diarrhoea. This could be the
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contributing factor, causing a high prevalence rate of diarrhoea in rural areas of Chandigarh, inspite of availability of safe drinking water to over three-fourth households and existence of a strong health infrastructure. In conclusion, mothers should be educated regarding hygienic practices, correct feeding pattern, ORT and a b o u t avoiding irrational usage of drugs during diarrhoea. REFERENCES
1. UNICEE The state of worlds children- A sununary. 1990 : 1-14. 2. Editorial. Water with sugar and salt, Lancet, 1978; 11 : 300. 3. Census of India. 1991. Series 28, Chandigarh. 4. Bhattacharya R, Kaur P. Epidemiological correlates of diarrhoea in a rural area of Varanasi. Ind Community Med 1989; 2 : 7982. 5. Mishra CP, Kumar S e t al. A study on some diarrhoea related practices in Urban Mirzapur Ind J Public Health 1990 : 34 (1). 6. Report of special committee. Chandigarh 2020, socio-economic planning project health services 1995. 7. WHO. A manual for the treatment of acute diarrhoea WHO/CDD/SER/802 Rev. 1984 : 1. 8. Saluja A, Mittan SK et al. Role of enteroinvasive E. coli in acute invasive diarrhoea. Ind Pediatr 1986; 25 : 422-427. 9. Viswanathan H, Rohde JE. Diarrhoea in rural India, Vision books, 1990, p-50. 10. Buch NA, Hassan M, Bhat IA. Parental awareness and practices in acute diarrhoea. Indian Pediatr 1995; 32 : 76-79.
