Saramma K T

A STUDY TO ASSESS THE KNOWLEDGE OF
MOTHERS OF UNDERFIVE CHILDREN REGARDING
HOME MANAGEMENT OF DIARRHOEAL DISEASES
IN SELECTED AREAS OF HASSERGHATTA-PHC,
BANGALORE
by
SARAMMA T. T.
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment
Of the requirements of the degree of
Master of Science in Nursing
in
Community Health Nursing
Under the guidance of
Prof. Arul Mani Esther Rani. TP M.Sc (N)
DEPARTMENT OF COMMUNITY HEALTH NURSING
EAST WEST COLLEGE OF NURSING
AFFLIATED TO RAJIV GANDHI UNIVERSITY
OF HEALTH SCIENCES, KARNATAKA
BANGALORE
2006
i
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled a study to assess the
knowledge of mothers of underfive children regarding home management
of diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore
is a bonafide and genuine research work carried out by me under the
guidance of Pro. Arul Mani Esther Rani, Head of Department of
Community Health Nursing, East West College of Nursing, Bangalore.
Date: Saramma T. T.
Pace: Bangalore East West College Of Nursing
Bangalore
ii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled a study to assess the
knowledge of mothers of underfive children regarding home management of
diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore a bonafide
research work done by Saramma T. T. in partial fulfillment of the requirement for
the degree of Master of Science in Nursing (Community Health Nursing).
Date: Signature of the guide
Place: Bangalore Name: Prof. Arul Mani Esther Rani
Designation and Department
Head of the Department
iii
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled a study to assess the
knowledge of mothers of underfive children regarding home management of
diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore is a
bonafide research work done by Saramma T. T. under the guidance of
Prof. Arul Mani Esther Rani, Head of Community Health Nursing Department.
Seal and Signature of HOD Seal and signature of the Principal
Name: Prof. Arul Mani Esther Rani Name: S. Chitra
Date: Date:
Place: Bangalore Place: Bangalore
iv
COPYRIGHT
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/thesis in
print or electronic format for academic/research prupose.
Date: Signature of the Candidate
Place: Bangalore Name
Rajiv Gandhi University of Health Sciences, Karnataka
v
ACKNOWLEDGEMENT
This study was undertaken and completed under the guidance of
Prof. Arul Mani Esther Rani. M.Sc (N) I am grateful to her for the constant
guidance, support, and encouragement provided for the successful completion of
this study.
I am grateful to Prof. S. Chitra, Principal of East West College of Nursing
for the guidance, support, and expertise suggestions contributed throughout the
conduction of this study.
My sincere thanks go to Ms. Prabavathy. M. Sc (N) for her valuable
suggestions and support rendered for the completion of this study.
My sincere thanks go to Prof. Vimalakumari P. G. M.Sc (N) for providing
expertise suggestions and support for the completion of this study.
I thank Dr. Dinesh for the guidance and valuable suggestions provided
during the conduction of the study.
I am extremely grateful to Prof. H.S. Surendra (statistician) for his
valuable suggestions, constant guidance and support rendered throughout the
conduction of the study.
I express my gratitude and thanks to all the experts who have validated the
tool and for providing expertise suggestions and remarks.
I also thank all my friends and the members of my family for the
cooperation and help rendered for the completion of this study.
Date: Signature of the Candidate
Place: Name: Saramma T.T.
vi
LIST OF ABBREVIATIONS USED
(In alphabetical order)
HAF: Home Available Fluids
HRS: Home made Recommended Solution
ORS: Oral Rehydration Solution
ORT: Oral Rehydration Therapy
SSS: Sugar-Salt Solution
vii
ABSTRACT
A study to assess the knowledge of mothers of underfive children regarding home
management of diarrheal diseases in selected areas of Hasserghatta-PHC,
Bangalore.
Objectives of the study
1. To assess the knowledge of mothers of underfive children regarding home
management of diarrhea.
2. To compare the knowledge of mothers of underfive children between rural
and urban slum area.
3. To associate the knowledge of mothers of underfive children regarding
home management of diarrhea with selected demographic variables.
4. To develop a health information material based on study findings.
The tool selected for data collection was structured interview schedule. Eleven
experts validated the tool. Reliability of the tool established by using split half
technique. The reliability coefficient of the test for knowledge scale was found to
be r11 = 0.9235 and validity coefficient as 0.9610.
The research approach adopted for the study was a descriptive study. The
study was conducted on a total of 100 mothers comprising 50 from Hassarghatta
rural area and 50 from Dasarahalli urban slum, Bangalore. Data was collected
from 19th September 2005 to 15th October 2005. A pretest on knowledge of
viii
mothers regarding diarrhea was also administered on the first and second day for
both the groups.
The data obtained were analyzed based on the set of objectives of the study
using descriptive and inferential statistics.
Major findings of the study
Findings related to sample characteristics.
Majority of mothers 50% belonged to the age group of 21-24 years, 52%
illiterates, 86% housewives, 97% of mothers were Hindus, 49% belonged to
nuclear family, 53% had income less than rupees 1500 per month, 40% of
mothers belonged to a family size of five and above. A majority 41.7% of the
families had two under-five children. A majority of the subjects 61% did not have
any previous exposure to any media. Nearly one-fourth of the underfive children
were infants 24.7% and 51.4% were males.
Findings related to demographic variables.
The mean knowledge score of rural area mothers was 38.33%, which was
higher than in urban slum area of 14.82%.
Mothers more than 25 years of age had higher mean knowledge score of
33.12% than mothers aged 17-20 years 18.61%.
Mothers belonging to nuclear family had a slightly higher mean

knowledge score of 29.13% than joint family 24.12%, but was found to be
non significant at 5% level.
The mean knowledge score of literate mothers 37.42% was higher than
that of illiterate mothers 16.56%.
The mean knowledge score of housewives 28.31% was found to be higher
than labourers 15.91%.
ix
The mean knowledge score of mothers having one underfive children was
found to be slightly high 26.92% than having two underfive children
26.13%, but was found to be non significant at 5% level.
Families having a monthly income of more than rupees 2500 per month
had a mean knowledge score of 35.43%, which was higher than having
income of less than rupees 1500 per month 22.64%.
The mean knowledge score of mothers exposed to media was higher
(36.44%) than that of not exposed to any media (19.88%).
Findings on knowledge assessment related to home management of
diarrhea
Findings related to causes, signs and symptoms, and complications:
On the whole mothers had a highest mean knowledge score regarding
meaning of diarrhea 57% (i.e. at least 3 watery stools per day) (rural 82%,
urban32%) followed by causes of food contamination 32.5% (rural 42%, urban
23%). The knowledge on the exact cause of diarrhea i.e. microorganisms was
only 7%.
The mean knowledge score on diarrhea transmission including contaminated
water, contaminated food, and poor environmental sanitation was 28% (rural
34%, urban 22%).
The mean score on reason for developing diarrhea including bottle-feeding
was 26% and water storage in a wide mouthed container was 8%.
Regarding dangerous signs of diarrhea the overall mean score was 30%
(rural 42%, urban 18%). The mean knowledge score of the main signs were
dehydration 16%, at least 8 watery stools was 39%, and fever 19%. Regarding
complications of diarrhea the overall mean score was 21.3% (rural 37.3%, urban
x
5.3%). Urban slum mothers had poor knowledge regarding death 0%,
malnutrition 10% and anemia 6% as the complications of diarrhea, while rural
mothers had a better knowledge. Mothers had the least score on followed by
meaning of dehydration i.e. loss of water and salts from the body 3.5% (rural 6%,
urban 1.0%). All these datas were subjected to statistical tests and it indicates the
mean knowledge score of mothers were found to be significant at 5% level.
Findings related to oral fluid and food intake during diarrhea.
Regarding the management of diarrhea at home the overall mean
knowledge score of mothers was 23.3% (use of Home Available Fluids 39%,
ORS 15%, and SSS 7%. The mean score of rural mothers were 26.7% and urban
14%.
Regarding the use of home based foods, mothers had the highest overall
mean knowledge score regarding the foods to be avoided during diarrhea 54.3%
(rural 97%, urban 11.5%), followed by the knowledge on the foods to be given
during diarrhea was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural
29%, urban 17.5%). The mean knowledge score regarding increasing the quantity
of food during and after diarrhea was very negligible 5% (rural 10%, urban 1%).
On the whole the knowledge on giving usual amounts 24% but 71% restricted
solid foods during diarrheal episodes, which indicates a limited knowledge on use
of home based foods.
Regarding ORS, the overall mean knowledge score of mothers on
availability of ORS packets was high 50.7% (rural 25.4%, urban 18.3%) followed
xi
by advantages of using ORS 26% (rural 36.7%, urban 16%), correct method of
preparation of ORS 11% (rural 20%, urban 2%), usage of ORS within 24 hours
8% (rural 14%, urban 2%), correct frequency of giving ORS 7.3% (rural 12%,
urban 2.7%), and precautions to be followed while preparing ORS was 1.0%
(rural 2%, urban 1%). On the whole knowledge on precautions and preparations
of ORS was found to be very low in both the areas.
Regarding knowledge on various home available fluids that can be during
diarrhea the overall mean knowledge score was 21.9% (rural 25.4%, urban
15.4%)and on increasing the quantity of oral fluids during diarrhea was found to
be only 19% (rural 28%, urban 10%). Regarding breastfeeding the overall mean
score on increasing the frequency of breastfeeding 23% (rural 30%, urban 16%).
However, a few mothers mentioned about giving usual amounts 60%.
All these findings indicate that rural mothers had more knowledge than urban
mothers. All these datas were subjected to statistical tests and it indicates the
Findings related to prevention and control measures of diarrhea.
The overall mean knowledge score of mothers regarding boiling of infants
feeding utensils was found to be higher 64% (rural 94%, urban 20%) followed by
when the child requires medical aid 34.7% (rural 43.3%, urban 26%), prevention
of occurrences of diarrhea 32.5% (rural 50.5%, urban 14.5%), prevention of feco-
oral contamination 27% (rural 52%, urban 2%), use of boiled cooled water for
drinking 26% (rural 50%, urban 2%), frequency of hand washing with soap and
xii
water 25% (rural 48%, urban 2%), and knowledge on use of clean water was 23%
(rural 40%, urban 6%). However, these findings indicate that rural mothers had
more knowledge than urban mothers. All these datas were subjected to statistical
tests and it indicates the mean knowledge score of mothers were found to be
significant at 5% level.
On the basis of the study following recommendations were made.
This study could be replicated in a larger sample to generalize the
findings.
A similar study can be carried out to find out the effectiveness of planned
teaching programme using the health information material developed for
the present study.
A study can be conducted on attitude, beliefs and practice regarding oral
fluids and food intake during and after diarrhea at home.
A study can be carried out to find out the attitude and actual practices of
mothers regarding prevention of diarrhea.
A study can be conducted to find out the knowledge and practices of
health care providers regarding diarrhea.
xiii
TABLE OF CONTENTS
1. Introduction Page No 1-8
2. Objective Page No 9-14
3. Review of Literature Page No 15-27
4. Methodology Page No 28-34
5. Results Page No 35-71
6. Discussion Page No 72-82
7. Conclusion Page No 83
8. Summary Page No 84-93
9. Bibliography Page No 94-99
10. Annexure Page No 100
xiv
LIST OF TABLES
Sl. No Tables Pages
1. Personal characteristics of respondents. 37
2. Family related characteristics of respondents. 37
3. Child related characteristics of respondents. 38
4. Diarrheal episodes and media of exposure on 40
5. Aspect wise knowledge on Home management 41
of diarrheal diseases among mothers.
6. Statement wise over all assessment of Knowledge 43
on meaning, etiology and manifestations, and
complications.
7. Statement wise over all assessment of Knowledge 45
on home management using oral fluids and foods.
8. Statement wise over all assessment of knowledge 47
on control measures and prevention of diarrhea.
9. Residence wise Knowledge on home management 49
of diarrheal diseases among mothers.
on etiology and manifestations among mothers
(rural, urban).
11. Statement wise overall assessment of 54
knowledge on home management using
oral fluids and foods among mothers (rural, urban).
xv
on control measures and prevention of
diarrhea among mothers (rural, urban).
13. Impact of residence on knowledge of home 59
management of diarrheal diseases.
14. Impact of age on knowledge of children on home 59
management of diarrheal diseases among mothers.
15. Impact of education on knowledge of home 65
16. Impact of occupation on knowledge of home 66
17. Impact of type of family on knowledge of home 67
18. Impact of family income on knowledge of home 67
19. Impact of number of living children on knowledge 68
of home management of diarrheal diseases.
20. Impact of family size on knowledge of home 69
21. Impact of number of episodes on knowledge of home 70
22. Impact of previous exposure to media on knowledge 70
of home management of diarrhea among mothers.
23. Comparison of literacy rate between urban and 71
rural area.
xvi
LIST OF FIGURES
Sl. No Tables Pages
Figure. 1: Personal characteristics of Respondents 39
Figure. 2: Aspect wise knowledge on Home management 42
of Diarrheal diseases among mothers
Figure.3: Residence wise knowledge on Home management 50
of diarrheal diseases of among mothers
Figure 4: Impact of Residence and Age on knowledge of 60
mothers on home management of diarrheal diseases.
Figure. 5: Impact of Education on knowledge of Home 61
management of Diarrheal diseases
Figure. 6: Impact of Occupation and Type of Family on 62
knowledge of Home management of diarrheal
diseases
Figure .7: Impact of Family size on knowledge of Home 63
Figure . 8: Impact of Family income on knowledge of Home 64
xvii
1. INTRODUCTION
The countrys children is a supremely important asset.
-National Health Policy
"Health is not everything, but without health you have nothing."
Health is both a responsibility as well as right. Protecting the health and
development of children is a long-term contribution to the growth and development of the
country as a whole. Children under five years of age constitute to 15-20% of the Indias
population. Their protection is a greatest investment for countrys economic prosperity
and political stability (Basavanthappa, 2003) [1].
Worldwide, almost 30,000 children under age 5 are dying every day that's more
than 10 million children a year nearly all from preventable or treatable conditions like
diarrhea, pneumonia, measles and malaria. Malnutrition contributes to half of these
deaths. Oral rehydration therapy currently helps save one million children's lives from
diarrhea-related diseases each year. Yet, more than two million diarrhea-related deaths
still occur each year (David Oot, 2004) [2]. Diarrhea is responsible for about one in five
deaths of children in the world (Margaret Kosek, 2003) [3].
1
More than 1.5 million children under five continue to die each year as a result of
acute diarrhea in developing countries (UNICEF/WHO, 2004) [4]. Eighty percentage of
underfive deaths due to diarrhea occur in the first 2 years of their life [3] and as many as
10% of infant deaths in India result from diarrhea (Tejal Baraj-Jaitly, 2002) [5].
The problem of childhood diarrhea is severe in India 550,000 deaths per year and
is the second-leading cause of death for children under the age of five [6] (Christian
Science Monitor, 2005). The global report (March, 2004) [7] released on World Water
Day, more than five lakh (500,000) Indian children die each year based on diarrheal
disease rates. Nearly half of all children aged underfive are not growing normally and the
mortality rate for this group is 93 per one thousand live births.
In India, 50% of all deaths occur below 5 years, 33% below 1 year, 20% below 1
month, and 10% below 1 week. Almost 500 million children suffer from acute diarrhea
annually. Of them 5 million die every year. In India alone 1.5 million children become a
casualty due to diarrhea every year (Suraj Gupte, 2001) [8]. In India, diarrhea accounts
for 21.2% and neonatal factors 21.2% as the major cause of mortality followed by
pneumonia 18.2% and malnutrition were the major killers in children between 1-5 years.
Mortality in females was higher than males in infancy (Khalique N, 1993) [9]. In
Karnataka, it is estimated that 24,800 children die every year due to acute diarrheal
diseases (CSSM review, 1995) [10].
2
Diarrheal diseases refer to a group of diseases in which the predominant symptom
is diarrhea. (Mazingrira, 1984) [11], the episodes are generally associated with other
infectious diseases making treatment and prevention more difficult. Diarrhea kills 8 or 9
children under the age of 5 every minute, often simply draining out the water and salts
the body needs to keep functioning. (Wishvas Rane, 2004) [12], acute diarrhea is often a
self-limiting condition. If dehydration is prevented or corrected with oral rehydration
therapy, no specific treatment is recommended even if the diarrhea is due to infection.
There is little evidence that antibiotics are useful in shortening illness or reducing fluid
loss, exceptions being cholera and acute bacillary dysentery.
NEED FOR THE STUDY
In India, diarrheal disease is a major public health problem among children under
the age of five years. (UNICEF/WHO, 2004) [4], diarrhea accounts for 15% of global
deaths among underfive children. Diarrhea claims the lives of 32 million children in the
underfive-age group in developing countries. The number can be dramatically reduced
through critical therapies such as prevention and treatment of dehydration with ORS and
fluids available in the home, breastfeeding, and continued feeding.
Diarrheal diseases cause a heavy economic burden for health services and as well
as to the country. (Jayaram A, 2001) [13], The Hindu News paper report states that nearly
seven lakh children died in India every year owing to diarrhea, which was easily
preventable. The country should promote preventive and community-based quality
healthcare. It also encourages private practioners to carry a significant share of the burden
of public health care.
3
Various aspects of home management of diarrhea are:
(i) Recognition of dangerous signs of diarrhea.
(ii) Use of home available fluids.
(iii) Correct method of preparation of ORS and initiation of ORS.
(iv) Continued feeding during diarrheal attacks.
(v) Modification of diet and use of home available foods.
(vi) Increasing the quantity and frequency of feeding during after diarrheal
attacks.
(viii) Exclusive breast-feeding at least up to six months of age.
(ix) Following mainly hygienic practices to combat infection.
(x) Seeking medial aid when needed.
(Mangala, 2003) [14], the global communication efforts have concentrated on assisting
national programmes to promote the three rules of case management at home:
(1) Increase fluid intake.
(2) Continue feeding.
(3) Seek medical care when needed.
Thus, maternal knowledge and appropriate diarrheal management at home are of great
importance in the reduction of complication of dehydration and malnutrition.
4
Based on survey of India (2001), the total 0-6 years population of Bangalore rural
is 12% and Bangalore urban is 12.0%. The data obtained from Ministry Of Home Affairs,
Bangalore (2001), states the young dependency ratio of Karnataka is 532. In India, the
women between the age group of 15-34 years constitute 33.37% (Census of India, 2001)
[15], and in Karnataka, they constitute 35.3% of the total population who are the core
caretakers of underfive children.
Various strategies and programmes including GOBI, RCH, CSSM, and UNICEF
are focusing their efforts in averting the deaths of underfive children due to diarrhea. In
spite of so many interventions, the situation is still dismal.
The goal of World Summit for Children 1990, to be attained by the year 2000 was
to reduce the underfive deaths to one-third and halving the child deaths caused by
diarrhea and 25% reduction in the diarrheal incidence rate. A priority is to increase the
proportion of patients receiving ORT and continued feeding to 80 percent by the end of
1995, but currently only 38% of the diarrheal dehydration sufferers are treated with ORT,
(WHO, 2003) [16].
National Diarrheal Disease Control Programme was started during the Sixth plan
to bring down diarrhea-related mortality. The key element of the WHO Diarrheal Disease
Control Programme was implementation of oral rehydration therapy. The objective is to
educate mothers to enable them to take care of children suffering from diarrhea by home
made fluids, continued feeding during diarrhea, and to recognize early signs of
5
dehydration. The other strategy of diarrhea prevention is to promote exclusive
breastfeeding for the first 4-6 months of life and proper weaning. Ultimately, it aims at
improving knowledge and practice of appropriate home management among caretakers of
young children (Park K, 2001) [17].
A study conducted by Anand K, et al. (1992), [18] on knowledge-regarding
diarrhea in rural mothers of Haryana revealed that diarrheal incidence stood at 2.88
episodes/child/year, just 24.1% defined diarrhea accurately. Only 29.7% knew about
sugar-salt solution or commercial ORS, only 9.7% could correctly prepare it, 38% gave
weak tea or curd, 81.4% continued to feed a child during a diarrheal episode,
breastfeeding was continued, and 64% did not know the dangerous signs of diarrhea. The
most reported danger signs were duration of at least 3 days (17%) and at least 6 stools per
day (14%). These findings showed limited knowledge about diarrhea and diarrheal
management by mothers.
Most of the diarrheal deaths are caused due to dehydration. Many of the millions
of children who die every year in developing countries from diarrhea could be saved if
mothers knew how to give ORT promptly. (Dua, et al. (1999), [19], The National Family
Health Survey 1992-1993 revealed that 42.7% of mothers knew about ORS packets and
25.9% had ever used them. According to UNICEF (1988), 70% of 4 million deaths could
have been prevented if the knowledge of the use of the low-cost ORT was universal.
Early administration of ORS leads to fewer office, clinic, and emergency department
(ED) visits and to potentially fewer hospitalizations and deaths.
6
A study conducted by Bhandari N, et al. (1995) [20] on patterns of use of oral
rehydration therapy in an urban slum community of Tigri, New Delhi, in 200 households.
In the 291 episodes occurring among 108 enrolled children, home available fluids in not
more than the usual amounts were used in 8.2 episodes, sugar-salt solution (SSS) in
14.7% of cases, oral rehydration salt solution (ORS) in 7.9% of cases and either of these
in 29.4% of cases. The amount of ORS administered to children was inadequate at all
ages, with majority consuming only spoonfuls or sips.
Diarrhea is a major cause for malnutrition. [14] In India, diarrhea accounts for
22% of the child mortality and malnutrition accounts for 60% of diarrheal deaths. The
episodes of diarrhea are more prolonged and severe in malnourished child, thereby
raising the risk of the death. Maternal knowledge regarding modification of diet,
increasing the quantity and frequency of feeding and continued breastfeeding during and
after diarrheal episodes plays a significant role in the prevention of malnutrition among
underfive children.
Knowledge on preventive aspects has the greatest impact on health often related
to improving of hygienic practices at household level. A large percentage of hygienic
activities take place in home or close to the home. Feco-oral transmission accounts for
most diarrheas. Knowledge on optimum utilization of the available health facilities needs
to be focused in the preventive aspect of diarrhea.
7
Mothers still lack knowledge on actual cause of the disease and some of the basic
underlying hygienic principles including washing hands with soap and water after
defecation, safe disposal of feces, use of sanitary latrines, and use of safe food and safe
drinking water (Melanie Nielse, 2001) [21]. Mothers knowledge regarding domestic
hygiene, food hygiene, personal hygiene, and environmental sanitation are important in
reducing the prevalence of childhood diarrhea (Sheth Mini, 2004) [22].
The present underfive population of Hasserghatta-PHC, Bangalore, is 23,831. The
records revealed that 615 under five children in the year 2002-2003, and 710 underfive
children in the year 2003-2004 came to the PHC with acute diarrheal episodes. An
increase in the incidence of 100 more children having diarrheal episodes were found in
the year 2004. As a community health nurse, there was a felt need to assess the actual
knowledge of mothers of underfive children regarding home management of diarrhea.
These findings and the above supportive studies and its recommendations have
influenced the investigator to undertake this study.
8
2. OBJECTIVES
Statement of the problem
A study to assess the knowledge of mothers of underfive children regarding home
management of diarrheal diseases in selected areas of Hasserghatta-PHC, Bangalore.
Objectives of the study
2. To compare the knowledge of mothers of underfive children between rural and
urban slum area.
3. To associate the knowledge of mothers of underfive children regarding home
management of diarrhea with selected demographic variables.
Hypotheses
The following hypotheses were formulated based on the objectives of the study.
H0 (1): There is less knowledge among mothers of underfive children regarding home
H0 (2): There is no difference in the knowledge among rural and urban mothers regarding
home management of diarrhea.
9
H0 (3): There is no impact of demographic variables on knowledge of mother regarding
Assumptions
1. Mothers have some knowledge regarding the causes, signs and symptoms, and
prevention and control measures of diarrhea.
2. Mothers have limited knowledge regarding preparation and initiation of oral
rehydration therapy including use of ORS, home available fluids and foods during
diarrhea.
3. Knowledge of mothers is influenced by variables such as age, literacy, occupation,
type of the family, number of underfive children, family size, family income, residential
area, and previous exposure to media.
Operational definition
Diarrhea: It is the passage of three or more loose stools per day in children.
Under five: Children belonging to the age group of 0-5 years.
Mothers: Mothers having underfive children.
Knowledge: Knowledge refers to the mothers correct verbal response to the prepared
structured interview schedule regarding home management of diarrhea in children.
Assessment: Refers to the process used to identify the levels of knowledge on home
Home management: The mothers ability to recognize the signs and symptoms of
diarrhea, prepare and use home available fluids and ORS, modify the diet, follow
10
hygienic practices and be alert to seek medical aid when needed to combat diarrhea at
home.
Home available fluids: Any recommended fluid available at home, which can be given
during diarrhea.
Health information material
It is an instruction regarding prevention and control of diarrhea at home, designed
and organized systematically for mothers as per the findings of the present study.
Delimitation
The study was limited to:
1. Hassarghatta rural and Dasarahalli urban area of Bangalore District.
2. Mothers who have underfive children.
3. Mothers who were willing to participate in the study only were considered as
sample.
4. Verbal statements of the mothers knowledge were considered as response.
Conceptual framework of the study
A theory is a conceptual system or framework invented for some purpose
(Dickoff and James, 1968). A theory is a set of interrelated constructs (concepts adapted
for a scientific purpose), definitions and propositions that present a systematic view of
phenomena by specifying relations among variables, with the purpose of explaining and
predicting the phenomena (Kerlinger, 1986) [23].
11
The framework of the present study is based on Orems self care theory. Orem
presents three theoretical constructs (1) self care construct, (2) self care deficit construct,
and (3) the nursing systems construct.
She states that self-care is the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well being. In the present
study, mothers are the dependent self-care agents (self care agency), as they provide care
to the children.
Self-care deficit is a health-related criterion for identifying one who needs nursing
care. Assessing the knowledge of mothers regarding home management of diarrhea
identifies the self-care deficits. It is conceptualized that mothers have some knowledge
regarding home management of diarrhea. Moreover, the knowledge of the mothers will
also vary according to the demographic variables such as age, education, occupation,
family income, number of underfive children, family size, previous exposure to media,
and residential area. This is done by the nursing care agency.
She also states that persons are able, or can and should learn to perform self-care
measure, but cannot do with assistance. The way an individual meets his self-care
demands is not an instinct but is a learned behavior. Mothers have the ability to meet the
self-care needs of her children with guidance, support and teaching. She also
conceptualizes that mothers have the capacity to reflect upon themselves and
12
environment, symbolize what they experience. They can use symbolic creations in
thinking and communicating. By guiding mothers, she can be beneficial for themselves
and for others. Thus, mothers belong to a supportive educative system as per
classification of patient care by nursing care construct. As per the findings of the study in
order to meet her therapeutic self-care demands regarding diarrhea, an information
material was developed focusing on illustrations for the use of mothers.
13
Conceptual framework based on Orems self care theory
Self care agency

(Mothers of under
five children)
Assessment on Knowledge on
therapeutic self-
care demands of diarrhea.
mothers.
Meaning of diarrhea
Factors Etiology
Manifestations
Residence Complications
Age of the mother
Religion
Mothers occupation (Nursing care
Education of mother agency)
Use of HAF
Family income Data collection
Use of ORS
Type of family
Breast-feeding
Family size
Home-based foods
Exposure to media
Previous experience
Child related
characteristics
Prevention and control
Knowledge measures of diarrhea
score of
mothers
Development of health
information material.
Meeting
m the self care
deficits of dependent
care agents
(Mothers)
14
3. REVIEW OF LITERATURE
The review of literature is organized under the following headings:
1. The underfive mortality and morbidity due to diarrhea.
2. The incidence and prevalence of diarrhea.
3. The home management of diarrhea.
The under-five mortality and morbidity due to diarrhea
Borooah Vani K (2004) [24], carried out a study that states Haryana (one of the
richest states in terms of mean household income) more than 9 out of 10 households had
diarrhea among under-three children 92.3%, while neighboring Punjab (as rich as
Haryana), the incidence was just over one in two, and in a relatively poor West Bengal
the incidence was about one in three.
Victoria, et al. (1993) [25], carried out a multi-centric study revealed the
population-based data on deaths due to diarrhea among children less than 5 years of age
were obtained from areas of Brazil (227 deaths), Senegal (531), Bangladesh (236) and
India (146). Persistent diarrheal episodes were more common in India and Senegal
between 1-4 years.
Aswathi, et al. (1993) [26], conducted a study in urban slums of Lucknow in 28
randomly selected slums revealed the annual underfive mortality was 71 deaths among
2796 children; pneumonia in 19.7%, diarrhea in 18.35% and measles in 11.4% and high
fever in 21.1%.
15
Khalique, et al. (1993) [9] conducted a study in 9 villages of Rural Health
Training Center, Jawan, Aligarh, India, having 1792 registered families. The infant
mortality rate was 79.3 per 1000 live births. Higher mortality in children between 1-2
years (29.6/1000) in comparison to 2-5 years (16.2/100) reflected higher vulnerability of
children below 2 years. Diarrhea 21.2% and neonatal factors 21.2% were the major cause
of mortality followed by pneumonia 18.2% and malnutrition were the major killers in
children between 1-5 years. Mortality in females was higher than males in infancy.
The incidence and prevalence of diarrhea
Banerjee, et al. [27] (2002) conducted a combination of retrospective and
prospective study in an urban area in West Bengal among underfive children of different
socioeconomic status; the overall prevalence was 31.67%. This implies that the
prevalence among under-fives ranges from 26.4% to 37% with 95% confidence, highest
in the lower socioeconomic class 41%.
Bhandari N, et al. (1992), [28] in a longitudinally followed cohort children under
six years of age in rural India revealed 1663 episodes of diarrhea and 23 related deaths
were recorded in 1467 children followed up in 20 months. The diarrheal attack rates were
24 times higher in children with severe malnutrition. The case fatality rate was 0.64% and
0.8% in episodes of one and two weeks duration and increased to 13.95 for persistent
episodes.
16
Guerrant RL, et al. (1990) [29] in a study done in Cleveland, Ohio from 1948-
1957, researchers learned that people had diarrhea an average of 1.52 times annually. The
age specific rates climbed from 1 episode/child 1-year old/years to 2-2.2 episodes/child
1-10 years old/year. In a similar study done in Charlottesville Virginia between August
1975-July 1977, the overall diarrhea attack rate stood for children 3 years old, it was 2.5
episodes/year. In developing countries, attack rates range from 5-12 episodes/child/year
with the highest rates in the first 2 years of life (e.g., in India, among the urban poor, 18.6
episodes/child/per year).
Causes of diarrhea and hygiene
Melanie Nielse (2001) [21] conducted a study on Childhood diarrhea and
hygiene: Mothers perceptions and practices in the Punjab, Pakistan. 200 households
from 10 villages were selected by random sampling. The mothers revealed that causes of
diarrhea were too much food 66%, too little food 4%, hot and cold food 7%, cold or hot
environment 16%, bad breast milk 2%, contaminated food 26%, contaminated water 4%,
insects or flies 2%, dirtiness 8%, soil eating 6%, others teething 6%, other causes 16%,
and do not know the causes 2%. Fecal contamination was never presented as a direct
cause of diarrhea and the feces of infants were not associated with germs. Only a few
mothers mentioned bacteria or germs in association with flies. Only 5 (2.5%) of the
surveyed mothers mentioned the need for a toilet for hygienic purposes. Lack of fuel or
resources for fuel were not found to be a primary reason for not boiling the water.
Another argument for not boiling the water was the change of taste. This indicates a lack
of knowledge regarding causes of diarrhea.
17
Home management of diarrhea
Sheth Mini and Obrah Monika (2004) [22] conducted a study in Gujarat, India
regarding feeding practices was conducted on mothers (n=200) of underprivileged
children in Anganwadi Centers. It revealed that contaminated water, contamination of
food also play an important role in the etiology of diarrhea. Most of the households
(50.5%) had poor ratings for environmental sanitation. The personal hygiene (PH) rating
for the mothers at the baseline were poor (38.5%) to average (30.5%). Poor
environmental sanitation and personal hygiene of mothers continues to be the leading
etiological factor for diarrhea. Behaviors such as child defecation on the floor, water or
rag being used to cleanse the child after defecation and mother not washing the child's
hand or her hands with soap and water after defecation or cleansing child's perineum
were directly related to high incidence of diarrhea. Food safety education package
incorporated three messages: washing hands with soap and water, avoid feeding leftover
food and keep surrounding clean reduces the prevalence of diarrhea.
Agarwal, et al. (2002) [30] conducted a study in New Delhi, showed a reduction
in diarrheal morbidity episodes by 40% when Actimel was started in a 3-month followup.
It reduces the duration of diarrhea in children.
Pandey A, et al. (2002) [31] conducted a study on gender differences among
underfive children (263 boys and 267 girls) in seeking health care among rural
community of West Bengal revealed that at the household level girls were less likely to
get home fluids and ORS during diarrhea. Qualified professionals were consulted more
18
often and sooner for boys than girls. The boys were 4.9 times more likely to be taken
early for medical care and 2.6 times more likely to be seen by qualified allopathic doctors
compared to girls.
Datta V, et al. (2001) [32] conducted a study on maternal knowledge and
practices towards diarrhea and ORT in rural Maharastra among 75 mothers revealed that
69.3% of them had per capita income less than Rs. 500. 68% of the mothers knew correct
definition of diarrhea but only 5.3% of them were aware that diarrhea leads to
dehydration. 90.7% of the mothers were aware of ORT and ORS was easily available to
the majority, but only 60% practiced ORT. Nearly 1/3rd of the mothers were mixing ORS
in wrong fluid. Nearly half of the mothers were not practicing adequate hand washing,
32% were using feeding bottles. The maternal knowledge towards diarrhea and ORS was
inadequate in the population and there was big gap between actual and desired practices.
Zodepy, et al. (1999) [33] conducted a case control study in 387 cases in a
Government Medical College Hospital, Nagpur, India, for a prediction model for
moderate or severe dehydration in children. It revealed that frequency of stools more than
8 per day, frequency of vomiting of more than 2 per day, not giving ORS, under nutrition,
not washing hands by mother, withdrawal of breast feeding, not giving home available
fluids, or both, during mild to moderate dehydration were found to be the significant risk
factors causing diarrheal mortality.
19
Bhatia, V. et al. (1999) [34] conducted a study on attitude and practices regarding
diarrhea in rural community, Chandigarh in 120 randomly selected samples revealed that
majority of the underfive children 88.1% had treatment for diarrhea whereas only 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 preparation. A large number
restricted food during the episodes.
Mercy Thomas (1999) [35] conducted a study in Mangalore regarding oral fluid
and food intake in an urban area revealed that most of the mothers were of low
socioeconomic status and belonging to joint family. Mothers had only 50% of the
knowledge on diet and oral fluid to be given to underfive children. Most of the mothers
had knowledge on continuation of breastfeeding during diarrhea, but the mothers had
poor knowledge regarding foods that are to be given and the foods that are to be avoided.
Poor knowledge was found in the areas regarding the amount of fluid to be given 44.8%
and frequency of administering oral fluid 42.76%, but knowledge on preparation of ORS
package was severely lacking.
Rao KV, et al. (1998) [36], the government of India identified ORT promotion as
a priority child survival strategy. The effects of exposure to electronic media messages on
the mothers knowledge about use of ORT were investigated in 1992-3. 43% of mothers
were aware of ORS. Only 18% of infants received ORS and 19% were given
recommended homemade solution during the episode of diarrhea; 69% received neither
ORS nor RHS. Children with diarrhea were twice likely to receive decreased amount of
20
breast milk and other fluids than to be given increased amounts. The low use of ORS is
especially alarming since 61% of children with diarrhea in the previous 2 weeks were
taken to health facility for treatment. 94% of these were given antibiotics. These findings
indicate a need to strengthen education programs in this area for both mothers and health
care providers.
Bhal, et al. (1997) [37] a clinical trial study conducted at Shimla, Himachal
Pradesh regarding the cost effectiveness of oral rehydration therapy revealed that 47.6%
were infants and 58% came from rural areas. 87% had acute diarrhea, 10.4% had
dysentery and 2.6% had persistent diarrhea. Diarrhea was most prevalent during April to
September. 41.9% of presenting children had received ORT before coming to DTU; as a
result severe dehydration was seen only in 10.7% cases. Comparison of data on 166
children admitted to a study hospital in 1986-87 revealed a significant decline in
admission rate due to dehydration and associated illness (100% vs 26.8), use of
antimicrobials (66.2% vs 15.3%). 84.6% children in 1993-1994 were treated with ORT
alone. The average cost of ORT per child was 4.49% compared with Rs. 40.29 for
intravenous fluids. The study recommends health education campaigns aimed at
promoting even more widespread use ORT by mothers and health workers are needed.
Taneja, et al. (1996) [38] a study conducted on 6285 persons of Jhuggi clusters of
New Delhi to identify the diarrhea management at home and at a health facility to
determine knowledge levels about oral rehydration solution revealed that only 31.3%
received ORS or home available fluids. Only 11.5% could correctly measure the water
21
needed to make 1 liter of ORS. The study recommends that families need training in
correct preparation and use of ORS.
Mehta M (1996) [39], a comment on a nutritional management of diarrheal
diseases, states that nutritional management of acute infant and child diarrhea included
continued small feedings during acute illness and compensatory increase in feeding
during convalescence. A dietary intake of at least 125% of the recommended diet should
be attempted until the child gains the previous-illness weight. Continued breastfeeding
reduces the severity and complications of diarrhea. Full strength milk can be
administered as soon as dehydration is corrected. However, with persistent diarrhea total
elimination of artificial milk is necessary. Breast milk or animal milk should be
administered every 3-4 hours with staple foods enriched with oil and sugar.
Buch, et al. (1995) [40] conducted a study in Srinagar, Kashmir, in the Pediatrics
Outpatient Department interviewed 1600 parents of infants with acute diarrhea divided
into two groups. Group A (physicians, engineers, teachers, professors, lawyers, clerks,
educated business professionals: N=660) and Group B all others and uneducated parents:
N=940). Most infants were boys (66.2%)with acute diarrhea and aged 6 to 9 months
58.7%. Only 15% of all parents knew the definition of diarrhea (3 loose stools per day)
with Group B more likely to know it more than Group A parents 18.5% vs; p.001). 81.9%
of all parents incorrectly considered frequent stools as constituting diarrhea. The parents
considered weaning, maternal diet, and teething to be the major cause of diarrhea (58.1%,
42.5%, and 34.4%, respectively). Group A parents were more likely to report infections
22
while Group B parents were more likely to treat diarrhea with antidiarrhoeals and
antispasmodic drugs. Group A parents were most likely to use both these drugs and oral
dehydration therapy than Group B parents 62.5% vs 7.9%; p 001). Few parents 6.6%
administered only ORT. Group A parents were much more likely than Group B parents to
know the composition of various ORT brands, reconstitution of the solution, and their
utility in diarrhea (65.6% vs 7.7%). Group B parents preferred dietary restrictions during
diarrhoeal episode than group A parents 28.7% vs 6.2%. These finding reflect limited
parental knowledge about diarrhea and its treatment.
Bhandari N, et al. (1995) [20] conducted a study on patterns of use of oral
rehydration therapy in an urban slum community of Tigri, New Delhi, in 200 households
with at least one child under age five were interviewed to assess their knowledge,
attitudes and reported practices regarding management of diarrhea in children. In the 291
episodes occurring among 108 enrolled children, home available fluids in more than the
usual amounts were used in 8.2 episodes, sugar salt solution (SSS) in 14.7% of cases, oral
rehydration salt solution (ORS) in 7.9% of cases and either of these in 29.4% of cases.
The amount of ORS administered to children was inadequate at all ages, with majority
consuming only spoonfuls or sips.
Kaur P and Singh G (1994) [41] conducted a study to determine the food and
fluid practices during diarrhea among 2,160 children under five in rural area of Varanasi.
Most of the families 82% obtained water from wells. There were 2198 diarrhea episodes.
The prevalence of diarrhea was 72.2%. Families who kept their water covered had lower
23
prevalence of diarrhea than those who did not cover their water (84% vs 49.4%). Families
who washed with ash had a lower prevalence of diarrhea than those who washed them
mud or both 60.07% vs. 80.02% and 68.1% respectively. Families who washed their
hands with soap before meals suffered diarrhea less often those who did not 59% vs 73%.
Anand K, et al. (1992) [18] conducted a study on knowledge and practices
regarding diarrhea in rural mothers of Haryana. The findings revealed that diarrheal
incidence stood at 2.88 episodes/child/year. Just 24.1% defined diarrhea accurately (i.e.
WHO definition = 3 loose stools per day). Only 40% defined diarrhea to b e more than 6
stools/day). Only 29.7% knew about sugar salt solution or commercial ORS only 9.7%
could correctly prepare it and 38% gave weak tea or curd. 81.4% continued to feed a
child during a diarrheal episode. Breastfeeding was continued. 64% did not know the
dangerous signs of (duration of at least 3 days, at least 6 stools per day, blood in stools,
and lethargy), indicating a need to seek medical care. The most reported danger signs
were duration of at least 3 days (17% and at least 6 stools per day (14%). These findings
showed limited knowledge about diarrhea and diarrhea management.
Reddiah VP and Kapoor SK. (1991) [42] conducted a study in New Delhi, among
children under the age of 4 years for a period of one year by domiciliary visits revealed
more than 2/3 gave mainly home made ORS. 69.9% restricted food intake during attack.
Family with more than one child had more attacks. All the age groups were similarly
affected. 42.2% were shown to R.M.P.s. and 33% consulted friends or relatives.
24
Mahendraker. A.G, et al. (1991) [43] conducted a study on medico social profile
of underfive children suffering from diarrheal diseases in Pune. Diarrheal illness was
more common in low socioeconomic status than upper classes (65.81% for social class III
and 22.37% for social class IV vs 3.94-7.88 for social class I-II. The incidence of
diarrhea was inversely proportional to maternal literacy status (42.1% for illiteracy,
32.89% for primary school, 10.53% for middle school, 9.21% for secondary school, and
5.27% for higher education). A family size of more than 4 was associated with higher
incidence of diarrhea and more common in overcrowded households than in non-crowded
households. 73.68% vs 26.32%). Children younger than 24 months who were exclusively
breastfed made up a smaller proportion of diarrhea cases than their counterparts who
were not exclusively breastfed. 50% of the mothers did not know about ORT. Of the
mothers who did know about it, only 26.32% were using it.
Chowdhury, et al. (1991) [44] conducted a field trial in Bangladesh, although the
mothers agreed that rice based solutions stopped diarrhea more quickly, they used sugar-
based solutions twice as often in 40% of severe watery episodes as the rice-based
solutions in 18% because rice ORT was time consuming and difficult to prepare.
Mishra CP, et al. (1990) [45] conducted a study in urban Mirzapur among 350-
410 underfive children were selected from 200 urban families of 3 slums revealed that
prevalence of diarrhea varied between 8.7% to 33%. Breastfeeding was not restricted
while other forms of feeding was continued in 57.1% to 66.3% of cases. Use of ORT
increased from 0% to 39.62% possibly as a result of health education.
25
Huffman SL, et al. (1990) [46] conducted a case control study in Brazil has shown
that young infants who are not breast fed have a 25 time greater risk of dying of diarrhea
than those who are exclusively breastfed. A longitudinal study in urban slums of Lima,
Peru found that exclusively breastfed infants have a reduced risk of diarrheal morbidity
when compared with infants receiving only water in addition to breast milk.
Breastfeeding helps maintain hydration status during diarrheal episodes.
Kothari G (1987) [47] conducted a study on Diarrhea in urban slums Bombay,
revealed that almost half of them had diarrhea. Yet nearly half of the population live in
the slums characterized by unhygienic living conditions, overcrowding, poor housing,
and lack of basic amenities. People living in slums are more vulnerable to communicable
diseases and malnutrition. Children under age 3 suffer from diarrhea and dysentery. It
was a common practice to withhold breast milk and food during diarrhea to give
unsuitable remedies. The incidence of diarrhea is greatest at the time of weaning. The
infants were bottle-fed with formula milk. Most of the families did not use ORT for
diarrhea. Nearly 50% believed it was due to ignorance about hygiene, 18% gave reasons
such as artificial milk or teething, and 34% had no idea about etiology. For correct
diarrhea treatment, drugs and ORT were favored by 63, drugs alone by 29, and ORT
alone by 5. When asked about ORT, 55 said that they would use oral rehydration salts
(ORS), and 13 stated that they would use sugar salt solution.
26
According to report in Mazingira (1984) [10], a study has proved that rice water
to be effective treatment by investigators at International Center for Diarrheal Disease
Research, Bangladesh (ICDDR, B), who have shown that cereal based solutions are even
more effective than the much publicized mixtures of water, sugar, and salts. Tests have
shown that 80-86% of the rice powder is converted to glucose and absorbed. Dr. A. Majid
Molla (ICDDR, B) who pioneered the use of powder in ORT, 1 liter of rice powder
solution is twice as effective as 2 liters of sugar salt solution.
27
4. METHODOLOGY
This chapter deals with the description of the methodology selected for this
study. It includes description of the research approach, research design, setting, sample
and sampling technique, development of the tool, description of the tool, validity, pilot
study, data collection and plan for analysis.
Research Approach
A descriptive survey was considered to be the most appropriate research
approach for this study. In view of the nature of the problem and the objectives to be
achieved, an epidemiological approach was used for assessing and comparing the
knowledge of the mothers in the selected areas regarding home management of diarrhea.
Research design
The research design selected for the present study was descriptive design to
assess the knowledge of mothers regarding home management of diarrhea. A purposive
random sampling technique was used to select 100 mothers comprising of 50 from rural
and 50 from urban slum area.
Attribute variable
Age, educational qualification, occupation, number of underfive children,
family size, religion, family income per month, gender of the child, exposure to media,
and residential area.
28
Setting of the study
The study was conducted in Hassarghatta rural area and Dasarahalli urban slum,
covered by Hasserghatta-Primary Health Center, Bangalore. Hassarghatta-PHC has a
total underfive population of 23,831.
Population
The accessible population for the study was mothers having children underfive
years of age in Hassarghatta rural and Dasarahalli urban slum of Bangalore, Karnataka.
Sample and Sampling Technique
A purposive random sampling technique was used to select the sample. A 100
sample of mothers having children under the age of five years were selected; 50 from
rural and 50 from urban slum.
Criteria for selection of sample
Inclusion criteria:
The mothers having under-five children.
The mothers residing in Hasserghatta rural area and Dasarahalli urban slum of
Hassarghatta-PHC, Bangalore.
The mothers who give consent for the study.
29
Exclusion criteria
Mothers who were not having underfive children.
Mothers who were not present during the data collection.
Mothers who had not given consent for the study.
Selection of the tool
A structured interview schedule was used where the investigator asked questions
orally to the participants in a face-to-face meeting. It is considered as the most
appropriate instrument to elicit the responses from illiterate mothers and from those who
needed additional clarification regarding questions related to diarrheal aspects.
Development of the tool
Based on the theoretical framework of the study, a structured interview schedule
was developed to assess the knowledge of mothers regarding home management of
diarrhea.
The following steps were carried out in preparing the tool:
a. Literature review.
b. Preparation of blue print.
c. Consultation of experts in the field.
30
Preparation of blue prints
A blue print consisting of items pertaining to the knowledge of mothers regarding
home management of diarrhea was prepared. There were 29 items on the knowledge
regarding various aspects of diarrhea.
Description of the tool
A structured interview schedule comprised of four parts:
Part-A: Demographic data consisting of 15 items seeking information about the
background data such as age, gender, educational status, occupation, family income, type
of family, number under five children, family size, religion, and residential area.
Part B: Consists of 8 items on knowledge on meaning, etiology, signs and symptoms,
and complications.
Part C: Consists of 14 items on use of oral fluids and oral foods during diarrhea.
Part D: Consists of 9 items on prevention and control measures. It consisted of a total of
29 objective type items with choosing the most appropriate responses for each item. Each
item had one or more correct answers all of which were scored. Each correct answer was
given a score of one and wrong answer zero. The total score was 80.
Validity of the tool
Eleven experts comprising nurse, educators and one doctor established the
validity of the tool. After the expert suggestion, the tool was modified and the final tool
consisted of:
Background data 15 items
31
Knowledge 29 items
Persons proficient in Kannada computed the validity of the tool.
Pre-testing
Pre-testing of the structured interview schedule was done to check clarity of the
item, ambiguity of the language, and feasibility of the tool. The tool was administered to
12 samples residing outside the project area of Hassarghatta. The tool was found feasible,
items were clear and language was found unambiguous. It took about 35-40 minutes to
interview each mother.
Reliability
Reliability of the tool was established by using split half technique. The reliability
coefficient of the test for the knowledge scale was found to be rII = 0.9235 and validity
coefficient as 0.9610. Since the knowledge reliability coefficient for scale rII>0.70 tool
was found to be reliable.
Development of criteria checklist
A criteria checklist was prepared for the assessment of knowledge of mothers
regarding diarrhea. It was based on the literature review and opinion of experts. The
checklist consisted of criterion statements under the broad headings of content, items
relevant/relevant to some extent/not relevant and suggestion and remarks.
32
Content validity
The tool was given to the experts along with criteria checklist. The experts were
requested to validate the content of the tool and asked to indicate suitable suggestion.
There was 70 percent agreement on meets of the criteria and 30 percent on partial meets
on the criteria. These suggestions were accepted and this ensured the clarity and validity
of the tool.
Procedure for data collection
Data was collected from 19th September, 2005 to 15th October, 2005.
Data analysis plan
The data obtained were analyzed based on the set of objectives of the study using
descriptive and inferential statistics. The plan for data analysis was as follows:
Organize the data in a master sheet.
Frequencies and percentage for the analysis of the background data. Further,
students t-test was employed to compare the significant difference in the mean
knowledge score between rural and urban areas. Analysis of variance technique is
used (F-test) to know the impact of demographic characteristics on the knowledge
of mothers on management of diarrheal diseases.
Pilot study
A pilot study was conducted during the month of 17th to 27th August 2005 at
Hassarghatta rural and Dasarahalli urban slum area of Bangalore, Karnataka. The purpose
33
of the study was (1) to assess the knowledge of mothers of underfive children regarding
home management of diarrhea (2) to plan for data analysis and (3) to find out the
feasibility of conducting the research study.
Twelve mothers who were having children underfive years of age were selected
from two selected areas, six from each area. The overall mean knowledge score was
36.28% with a SD of 13.8. The mean knowledge score of mothers of urban slums
(47.53%) was found to be higher than rural area (25.03%) on establishing statistical
significant results. Hence, the study was found to be feasible.
34
5. RESULTS
This chapter deals with the analysis and interpretation of the data collected on
knowledge of mothers of underfive children regarding home management of diarrheal
diseases from urban slum and rural area of Bangalore. A structured interview schedule
was used for data collection and analysis was done using descriptive and inferential
statistics.
The objectives of the study were
urban slum areas.
Hypotheses
The following hypotheses were formulated based on the objectives of the study.
35
H0 (2): There is no difference in the knowledge among rural and urban mothers regarding
Presentation of the data
The data collected were coded and entered in a master sheet for tabulation and
statistical processing. The analysis of data is categorized and organized in the following
heading:
Sample characteristics.
Knowledge of mothers of underfive children regarding home management of
diarrheal diseases.
Comparison of knowledge of mothers of underfive children between rural and
urban slum area.
Association between the knowledge of mothers regarding home management
of diarrhea with selected variables.
Analysis of sample description
The sample characteristics are described in terms of residential area, age,
educational qualification, occupation, type of the family, number of underfive children,
size of the family, family income and religion.
36
TABLE 1
Personal characteristics of Respondents
Respondents
Characteristics Category
Number Percent
Urban 50 50.0
Area
Rural 50 50.0
17-20 years 29 29.0
Age group 21-24 years 50 50.0
25-29 years 21 21.0
Illiterate 52 52.0
Primary 7 7.0
Education Middle 11 11.0
High school 25 25.0
PUC 5 5.0
Laborer 14 14.0
Occupation
Housewife 86 86.0
Total 100 100
Table-1 identifies the data of mothers by residential area, age, education and
occupation. 50% of them belonged to urban slum and 50% belonged to rural area. A
majority 50% belonged to the age group of 21-24 years. A majority of them 52% was
illiterate, rest 48% were literates out of whom 25% educated up to high school, 11%
educated up to middle school, 5% up to PUC, and 7% up to primary school. A majority
of them 86% were housewives and only 14% were laborers (Figure-1).
TABLE 2
Family related characteristics of Respondents
Respondents
Number Percent
Hindu 97 97.0
Religion
Muslim 3 3.0
Nuclear 49 49.0
Type of Family Joint 39 39.0
Extended 12 12.0
37
< Rs. 1500 53 53.0
Family Income/m Rs. 1500-2500 34 34.0
> Rs. 2500 13 13.0
22.0
Three 22
20.0
Family Size Four 20
18.0
(members) Five 18
40.0
Five& above 40
Total 100 100
Table-2 shows family related characteristics of mothers. Majority were Hindus
(97%), and only a negligible percentage (3%) was Muslims. Nearly half of the mothers
(49%) of them belonged to nuclear family, followed by joint family (39%), and extended
family (12%). More than half of the mothers (53%) had a family income of less than
Rs.1500. Only 13% had income more than Rs. 2500 per month. A majority (40%)
belonged to a family size of five and above followed by a family size of three (22%).
TABLE 3
Child related characteristics of Respondents
N=100
Respondents
Number Percent
< 1 year 36 24.7
1 year 28 19.2
2 years 30 20.5
Age of the Child (n=146)
3 years 27 18.5
4 years 19 13.0
5 years 6 4.1
Male 75 51.4
Sex of the Child (n=146)
Female 71 48.6
First 74 74.0
Birth order of the Child
Second 51 51.0
(n=146)
Third 21 21.0
One 56 56.0
Number of under 5 children in
Two 41 41.0
the Family
Three+ 3 3.0
38
Fig 1
39
Table-3 shows data on underfive children by age, sex, order of birth, and number
of under five children in the family. A majority 24.7% belonged to less than 1 year of age
followed by 20.5% of 2 years, 19.2% of 1 year, and, 18.5% of 3 years, 13% of 4 years
and only 4.1% of 5 years of age. A majority of them (51.4%) were male children and the
rest (48.6%) were females. A majority 74% was first child, 51% second child, and 21%
third child. A majority of the families (56.3%) had one underfive child, 41% had two
underfive children and 3% had three+ underfive children in the family.
TABLE 4
Diarrheal episodes and Media of Exposure on management of diarrhea at home.
N=100
Respondents
Aspects Category
Number Percent
No 28 28.0
0 1 year 39 39.0
Diarrheal episodes in past 3
1-2 years 20 20.0
months
2-3 years 8 8.0
3-5 years 5 5.0
Media of Exposure @
Television 19 19.0
Relatives/Friends 5 5.0
Medical personals 26 26.0
No response 61 61.0
Yes 20 20.0
Previous use of ORS
No 80 80.0
@ Multiple Response
Table-4 shows data regarding diarrheal episodes and exposure to media regarding
diarrheal management. Regarding occurrences of diarrheal episodes when asked to
mothers by recall method it was found that the number of episodes in the past 3 months
was highest in the age group of 0 to 1 year (39 episodes) followed by 20 episodes in the
40
age group of 1 to 2 years and the least between 3 to 5 years (5 episodes). These findings
indicate that the number of episodes decreases as the age increases.
A majority of them 61% were not exposed to any media regarding diarrhea, 26%
were exposed to medical personnels, 19% to television, and only 5% received
information from friends/relatives. Only 20% used ORS at home for treating diarrhea in
the past. These findings emphasize on the need for health education using mass media.
Analysis on knowledge of mothers regarding home management of diarrhea of total
population
TABLE - 5
Aspect wise Knowledge on Home management of Diarrheal diseases among mothers
Knowledge Score
Stateme Max.
Mean
Knowledge Aspects nts Score SD
Mean (%)
(%)
Meaning, Etiology, Manifestations

8 27 7.11 26.33 16.4
and complications
Home management using oral fluids
14 39 9.48 24.31 14.1
and foods
Control measures and prevention of
7 14 4.50 32.12 23.7
Diarrhea
Over all 29 80 21.26 26.58 12.0
Table 5 shows data on knowledge aspects of home management of diarrhea. It
reveals that the mean knowledge score of mothers on meaning etiology and
41
Fig 2 knowledge
42
manifestations of diarrhea was 26.33%, home management using oral fluids and oral
foods was 24.31%, control measures and prevention of diarrhea 32.12%. The overall
mean percentage of the knowledge aspect regarding diarrheal management was 26.58%
with a SD of 12% (Figure-2). These findings reveal that there is less knowledge among
mothers of underfive children regarding home management of diarrhea. Thus, null
hypotheses H0(1) is accepted.
TABLE 6
Statement wise over all assessment of Knowledge on meaning, etiology and
manifestations, and complications.
N=100
Statements Knowledge (%)
Max
No Score
Mean SD
Meaning of Diarrhea
1 1 57.0 50.0
The causes for Diarrhea
2 1 7.0 3.0
Main reason for developing diarrhea
3 4 21.3 25.7
Diarrheal transmission
4 4 28.0 26.2
Causes of food contamination
5 4 32.5 29.8
The dangerous signs of diarrhea
6 9 30.0 22.5
Meaning of dehydration
7 1 30.0 20.0
Complications of Diarrhea
8 3 21.3 27.8
From Table 6 and Annexure-A, it is clear that mothers had a highest overall mean
knowledge score regarding meaning of diarrhea 57% (passage of three or more loose
watery stools per day), followed by causes of food contamination 32.5% (open kept foods
43
30%, Dirty fingers 47%, unclean nipples 20%, flies 33%), followed by meaning of
dehydration 30% (loss of water and salts).
The overall mean score on dangerous signs of diarrhea was 30% (at least 8 watery
stools per day 39%, dehydration 16%, fever 19%, dry and sunken eyes 42%, loose skin
21%, frequent vomiting 40%, noisy breathing 11%, sunken fontenelle 24%, lethargy
58%).
The overall mean knowledge score on diarrhea transmission was 28%
(contaminated water 24%, contaminated food 63%, poor environmental sanitation 12%,
poor personal hygiene 13%). Regarding the reasons for developing diarrhea the mean
score was 21.3% (bottle feeding 26%, water storage in a wide mouth container 8%,
indiscriminate disposal of children stools 18%, non use of soap for washing feeding
containers 33%).
The mean score for complications of diarrhea was 21.3% (shock and death 22%,
malnutrition 27%, and anemia 12%). However, mothers had a poor knowledge regarding
the exact etiology of diarrhea i.e. microorganisms 7%.
TABLE 7
Statement wise over all assessment of Knowledge on Home management using
oral fluids and foods
44
N=100
Statements Max Knowledge (%)
No Score
Mean SD
9 Initial management of Diarrhea at home 3 20.3 28.8
10 Increasing Oral fluid intake during diarrhea 1 19.0 4.0
11 Advantages of using Oral rehydration solution 3 26.3 30.4
12 Method of preparation of Oral rehydration 1 11.0 3.0

salt solution
13 Frequency of giving Oral rehydration salt 3 7.3 1.1

solution
14 Usage of Oral rehydration solution within 24 1 8.0 1.3
hours.
15 Precautions to be taken while using Oral 2 1.5 0.7

rehydration solution
16 Availability of Oral rehydration salt packets 3 50.7 35.9
17 Home available Fluids that can be given 7 21.9 15.0

during diarrhea
18 Increasing of breast feeding during diarrhea 1 23.0 4.0
19 Increase of Oral food intake during and after 1 5.5 1.2

diarrheal episodes
20 Home based foods that can be given during 5 26.6 17.5
diarrhea
21 Fruits that have been given during diarrhea 4 23.3 21.1
22 Home based foods to be avoided during 4 54.3 45.4

diarrhea
Table 7 and Annexure-B describes the knowledge of mothers regarding use of oral
fluids and foods during and after diarrhea.
Regarding the initial management of diarrhea at home the overall mean
knowledge score of mothers was 23.3% (use of home available fluids 39%, ORS 15%,
45
and SSS 7%). However, 36% of mothers mentioned of giving only drugs and 34%
mentioned consulting a physician immediately during diarrheal episodes. This indicates
limited knowledge of mothers regarding early initiation of home management using
fluids.
Regarding the use of home based foods; mothers had the highest overall mean
knowledge score on foods to be avoided during diarrhea 54.3%, while the knowledge on
the foods to be given during diarrhea was only 26.6% (well cooked vegetables 15%,
bread/biscuits 32%, steamed foods/bland diet 40%, double boiled rice gruel/kanji 20%,
other foods 26%). Regarding fruits the means score was 23.3% (apple 50%, pineapple
9%, Banana 25%, Mangoes 9%). The mean knowledge score on giving usual amounts
was 24% while on increasing the quantity of food during and after diarrhea was very
negligible 5%. However, a majority of them 71% mentioned about restriction of solid
foods during diarrheal episodes indicating a limited knowledge regarding use of home-
based foods.
Regarding ORS, mothers overall mean knowledge score on availability of ORS
packets was 50.7% which was higher than advantages of using ORS (26.3%), method of
preparation of ORS 11%, usage of ORS within 24 hours (8%), the correct frequency of
giving ORS (7.3%), and precautions to be followed while preparing ORS was only 1.0%
which was very poor.
46
Regarding knowledge on various home available fluids that can be given during
diarrhea the mean knowledge score was 21.9% (curds 24%, rice water with salt 17%,
tender coconut water 53%, tea 12%, vegetable soups 5%, boiled cooled water 23%, other
fluids 19%).
Regarding increasing the quantity of oral fluids during diarrhea was found to be
only 19%, usual amounts 27%. However, a few mothers (46%) mentioned about
restriction of fluid during diarrhea and 3% stopping oral fluids completely.
Regarding breastfeeding the score on increasing the frequency of breastfeeding
23% and usual amounts 60%. However, a few mothers mentioned about decreasing the
frequency of breastfeeding 9% and discontinuing the feeding 8%.
TABLE 8
Statement wise over all assessment of knowledge on control measures and prevention of
Diarrhea
N=100
Statements Knowledge (%)
Max
No Score
Mean SD
Child requires medical aid when there is
23 3 34.7 24.1
Occurrence of diarrhea can be prevented
24 4 32.5 28.3
Water used for drinking at home
25 1 26.0 4.0
Clean water type
26 1 23.0 4.0
Frequency of hand washing with soap and water
27 2 25.0 41.7
47
Method of cleaning of infants feeding utensils at
28 1 64.0 5.0
home
Measures used to prevent feco oral contamination
29 2 27.0 29.7
Table-8 and Annexure-C shows data regarding the knowledge of mothers regarding
control and prevention of diarrhea.
The overall mean knowledge score of mothers regarding boiling of infants
feeding utensils was found to be higher 64%, followed by the mean score on when the
child requires medical aid 34.7% (presence of several loose stools within 1 or 2 hours
with or without blood and mucus 10%, diarrhea lasting more than 3 days 72%, and
failure of home treatment 22%). However, 23% did not know when to seek medical aid
during diarrhea.
Regarding prevention of occurrences of diarrhea the mean knowledge score was
32.5% (keeping foods covered 24%, exclusive breastfeeding 36%, Good weaning
practices 42%, and hand washing with soap and water 28%).
Regarding prevention of feco-oral contamination the overall mean knowledge
score was 27% (use of sanitary latrines 49%, covering human excreta with saw dust or
mud 5%).
The mean knowledge score on usage of boiled drinking water 26% and knowledge about
use of clean water was 23%.
48
Regarding adequate hand washing with soap and water the mean score was 25%.
Knowledge on washing hands with soap and water after defecation or cleaning the baby
28% and before preparing/eating food/feeding the child 22%).
Analysis on comparison of knowledge of mothers regarding home management of
diarrhea between urban an rural area
TABLE-9
Residence wise knowledge on home management of diarrheal diseases among mothers

(rural, urban)
Knowledge Score (%)
Knowledge Aspects Rural (n=50) Urban (n=50)
t-
Mean SD Mean SD Test
Meaning, Etiology and Manifestations
36.16 15.2 16.50 10.7 7.48 *
Home management using oral fluids
34.46 10.8 14.16 8.5 10.44 *
and foods
Control measures and prevention of
51.17 17.6 13.07 9.3 13.53 *
Diarrhea
Over all
38.33 11.0 14.82 7.1 12.70 *
* significant at 5 % Level
Table-9 shows the mean percentage of knowledge score in accordance with the
residential area.
In rural area the mean knowledge score on mothers meaning, etiology,
manifestations, and complications was 36.16% which was much higher than urban area
of 16.50%, the mean knowledge score on home management using oral fluids and foods
in rural was higher 34.46% and lower in urban area which was 14.16% (Figure-3). The
mean knowledge score of mothers on control measures and prevention was higher in
49
Fig -3
50
rural 51.17% and lower in urban area 13.07%. The overall mean knowledge score of
mothers in rural area was 38.33%, which was higher than urban area of 14.82% with a
mean SD of 7.1. However, the data subjected to statistical test indicates the mean
knowledge score between the rural and urban area were found to be significant at 5%
level (t=12.70). Hence, the null hypotheses H0 (2) i.e. there is no difference in the
knowledge among rural and urban mothers regarding home management of diarrhea is
rejected.
TABLE 10
Statement wise over all assessment of knowledge on etiology and manifestations among
mothers (rural, urban)
Knowledge (%)
t-
No Statement Rural Urban
Test
Mean SD Mean SD
Meaning of Diarrhea
1 82.0 40.0 32.0 50.0 5.52 *
The causes for Diarrhea are
2 8.0 3.0 6.0 2.0 3.92 *
Main reason for developing diarrhea
3 30.0 27.7 12.5 20.4 3.60 *
Diarrhea is transmitted through
4 34.0 26.1 22.0 25.1 2.34 *
Causes of food contamination
5 42.0 30.1 23.0 26.6 3.34 *
The dangerous signs of diarrhea
6 42.0 22.0 18.0 15.5 6.31 *
Loss during dehydration (loss of salt
7 and water) 6.0 2.0 1.0 0.8 16.41 *
Complications of Diarrhea are

8 37.3 29.8 5.3 12.3 7.02 *
Significant at 5 % Level
51
Table-10 and Annexure-A shows data regarding overall assessment of knowledge on
meaning, etiology, manifestation, and complications between urban and rural mothers.
The mean knowledge score of mothers regarding meaning of diarrhea in rural area
was 82%, which was much higher than urban area, which was only 32%.
The mean knowledge score of mothers regarding the exact cause of diarrhea
(microorganisms) in rural area was 8%, which was slightly higher than urban area, which
was very poor 6%.
The mean knowledge score of mothers regarding reasons for developing diarrhea
in rural area was 30% (bottle feeding 36%, water storage in a wide mouth container 10%,
indiscriminate disposal of children stools 26%, non use of soap for washing feeding
containers 48%), which was higher than urban area of only 12.5% (bottle feeding 16%,
water storage in a wide mouth container 6%, indiscriminate disposal of children stools
10%, non use of soap for washing feeding containers 18%).
The mean knowledge score of mothers regarding transmission of diarrhea in rural
area was 34% (contaminated water 26%, contaminated food 80%, poor environmental
sanitation 14%, poor personal hygiene 16%), which was much higher than urban area of
22% (contaminated water 22%, contaminated food 46%, poor environmental sanitation
52
10%, poor personal hygiene 10%). However, the knowledge scores on environmental
sanitation and personal hygiene were poor in both the groups.
The mean knowledge score of mothers regarding causes of food contamination in
rural area was 42% (open kept foods 38%, dirty fingers 54%, unclean nipples 30%, flies
46%), which was much higher than urban area of only 23% (open kept foods 22%, dirty
fingers 40%, unclean nipples 10%, flies 26%).
The mean knowledge score of mothers regarding dangerous signs of diarrhea in
rural area was 42% (at least 8 watery stools per day 48%, dehydration 22%, fever 34%,
dry and sunken eyes 54%, loose skin 36%, frequent vomiting 56%, noisy breathing 20%,
sunken fontenelle 38 %, lethargy 70%), which was much higher than urban area of 18%
(at least 8 watery stools per day 30%, dehydration 10%, fever 4%, dry and sunken eyes
30%, loose skin 6%, frequent vomiting 24%, noisy breathing 2%, sunken fontenelle 10%,
lethargy 46%).
The mean knowledge score of mothers regarding meaning of dehydration (loss of
water and salt) in rural area was 6%, while none of the mothers in urban area could
mention it (0%).
The mean knowledge score of mothers regarding complications of diarrhea in
rural area was 37.3% (shock and death 44%, malnutrition 44%, anemia 18%), which was
much higher than urban area of 5.3% (shock and death 0%, malnutrition 10%, anemia
53
6%). These findings indicate that urban mothers had very limited knowledge regarding
the complications of diarrhea.
On the whole regarding meaning, etiology, manifestation, and complications, the
knowledge of mothers in rural area was found to be higher than urban area. The data
subjected to statistical tests indicate the mean knowledge score of the mothers was found
to be significant at 5% level.
TABLE 11
Statement wise overall assessment of knowledge on home management using oral fluids
and foods among mothers (rural, urban)
No Statement Knowledge (%)
t-
Rural Urban
Test
Mean SD Mean SD
9 Initial management of Diarrhea at
26.7 31.6 14.0 24.4 2.25 *
home
10 Increased oral fluid intake during
diarrhea 28.0 5.0 10.0 3.0 21.83 *
11 Advantages of using Oral

36.7 33.8 16.0 22.6 3.60 *
12 Method of oral rehydration salt
20.0 4.0 2.0 1.0 30.87 *
solution is prepared
13 Frequency of giving Oral
12.0 22.1 2.7 1.1 2.97 *
rehydration salt solution
14 Oral rehydration solution should be
14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using
12.0 9.9 1.0 0.2 7.86 *
Oral rehydration solution
16 Oral rehydration salt packets are
70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be
25.4 15.4 18.3 13.9 2.42 *
given during diarrhea
18 Increase of breast feeding during
diarrhea 30.0 5.0 16.0 4.0 15.46 *
19 Increase of oral food intake during

10.0 3.0 1.0 0.2 21.17 *
and after diarrheal episodes
20 Home based foods that can be given 33.2 19.6 20.0 12.1 4.05 *
54
during diarrhea
21 Fruits that have been given during
29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during
97.0 12.0 11.5 16.9 29.17 *
diarrhea
* Significant at 5 % Level
Table 11 and Annexure- B describes the knowledge of mothers regarding use of oral
fluids and foods during and after diarrhea in the urban and rural area.
Regarding the mean score on initial management of diarrhea at home in rural area
was 26.7%, (using home available fluids 48%, ORS 20%, and SSS 12%, which was
higher than urban area of 14% (using home available fluids 30%, ORS 10%, and SSS
2%).
Regarding the use of home based foods during diarrhea, the knowledge scores of
mothers both in rural area and urban area are home based foods to be avoided 97.0% and
11.5%, foods that can be given during diarrhea 33.2% and 20%, increasing oral food
intake during diarrhea 10% and 1%, fruits 29% and 17.5% respectively. It is clear from
this data that rural mothers had more knowledge than urban mothers.
Regarding ORS, mothers mean knowledge scores in rural and urban areas are
availability of ORS packets 70.7% and 30.7%, advantages of using ORS 36.7% and 16%,
method of preparation of ORS 20% and 2%, usage of ORS within 24 hours 14%, and 2%,
frequency of giving ORS 12% and 2.7%, and precautions to be followed while preparing
55
ORS was 12% and 1% respectively. On the whole the knowledge of rural mothers was
found to be higher than urban mothers.
Regarding intake of oral fluids during diarrhea at home the mean knowledge score
on home available fluids in rural area was 25.4% (curds 34%, rice water with salt 4%,
tender coconut water 80%, tea 4%, vegetable soups 8%, boiled cooled water 36%, other
fluids 12%) which was higher than urban area 18.3% (curds 14%, rice water with salt
30%, tender coconut water 26%, tea 20%, vegetable soups 2%, boiled cooled water 10%,
other fluids 26%). Regarding increasing the quantity of oral fluids during diarrhea rural
10% and urban was 1% respectively. These findings reflect inadequate knowledge on use
of home available fluids.
Regarding breastfeeding mothers knowledge on increasing the frequency of
breastfeeding in rural was 30% and in urban was 16%.
On the whole, regarding knowledge of mothers about the intake of oral fluids and
foods during diarrhea in rural area was found to be higher than urban slum area. The data
to be significant at 5% level. However, the knowledge level was found to be less in both
the areas.
56
TABLE 12
Statement wise over all assessment of knowledge on control measures and prevention of
diarrhea among mothers (rural, urban)
No Statement Knowledge (%)

t-
Rural Urban
Test
Mean SD Mean SD
23 Child requires medical aid when
43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be
50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home
50.0 5.0 2.0 1.0 66.56 *
26 Clean water type
40.0 5.0 6.0 2.0 44.64 *
27 Frequency of hand washing with
48.0 47.3 2.0 1.4 6.87 *
soap and water is done
28 Cleaning of infants feeding utensils
94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral
52.0 20.1 2.0 0.9 17.57 *
contamination
Table 12 and Annexure-C shows the data regarding the knowledge scores of
mothers regarding control and prevention of diarrhea among urban and rural areas
The mean knowledge score of mothers regarding boiling of infants feeding utensils was
found to be higher in rural 94% than urban 34%.
Regarding knowledge prevention of feco-oral contamination the mean score in
rural area was 52% (covering human excreta with mud 10% and use of sanitary latrines
94%), which was low in urban area 2%(covering human excreta with mud 0% and use of
sanitary latrines 2%).
57
Regarding prevention of occurrences of diarrhea the mean knowledge score in
rural area was 50.5% (keeping the foods covered 44%, exclusive breastfeeding 48%,
good weaning practices 58%, hand washing with soap and water 52%), which higher than
urban slum 14.5% (keeping the foods covered 4%, exclusive breastfeeding 24%, good
weaning practices 26%, hand washing with soap and water 4%).
Regarding usage of boiled cooled water for drinking at home the mean score in
rural area was 50% and urban 2%. Knowledge about adequate hand washing with soap
and water rural 48% and urban 2%, and knowledge about use of clean water rural 40%
and urban 6%.
Regarding knowledge on when to seek medical aid the mean score of rural
mothers was 43.3% and urban 26.0%.
On the whole, regarding knowledge of mothers about control and prevention of
diarrhea in rural mothers was found to be much higher than urban mothers. The data
to be significant at 5% level.
Association of knowledge of mothers of underfive children regarding home
management of diarrhea based on baseline data.
58
TABLE 13
Impact of residence on knowledge of home management of diarrheal diseases (rural,

urban)
Knowledge Score (%)
Sample F
Residence Mean (%)
(n) Mean SD (%) Value
Rural
50 30.66 38.33 11.0
Urban 160.16 *
50 11.86 14.82 7.1
Combined
100 21.26 26.58 15.0
NS : Non-Significant. * Significant at 5 % Level
Table-13 shows the mean knowledge score in accordance with the residential
area. In rural it was 38.33%, which was higher than urban area, which was 14.82%
(figure-4). The overall mean knowledge score of both urban slum and rural area was
26.58% with mean SD of 15.0% The data subjected to statistical test indicate the mean
knowledge score according to residence wise was found to be significant at 5% level
(F =160.16).
TABLE 14
Impact of age on knowledge of home management of diarrheal diseases among mothers

Knowledge Score (%)
Age group Sample F
Mean (%)
17 20 years
29 14.89 18.61 13.1
7.30 *
21 24 years
50 22.76 28.45 14.8
59
25-29 years
21 26.50 33.12 13.89
Combined
100 21.26 26.58 15.0
fig-4
60
Fig-5
61
Fig-6
62
Fig-7
63
Fig-8
64
Table-14 shows mean knowledge score of mothers belonging to the age group of 25 and
above had a slightly high score 33.12% followed by mothers belonging to the age group
of 21-24 years of 28.45% and the least scores between the age group of 17-20 years of
18.61% (Figure-4). The data subjected to statistical test indicate the mean knowledge
score according to age wise was found to be significant at 5% level (F =7.30).
TABLE 15
Impact of education on knowledge of home management of diarrheal diseases among

mothers
Knowledge Score (%)
Education Sample F
Mean (%)
Illiterate
52 12.45 16.56 8.7
Primary/Secondary
18 26.80 33.50 13.5
50.07 *
High school/PUC
30 31.82 39.78 11.7
Combined
100 21.26 26.58 15.0
Significant at 5 % Level
Table 15 shows the mean knowledge score of mothers educated up to high school/PUC
had a higher score of 39.78% followed by mothers educated up to primary/secondary
33.50%, and illiterates had the lowest score of 16.56% (Figure-5). The data subjected to
65
statistical test indicate the mean knowledge score according to education was found to be
significant at 5% level (F =50.07). Thus, null hypotheses H0 (3) i.e. there is no impact of
demographic variables on knowledge of mothers regarding home management of
diarrhea is rejected.
TABLE 16
Impact of occupation on knowledge of home management of diarrheal diseases among

mothers
Occupation Knowledge Score (%)
Sample F
(n) Mean Mean (%) SD (%) Value
Labourer 14 12.73 15.91 7.1

8.88 *
House wife 86 22.65 28.31 15.2
Combined 100 21.26 26.58 15.0
Table-16 shows the mean knowledge scores of housewives were found to be higher
(28.31%) than labourers (15.91%) (Figure-6). The data subjected to statistical test
indicate the mean knowledge score according to occupation of the mother was found to
be significant at 5% level (F =8.88). Thus, null hypotheses H0 (3) i.e. there is no impact
of demographic variables on knowledge of mothers regarding home management of
diarrhea is rejected.
TABLE 17
Impact of type of family on knowledge of home management of Diarrheal diseases

among mothers
66
Type of Knowledge Score (%)
Family Sample F
Nuclear 49 23.30 29.13 15.8

2.85 NS
Joint 51 19.30 24.12 13.9
Combined 100 21.26 26.58 15.0
NS : Non-Significant
Table 17 shows the mean knowledge score of mothers belonging to nuclear
family was found to be slightly higher (29.13%) compared to joint family (24.12%)
(Figure-6). The data subjected to statistical test indicates the mean knowledge score
according to the type of the family was found to be non significant at 5% level
(F =2.85)NS. Thus, null hypotheses H0 (3) i.e. there is no impact of demographic
variables on knowledge of mothers regarding home management of diarrhea is accepted.
TABLE 18
Impact of family income on knowledge of home management of Diarrheal diseases

among mothers
Family Income Knowledge Score (%)

Sample F
Mean (%)
< Rs. 1500
53 18.11 22.64 14.8
Rs. 1500-2500
34 23.46 29.32 14.5
5.04 *
> Rs.2500
13 28.34 35.43 12.4
Combined
100 21.26 26.58 15.0
67
Table 18 shows that the mean knowledge score of mothers having income more than Rs.
2500 per month had a slightly higher knowledge of 35.43% followed by mothers having
income between Rs. 1500-2500 per month of 29.32%, and the least knowledge 22.64%
by mothers having income of less than Rs. 1500 per month (Figure-8). The data subjected
to statistical test indicate the mean knowledge score according to monthly income of the
family was found to be significant at 5% level (F =5.04). Thus, null hypotheses H0 (3)
i.e. there is no impact of demographic variables on knowledge of mothers regarding
home management of diarrhea is rejected.
TABLE 19
Impact of number of underfive living children on knowledge of home management of
diarrheal diseases among mothers.
Living children Knowledge Score (%)

under 5 years
Sample F
Mean (%)
One
56 21.54 26.92 15.9
Two+ 0.07 NS
44 20.90 26.13 13.8
Combined
100 21.26 26.58 15.0
NS :Non-Significant
Table-19 shows the mean knowledge score of mothers having one underfive child
had a slightly higher 26.92 than with more than two underfive children of 26.13%. The
overall mean knowledge score was 26.58%. The data subjected to statistical test indicate
68
the mean knowledge score according to monthly income of the family was found to be
non significant at 5% level (F =0.07) NS.
TABLE 20
Impact of family size on knowledge of home management of diarrheal diseases among
mothers
Knowledge Score (%)

Family Size Sample F
Mean (%)
Three/Four
42 24.28 30.35 16.1
Five and above 4.77 *
58 19.07 23.84 13.6
Combined
100 21.26 26.58 15.0
Table-20 (Figure-7) shows the mean knowledge score of mothers belonging to a
family size of three/four was higher (30.35%) than mothers belonging to a family size of
five and above (23.84%). The data subjected to statistical test indicate the mean
knowledge score according to family size was found to be significant at 5% level.
(F =4.77). Thus, null hypotheses H0 (3) i.e. there is no impact of demographic variables
on knowledge of mothers regarding home management of diarrhea is rejected.
TABLE 21
Impact of number of episodes on knowledge of home management of diarrheal diseases
69
Number of Knowledge Score (%)
Diarrheal
Sample F
episodes Mean (%)
Nil 28 22.70 28.37 15.2
One time 39 21.05 26.31 16.5
1-2 times 20 20.87 26.09 14.0 0.24NS
Above 2 times 13 19.41 24.26 12.1
Combined
100 21.26 26.58 15.0
NS :Non-Significant
Table 21 shows that out of 100 mothers 72 of them had experience with
managing with diarrheal episodes of their children. However, the data subjected to
statistical test indicate the mean knowledge score according to previous experience with
NS
diarrheal episodes was found to be non significant. (F =0.24) . These findings also
indicate a need for health education.
Table -22
Impact of previous exposure to media on knowledge of home management of diarrhea
among mothers
Knowledge Score (%)

Exposure to
t-test
media Urban Rural
Value
n Mean SD N Mean SD
Yes 4.82*
10 23.41 8.7 24 40.93 12.8
No 13.39*
40 12.68 4.8 21 34.74 6.7
Combined
50 14.82 7.1 50 38.33 11.0
F-test 28.21* 4.08*
70
Table-22 identifies the data regarding impact of knowledge of mothers with regard to
exposure to media. Only one-fifth (10) of the urban mothers and more than half of the
rural mothers (29) were exposed to media. The mean knowledge score of those who were
exposed to media (urban 23.41% and rural 40.93%) was higher than that not exposed to
any media previously. However, the data subjected to statistical test indicates a
significant difference of knowledge between rural and urban. The result indicates
significant findings for urban (F = 28.21*) and rural (F=4.08*). These findings indicate
null hypothesis H0 (3) was rejected. These findings also emphasize the need for health
education regarding home management of diarrhea.
Table 23
Comparison of literacy rate between urban and rural area.
Education Rural Urban

N % N %
Illiterate 8 16 44 88
Primary 4 8 3 6
Middle School 9 18 2 4
High School 24 48 1 2
PUC 5 10 0 0
Total 50 100 50 100
From the above table it is clear that majority of urban mothers (88%) were illiterates
when compared to rural mothers where only 16% were illiterates.
71
6. DISCUSSION
The study was designed to assess the knowledge of mothers of under five children
regarding home management of diarrhea. Fifty mothers of Dasarahalli urban slum and
fifty mothers of Hassarghatta rural area were selected for the study. The total sample size
was 100. The content areas included; meaning, etiology, manifestations, complications,
usage of oral rehydration salt solution, home available fluids and foods, prevention and
control measures of diarrhea.
In this study, nearly half of the mothers 50% belonged to the age group of 21-24
years. In this study, majority of the mothers were Hindus 97%.
A majority of mothers 52% were illiterate and 25% educated up to high school,
11% educated up to middle school, 5% up to PUC, and 7% up to primary school. A
majority of them (86%) were housewives. These findings are similar to the study done by
Mahendraker AG, (1991) [43] which revealed 42.1% for illiteracy, 32.89% for primary
school, 10.53% for middle school, 9.21% for secondary school, and 5.27% for higher
education.
In this study, nearly half of the mothers (49%) belonged to nuclear family,
followed by joint family (39%). These findings are similar to a study conducted by
Mercy Thomas (1999) [35] that revealed most of the mothers belonged to joint family.
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In this study, more than half of the mothers 53% had a monthly family income of
less than Rs.1500. Only 34% had income more than Rs. 2500 per month. These findings
are close to a similar study conducted by Datta V (2001) [32] that revealed 69.3% of
them had per capita income less than Rs. 500.
In this study, a majority of mothers 40% belonged to a family size of five and
above followed by a family size of three (22%). These findings are in conformity with the
study conducted by Kothari G (1987) [47] on diarrhea in urban slums of Bombay, which
revealed that nearly half of the population living in the slums is overcrowded.
In this study, a majority of children (24.7%) belonged to less than 1 year of age
followed by 20.5% of 2 years, 19.2% of 1 year, 18.5% of 3 years, and 13% of 4 years. A
majority of them 51.4% were male children and the rest 48.6% were females.
In the present study, a majority of children 74% was first child, 51% second child,
and 21% third child. A majority of mothers 56.3% had one underfive child, 41% had two
underfive children and 3% still had three underfive children in the family indicating the
need for family planning.
In this study, regarding occurrences of diarrheal episodes, when asked to mothers
by recall method, it was found that the number of episodes in the past 3 months was
highest in the age group of 0-1 year (39 episodes) followed by 20 episodes in the age
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group of 1 to 2 years and the least between 3 to 5 years (5 episodes). These findings
indicate that the number of episodes decreases as the age increases.
In this study, a majority of them 61% were not exposed to any media regarding
diarrhea, 26% were exposed to medical personnels, 19% to television, and only 5%
received information from friends/relatives. The findings of the study are in conformity
of studies conducted by Rao KV, et al. (1998) [36] and Kothari G (1987) [47] and
Reddiah VP, et al. (1991) [42] that states 33% consulted relatives/friends.
Analysis on knowledge of mothers regarding home management of diarrhea of total
population
In the present study, the overall mean knowledge score of total mothers regarding
etiology and manifestations of diarrhea was 26.33%, home management using oral fluids
and oral food was 24.31%, control measures and prevention of diarrhea 32.12%. The
overall mean score of the knowledge aspect regarding diarrheal management was 26.58%
with SD of 12%. This finding is supported by a study done by Datta V, et al (2001) [32].
In this study, knowledge of mothers regarding meaning of diarrhea 57% (at least 3
watery stools per day) (urban 82%, rural 32%). This is similar to a study conducted by
Anand K, et al. (1992) [18], which states just 24.1% could correctly define diarrhea.
74
In this study, regarding causes of food contamination, the mean knowledge score
was 32.5% (rural 42%, urban 23%), which is almost similar to a study conducted by
Melanie Nielse (2001) [21] and Sheth Mini and Obrah Monika. (2004) [22], which states
that only 26% mentioned that contaminated food is the cause of diarrhea.
In this study, regarding the reasons for diarrhea, the mean score was 21.3%(rural
30%, urban 12.5%), and complications of diarrhea 21.3% (rural 37.3%, urban 5.3%).
Regarding meaning of dehydration, the mean knowledge score was 3.5% (rural 6%,
urban 1.0%) and dangerous signs of diarrhea 30% (rural 42%, urban 18%). These
findings are much low when compared with the study conducted by Anand K, et al.
(1992) [18], which indicates that 60% of mothers knew about the dangerous signs of
diarrhea.
The mean knowledge score on diarrhea transmission including contaminated
water, contaminated food, poor personal hygiene and environmental sanitation was
28%(rural 34%, urban 22%). Similar findings found in a study conducted by Sheth Mini
and Obrah Monika (2004) [22], which indicate that ratings were poor on these areas.
All these datas were subjected to statistical tests and it indicates the mean
knowledge score of mothers were found to be significant at 5% level.
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In this study, regarding the initial management of diarrhea at home, the mean
knowledge score of all mothers was 20.3% (home available fluids 39%, ORS 15%, and
SSS 7%). The mean knowledge score in rural 26.7% and urban14%. These findings are
similar to a study conducted by Bhandari N (1995) which states that sugar salt solution
(SSS) in 14.7% of cases, oral rehydration salt solution (ORS) in 7.9% and Taneja et al.
(1996) which states the knowledge levels about oral rehydration solution revealed that
only 31.3% received ORS or home available fluids and Anand K, et al. (1992) [18] states
that only 29.7% knew about sugar salt solution. A study conducted by Mahendraker. A.G
(1991) also reveals that 50% of the mothers did not know about ORT.
In this study, regarding the use of home based foods, mothers had, the highest
mean knowledge score regarding the foods to be avoided during diarrhea 54.3% (rural
97%, urban 11.5%), followed by the knowledge on the foods to be given during diarrhea
was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural 29%, urban 17.5%).
The mean knowledge score regarding increasing the quantity of food during and after
diarrhea was very negligible 5.5% (rural 10%, urban1%). These findings are of support to
the studies conducted by Agarwal, et al. (2002) [30] and Mercy Thomas (1999) [35],
which states that mothers had poor knowledge regarding foods that are to be given and
the foods that are to be avoided.
In this study regarding ORS, mothers mean knowledge score on availability of
ORS packets was 50.7% (rural 70.7%, urban 30.7%), which was higher than advantages
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of using ORS 26.3% (rural 36.7%, urban 16%), correct method of preparation of ORS
using 1 liter of water 11% (rural 20%, urban 2%), usage of ORS within 24 hours 8%
(rural 14%, urban 2%), correct frequency of giving ORS 7.3% (rural 12%, urban 2.7%),
and precautions to be followed while preparing ORS was 1.5% (rural 2%, urban 1%)
which was very poor. These findings are similar to studies conducted by Taneja, et al.
(1996) [38], which states that only 11.5% could correctly measure the water needed to
make 1 liter of ORS and Bhandari N (1995) [20] which states that the amount of ORS
administered to children was inadequate at all ages, with majority consuming only
spoonfuls or sips. A study conducted by Mercy Thomas (1999) [35] also reveals that
knowledge on preparation of ORS package was severely lacking among the mothers.
In this study regarding knowledge on various home available fluids that can be
given during diarrhea the mean knowledge score was 21.9% (rural 25.4%, urban18.3%).
These findings are similar to a study conducted by Anand K, et al. (1992) [18], which
states that 38% gave weak tea or curd.
In this study regarding increasing the quantity of oral fluids during diarrhea, the
overall mean score was found to be only 19%, usual amounts 27%, and 46% restricted
fluid intake during diarrhea for their children, and 3% stopped oral fluids completely.
This is similar to a study conducted by Mercy Thomas (1999) [35], which states that only
50% of the mothers had knowledge regarding oral fluid intake during diarrhea.
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In this study regarding breastfeeding the score on increasing, the frequency of
breastfeeding 23% and usual amounts 60%, discontinued 8%, and 9% decreased in
frequency of breastfeeding during diarrhea. Only illiterate mothers restricted
Breastfeeding. The mean knowledge score of urban was 30% and rural 16%. These
finding is in contrast to a study conducted by Bhatia V (1996) and Mishra CP (1990)
[45], which states that breastfeeding, was not restricted.
However, all these findings indicate that rural mothers had more knowledge than
urban slum mothers. All these datas were subjected to statistical tests and it indicates the
In this study regarding knowledge of mothers regarding control and prevention of
diarrhea the mean knowledge score of mothers regarding boiling of infants feeding
utensils was found to be the highest 64% (rural 94%, urban 20%). High literacy rate in
rural areas was found to be a major contributing factor for this finding as observed by the
investigator during the survey.
In this study regarding, the usage of boiled cooled water for drinking 26% (rural
50%, urban 2%) and use of clean water was 23% (rural 40%, urban 6%). These findings
are similar to a study conducted by Melanie Nielse (2001) [21], which states that lack of
fuel or resources for fuel were not found to be a primary reason for not boiling the water.
78
In this study regarding prevention of occurrences of diarrhea, the mean
knowledge score of total subjects was 32.5% (keeping foods covered 24%, exclusive
breastfeeding at least 4 to 6 months 36%, Good weaning practices 42%, and hand
washing with soap and water 28%). The mean knowledge score of rural was 50.5% and
urban 14.5%. These findings are supported by studies conducted by Sheth Mini and
Obrah Monika (2004) [22], Datta V et al (2001) [32] and Kaur P (1994) [41], which
states that mothers had poor knowledge on washing hands with soap and water and other
hygienic activities.
In this study regarding prevention of feco-oral contamination, the mean score was
27% (use of sanitary latrines 49%, covering human excreta with saw dust or mud 5%).
The mean score in rural area was 52% (covering human excreta with mud 10% and use of
sanitary latrines 94%) and urban area 2%. Knowledge on use of sanitary latrines of urban
mothers was only 4% and none of the mothers had knowledge on covering the human
excreta with mud or saw dust though majority of them used open field defecation.
In this study, the mean score on when the child requires medical aid 34.7%
(presence of several loose stools within 1 or 2 hours with or without blood and mucus
10%, diarrhea lasting more than 3 days 72%, and failure of home treatment 22%). The
mean knowledge score of rural was 43.3% and urban 26%. This finding indicates that
mothers had poor knowledge on presence of blood in the stool as a dangerous sign.
However, 23% did not know when to seek medical aid during diarrhea. These findings
are also supported by Anand K, et al. (1992) [18], which states that only 62% knew the
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dangerous signs of diarrhea. All these datas were subjected to statistical tests and it
indicates the mean knowledge score of mothers were found to be significant at 5% level.
In this study, the overall mean knowledge score of mothers regarding all the
knowledge aspects of diarrhea in rural was 38.33%, which was higher than urban area of
14.82% with SD of 7.1. However, the data subjected to statistical test indicates the mean
knowledge score between the rural and urban area were found to be significant at 5%
level (t=12.7*).
In rural area, the mean knowledge score on meaning, etiology, manifestations,
and complications was 36.16% which was higher than urban area which was 16.50%, the
mean knowledge score on home management using oral fluids and foods in rural area
was higher 34.46% and lower in urban area which was 10.8%. The mean knowledge
score of mothers on control measures and prevention was higher in rural area 51.17% and
lower in urban 11.0%.
Association of knowledge of mothers of underfive children regarding home
management of diarrhea based on baseline data.
In this study, it shows the overall mean knowledge score based on residential area
indicates that rural area had higher knowledge 38.33% than urban area 14.82%. The
overall mean knowledge score of both urban slum and rural area was 26.58%. The data
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subjected to statistical test indicate the mean knowledge score according to residence
wise was found to be significant (F =160.16) at 5% level.
In this study, the mean knowledge score of mothers belonging to the age group of
25 and above had a slightly high score 33.12% followed by mothers belonging to the age
group of 21-24 years of 28.45% and the least scores between the age group of 17-20
years of 18.61%. The data subjected to statistical test indicate the mean knowledge score
according to age wise was found to be significant (F =7.30) at 5% level.
In this study, the mean knowledge score of mothers educated up to high
school/PUC had a higher score of 39.8% followed by mothers educated up to
primary/secondary 33.50%, and illiterates had the lowest score of 16.56%. The data
subjected to statistical test indicate the mean knowledge score according to education was
found to be significant (F =50.07) at 5% level.
With regard to occupation in this, study the mean knowledge scores of
housewives were found to be higher 28.31% than laborers, which was 15.91%. The data
subjected to statistical test indicate the mean knowledge score according to occupation of
the mother was found to be significant (F =8.88) at 5% level.
In this study, the overall mean knowledge score of mothers belonging to nuclear
family was found to be slightly higher 29.13% than joint family, which was 24.12%. The
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data subjected to statistical test indicate the mean knowledge score according to the type
of the family was found to be non significant (F =2.85) at 5% level.
In this study, the overall mean knowledge score of mothers having income more
than Rs. 2500 per month had a slightly higher knowledge of 35.43% followed by having
mothers having income between Rs. 1500-2500 per month of 29.32%, and the least
knowledge 22.64% by mothers having income of less than Rs. 1500 per month. The data
subjected to statistical test indicate the mean knowledge score according to monthly
income of the family was found to be significant (F =5.04%) at 5% level.
In this study, the mean knowledge score of mothers having one underfive child
had a slightly higher 26.92% than with more than two underfive children of 26.13%. The
overall mean knowledge score was 26.58%. The data subjected to statistical test indicate
the mean knowledge score according to monthly income of the family was found to be
significant (F =0.07%) at 5% level.
In this study that out of 100 mothers 72 of them had experience with managing
with diarrheal episodes of their children. However, the data subjected to statistical test
indicate the mean knowledge score according to previous experience with diarrheal
episodes was found to be non significant. (F =0.24%).
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7. CONCLUSION
The following conclusions were drawn from the study:
Majority of subjects 50% were in the age group of 21-24 years and 86% were
Hindus, and majority of them were illiterates (52%).
Rural mothers had higher knowledge than urban slum mothers.
All mothers had inadequate knowledge in all content areas regarding causes, signs
and symptoms, complications of diarrhea, use of oral fluids and food intake
during and after diarrhea, and prevention and control measures.
Only 39% of the subjects had previous exposure to media regarding management
of diarrhea.
There was significant difference in the knowledge of mothers with regard to age,
occupation, family size, family income, residence, literacy and previous exposure
to media.
There was no significant difference in the knowledge of mothers with regard to
family type, number of underfive children in the family, or previous experience
with managing diarrhea episodes at home.
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8. SUMMARY
This chapter deals with the summary, findings, implications, limitations and
recommendations of the study.
SUMMARY OF THE STUDY
The primary aim of the study was to assess the knowledge of mothers of
underfive children on home management of diarrheal diseases. The assessment included
specific content areas like definition, etiology, manifestations, complications, use of oral
fluids and home based foods, prevention and control measures of diarrhea.
The objectives of the study were:
urban slum area.
The study attempted to examine the following hypotheses and assumptions
Hypotheses
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The following hypotheses were formulated based on the objectives of the study:
H0 (2): There is no difference in the knowledge among rural and urban mother regarding
Assumptions
1. Mothers have some knowledge regarding the causes, signs and symptoms, and
prevention and control measures of diarrhea.
2. Mothers have limited knowledge regarding preparation and initiation of oral
rehydration therapy including use of ORS, home available fluids and foods during
diarrhea.
3. Knowledge of mothers is influenced by variables such as age, literacy, occupation,
type of the family, number of underfive children, family size, family income, residential
area, and previous exposure to media.
The theoretical framework adopted for the study was based on Orems self care
deficit theory. A review of related literature helped the investigator to develop the tool
regarding home management of diarrhea, conceptual framework, and in planning for data
analysis. The review of literature further helped in developing a health information
material.
85
The research approach adopted for the study was a descriptive study. The
independent variables are home management of diarrhea. The dependent variable was
score on knowledge test. The extraneous variables are demographic variables.
The study was conducted in Dasarahalli urban slum and Hassarghatta rural area of
Bangalore Karnataka State. Purposive random sampling was used to select the sample
respondents. The samples consisted of 100 mothers having under five children (urban
slum n = 50 and rural area n = 50).
The tool used for data collection was a structured interview schedule. It had four
sections. Part-A; consists of 15 items related to demographic characteristics, Part-B;
consists of 8 items related to etiology and manifestations of diarrhea, Part-C; consists of
14 items related to usage of oral fluids and oral foods, and Part-D; consists of 9 items
related to prevention and control measures of diarrhea. Ten experts established the
content validity of the tool. The tool was found to be reliable and feasible. The reliability
of the tool was established by split half method. The reliability coefficient of knowledge
test was r = 0.96 (p < 0.05).
Pilot study was conducted during the period of 17th August 2005 to 27th August
2005 in Hasserghatta rural area and Dasarahalli urban slum of Karnataka state. The
purpose of the pilot study was to find out the feasibility of the study and to determine
86
strategy for statistical analysis. Purposive random sampling was done from these areas
for conducting pilot study.
The final study was conducted during the period of 19th September 2005 to 15th
October 2005 in Hassarghatta rural area and Dasarahalli urban slum of Bangalore,
Karnataka State. The sample consisted of 50 mothers of under five children residing in
Hassarghatta rural area and 50 mothers of underfive children residing in Dasarahalli
urban slum area.
The data gathered were analyzed and interpreted based on the set objectives of the
study. Descriptive and inferential statistics were used for data analysis. Students t-test
employed in testing the main knowledge between urban and rural mothers. Further F-test
is used in testing the impact of demographic variables on knowledge of mothers
regarding home management of diarrhea.
FINDINGS
The major findings of the study are summarized as follows:
Findings related to sample characteristics.
Majority of mothers (50%) belonged to the age group of 21-24 years.
Majority (52%) of mothers were illiterate and house wives (86%)
Majority (97%) of mothers were Hindus and (49%) belongs to nuclear family.
A majority (53%) of mothers had income less than Rs. 1500 per month.
Majority (40%) of mothers belonged to a family size of five and above.
87
Nearly one-fourth (24.7%) of the children were less than one year of age and
more than half of underfive children 51.4% were males.
A majority (41%) of the families had two underfive children and 3% of families
had 3+ underfive children.
A majority of the subjects (61%) were not exposed to any media regarding
Findings related to demographic variables.
The mean knowledge score of rural area mothers was 38.33%, which was higher
than in urban area (14.82%).
Mothers more than 25 years of age had higher mean knowledge score of 33.12%
than mothers aged 17-20 years (18.61%).
Mothers belonging to nuclear family had a slightly higher mean knowledge score
of 29.13% than joint family (24.12%), but no significant difference.
The mean knowledge score of literate mothers was higher (37.42%) than that of
illiterate mothers (16.56%).
The mean knowledge score of housewives 28.31% was found to be higher than
labourers (15.91%).
The mean knowledge score of mothers having one underfive children was found
to be slightly higher (26.92%) than having two underfive children (26.13%), but
no significant difference.
88
Families having a monthly income of more than Rs. 2500 per month had a mean
knowledge score of 35.43%, which was higher than having income of less than
Rs. 1500 per month (22.64%).
The mean knowledge score of mothers exposed to media was higher (36.44%)
than that of not exposed to any media (19.88%).
Findings on knowledge assessment related to home management of diarrhea
Findings related to cause, signs and symptoms, and complications:
On the whole mothers had a highest mean knowledge score regarding meaning of
diarrhea 57% (i.e. at least 3 watery stools per day) (rural 82%, urban 32%) followed
by causes of food contamination 32.5% (rural 42%, urban 23%), followed by
meaning of dehydration 3.5% (rural 6%, urban 1.0%) and dangerous signs of diarrhea
30% (rural 42%, urban 18%). The mean knowledge score on diarrhea transmission
was 28% (rural 34%, urban 22%), reasons for developing diarrhea was 21.3% (rural
30%, urban 12.5%), and complications of diarrhea 21.3% (rural 37.3%, urban 5.3%).
All these datas were subjected to statistical tests and it indicates the mean knowledge
score of mothers were found to be significant at 5% level.
Regarding the initial management of diarrhea at home the mean knowledge score
of all mothers were 20.3% (home available fluids 39%, ORS 15%, and SSS 7%). Among
rural mothers it was 26.7%, (using Home Available Fluids 48%, ORS 20%, and SSS
12%, which was higher than urban mothers of 14% (using Home available fluids 30%,
89
ORS 10%, and SSS 2%). The overall knowledge score of total subjects was 20.3% (rural
26.7%, urban 14%).
Regarding the use of home based foods, mothers had the highest overall mean
knowledge score regarding the home based foods to be avoided during diarrhea 54.3%
(rural 97%, urban 11.5%), followed by the knowledge on the foods to be given during
diarrhea was only 26.6% (rural 33.2%, urban 20%), and fruits 23.3% (rural 29%, urban
17.5%). The mean score on increasing the quantity of food during and after diarrhea was
very negligible 5.5% (rural 10%, urban 1%). On the whole the knowledge on giving
usual amounts 24%, but 71% mentioned about restricting solid foods during diarrheal
episodes, which indicates a limited knowledge on use of home based foods.
Regarding ORS, the overall mean knowledge score of mothers on availability of
ORS packets was high 50.7% (rural 70%, urban 30.7%) followed by advantages of using
ORS 26% (rural 36.7%, urban 16%), correct method of preparation of ORS 11% (rural
20%, urban 2%), usage of ORS within 24 hours 8% (rural 14%, urban 2%), correct
frequency of giving ORS 7.3% (rural 12%, urban 2.7%), and precautions to be followed
while preparing ORS was 1.5% (rural 2%, urban 1%). On the whole knowledge on
precautions and preparations of ORS was found to be very low or negligible in both the
areas.
Regarding knowledge on various home available fluids that can be given during
diarrhea the overall mean knowledge score was 21.9% (rural 25.4%, urban 18.3%)and on
90
increasing the quantity of oral fluids during diarrhea was found to be only 19% (rural
28%, urban 10%). Regarding breastfeeding the overall mean score on increasing the
frequency of breastfeeding 23% (rural 30%, urban 16%) and usual amounts 60%. Others
discontinued 8%, and 9% decreased the frequency of breastfeeding. These findings
indicate a limited knowledge on this sub area.
However, all these findings indicate that rural mothers had more knowledge than
urban mothers. All these datas were subjected to statistical tests and it indicates the mean
The mean knowledge score of mothers regarding boiling of infants feeding
utensils was found to be higher 64% (rural 94%, urban 34%) followed by when the child
requires medical aid 34.7% (rural 43.3%, urban 26%), prevention of occurrences of
diarrhea 32.5% (rural 50.5%, urban 14.5%), prevention of feco-oral contamination 27%
(rural 52%, urban 2%), usage of boiled drinking water 26% (rural 50%, urban 2%),
frequency of hand washing with soap and water 25% (rural 48%, urban 2%), and
knowledge on use of clean water was 23% (rural 40%, urban 6%).
However, these findings indicate that rural mothers had more knowledge than
urban mothers. All these datas were subjected to statistical tests and it indicates the mean
91
IMPLICATION
Nursing service/Administration
Nurses play an important role in prevention of disease and promotion of health.
The findings of the present study indicate a deficit in the knowledge of mothers regarding
home management of diarrhea. Thus, this study will enable the nurse as a member of the
multidisciplinary team to understand and assess the level of knowledge of mothers,
expand their knowledge for planning effective in-service and health education
programmes for specific communities and hospitals. Further, this will enable them to
prioritize and focus their nursing care activities based on the needs of the society.
Nursing education
These findings will help the student nurses to identify the deficits of knowledge
on various sub areas of home management of diarrhea. They should be able to recognize
the major health problems and focus on improving their knowledge and practice in the
prevention and control of diseases in the field.
Nurses as educationists can plan health education programmes for various nursing
personnels in the hospital as well as community. This study will enable them to identify
the learning needs of the mothers. Further, they can adapt to different teaching-learning
strategies for various nursing personnels for effectiveness of home management of
diarrhea by mothers. This will also enable nurses to identify the changing learning needs
of the society as an educationist and contribute for the curriculum development and
preparation in nursing as well as non-nursing field.
92
Nursing research
The researchers can carry out studies to identify cost effective ways for dissemination of
health information to the public and test its effectiveness regarding reduction and
mortality and morbidity due to diarrhea. This study will also enable them to identify and
focus on specific areas for conduction of further studies.
RECOMMENDATIONS
This study could be replicated in a larger sample to generalize the findings.
A similar study can be carried out to find out the effectiveness of planned
teaching programme using health information material developed for the present
study.
A study can be conducted regarding on attitude, beliefs and practice regarding
oral fluids and food intake during and after diarrhea at home.
A study can be carried out to find out the attitude and actual practices of mothers
regarding prevention of diarrhea.
A study can be conducted to find out the knowledge and practices of health care
providers regarding diarrhea.
LIMITATIONS
The size of the sample was small which imposes limitations generalization.
Mothers who could understand Kannada and English only were included in
the study.
Mothers were limited to only those who were having underfive years of age.
93
9. BIBLIOGRAPHY
1. Basavanthappa BT. Community health nursing. 1st ed. New Delhi: Medical
Publishers (P) LTD; 2003. p. 298.
2. David Oot. Saving children. Washington times. 2004; January 18.
3. Margaret Kosek, Caryn Bern, Guerrant RL. The global burden of diarrheal
disease, as estimated from studies published between 1992 and 2000. Bulletin of
the World Health Organization 2003; 81:197-204.
4. Clinical management of acute diarrhea. WHO/UNICEF Joint statement. Geneva.
Switzerland. 2004; May. (www. who.int) (www. Unicef.org)
5. Tejal Baraj-jaitly. Health status of children in India. Health For The Millions
2002; October-November. p. 19.
6. India's Popular Soap Operas Become a National Soapbox. Christian Science
Monitor. 2005; June 10.
7. Poor Hygiene Kills 500,000 Children Each Year in India. Asia Pacific disease
outbreak/surveillance reports. India: Week of Mar 22, 2004. (http://timesofIndia.
Indiatimes.com/articleshow/580688.cms) access date 9/7/2005
8. Suraj Gupte. A short textbook of pediatrics. 9th ed. New Delhi: Medical
publishers; 2001. p. 4-5.
9. Khalique N, Sinha SN, Yunus M, Malik A. Early childhood mortality- a rural
study. J R Soc Health 1993 Oct; 113(95): 247-9.
10. A newsletter on child survival and safe motherhood program. New Delhi.
Government of India. CSSM review 1995. p.26.
94
11. No author. Cereal aids fight against diarrhea. Mazingira 1984 July; 8 (3): 9.
12. Wishvas Rane. Nitromidazole-Quninoline Anti-diarrhoeals neither rationale nor
necessary. Health Action 2004 Jan; p. 25-26.
13. Jayaram A. Vajpayeee hits out the cost of medicare. Online edition of Indias
National Newspaper. The Hindu January 20, 2001. (Vajpayee hits out at high cost
of medicare.htm) access date 10/12/2004)
14. Mangala S, Gopinath D, Narasimhamurthy NS, Shivaram C. Feeding practices in
Under-Fives during diarrhea before and after educational intervention. Indian
Pediatrics 2003; 37: 312-314 (http://www.indianpediatrics.net/march-312-
314.htm) access date 9/7/2005.
15. Census of India, 2001. Karnataka State PLCN:29. p.10, 31, 62. (http:// www.
Censusindia. Net)
16. Environmental sanitation conditions and health impact: a case-control study
(2003). Prevelance of diarrhea Bulletin of the World Health Organization 2003;
81 (3)
17. Park K. Textbook of social and preventive medicine. 17th ed. Jabalpur:
Bhanarsidas Bhanot Publishers; 2001. p. 81-96.
18. Anand K, Lobo J, Sundaram KR, Kapoor SK. Knowledge and practice regarding
diarrhea in rural mothers of Haryana. Indian Pediatr. 1992 Jul; 29 (7): 914-7.
19. Dua T, Bhal R, Bhan MK. Lessons learnt from Diarrheal Disease Control
program and implications for the future. Indian J Pediatrics 1999 Jan-Feb; 66(1): 55-
61.
95
20. Bhandari N, Qadeer I, Bhan MK. Patterns of use of oral rehydration therapy in
urban slum community. J Indian Med Assoc. 1995 Jun; 93(6): 239-42.
21. Melanie Nielsen, Anneke Hoogvorst, Flemming Konradsen, Muhammed
Mudasser and Wim van der Hoek. Childhood diarrhea and hygiene: Mothers
perceptions and practices in the Punjab, Pakistan: 2001 Working Paper 25.
Colombo, Sri Lanka: International Water Management Institute. (www.iwmi.org)
Access date 14/11/2005.
22. Sheth Mini and Obrah Monika. Diarrhea prevention through food safety
education. The Indian J of pediatrics 2004; 71 (10): 879-82.
23. BT Basavanthappa Nursing Research. 1st ed. New Delhi: Medical Publishers
(P) LTD; 2005. p. 67.
24. Borooah Vani K. On the incidence of diarrhea among young children.
Ecconomics and Human Biology 2 (2004) 119-38 (www.sciencedirect.com)
25. Victoria CG, Huttly SR, Fuchs SC, Barros FC, Garenne M, Leroy O, et al.
International differences in clinical patterns of diarrheal deaths: a comparison
of children from Brazil, Snegal, Bangladesh, and India. J Diarrheal Dis Res
1993, Mar; (1): 25-9
26. Aswathi S, Pande VK, Glick H. Underfive mortality in the urban slums of
Lucknow. Indian J of Pediatrics 1996 May-Jun; 63(3): 363-8.
27. B. Banerjee, S. Hazra, and D. Bandyopadhyay. Diarrhea Management Among
Under Fives. Indian Pediatrics 2004 mar; 17(41): 259
96
28. Bhandari N, Bhan MK, Sazawal S. Mortality associated with acute watery
diarrhea, dysentery, and persistent diarrhea in rural India. Acta pediatric
Supplement 1992 Sep; 381: 3-6
29. Guerrant RL, Hughes JM, Lima NL, Crane J. Diarrhea in developed and
developing countries: magnitude, special settings, and etiologies. Rev Infect
Dis. 1990 Jan-Feb; 12 Suppl 1:S41-50
30. Agarwal KN and Bhasin SK. Feasiblity studies to control acute diarrhea in
children by feeding fermented milk preparations Actimel and Indian Dahi, Eur
J Clin Nutri 2002 Dec; 56 Suppl 4:S 56-9.
31. Pandey A, et al. gender differences in health care seeking during common
illness in a rural community of west Bengal, India. J Health Popul Nutr. 2002
Dec; 20 (4): 306-11.
32. Datta V, John R, Singh VP, Chaturvedi P. Maternal knowledge, attitude and
practices towards diarrhea and oral rehydration therapy in rural Maharastra.
Indian J Pediatr. 2001 Nov; 68 (11): 1035-7
33. Zodepy SP, Despande SG, Ughade SN, Kulkarni SW, Shrikhande SN, Hinge
AV. A predication model for moderate or sever dehydration in children with
diarrhea. J Diarrheal Dis Res 1999 Mar; 17 (1): 10-6.
34. Bhatia V, Swami HM, Bhatia M, Bhatia SP. Attitude and practice in rural
community in chandigarh. Indian J Pediatr 1999 Jul-Aug; 66(4): 499-503.
35. Mercy Thomas. Mothers knowledge on the diet and oral fluid intake during
diarrheal diseases of the children below five years of age in a selected urban
community in Mangalore. 1999. Unpublished thesis.
97
36. Rao KV, Mishra VK, Retherford RD. Mass media can help improve treatment
of childhood diarrhea. Natal Fam Health Surv Bull 1998 August; (11): 1-4
37. Bhal L, Sharma VK, Kaushal RK. Experience with diarrhea training and
treatment unit in Shimla. Indian Pediatr 1997 Jun; 34 (6): 527-34.
38. Taneja DK, Lal P, Aggarwal CS, Bansal A, Gogia V. Diarrhea management in
some Jhuggi clusters in Delhi. Indian pediatric 1996 Feb; 33(2): 117-9
39. Mehta M. Nutritional management of diarrheal diseases. Indian Peadiatr. 1996
Jun; 33 (6): 524-5; author reply 525.
40. Buch NA, Hassan M, Bhat IA. Parental awareness and practices in acute
diarrhea. Indian Pediatr. 1995 Jan; 32 (1): 76-9
41. Kaur P, Singh G. Food Practices during diarrhea. Indian J Public Health 1994
April-Jun; 38(2): 58-61.
42. Reddiah VP and Kapoor SK., Epidemiology of diarrhea and its implications
for providing services. Indian J pediatrics 1991 Mar-Apr; 58(2): 205-8
43. Mahendraker AG, Dutta PK, Urmil AC, Moorth TS. A study on medico social
profile of under five children suffering from diarrheal diseases. Indian J
Matern Child Health 1991; 2(4): 127-30.
44. Chowdhury AM, Karim F, Rhode JE, Ahmed J, Abed FH. Oral rehydration
therapy: a community trial comparing the acceptability of homemade sucrose
and cereal based solutions. Bull World health organ 1991; 69 (2): 229-34
45. Mishra CP, Kumar S, Tiwari IC, Prasad DN. A study on some diarrhea related
practices in urban Mirzapur. India J Public health 1990 Jan-Mar; 34 (1): 6-10
98
46. Huffman SL and Combest C. Role of breastfeeding in the prevention and
treatment of diarrhea. J Diarrhoeal Disease Res. 1990 Sep: 8 (3): 68-81.
47. Kothari G. Diarrhea in urban slums. Bombay. Dialogue Diarrhea 1987 Dec;
(31): 4-5.
99
ANNEXURE A
Statement wise over all assessment of Knowledge on Etiology and Manifestations

N=100
Statements Response (%)
No
Urban Rural Combined
1 Meaning of Diarrhea 32 82 57
2 The causes for Diarrhea are 6 8 7
3 Main reason for developing diarrhea
a Bottle feeding 16 36 26
b Water storage in a wide mouthed container 6 10 8
c Indiscriminate disposal of children stool 10 26 18
d Non use of soap for washing feeding containers 18 48 33
4 Diarrhea is transmitted through
a Contaminated water 22 26 24
b Contaminated food 46 80 63
c Poor environmental sanitation 10 14 12
d Poor personal hygiene 10 16 13
5 Causes of food contamination
a Open kept food \s 22 38 30
b Dirty fingers 40 54 47
c Unclean nipples 10 30 20
d Flies 20 46 33
6 The dangerous signs of diarrhea
a At least 8 watery stools per day 30 48 39
b Dehydration 10 22 16
C Fever 4 34 19
d Dry and sunken eyes 30 54 42
e Loose skin 6 36 21
f Frequent vomiting 24 56 40
g Noisy breathing 2 20 11
h Sunken Fontenelle 10 38 24
i Lethargy 46 70 58
7 During dehydration there is loss of 0 6 3
b Water and salts
8 Complications of Diarrhea are
a Shock and death 0 44 22
b Malnutrition 10 44 27
c Anemia 6 18 12
100
ANNEXURE -B

N=100
No
9 Initial management of Diarrhea at home
a Home available fluids 30 48 39
bOral rehydration salt solution 10 20 15
c Sugar Salt solution 2 12 7
10 Oral fluid intake during diarrhea to be 10 28 19
b increased
11 Advantages of using Oral rehydration solution
a Readily available as powder in packets 36 62 49
bContinued when there is vomiting 2 14 8
c Replaces electrolytes and water 0 6 3
12 Oral rehydration salt solution is prepared 2 20 11
a 1 liter of boiled cooled water
13 Frequency of giving Oral rehydration salt
solution
a After each loose stool 6 16 11
b Quarter glass after each stool for below 2 years 0 0 0
c 1 glass after each loose stool for above 2 years 0 0 0
14 Oral rehydration solution should be used 2 14 8
Within 24 hours
15 Precautions to be taken while using Oral
a Store in a cool dry place in a closed container 0 4 2
c Avoid soft drinks and sweetened drinks 0 0 0
16 Oral rehydration salt packets are available
a Subcenters/Hospitals 20 82 51
b Provisional stores 0 54 27
c Medical shops 72 76 74
17 Home available Fluids that can be given during
diarrhea
a Curds 14 34 24
b Rice water with salt 30 4 17
c Tender coconut water 26 80 53
d Tea 20 4 12
101
eVegetable soups 2 8 5
fBoiled cooled water 10 36 23
g Other fluids 26 12 19
18 Breast feeding during diarrhea to be 16 30 23
b increased
19 Oral food intake during and after diarrheal 0 10 5
b episodes
Increased
20 Home based foods that can be given during
diarrhea
a Well cooked smashed vegetables 0 30 15
b Bread/Biscuits 22 42 32
c Steamed foods/bland diet 28 52 40
d Double boiled rice gruel/kanji 18 22 20
e Any other 32 20 26
21 Fruits that have been given during diarrhea
a Apple 28 72 50
b Pineapple 10 8 9
c Bannana 24 26 25
d Mangoes 8 10 9
22 Home based foods avoided during diarrhea
a Raw vegetables 12 100 56
b Chocolates and sweets 0 92 46
c Animal fats 4 98 51
d High fiber foods 30 98 64
102
ANNEXURE-C
Statement wise over all assessment of Knowledge on Control measures

and prevention of Diarrhea
N=100
No
23 Child requires medical aid when there is
a Presence of several stools in 1 or 2 hours with or 4 16 10
without blood and mucus
b Diarrhea lasting at least more than 3 days and 60 84 72
lethargy
c Failure of home treatment 14 30 22
24 Occurrence of diarrhea can be prevented
b Keeping the foods covered 4 44 24
c Exclusive breast feeding 24 48 36
D Good weaning practices 26 58 42
f Hand washing with soap and water 4 52 28
25 Water used for drinking at home 2 50 26
d Boiled cooled water
26 Clean water type 6 40 23
b Bhore water
27 Frequency of hand washing with soap and
water
b After defecation or cleaning the baby 2 54 28
c Before preparing/eating food/feeding the child 2 42 22
28 Cleaning of infants feeding utensils is done at 34 94 64
home
d. Soap and water and boiling b efore each feed
29 Measures used to prevent feco oral
contamination
b Covering human excreta with saw dust 0 10 5
c Use of sanitary latrines 4 94 49
103
ANNEXURE -D
LETTER SEEKING PERMISSION TO CONDUCT STUDY
Reference: No. EWCON/648/2004 Date: 30/09/2004
From,
The Principal
East West College of Nursing
Rajajinagar
Bangalore.
To,
The Medical Officer
Hassarghatta PHC
Bangalore.
Sub: Permission to conduct study.
Ms. Saramma T. T. is a M.Sc Nursing student (Community Health Nursing) of
East West College of Nursing, Bangalore. She has selected a topic assess the knowledge
of mothers of underfive children regarding home management of diarrhea in selected
areas of Bangalore. Kindly give her permission to conduct this study in Hassarghatta-
PHC and help her by giving needed details regarding her study.
Thanking you,
Prof. S. Chitra
Principal
104
ANNEXURE - E
Permission letter
105
ANNEXURE-F
BLUE PRINT FOR CONTENT OF THE TOOL
KNOWLEDGE QUESTIONNAIRE
S. No Questions Total Total score Score

number of percentage
questions
27 33.75%
Part-B
1, 2,3,4,5,6,7,8 8
Knowledge
regarding
recognition of
diarrhea
Part-C 39 48.75%
9, 10, 11, 12,
Home management 13, 14, 15, 16, 14
of diarrhea using 17, 18, 19, 20,
oral fluids and 21, 22.
foods
4.Part D 23, 24,25, 26, 14 17.5%

27, 28,29. 9
Control measures
and prevention
Grand Total 29 80 100%
106
ANNEXURE - G
LETTER SEEKING EXPERT OPINION IN VALIDATING THE TOOL USED

TO ASSES THE KNOWLEDGE OF MOTHERS REGARDING HOME
MANAGEMENT OF DIARRHEA.
From,
Ms. Saramma T. T.
MSc (N) II year
East West College of Nursing
Bangalore.
To,
Sir/Madam,
Sub: Seeking validation of tool.
I am a student of Masters in Nursing (Community Health Nursing) studying in
East West College of Nursing, Bangalore, working on thesis. This thesis is to be
submitted to RGUHS as a partial fulfillment of the requirement of Masters degree in
Nursing. The title of my study is to assess the knowledge of mothers of underfive
children regarding home management of diarrhoeal diseases in selected areas of
Bangalore.
Objectives of the study:
107
urban slum area.
I am herewith enclosing
1. Questionnaire.
2. Blue Print of questionnaire.
3. Criteria for content validity.
4. Content validity certificate.
I kindly request you to give your valuable suggestions and expert comments
regarding the content of the tool.
Thanking you,
Yours sincerely,
Saramma T. T.
M.Sc (N) student
108
ANNEXURE-H
TOOL IN ENGLISH
STRCTURED INTERVIEW SCHEDULE
INSTRUCTIONS
Please read the following items carefully and place a tick mark Tot
against the most appropriate responses. Scores 80
PART A
BASELINE DATA
Serial Number
Code Number
1. Area
a. Urban slum
b. Rural
2. Age of the mother in years __________
3. Education of the mother
a. Illiterate
109
b. Primary school
c. Middle school
d. High school
e. PUC
f. Graduate
g. Post graduate
4.Occupation of the mother
a. Employee/government/private
b. Labourer
c. Business
d. Housewife
e. Professional/medical/engineer/others
5. Monthly income of the family per month in rupees _________
6. Type of family
a. Nuclear
b. Joint
c. Extended
7. Religion
a. Hindu
110
b. Muslim
c. Christian
d. Others
8. Age of the child in years
a. < 1
b. 1
c. 2
d. 3
e. 4
f. 5
9. Sex of the child
a. Male
b. Female
10. Birth order of the child
a. First
b. Second
c. Third
d. Fourth
e. Fifth
f. Fifth and above
111
11. Number of underfive children in the family
a. One
b. Two
c. Three
d. Four
12. Number of diarrheal episodes of diarrhea within the past 3 months age wise
a. 0-1 year _________
b. 1-2 year _________
c. 2-3 year _________
d. 3-4 year ________
d. 4-5 year ________
13. Family size
a. Three
b. Four
c. Five
d. Five and above
14. Previous exposure to media regarding management of diarrhea were
a. TV
b. Radio
112
c. News paper/magazines
d. Friends
e. Relatives
f. Medical personnels
g. None of the above
15. Have you ever used ORS ? Yes/NO
PART B
KNOWLEDGE REGARDING ETIOLOGY AND MANIFESTATIONS
1. Diarrhea means passage of
a. Frequent formed stools per day 0
b. Three or more loose watery stools per day 1
c. Less than three loose stools per day 0
d. Do not know 0
2. The exact causes of diarrhea are
a. Microorganisms 1
b. Curse 0
c. Evil eye 0
d. Do not know 0
3. The main reasons for developing diarrhea are
113
a. Bottle feeding 1
b. Water storage in a wide mouth container 1
c. Indiscriminate disposal of childrens stool 1
d. Non use of soap for washing feeding containers 1
e. Do not know 0
4. Diarrhea is transmitted through
a. Contaminated water 1
b. Contaminated food 1
c. Poor environmental sanitation 1
d. Poor personal hygiene 1
e . Do not know 0
5. The causes of food contamination are
a. Open kept foods 1
b. Dirty fingers 1
c. Unclean nipples 1
d. Flies 1
e. Do not know 0
6. The dangerous signs of diarrhea
a. At least 8 watery stools per day 1
b. Dehydration 1
114
c. Fever 1
d. Dry and sunken eyes 1
e. Loose skin 1
f. Frequent vomiting 1
g. Noisy breathing 1
h. Sunken fontenelle 1
I. Lethargy 1
J. Do not know 0
7. During dehydration there is loss of
a. Excess water from the body 0
b. Excess water and salts 1
c. Salts 0
d. Do not know 0
8. Complications of diarrhea are
a. Death 1
b. Malnutrition 1
c. Anemia 1
d. Do not know 0
PART C
KNOWLEDGE ON HOME MANAGEMENT OF DIARRHEA USING ORAL
115
FLUIDS AND FOODS
9. Initial management of diarrhea at home includes
a. Home available fluids
b. Oral rehydration salt solution 1
c. Sugar Salt solution 1
d. Only drugs 1
e. Consulting a physician immediately 0
10. The oral fluid intake during diarrhea to be
a. Restricted
b. Increased 0
c. Stopped completely 1
d. Usual amounts 0
e. Do not know 0
11.The advantages of using Oral Rehydration Solution are
a. Readily available as powder in packets
b. Continued when there is vomiting 1
c. Replaces electrolytes and water lost from the body 1
d. Do not know 1
12.Oral rehydration salt solution is prepared by mixing
one standard packet (WHO) in
116
a. l liter of boiled cooled water
b. 1 glass of boiled cooled water 1
c. 5oo ml of clean water 0
d. Do not know 0
13. The frequency of giving Oral Rehydration Salt solution are
a. After each loose stool
b. Quarter to half glass after each loose stool for children below 2 years 1
c. 1 glass after each loose stool for children above 2 years of age 1
d. Do not know 1
14. Oral rehydration salt solution should be used within
a. 6 hours
b. 12 hours 0
c. 24 hours 0
d. Do not know 1
15. Precautions to be taken while using Oral rehydration solution are
a. Store it in a cool dry place in a closed container
b. Prepare fresh solution each time 1
c. Avoid soft drinks and sweetened drinks 0
d. Do not know 1
117
16. Oral Rehydration Salt Packets are available at
a. Sub centers/Hospitals
b. Provisional stores 1
c. Medical shops 1
d. Do not know 1
17. The home available fluids that can be given during diarrhea are
a. Curds
b. Rice water with salt 1
c. Tender coconut water 1
d. Tea 1
e. Soups 1
f. Boiled cooled water 1
g. Any other 1
h. Do not know 1
18. Breastfeeding during diarrhea to be
a. Discontinued
b. Increased in frequency 0
c. Decreased in frequency 1
d. Usual amounts 0
19. The oral food intake during and after diarrheal episodes
118
a. Restricted
b. Increased till the child gains the previous weight 0
c. Usual amounts 1
d. Stopped 0
e. Do not know 0
20. The home based foods that can be given during diarrhea are
a. Well cooked smashed vegetables
b. Bread/Biscuits 1
c. Steamed foods/bland diet 1
d. Double boiled rice gruel/kanji 1
e. Any other 1
f. Do not know 1
21. Fruits that can be given during diarrhea are
a. Apple
b. Pineapple 1
c. Banana 1
d. Mangoes 1
e. Do not know 1
22. Home based foods to be avoided during diarrhea are
a. Raw vegetables
119
b. Chocolates and sweets 1
c. Animal fats 1
d. High fiber foods 1
e. Do not know 1
PART D
KNOWLEDGE REGARDING CONTROL MEASURES
AND PREVENTION OF DIARRHEA
23. The child requires medical aid when there is
a. Presence of several loose stools in 1 or 2 hours with or without blood and
mucus
b. Diarrhea lasting at least more than 3 days and lethargy 1
c. Failure of home treatment 1
d. Do not know 1
24. The occurrences of diarrhea can be prevented by
a. Using left over food
b. Keeping the foods covered 0
c. Exclusive breast feeding 1
d. Good weaning practices 1
120
e. Keeping dirty clothes uncovered 1
f. Hand washing with soap and water 0
g. Do not know 1
25. Water used for drinking at home is
a. Non boiled water from any source
b. Filtered by cloth 0
c. Sometimes boiled or filtered water 0
d. Boiled cooled water 0
26. Clean water is
a. Tap water
b. Bhore water 0
c. Well water 1
d. Do not know 0
27. Frequency of hand washing with soap and water is
a. Sometimes
b. After defecation or cleaning the baby 0
c. Before preparing/eating food/feeding the child 1
d. Not required 1
28. Cleaning of infants feeding utensils is done at home using
121
a. Plain water alone
b. Mud/sand 0
c. Soap and water 0
d. Soap and water and boiling before each feed 0
29. Measures used for prevent feco oral contamination are
a. Open field defecation
b. Covering human excreta with saw dust or mud 0
c. Use of sanitary latrines 1
d. Do not know 1
122
ANNEXURE I
EVALUATION CRITERIA CHECKLIST FOR VALIDITATION OF TOOL

INSTRUCTIONS
The expert is requested to go through the following evaluative criteria checklist prepared for
validating the tool for assessing the knowledge.
Specific Content Item
Areas Numbers Criteria Suggestion and remarks
Relevant
Relevant to
some extent
Not relevant
123
ANNEXURE-J
LISTS OF EXPERTS FOR CONTENT VALIDATION OF THE
TOOL
1. Vimalakumari P.G.
Principal
Indira Nursing College
Managalore.
2. Dr. T.M. Krishnaveni
Professor
Mallige College of Nursing
Bangalore-13
3. Dr. Ms. K.P. Neeraja
Principal
Navodhya College of nursing
Raichur
4. Mrs. Sunitha
Principal
Rajiv Gandhi College of Nursing
Bangalore
124
5. Dr. Jayanth Kumar K.
Proffessor and Head
Dept of community Medicine
M.S. Ramiaha Medical College
Bangalore.
6. Mrs. Saroja Jayakumar
Principal
Manipal School of Nursing
Bangalore
7. Ms. R. Prabavathy
Principal
Hosmat College of Nursing
Bangalore
8. Mr. H. S. Surendra
Associate Professor of Statistics
College of B S &H.
University of Agricultural Sciences
GKVK. Bangalore-55
125
9. Ms. M. Naveenatha
Lecture
Manipal College Of Nursing
MAHE, Manipal.
10. Mrs. Prema. P
Lecturer
Navodaya College of Nursing
Raichur
11. Mrs. Gangabai.B. Kulkarni
Professor and HOD
MSRINER, Bangalore-54
126
ANNEXURE-K
TOOL IN KANNADA VERSION
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Nluuq oS.
H)
)Aww
)o.
m) uu
C) Sr.
22. vS uu uu
B yusS
H) qNS.
)XNg q rxS.
)Hn Nu yusS.
m)ww yusS.
C) Sr.
S - 4
23. SS NT uO YOq
Nl uS.
136
H) 1 Sg As 3 Sg S AwN
N
q Nmu v uS.
)3 vwS Bu Aru vu xO
uS.
)ww MvSu SoSu
uS.
m)Sr.
24. vu BS Nw
qluu AS.
H) N vwS u qh
Bw rwu.
)B yusSw Ylu.
)QlT 6 rS N q
Epu.
m)3 rS wq SS yN
Bw Nlu.
C) Nu gSw S
qSu Ylvu.
Hy) NSw y q xxu
qu.
d) Sr.
25. Nm w uN
x.
H) u Nvu xw
EyTu.
)gu vNh x.
)N Nvu As vNu x.
m)Nvu x.
26. uu x Hu.
137
H) w x
)N x
) x.
m)Sr.
27. y q x EyT
Nquw lNuu.
H) N AwSoT.
) cw mu N As
Sw X
mu .
)B q q rw u
As SS
B rx u.
m)ANq C.
28. S B yqSw X
l w
uuS.
H) w xxu.
)o / .
)y q x.
m)y q x q yr
u
Nu.
29. RNT l v Nw
xru S.
H) qu w cw.
)u h As pxu ww
du
138
w Xu.
)yqNu cw
XSw u.
m)Sr.
139
TABLE 1
Personal characteristics of Respondents
Characteristics Category Respondents

Number Percent
Area Urban 50 50.0
Rural 50 50.0
Age group 17-20 years 29 29.0
21-24 years 50 50.0
25-35 years 21 21.0
Education Illiterate 52 52.0
Primary 7 7.0
Middle 11 11.0
High school 25 25.0
PUC 5 5.0
Occupation Labourer 14 14.0
Housewife 86 86.0
Total 100 100
TABLE 2
Family related characteristics of Respondents

Number Percent
Religion Hindu 97 97.0
Muslim 3 3.0
Type of Family Nuclear 49 49.0
Joint 39 39.0
Extended 12 12.0
Family Income/m < Rs. 1500 53 53.0
Rs. 1500-2500 34 34.0
> Rs. 2500 13 13.0
Family Size Three 22 22.0
(members) Four 20 20.0
Five 18 18.0
Five& above 40 40.0
Total 100 100

TABLE 3
Child related characteristics of Respondents
N=100
Number Percent
Age of the Child (n=146) < 1 year 36 24.7
1 year 28 19.2
2 years 30 20.5
3 years 27 18.5
4 years 19 13.0
5 years 6 4.1
Sex of the Child (n=146) Male 75 51.4
Female 71 48.6
Birth order of the Child (n=146) First 74 74.0
Second 51 51.0
Third 21 21.0
Under 5 children in the Family One 56 56.0
Two 41 41.0
Three+ 3 3.0
TABLE 4
Diarrheal episodes and Media of Exposure on management of diarrhea
N=100
Aspects Category Respondents
Number Percent
Diarrheal episodes in past 3 No 28 28.0
months 0 1 year 39 39.0
1-2 years 20 20.0
2-3 years 8 8.0
3-5 years 5 5.0
Media of Exposure @ Television 19 19.0
Relatives/Friends 5 5.0
Medical personals 26 26.0
No response 61 61.0
@ Multiple Response
TABLE 5
Aspect wise Knowledge on Home management of Diarrheal diseases among mothers
Stateme Max. Knowledge Score

Knowledge Aspects nts Score
Mean Mean SD
(%) (%)
Etiology and Manifestations 7 27 7.11 26.33 16.4
Home management using oral fluids 15 39 9.48 24.31 14.1

and foods
Control measures and prevention of 7 14 4.50 32.12 23.7
Diarrhea
Over all 29 80 21.26 26.58 12.0
TABLE 6
Residence wise Knowledge on Home management of Diarrheal diseases among mothers
Knowledge Score ( % )
Knowledge Aspects Urban (n=50) Rural (n=50) t-
Mean SD Mean SD Test
Etiology and Manifestations 36.16 15.2 16.50 10.7 7.48 *
Home management using oral fluids 34.46 10.8 14.16 8.5 10.44 *
and foods
Control measures and prevention of 51.17 17.6 13.07 9.3 13.53 *
Diarrhea
Over all 38.33 11.0 14.82 7.1 12.70 *
* significant at 5 % Level
TABLE 7
Impact of Residence on Knowledge of Home management of Diarrheal diseases
Knowledge Score (%)

Residence Sample F
Urban 50 30.66 38.33 11.0
Rural 50 11.86 14.82 7.1 160.16 *
Combined 100 21.26 26.58 15.0
NS : Non-Significant. * Significant at 5 % Level
TABLE 8
Impact of Age on Knowledge of children on in prevention of dental carries
Age group Knowledge Score (%)

Sample F
17 20 years 29 14.89 18.61 13.1

7.30 *
21 24 years 50 22.76 28.45 14.8
25 35 years 21 26.50 33.12 13.89
Combined 100 21.26 26.58 15.0
TABLE 9
Impact of Education on Knowledge of Home management of Diarrheal diseases
Education Knowledge Score (%)

Sample F
Illiterate 52 12.45 16.56 8.7
Primary/Secondary 18 26.80 33.50 13.5 50.07 *
High school/PUC 30 31.82 39.78 11.7
Combined 100 21.26 26.58 15.0
TABLE 10
Impact of Occupation on Knowledge of Home management of Diarrheal diseases
Occupation Knowledge Score (%)

Sample F
Labourer 14 12.73 15.91 7.1

8.88 *
House wife 86 22.65 28.31 15.2
Combined 100 21.26 26.58 15.0
TABLE 11
Impact of Type of Family on Knowledge of Home management of Diarrheal diseases
Type of Knowledge Score (%)

Family Sample F
Nuclear 49 23.30 29.13 15.8

2.85 NS
Joint 51 19.30 24.12 13.9
Combined 100 21.26 26.58 15.0
NS : Non-Significant
TABLE 12
Impact of Family Income on Knowledge of Home management of Diarrheal diseases
Family Income Knowledge Score (%)

Sample F
< Rs. 1500 53 18.11 22.64 14.8
Rs. 1500-2500 34 23.46 29.32 14.5 5.04 *
> Rs.2500 13 28.34 35.43 12.4
Combined 100 21.26 26.58 15.0
TABLE 13
Impact of Living children on Knowledge of Home management of Diarrheal diseases
Living children Knowledge Score (%)

under 5 years Sample F
One 56 21.54 26.92 15.9

0.07 NS
Two+ 44 20.90 26.13 13.8
Combined 100 21.26 26.58 15.0
NS :Non-Significant
TABLE 14
Impact of Family type on Knowledge of Home management of Diarrheal diseases
Family Type Knowledge Score (%)

Sample F
Nuclear 42 24.28 30.35 16.1

4.77 *
Joint 58 19.07 23.84 13.6
Combined 100 21.26 26.58 15.0
TABLE 15
Impact of Number of episodes on Knowledge of Home management of

Diarrheal diseases
Number of Knowledge Score (%)

Diarrheal Sample F
episodes (n) Mean Mean (%) SD (%) Value
Nil 28 22.70 28.37 15.2

One time 39 21.05 26.31 16.5 0.24NS
1-2 times 20 20.87 26.09 14.0
Above 2 times 13 19.41 24.26 12.1
Combined 100 21.26 26.58 15.0
NS :Non-Significant
TABLE 16

N=100
No Score
Mean SD
1 Meaning of Diarrhea 1 57.0 50.0
2 The causes for Diarrhea are 1 7.0 3.0
3 Main reason for developing diarrhea 4 21.3 25.7
4 Diarrhea is transmitted through 4 28.0 26.2
5 Causes of food contamination 4 32.5 29.8
6 The dangerous signs of diarrhea 9 30.0 22.5
7 Loss during dehydration 1 30.0 20.0
8 Complications of Diarrhea are 3 21.3 27.8

TABLE 17

N=100
No Score
Mean SD
9 Initial management of Diarrhea at home 3 20.3 28.8
10 Oral fluid intake during diarrhea 1 19.0 4.0
11 Advantages of using Oral rehydration solution 3 26.3 30.4
12 Oral rehydration salt solution is prepared 1 11.0 3.0
13 Frequency of giving Oral rehydration salt 3 7.3 1.1

solution
14 Oral rehydration solution should be used 1 8.0 1.3
15 Precautions to be taken while using Oral 2 1.0 0.7

16 Oral rehydration salt packets are available 3 50.7 35.9
17 Home available Fluids that can be given 7 21.9 15.0

during diarrhea
18 Breast feeding during diarrhea 1 23.0 4.0
19 Oral food intake during and after diarrheal 1 5.0 1.2

episodes
20 Home based foods that can be given during 5 26.6 17.5
diarrhea
21 Fruits that have been given during diarrhea 4 23.3 21.1
22 Home based foods avoided during diarrhea 4 54.3 45.4

TABLE 18
N=100
No Score
Mean SD
23 Child requires medical aid when there is 3 34.7 24.1
24 Occurrence of diarrhea can be prevented 4 32.5 28.3
25 Water used for drinking at home 1 26.0 4.0
26 Clean water type 1 23.0 4.0
27 Hand washing with soap and water is done 2 25.0 41.7
28 Cleaning of infants feeding utensils is done at 1 64.0 5.0

home
29 Measures used to prevent feco oral contamination 2 27.0 29.7
TABLE 19
No Statement Knowledge (%) t-

Urban Rural Test
Mean SD Mean SD
1 Meaning of Diarrhea 82.0 40.0 32.0 50.0 5.52 *
2 The causes for Diarrhea are 8.0 3.0 6.0 2.0 3.92 *
3 Main reason for developing diarrhea 30.0 27.7 12.5 20.4 3.60 *
4 Diarrhea is transmitted through 34.0 26.1 22.0 25.1 2.34 *
5 Causes of food contamination 42.0 30.1 23.0 26.6 3.34 *
6 The dangerous signs of diarrhea 42.0 22.0 18.0 15.5 6.31 *
7 Loss during dehydration 6.0 2.0 1.0 0.8 16.41 *
8 Complications of Diarrhea are 37.3 29.8 5.3 12.3 7.02 *
TABLE 20


Urban Rural Test
Mean SD Mean SD
9 Initial management of Diarrhea at 26.7 31.6 14.0 24.4 2.25 *
home
10 Oral fluid intake during diarrhea 28.0 5.0 10.0 3.0 21.83 *
11 Advantages of using Oral 36.7 33.8 16.0 22.6 3.60 *

12 Oral rehydration salt solution is 20.0 4.0 2.0 1.0 30.87 *
prepared
13 Frequency of giving Oral 12.0 22.1 2.7 1.1 2.97 *
14 Oral rehydration solution should be 14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using 12.0 9.9 1.0 0.2 7.86 *
16 Oral rehydration salt packets are 70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be 25.4 15.4 18.3 13.9 2.42 *
18 Breast feeding during diarrhea 30.0 5.0 16.0 4.0 15.46 *
19 Oral food intake during and after 10.0 3.0 1.0 0.2 21.17 *
diarrheal episodes
during diarrhea
21 Fruits that have been given during 29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during 97.0 12.0 11.5 16.9 29.17 *
diarrhea
TABLE 21


Urban Rural Test
Mean SD Mean SD
23 Child requires medical aid when 43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be 50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home 50.0 5.0 2.0 1.0 66.56 *
26 Clean water type 40.0 5.0 6.0 2.0 44.64 *
27 Hand washing with soap and water 48.0 47.3 2.0 1.4 6.87 *
is done
28 Cleaning of infants feeding utensils 94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral 52.0 20.1 2.0 0.9 17.57 *
contamination
TABLE 22

Urban Rural Test
Mean SD Mean SD
1 Meaning of Diarrhea 82.0 40.0 32.0 50.0 5.52 *
2 The causes for Diarrhea are 8.0 3.0 6.0 2.0 3.92 *
3 Main reason for developing diarrhea 30.0 27.7 12.5 20.4 3.60 *
4 Diarrhea is transmitted through 34.0 26.1 22.0 25.1 2.34 *
5 Causes of food contamination 42.0 30.1 23.0 26.6 3.34 *
6 The dangerous signs of diarrhea 42.0 22.0 18.0 15.5 6.31 *
7 Loss during dehydration 6.0 2.0 1.0 0.8 16.41 *
8 Complications of Diarrhea are 37.3 29.8 5.3 12.3 7.02 *
TABLE 23


Urban Rural Test
Mean SD Mean SD
9 Initial management of Diarrhea at 26.7 31.6 14.0 24.4 2.25 *
home
10 Oral fluid intake during diarrhea 28.0 5.0 10.0 3.0 21.83 *
11 Advantages of using Oral 36.7 33.8 16.0 22.6 3.60 *

12 Oral rehydration salt solution is 20.0 4.0 2.0 1.0 30.87 *
prepared
13 Frequency of giving Oral 12.0 22.1 2.7 1.1 2.97 *
14 Oral rehydration solution should be 14.0 4.0 2.0 1.0 20.58 *
used
15 Precautions to be taken while using 12.0 9.9 1.0 0.2 7.86 *
16 Oral rehydration salt packets are 70.7 36.0 30.7 22.2 6.69 *
available
17 Home available Fluids that can be 25.4 15.4 18.3 13.9 2.42 *
18 Breast feeding during diarrhea 30.0 5.0 16.0 4.0 15.46 *
19 Oral food intake during and after 10.0 3.0 1.0 0.2 21.17 *
diarrheal episodes
during diarrhea
21 Fruits that have been given during 29.0 21.0 17.5 19.7 2.82 *
diarrhea
22 Home based foods avoided during 97.0 12.0 11.5 16.9 29.17 *
diarrhea
TABLE 24


Urban Rural Test
Mean SD Mean SD
23 Child requires medical aid when 43.3 22.6 26.0 22.6 3.80 *
there is
24 Occurrence of diarrhea can be 50.5 25.5 14.5 17.6 8.22 *
prevented
25 Water used for drinking at home 50.0 5.0 2.0 1.0 66.56 *
26 Clean water type 40.0 5.0 6.0 2.0 44.64 *
27 Hand washing with soap and water 48.0 47.3 2.0 1.4 6.87 *
is done
28 Cleaning of infants feeding utensils 94.0 20.0 34.0 50.0 7.88 *
is done at home
29 Measures used to prevent feco oral 52.0 20.1 2.0 0.9 17.57 *
contamination
Respondents (%)
0
10
20
30
40
50
60
70
80
90
Ur
ba
n
50
Area
Ru
ral
50
17
-2 0
29
21
-2 4
50
Age (yrs)
25
-3 5
21
Illit
e ra
te
52
Pr
im
a ry
Education
7
TABLE 25
Mi
dd
le
Hig
11
hs
ch
oo
l
25
PU
C
5
La
bo
ure
r
Occupation
Ho
14
us
ew
ife
86
Knowledge Score (%)
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
Etiology and
manifestations
26.33
Home management
using oral fluids and
goods
24.31
Controlmeasures and
Knowledge Aspects
prevention of diarrhea
32.12
Over all
26.58
Figure . 1 : Personal characteristic of Respondents
Urban Rural
51.17
60.00
50.00
36.16
34.46
Knowledge score (%)
40.00
30.00
16.50 13.07
20.00 14.16
10.00
0.00
Etiology and Home management Controlmeasures
manifestations using oral fluids and and prevention of
goods diarrhea
Knowledge aspects
Figure . 3 : Residence wise knowledge on Home management of

Diarrheal diseases among mothers
38.33
33.12
40.00
28.45
35.00
30.00
18.61
Knowledge score (%)
25.00
14.82
20.00
15.00
10.00
5.00
0.00
n l 0 4 5
Urba Rura 17-2 21-2 25-3
Residence Age (years)
Figure . 4 : Impact of Residence and Age on knowledge of children on

in prevention of dental carries
39.78
40.00
33.50
35.00
Knowledge Score
30.00 26.58
25.00 16.56
(%)
20.00
15.00
10.00
5.00
0.00
Illiterate
Primary /
Secondary High school /
PUC Combined
EDUCATION
Figure . 5 : Impact of Education on knowledge of Home management

of Diarrheal diseases
29.1
28.3
30.0
24.1
Knowledge score (%)
25.0 15.9
20.0
15.0
10.0
5.0
0.0
Labourer
House wife
Nuclear
Joint
Occupation Type of family
Figure . 6 : Impact of Occupation and Type of Family on knowledge of

Home management of Diarrheal diseases
40.00
35.43
35.00
29.32
30.00
26.58
25.00 22.64
Knowledge Score (%)
20.00
15.00
10.00
5.00
0.00
< Rs.1500 Rs.1500-2500 > Rs.2500 Combined
Family income per month
Figure . 7 : Impact of Family income on knowledge of Home management

of Diarrheal diseases
35.00
30.35
26.58
30.00
23.84
25.00
Knowledge Score (%)
20.00
15.00
10.00
5.00
0.00
Three / Four Five and above Combined
Family size
Figure . 8 : Impact of Family size on knowledge of Home management of

Diarrheal diseases

Saramma K T

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A STUDY TO ASSESS THE KNOWLEDGE OF

MOTHERS OF UNDERFIVE CHILDREN REGARDING

HOME MANAGEMENT OF DIARRHOEAL DISEASES

IN SELECTED AREAS OF HASSERGHATTA-PHC,

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

Of the requirements of the degree of

Master of Science in Nursing

Community Health Nursing

Under the guidance of

Prof. Arul Mani Esther Rani. TP M.Sc (N)

DEPARTMENT OF COMMUNITY HEALTH NURSING

EAST WEST COLLEGE OF NURSING

AFFLIATED TO RAJIV GANDHI UNIVERSITY

OF HEALTH SCIENCES, KARNATAKA

I hereby declare that this dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management

of diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore

is a bonafide and genuine research work carried out by me under the

guidance of Pro. Arul Mani Esther Rani, Head of Department of

Community Health Nursing, East West College of Nursing, Bangalore.

Pace: Bangalore East West College Of Nursing

This is to certify that the dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management of

diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore a bonafide

research work done by Saramma T. T. in partial fulfillment of the requirement for

the degree of Master of Science in Nursing (Community Health Nursing).

Date: Signature of the guide

Place: Bangalore Name: Prof. Arul Mani Esther Rani

Designation and Department

Head of the Department

Community Health Nursing

This is to certify that the dissertation entitled a study to assess the

knowledge of mothers of underfive children regarding home management of

diarrhoeal diseases in selected areas of Hasserghatta-PHC, Bangalore is a

bonafide research work done by Saramma T. T. under the guidance of

Seal and Signature of HOD Seal and signature of the Principal

Name: Prof. Arul Mani Esther Rani Name: S. Chitra

Place: Bangalore Place: Bangalore

print or electronic format for academic/research prupose.

Date: Signature of the Candidate

Place: Bangalore Name

Rajiv Gandhi University of Health Sciences, Karnataka

This study was undertaken and completed under the guidance of

guidance, support, and encouragement provided for the successful completion of

I am grateful to Prof. S. Chitra, Principal of East West College of Nursing

conduction of this study.

My sincere thanks go to Ms. Prabavathy. M. Sc (N) for her valuable

suggestions and support rendered for the completion of this study.

My sincere thanks go to Prof. Vimalakumari P. G. M.Sc (N) for providing

expertise suggestions and support for the completion of this study.

during the conduction of the study.

I am extremely grateful to Prof. H.S. Surendra (statistician) for his

valuable suggestions, constant guidance and support rendered throughout the

conduction of the study.

tool and for providing expertise suggestions and remarks.

cooperation and help rendered for the completion of this study.

Date: Signature of the Candidate

Place: Name: Saramma T.T.

(In alphabetical order)

HAF: Home Available Fluids

HRS: Home made Recommended Solution

ORS: Oral Rehydration Solution

ORT: Oral Rehydration Therapy