Knowledge , Attitude and Practice of Using ORS and Household Management of Childhood Diarrhoea

Introduction: Diarrhoea is defined as the passage of three or more loose stools per day. Diarrhoea is one of the leading causes of childhood mortality in India. The objectives of the study were to assess household Knowledge, Attitude and Practice for prevention of Diarrhoea in children through preformed questionnaires. Material and Methods: Four hundred and sixty eight under five children were selected for study by Cluster sampling method. Background information, details of acute diarrhoea and treatment modalities were obtained from mother of the under five children. This was a hospital based study conducted at a tertiary care hospital, from 1st May 2017 to 30th December 2017. Results: About 70 % of the moms were between the age assemble 25-32 years and the vast majority of them were housewives (72%).A greater part (>66%) of the moms were having essential/auxiliary education. Learning with respect to different parts of the diarrhoea and ORS surprisingly extremely unacceptable. In the present examination it is seen that learning in regards to ORS in looseness of the bowels is more in educated mother than uneducated. Three sitting of Educational mediations realized huge enhancement of the middle scores of learning, state of mind and practice expanded from 9, 6, 3 to 19, 14, 8, individually, Conclusion: The household knowledge regarding method of use and preparation of ORS for management of diarrhoea was observed to be lacking in this investigation. More estimates should be taken to enhance this learning and make moms mindful about the planning and utilization of ORS.


Introduction
D iarrhoea is still the second most vital enemy of kids all inclusive, with more than 800,000 under-fi ves kicking the bucket each year as indicated by UNICEF 1 .The primary purposes behind diarrhoeal assaults among youngsters are polluted water, un-healthiness, insuffi cient sanitation, poor cleanliness and absence of vaccination 1 .As per fi gures of the Health Ministry, in India, around 1.2 lakh youngsters younger than fi ve capitulate to looseness of the bowels consistently 1 .This means 328 loose bowels passing consistently per day and 13 consistently per hour.To be seen from 11-23 July, the Health Ministry propelled the across the nation 'Increased Diarrhoea Control Fortnight' (IDCF) 2 under which diff erent exercises have been arranged including visits by Accredited Social Health Activist (ASHA) specialists to every single such family unit which have kids younger than fi ve."ASHA specialists will visit all family units with kids beneath fi ve years old for preparation and diff erent aspect of ORS the ORS.They will clarify its advantages.The signifi cance of this movement is that ORS will be accessible in the family unit when required at the season of looseness of the bowels.Also, all wellbeing offi ces will have ORS corners which will persistently exhibit the best approach to set up the ORS blend.Diarrhoea remains one of the leading global causes of death among children under the age of fi ve years.ORS is simple, highly eff ective, inexpensive and appropriate therapy for diarrheal dehydration and since the introduction of ORT in 1979, there has been a steady decline in deaths due to diarrheal diseases 11 .Aim and objectives of this study were to assess household Knowledge, Attitude and Practice for prevention of Diarrhoea in Children through preformed questionnaires.

Materials and Methods
A cross-sectional descriptive study was carried out to assess the Knowledge, Attitude and Practice for household management of Diarrhoea in Children among mothers who attended the OPD at Institute of Medical Sciences and SUM Hospital Bhubaneswar over a period of eight months (1 st May to 30 th December 2017).A total of 468 mothers attended the paediatric OPD given their willingness to participate in the study.The mothers were enrolled in this study by using convenience sampling who had children of two months to fi ve years of age.Children below two months, above fi ve years and critically ill children needs ICU care were excluded from this study.In present study, data were collected by using a semi structured questionnaire.The knowledge and attitude of the mothers pertaining to ORS was defi ned as awareness about the availability and preparation of ORS and its use in the management of diarrheal diseases.The questionnaire included questions concerning the knowledge about childhood diarrhoea including its household management, role of ORS, method of preparation and also source of information about the household management of diarrheal diseases.

Results
In age insightful conveyance of mother under 25 year is 18.37 % and 25 to multi year is 70 % (   Most extreme no of mother fall under secondary education class (41.02%).In the current examination, the greater part of the respondents had a place with centre and lower fi nancial category 209(44.65%)and 157(33.54)respectively.102(21.79%) respondents had a place with the upper fi nancial class (Table 3).
In these examination 276 moms utilizes boil water for drinking and just 134 utilizes water sanitizer as a wellspring of water.As a preventive part Proper waste transfer by 198 (42.30%), hand washing 176(37.60%)and utilization of sterile restroom is found in 296(63.24%)cases (Table 4).In the present examination it is seen that learning in regards to ORS in looseness of the bowels is more in educated mother than uneducated gatherings.The consequences of training and learning are delineated in (Table 5 and 6) as pursues, No formal instruction 12(22.22%),tertiary 102(86.44%).Responses on the job of ORS were that it "diminishes water misfortune in looseness of the bowels," "decreases diarrheal frequency" and "renews water and electrolyte losses.Other diff erent parts of ORS Knowledge i.e. correct preparation, Quantities of ORS, damage of giving excessively ORS and when to stop ORS is likewise better in well-educated mothers (Table 5 and 6).
As many as 103 (22%) members knew how to plan ORS legitimately and could show the strategy for planning ORS (Table 5) Essential substitution treatment for the diarrhoea at home given by number of moms as pursues 186(39.74%)waters, sugar salt arrangement 192(41.02%)and ORS 236(50.48%).Other adjuvant liquid treatment given by the respondents are Pomegranate juice 78(16.66%)and coconut water 122 (26.40%) as shown in Table 7.
Basic learning in regards to cause, spread and counteractive action of the runs was extremely disappointing in our examination.Great learning in regards to cause, spread, and anticipation is 17.73%, 16.23% and 16.66% separately just (Table 8).Of the aggregate members, 147 (31.41%) had learning in regards to hand crafted ORS; generally utilized natively constructed ORS by members were kanji, sugar and salt arrangement, buttermilk with salt and daal ka pani (lentil soup).Reactions of the investigation members to the survey with respect to treatment are outlined in Figure 1.Maximum number of mothers utilizes probiotics 64 %, Ofl oxacin + metronidazole 57 % and Zinc 61%.Another vital perception in our examination in regards to fi rst choices mediation to be taken amid looseness of the bowels is Sugar Salt Solution 88 %, Antibiotics 84%, ORS 70% and just water 22% (Figure 2).

Discussion
Diarrhoea stays one of the main worldwide reasons for death among youngsters younger than fi ve years.ORS is straightforward, exceedingly compelling, economical and suitable treatment for diarrheal drying out and since the presentation of ORT in 1979, there has been an unfaltering decrease in passing because of diarrheal ailments 1 .Diarrhoea is the frequent (typically characterized as at least three times in multi day) passage of liquid or soft stool 2,3 It is the most widely recognized clinical indication of gastrointestinal infection and the second driving reason for death on the planet    89 have detailed that 65.7% of the members thought about ORS, and the mindfulness was more in literates when contrasted with uneducated people.Cantered wellbeing instruction of moms has been appeared to enhance their insight and practice in the utilization of ORS in the diarrhoea 9,10.According to NFHS, in India 43% of ladies thought about ORS pockets yet just 26% at any point utilized it 910.Similar results were obtained in the study by Widarsa KT et al. 10,11 Though a large portion of the ladies knew about the ORS powder, just third of them knew the correct method for utilizing it.This extent is comparative when contrasted with the information accessible from NFHS III in which it is 30% 11,12 .Knowledge in regards to the preventive measures is likewise insuffi cient among the moms.Over 60% of them couldn't recognize even a solitary measure from the choices gave to them.To strengthen the prior articulation, centred wellbeing training of moms in such manner might be of helpful 9,10,12,13 .In our examination, about 45% of the moms were of the misguided judgment that getting teeth is the explanation behind advancement of the runs.The greatness of this misguided judgment is likewise archived in diff erent examinations directed in India and in addition Iran, in these investigations the size is 64% and 48% respectively 13,14,15.A not very many moms had information in regards to the reason for looseness of the bowels.Just 17% of them gave rectify answer i.e. disease as the reason for the runs.Cabatbat, et al in their examination led in Philippines reports 77%, 34% and 23% moms recognizing dangerous drinking water, inability to wash hands in the wake of pooping, and subsequent to taking care of loose motion separately as regular purposes behind diarrhoeal diseases 14,15,16 .Knowledge with respect to the eating regimen to be pursued amid a scene of loose bowels is likewise restricted among the moms.Almost 40 % of the members said that eating routine should be limited amid the assault of looseness of the bowels.These perceptions are steady with the perceptions made in research directed by Suman, et al in Puducherry 16,17 .
In an investigation directed in south east area of Iran, Khalili, et al announced 81% and 58% moms recognizing risky water and unclean hands individually as reasons for diarrhoeal illness 17,18 .For children on normal family diet, regular solid food and fl uid intake was increased by (13.9% and 18.4%) and (7.6% and 16.5%) of the care-givers respectively.Continuous breastfeeding was practiced by all mothers (100%) while continued feeding with solid food and increased fl uid was given in 81.00% and 61.30% respectively, in Yala community (Okoro, 2000).Diff erent parts of network administration of youth diarrheal ailment, of specifi c concern are dietary limitations, utilization of anti-infection agents and acknowledgment of threat signs that require looking for expert help outside home (McLennan, 2002) 17,18 .About (11.1% and 22.7%) and (28.5% and40.3%) of the contemplated guardians, each confi ned greasy/ slick sustenance and powdered drain separately.In the meantime around 15.4% and 9.3% of them confi ned equation feed to their children 17,18 .Though moms knew about a few signs of dehydration, the level of learning about the real indications of lack of hydration because of looseness of the bowels was exceptionally poor.The examination directed in Tanzania and Indonesia likewise found comparative results 18,1919,20 .Sustaining ought to be proceeded except if generally minimal particular condition needs dietary change.In this study 63% were having good knowledge on sanitary latrine uses in relation to goo preventive measure of diarrhoea.About the proper source of drinking water 63% mothers had good knowledge and rest 26% and 11% were having average and poor knowledge respectively.Regarding preparation of ORS 30.98% mothers had good knowledge, 47.22% mothers had average knowledge and rest 21.79% had poor knowledge as depicted above.Similarly, as mentioned above 30.98%mothers were able to mention all the steps for the correct and complete preparation of ORS solution which is Similar to the other studies which found approximately 20% to 50% of the mothers were able to prepare ORS solution correctly and completely 20,21,22,23 .This may be because of moms' absence of related knowledge, an absence of legitimate training about the concerned issues and their ethnicity itself 23,24 .With respect to utilization of ORS, maximum moms were inadequate with regards to learning of giving the right sum (67%).Conversely, the utilization of anti-infection agents, antifungals, anthelminthic and antidiarrheal drugs is across the board in diarrhoea 24,25,26,27 which is very like our present study (67%).The signifi cance of breastfeeding amid loose bowels has been suffi ciently highlighted by Zwisler G et al 26,27 .A examine by Christopher S Yilgwan et al on predominance of the runs sickness and hazard factors indicated coordinate connection of pervasiveness of looseness of the bowels with low training and low fi nancial status of mothers 27,28 .It is necessary to strengthen parents' knowledge about diarrhoea and its treatment during hospital consultations, but also during health campaigns and through the media 27,28.

Conclusion
It is very sensible to presume that the learning with respect to the planning and utilization of ORT by guardians in eastern Odisha region is inadequate.This investigation uncovers uncontrolled utilization of superfl uous prescription i.e. anti-infection agents, probiotics and numerous all the more separated from the imperative ones like zinc and ORS.Preparation of Sugar Salt Solution and ORS should be demonstrated properly at health centres as a small group.Proper use of ORS in a diarrhoeal episode along with early recognition of dehydration and continuation of breastfeeding with other dietary treatment should be focused upon.

Fig 1 :
Fig 1: Showing drugs used for treatment of diarrhoea

Fig 2 :
Fig 2: First choice of intervention by parents during a child's diarrhoeal episode

Table 1 :
Age wise Distribution of mother's Population in the study

Table 4 :
Distribution of Mothers according to preventive measures has taken against diarrhoea.

Table 5 :
Correlation between mother's education and their knowledge regarding ORS

Table 6 :
Knowledge of mothers regarding diff erent aspects of ORS

Table 7 :
Distribution of respondents by Types of Fluid Given at Home, feeding pattern and restricted foods

Table 8 :
Knowledge about cause, spread and prevention of diarrhoea of the respondents 3,4,5.Unfortunately, particularly in developing nations, because of absence of legitimate information in mother, with respect to accessibility, planning and utilization of ORS, this objective is a long way from accomplished.Improper sterile conditions, risky drinking water and absence of cleanliness are likewise in charge of not ready to diminish the occurrence of diarrhoeal ailments.The outcomes are fairly unique in relation to the investigation completed by Sultana A. et al. in Rawalpindi who discovered that 60% mothers were found to have satisfactory learning in regards to the strategy for ORS readiness though a similar data was seen to be fractional and defi cient among 35.94% and 4.06% respondents albeit 61.87% moms were having a place from centre social class56.It was found in an instructive intercession contemplate in Nepal by Mukhtar Ansari et al that Education realized huge enhancement in information, state of mind and practice at fi rst, second and third development.The middle scores of information, disposition and practice expanded from 14, 7, 6 to 26, 9, 13, individually, because of rehashed intercessions.Besides, intercessions reinforced the connection between information, mentality and practice 67 .Study directed by Rasania et al. 78 have detailed that 69.8% of the members knew with respect to the job of ORS in looseness of the bowels and just 38.7% knew how to plan ORS legitimately.Dhadave et al.