A STUDY ON THE KNOWLEDGE AND  
PRACTICES OF CHILDHOOD DIARRHOEAL 
DISEASES MANAGEMENT AMONG  
MOTHERS IN THE WA DISTRICT, 
UPPER WEST REGION. GHANA
ERIC OWUSU
A  D ISSERTAT ION  SUBM ITTED  TO  THE  UN IVERSITY  O F  G HANA , 
LEGON  ( SCHOOL  O F  PUBLIC  HEALTH) IN  PARTIAL  FULFILLMENT 
O F  THE  REQU IREMENTS FOR  THE  AW ARD  OF  THE  M ASTERS  O F  
PUBLIC  HEALTH  DEGREE (M PH )
JUNE 1997
^ 3 5 1 8 1 2
RT 4-S6-J>5 Qu>
This is to  certify that this dissertation entitled “ A Study on the Knowledge and 
Management practices o f Childhood Diarrhoea! Diseases among Mothers o f the  
Wa District, Upper West Region, Ghana” submitted for the Masters in Public 
Health Degree o f the School o f  Public Health, University o f  Ghana, is a bonafide 
research work carried out by Mr. Eric Owusu under my supervision and that no part o f 
this dissertation has been submitted for any other degree.
The assistance received during the course o f  the research has been fully acknowledged.
CERTIFICATION 1
DR. GLORIA QUANSAH ASARE 
ACADEMIC SUPERVISOR 1
CERTIFICATION 2
This is to  certify that this dissertation entitled “ A Study on the Knowledge and 
Management practices of Childhood Diarrhoeal Diseases among Mothers of the 
Wa District, Upper West Region, Ghana” submitted for the Masters in Public 
Health Degree o f the School o f Public Health, University o f  Ghana, is a bonafide 
research work carried out by Mr. Eric Owusu under my supervision and that no part 
o f this dissertation has been submitted for any other degree.
The assistance received during the course o f the research has been fully acknowledged.
MR. ALFRED 0BU9BI 
ACADEMIC SUPERVISOR 2
DEDICATION:
This work is dedicated to my Loving Wife Christiana
Buruwaa Oduro, and to our children, Gloria, Irene and Eric Jnr.
ACKNOWLEDGMENT:
This Study was made possible through the provision o f funds by the Ministry o f  Health 
and the School o f  Public Health, University o f Ghana through the DANTDA financial 
support to the school for students field work.
I wish to  acknowledge with appreciation the co-operation accorded the study team  by the 
various community opinion leaders, Chiefs, Sub-district Health Management Teams and 
especially mothers in the study area who participated in the study.
To Ms. Grace Danlara the research assistant for her willingness to  assist in the study and 
for her wonderful guide and interpreter to me.
To Dr. Fulgence Sangbe-Dery, my field Supervisor for the great effort he put in to  guide 
and assist me in his supervisory role in the study.
To Dr. Ebenezer Appiah Denkyira, the Upper West Regional Director o f  Health Services 
for his back-up supervisory assistance and logistics support.
To Dr. Gloria Quansah Asare and Mr. Alfred Obuobi my academic supervisors for their 
supervisory assistance.
Warmest complements go to the Wa District Health Management Team and the Upper 
West Regional Health Administration for their wonderful working relationship.
To Mr. Manfred Yaw Owusu-Ansah the regional Biostatistician and Mr. James Addo o f 
the Disease Control Unit, Accra for their great assistance to the design o f  the study and 
computer support.
To Ms. Margaret Kwofie who worked tirelessly to  type this report w ith all seriousness.
To all my course mates, friends and well -wishers for their concern, support and guidance 
during the course, and all others for taking good care o f  my family whilst I was away from 
home to the Upper West Region for my field residency attachment to conduct this study.
Finally, to the great Architect of the universe through whose guidance and protection, I 
could overcome all obstacles and challenges in the course o f  my studies.
TABLE OF CONTENTS:
PAGE
Dedication   i
Acknowledgment ........................................................ ii
Table o f  Contents ........................................................ iii
List o f  Tables ........................................................ vii
Abstract ........................................................ viii
CHAPTER  1
1.0 INTRODUCTION ........................................................ 1
1.1 Background to  the Study ........................................................ 1
1.2 Problem Statement ........................................................ 4
1.3 Justification o f  the study ........................................................ 4
1.4 Literature Review ........................................................ 4
1.5 Objectives o f the study ........................................................ 7
1.6 Specific Objectives ........................................................ 7
CHAPTER  2:
2.0 THE STUDY AREA ........................................................ 8
2.1 Educational Infrastructure & Enrollment.......................................  9
2.2 Health Delivery Services ......................................................... 10
2.2.1 Health infrastructural Facilities ..........................................  10
2.2.2 Staffing   11
2.2.3 Finance   11
2.3 Health Problems   12
2.4 Child Health Services ........................................................ 13
iii
CHAPTER 3: ( z  f  J c l
3.0 METHODS 14
3.1 Study Design  14
3.1.1 Variables   14
3.1.2 The Study Population ........................................................ 15
3.2 Sample Size   16
3.3 Sampling Methods   16
3.3.1 Sub-District   16
3.3.2 Communities   17
3.3.3 Mothers   17
3.4 Data Collection   17
3.4.1 Data Collection tools ........................................................ 18
3.4.2 The Research Assistant ........................................................ 18
3.4.3 Pre-testing and Review o f Questionnaire.......................... 18
3.4.4 Data collection Techniques..................................................  19
3.4.5 Data quality Checks ........................................................ 19
3.4.6 Data Storage and Analysis ..................................................  20
3.5 Limitation of the Study ..........................................................  20
3.5.1 Communication   20
3.5.2 Respondents Bias .......................................................... 20
3.5.3 Recall Bias   20
3.5.4 Time and Mobility Constrain ts.............................................  21
iv
CHAPTER 4:
4.0 Analysis of Data   22
4.1 Results   22
4.1.1 Knowledge   22
4.1.2 Diarrhoea Management Practices  ........................................ 22
4.2 Characteristics of Respondents....................................................... 23
4.2.1 Age distribution o f R espondents............................................  23
4.2.2 Respondents Marital S ta tu s .....................................................  24
4.2.3 Educational Level ............................................................  25
4.2.4 Occupation o f  R espondents.....................................................  26
4.2.5 Ages o f Children in the s tu d y ..................................................  27
4.2.6 Diarrheoal Episode Experience o f  Children...........................  27
4.3 Mothers Knowledge about Diarrhoea ................................... 28
4.3.1 Causes o f  Diarrhoea ............................................................  28
4.3.2 Mothers knowledge about effects o f  Diarrhoea on the Child .. 29
4.4 Diarrhoea Management Practices .....................................................  30
4.4.1 Treatment ................................................................................  30
4.4.2 Enema Administration ...................................................................  31
4.4.3 O.R.S. Management ................................................................... 32
4.4.4 Feeding Practices ................................................................... 32
4.4.5 Breast-Feeding practices during Diarrhoea ................................ 33
4.5 Mothers’ Knowledge on Childhood Diarrhoea Prevention..................  34
4.6 Mothers Source o f Information on Diarrhoea..........................................  35
v
CHAPTER 5:
5.0 Discussions and Conclusion    37
5.1 Discussions   37
5.1.1 Knowledge on Causes o f Diarrhoea ...................................... 36
5.1.2 Knowledge o f the Effects and Dangers Associated w ith Diarrhoea
in children   37
5.1.3 Knowledge about Diarrhoea M anagem ent...................................  37
5.2 Home Management Practices   40
5.2.1 Breast feeding Practices .....................................................  40
5.2.2 Enema Administration •   40
5.2.3 O.R.S. Administration   40
5.3 Conclusion   42
5.4 Recommendation   43
Appendix A  - Questionnaire   46
Appendix B List o f  Abbreviations ...................................................... 51
List o f  References   52
LIST OF TABLES:
Table 1 .........................  Age distribution o f Respondents
Table 2 .........................  Respondents’ Marital Status
Table 3 .........................  Respondents’ level o f  formal Education
Table 4 .........................  Distribution o f Respondents occupation
Table 5 ......................... Age Distribution o f children in the study
Table 6 ........................ Ages at which children experienced diarrhoeal episode
Table 7 ........................ Mothers Responses on causes o f  childhood diarrhoea
Table 8 ........................ Number o f causes o f childhood diarrhoea known by mothers
Table 9 ........................ Mothers’ Responses on effects o f  diarrhoea on the child
Table 10 ......................  Action taken by mothers to treat episode o f  childhood diarrhoea
Table 11 ....................... Specific Treatment given by Mothers to  the child
Table 12 ......................  Mothers’ Reasons for giving Enema during diarrhoeal episode
Table 13 ......................  Mothers’ Reasons for Feeding the child during an episode
Table 14 ......................  Types o f food given to the child during diarrhoeal episode
Table 15 ........................ Mothers Reasons for Breast-feeding the child during an episode
Table 1 6 ......................... Mothers’ Responses on measures to Prevent childhood diarrhoea
Table 17 ........................ Mothers’ Sources o f Information about childhood diarrhoea
ABSTRACT
This study was undertaken in the Wa District o f the Upper West region o f  Ghana during 
the period o f  5th April to 15th May 1997 in six (6) sub-districts.
The study was to  answer the following question:
“ What level o f  knowledge do mothers in the Wa District have about diarrhoea, it’s 
causes, effects, appropriate home treatment and prevention, and what they practice during 
episodes o f  diarrhoea among young children”
There have been concerns expressed at the district and regional level sectors o f the 
Ministry o f  Health about the high prevalence and incidence o f  diarrhoeal diseases 
particularly among young children in the Wa district with high fatality rates despite efforts 
put in by the District Health Management Team to intensify health education activities in 
the district.
Though there had been previous attempt to  carry out a study to answer this question, the 
study was linked up to a nutritional survey carried out by the Nutrition Unit o f  the 
Regional Health Administration and only concentrated on a few mothers who attended the 
nutrition rehabilitation center in the region
This study is therefore intended to  provide further information on what mothers in the 
district know and practice about diarrhoeal diseases management for young children, with 
the view o f using the findings o f  the study to assist the District Health Administration and 
other health -related agencies in the district and the region in programming appropriate 
health education and promotion strategies to  reduce diarrhoeal- related diseases and 
improve promote the general health o f  young children in the district.
The study was conducted with the broad objective o f  finding out what women in the Wa 
district know about childhood diarrhoeal diseases and what they practice to  manage the 
disease during episodes. The specific objectives o f the study are:
1) To determine the level o f information that mothers in the study area have 
about diarrhoeal diseases.
2) To identify any gap between what the mothers know and what they are 
expected to  know about diarrhoeal diseases in young children.
3) To find out the management practices that mothers adopt during diarrhoea 
episodes in young children.
4) To recommend appropriate health intervention strategies and programmes for 
implementation to reduce the high prevalence o f  diarrhoeal diseases among 
young children in the district.
The sample size for the study was 210 mothers o f  the Wa district who have children up to
two (2) years. A  household survey was conducted to interview mothers who were
selected by means o f simple random sampling technique. A  structured questionnaire was
used as data collection tool to obtain information from the mothers on diarrhoeal diseases.
The main variables o f  study were:
1). Knowledge about diarrhoeal diseases, causes, effects, treatment and 
prevention.
2). Diarrhoea Management practices concerning treatment, feeding, breast­
feeding and prevention.
3). Sources o f information on childhood diarrhoeal diseases.
The major findings o f the study were as follows:
1) Mothers in the study area could adequately describe childhood diarrhoea but 
have limited knowledge about the causes, effects and dangers o f 
diarrhoeal diseases on the child.
ix
2) A significant proportion o f mothers in the study area strongly believe that 
supernatural forces such as witches and evil spirits could cause childhood 
diarrhoea.
3) More than half o f  the mothers treat the child with diarrhoea at home. Among 
the various home treatment practices they adopt include enema 
administration, administration o f various kinds o f drugs obtained from the 
local market and the administration o f  herbal concoctions.
4) A greater number o f  mothers are aware o f  the value o f  continued feeding and breast­
feeding the child and adopt the practice during diarrhoeal episode.
5) Though many mothers have ever heard o f Oral Rehydration Salt (sachets) as
an effective treatment o f  childhood diarrhoea, quite a number o f  the mothers have 
never used it to treat their children.
Based on the findings o f  the study, the following recommendations are suggested for
implementation.
1) Health Education and Promotion activities on diarrhoeal diseases in the study area 
should emphasize on teaching mothers about the “germ theory” o f disease causation, 
effects, dangers as well as appropriate home management practices and prevention o f  
diarrhoeal diseases.
2) The value o f the use o f  O.R.S should be emphasized for mothers to appreciate it’s use 
for treating their children with diarrhoea at home even before taking the child to a 
health facility.
3) Outreach Health services should be extended to those communities or villages in the 
study area which are far away from the existing health facilities, and during each 
outreach session, a brief teaching on childhood diarrhoea should be given to mothers 
by the health team.
4) Misconceptions and beliefs about diarrhoeal diseases that are strongly held by mothers 
in the study area should be disabused with correct and adequate information about 
diarrhoeal diseases.
5) O.R.T comers or centres should be established in all health centres in the district
which could be used as training or teaching centres for mothers who use the health 
facilities. Where possible some o f the mothers could be used as resource persons in
O.R.T training for mothers.
6) Health personnel particularly, Community and Public Health Nurses who do home 
visiting, should use the opportunity to teach mothers in their own homes about 
diarrhoea and it’s appropriate home management.
7) Mothers’ Clubs should be formed in all communities/villages so that mothers could 
share together information and experiences on diarrhoea management practices and 
other child survival activities.
CHAPTER  1
1.0 INTRODUCTION
1.1 BACKGROUND INFORMATION ON THE STUDY:
Diarrhoea remains a leading killer disease of the world’s children claiming almost 4 million young lives 
each year. Most o f the victims die of dehydration. Although all age groups are susceptible to the 
disease, it has the most serious consequences in children, annually causing over three million deaths in 
1995, 80% o f them among children under 5 (World Health Report 1996).
The typical African child under 5 has five episodes o f diarrhoea per year, a 10% risk o f suffering from 
diarrhoea on any given day, and 14% risk of dying from a severe episode (Better Health in Africa: A 
World Bank Publication 1994) Diarrhoea accounts for 25% o f all illness in Childhood and 15% o f 
admissions to health facilities (State o f the World Children 1994).
The W.H.O. estimates that 37% o f all cases of diarrhoea in the World occur in sub-Saharan Africa, 
where only 50% o f children benefit from Oral Rehydration Therapy (ORT), compared with 70% in 
Asia and North Africa (W.H.O. 1990). Child health in Africa is therefore threatened particularly by 
diarrhoea (Better Health in Africa 1994). In addition the disease contributes greatly to malnutrition in 
children because their intake o f food is reduced during an episode. This decreased food intake results 
from either loss of appetite or the often customary practice of withholding food from the child with 
diarrhoea from the believe that the feeding will induce continuous vomiting and worsen the child’s 
condition. The body’s ability to absorb nutrients during an episode o f diarrhoea also decreases and this 
contributes to malnutrition during repeated episodes. Furthermore, diarrhoea places a tremendous 
economic burden on the health care systems o f developing countries where there is increasingly limited 
health resources.
1
ill many developing countries tor example, more than one-third (1/3) o f the beds in children hospitals 
or wards are occupied by patients suffering from diarrhoea. So world-wide is the diarrhoea problem 
that the World Health Organisation (W.H.O) in 1976, established a programme for the control of 
diarrhoeal diseases. This programme is directed primarily towards children under five years o f  age.
The W .HO ’s formulation o f Oral Rehydration Salt (ORS) is widely accepted as the most appropriate 
physiologically single formulation for universal use in the treatment of diarrhoea. The ORS solution, 
administered early in the course o f diarrhoeal diseases, is capable o f reducing death from dehydration 
among young children and the serious effects on the nutritional status of it’s surviving victims. Other 
traditional sources o f  oral rehydration solutions such as Coconut water, rice water, porridge, kenkey 
water and other locally prepared substitutes for ORS which are inexpensive and effective are suitable 
for administration to the child during diarrhoeal episode. Mothers are taught at postnatal and child 
welfare clinics to prepare and administer these solutions to their children at home. Oral rehydration 
therapy does not prevent the diarrhoea, but it counteracts the dehydration which is the most serious 
cause o f death in diarrhoea.
Many countries have traditions and cultural health practices which may have adverse effects on child 
health. In some parts o f the world such as India, ritual purification is practised when a child with 
diarrhoea becomes dehydrated. The treatment usually consists o f chants and other ceremonies which, 
though not harmful in themselves, may delay the necessary rehydration therapy.
In certain parts o f  Ghana, research has shown that, mothers literally ‘sit’ their children with diarrhoea 
on hot stones and water with the belief that the ‘evil spirit’ that are suspected to be the cause o f the 
child’s diarrhoea will be burnt by the heat from the hot stone or water.
In yet other cultures in Ghana, mothers tend to administer all sorts o f herbal preparations and 
concoctions, suppositories or enema to their children during diarrhoea episodes.
TMs researcher gathered from his working experience while on the National Control of Diarrhoeal 
Diseases programme in Ghana, that many mothers (particularly those in the rural areas where health 
care facilities are non-existent) do not only lack the basic knowledge about the causes and appropriate 
treatment of diarrhoea but also practise various methods of diarrhoea management.
This study attempts to find out the knowledge and practices regarding childhood diarrhoea and it’s 
management among women in the Wa District o f the Upper West Region o f Ghana.
In the study area o f the Upper West Region o f Ghana where the research was conducted, there is 
strong traditional belief system about the causes o f diseases and ill-health as well as traditional health 
practices. This is coupled with poor health facilities which results in low accessibility o f  health services 
to majority o f the people. There is also high illiteracy rate among the people particularly among the 
female population. There is high prevalence and incidence of diarrhoeal diseases particularly among 
infants and young children with unacceptably high mortality rates from diarrhoeal diseases in the study 
area. (1994, 1995, 1996 Annual Reports UWR).
For these and other reasons, the researcher was particularly interested in carrying out this study to  find 
out what mothers in the study area know about childhood diarrhoea and what they practice as 
treatment at home when their children are affected by diarrhoea. The findings o f this study would be 
used to adopt new and effective health intervention strategies by the District Health Service and other 
health-related agencies in the district. The outcome o f the study would also be used as tools for 
training health service providers on appropriate health education programmes in the control of 
diarrhoeal diseases particularly among young children.
3
l.Z  PROBLEM  STA'i'feJVUSXMl':
Despite the intensive health education intervention earned out by the district health services, there is 
still high prevalence o f diarrhoeal diseases in the study district . (UWR Annual Report 1995,1996). 
Diarrhoea ranks second among the top five causes o f morbidity among young infants and children in 
most o f the health facilities. (Wa DHMT Annual Report 1995, 1996).
1.3 JUSTIFICATION OF THE STUDY:
Available statistics indicate that the Upper West region recorded the highest infant and child mortality 
rates in Ghana over the past two years. ( I.M.R -118  per 1000 live births, C.M.R -199  per 1000 live 
births) {UWR Annual report 1995 }.
Diarrhoea disease constitutes a major cause o f ill-health and death among young children in the study 
area and causes about 30% o f all deaths in infants and children in the region.
1.4 LITERATURE REVIEW
The focus on the study o f diarrhoeal diseases as a world-wide health problem, has raised questions 
about it’s contributory social factors, such as maternal knowledge, beliefs, attitudes and the action 
taken in response to an episode of diarrhoea in the child. Studies have been conducted to find out the 
knowledge, beliefs as well as practices adopted by mothers to the management o f  diarrhoea. In the 
rural or peri-urban North Indian States o f Jammu and Kashmir, illiterate mothers were used as 
subjects by a doctor in an effort to study maternal beliefs and attitudes concerning childhood diarrhoea. 
It was found out that half o f the mothers blamed diarrhoea on teething. Others blamed heat, cold, 
rain, worm infestation, curse o f the devil and faulty feeding practices o f  the child by the mother 
(Gupte, Suraji, Sasan, Avtar Singh 1983). In addition, Escobar et al (1983) found that beliefs about 
childhood diarrhoea were based on the hot and cold weather dichotomy which is prevalent in Latin
4
America. UiarrJioea was thought to be caused by exposure to cold conditions or by ingestion o f foods 
designated as cold.
A  survey o f people’s perception o f illness in Punjah, India (1972) revealed that 72% o f respondents 
attributed diarrhoea to physical causes such as the ingestion of incompatible combinations o f food, 
and 28% attributed it to supernatural causes such as “evil eye” .
On diarrhoea management practices, Escobar et al (1983) found out that many mothers recognised 
that children can die from diarrhoea, yet many did not know what dehydration was and how to treat it. 
Many had heard about oral rehydration solution (ORS) packets being advertised and distributed but 
only a few had clear understanding of their use. Among the Hulis in Papua New Guinea, the 
management o f diarrhoea, until 1979, involved the administration o f sulfadimidine syrup and Kaolin 
mixture. The health authorities introduced a programme o f Oral Rehydration Therapy. It was found 
however, that most mothers did not embrace the concept o f  rehydration because o f  their own views of 
the causes and effects o f diarrhoea. The soft stools and dry skin o f a child suffering from severe 
dehydration due to diarrhoea, were interpreted as manifestations o f an underlying disease process and 
that the cure involved a strengthening ritual, a prayer or some other “healing energy” (Frankel and 
Lehmana 1985).
In the North Indian States o f Jammu and Kashmiri, a researher, found that mothers were o f the view 
that milk, routine foods and fluids aggravated a child’s diarrhoea. Over half the mothers restricted 
food and/ or fluid intake before taking the child with diarrhoea to the hospital. Breast feeding was 
stopped and herbs, brandy, opium, mint and egg were used as home remedies by 30% o f the mothers. 
The mothers who were aware of the oral rehydration salts were not convinced o f its value, and only a 
few knew how to prepare the solution (Gupte, Suraj, sansan, Avtar Singh 1983) .
5
Aoyza et ai ( iy s 4 j in tneir researcn in rural Zimbabwe, reported that, maternal action in response to 
childhood diarrhoea varied. Six percent o f the mothers did not take any remedial action at all, while 
53% took the child to a health facility only later in the course o f the illness. Home management was 
common and comprised o f the administration of indigenous herbal remedies, enemas and prepared 
sugar and salt solution. These remedies were administered alone or alongside the treatment prescribed 
by a health worker. Others visited both herbalists and formal health services, while the rest visited 
health workers first, then to the herbalists when the child’s condition did not improve, and others did 
the reverse.
Other measures reported were the administration o f ‘over the counter’ drugs, exclusion o f food 
believed to have caused the diarrhoea and prayer by the apologetics who shun all fonns o f drugs and 
remedies. In a study of beliefs and practices relating to childhood diarrhoea and relying primarily on 
traditional healers as informants, Green (1985) found in Swaziland that enemas were used as treatment 
for diarrhoea which was regarded as due to natural cause. The study revealed that most children with 
diarrhoea were taken to clinics only after home herbal treatment and those of traditional healers had 
failed, by which time the child may be severely dehydrated. However, Mahalanabi, Merson and 
Bamua (1981) discovered that dehydration in cases o f acute diarrhoea o f any aetiology and in all age 
groups, can be treated with a simple glucose - electrolyte solution. Chen (1975) in addition, drew 
attention to other possible interventions so as to develop a multifaceted approach in which oral 
rehydration would be one o f several anti-diarrhoeal measures being implemented. Thus far, much has 
been done to highlight maternal knowledge, beliefs and measures taken in any response to an episode 
of diarrhoea in children. However, most o f these studies were conducted in different socio - economic 
and cultural settings which are quite different from that of Ghana.
The literature review does not teE us much of any such research done on maternal knowledge, beliefs 
and practices on diarrhoeal management in Ghana particularly in the study area. In this study, mothers 
o f the Wa district in the Upper West region will constitute the subjects o f the study.
It is hoped that the findings o f this study, will help focus the attention o f the District Health 
Administration, the District Assembly, NGO’s , researchers as well as other health related agencies, on 
a few interventions o f known or potential effectiveness which if  implemented along with oral 
rehydration therapy, could significantly reduce the morbidity and mortality rates due to diarrhoeal 
diseases among young children in the district.
1.5 OBJECTIVES:
The objective o f this study is to determine the knowledge that mothers have regarding diarrhoea, it’s 
causes, effects and how they manage episodes of the disease in young children.
1.6 SPECIFIC OBJECTIVES
1. To find out the knowledge mothers in the Wa district possess about causes, effects and appropriate 
treatment o f diarrhoeal diseases in young children,
2. To identify the various traditional practices adopted by mothers in the treatment o f  childhood 
diarrhoea.
3. To identify any limiting factors that discourage women in the district from adopting desirable 
practices in the management of diarrhoeal diseases in young children.
4. To determine any gap that exist between what the mothers know and what they practice in 
managing a diarrhoeal episode.
5. To provide appropriate health interventions that will enable the DHMT promote and encourage 
effective diarrhoea management practices among mothers.
The findings from this study will be communicated to the District Health Management Team 
(DHMT), the Regional Health Administration, the District Assembly and other health-related agencies 
operating in the district and the region, for any appropriate health intervention to be implemented.
7
CHAPTER 2
2.0 THE STUDY AREA:
The study was undertaken in the Wa district o f the Upper west region o f Ghana., This district is 
located at the north western part o f the country bordering Burkina Faso to the West, (separated by the 
black volta) Tumu district to the East, Nadowli district to the North and the Northern Region to the 
South. The district has a land area o f 5889.5 sq. Km which forms about 32% o f the total land area of 
the region. The 1997 population o f the district projected from 1984 with a growth rate o f  3.1 is 
246,751, with a population density o f 39 per square kilometre. There are 4 main ethnic groups in the 
district namely, the Dagaaba, Wala, Sissala and the Loobi. Akan, Hausa and English languages are 
widely spoken in the district particularly in the district capital and the major towns. The major religions 
in the district are Islam (70%), Christianity (15%) and traditional African religion. There is one rainy 
season from May to October followed by dry season from November to March where there is the cold 
and dusty harmattan.
The district is under-served in terms o f social amenities and infrastructural development such as 
schools, potable water, telecommunication, roads, health facilities and human resources. There is poor 
sanitation and nutrition as well as high level o f poverty and illiteracy. It is estimated that only 15% of 
the population in the district are literate. (2-Year Report by the Wa District Assembly) .
2.1 EDUCATIONAL 1 NIKASI KUCTURE & ENROLLMENT:
The district has 125 primary schools ( comprising 2 private and 123 public ) with an enrollment of 
19,366 as at March 1997.
There are 80 junior secondary schools with an enrolment of 6089, 5 senior secondary schools with an 
enrolment of about 2350, 1 Technical school, 1 vocational school and 1 Teacher Training school with 
a total enrolment of about 2400. There is one tertiary educational institution ( institute of adult 
education). There is a school drop out rate of about 17% at the primary school level and 23% at the 
secondary school level ( Min. of Education, UWR Annual report. Wa, 1995) . Within the health 
sector, transport situation has improved significantly since the establishment of the DANIDA health 
sector support programme (HSSP) in the district. The district health administration has two (2) 
vehicles and twenty four (24) motorcycles for it’s health activities. As at the end of 1996, all the 
vehicles and motorbikes available to the district were in good working conditions.
The average availability and utilization of transport in the district have been as follows:
TYPE OF TRANSPORT % AVAILABILITY % UTILIZATION
PICK-UP 77 70
MOTORBIKES 93 60
The low utilization of motorbikes in relation to it’s high availability is due to the fact that a greater 
number of newly posted staff to the district have not been trained to ride the motorbikes.
9
2.2 HEALTH DF,I,IVICKY SYSTEM:
2.2.1 HEALTH INFRASTRUCTURAL FACILITIES:
There are a total of twenty (20) health facilities (including one regional hospital) in the district as 
follows:
Type of Health 
Facility
Hospital Health
Centre
Clinic Maternity
Home
Total
Government 1 11 0 0 12
Mission 0 3 0 0 3
Private 0 0 2 3 5
Total 1 14 2 3 20
The spacial distribution of health facilities in the district, to  a large extent, determines the effective 
utilization o f the health services and subsequently the health status o f children in particular. These 
health facilities are located in fourteen (14) health sub-districts which are served by the following 
catchment area populations.
SUB DISTRICT POPULATION NO OF COMM’TIES 
SERVED
NO. OF OUTREACH 
CENTRES
1. Wa 69685 50 16
2. Busa 17163 44 20
3. Bulenga 15116 18 16
4. Holomuni 3749 7 7
5. Dorimon 19507 62 22
6. Wechau 20635 40 9
7. Bayiri 6621 24 12
8. Yaala 8584 9 9
9. Gurungu 10963 22 12
lO.Poyentanga 18169 39 19
11 .Lasia Tuolu 18270 37 20
12.Funsi 6340 7 7
13.Charia 14990 28 10
14.Loggu 16959 26 14
Total 246,751 411 200
10
Under the DAM DA Health Sector Support Programme (HSSP), seven (7) new health centres with 
staff quarters building and bore-hole water facilities have been constructed in the district., DHMT 
offices have also been constructed.
Similarly, under the Saudi Fund, two new health centres with staff quarters accommodation have been 
provided in the district. The health facilities in the district are distributed geographically in such a way 
that only about 20% o f the district total population has easy access to health care within 8 kilometres.
2.2.2 STAFFING:
The staff strength in the district is woefully inadequate with a human resource capacity o f 104 as at
March 1997. The skilled staff are made up o f the following categories o f staff mix:
STAFF CATEGORY Number Establishment % Shortfall
Doctors 1 1 -
Medical. Assistants 1 14 92.9
Midwives 15 28 46.4
Public Health Nurses 5 14 64.3
Comm’ty Psy. Nurses 1 14 92.9
Comm’ty Health Nurses 16 28 42.9
Lab. Technician 0 14 100
Tech. Officers (disease control) 4 14 71.4
Field Technicians (dis. control) 16 14 -
Dispensary Technician 0 14 100
TOTAL 59 155 61.9
The actual staffing situation falls short of established requirements particularly for medical assistants, 
nurses, midwives and Disease control technical officers. This situation is partly due to the fact that 
accepting transfers and postings to the district have always been difficult for several reasons 
prominently among which is lack o f accommodation and lack of staff motivation.
2.2.3 FINANCE:
The main sources o f funding health activities in the district are Government o f  Ghana (salaries and 
items 2-5 of the F.Es), and Danida under the Health sector support programme (HSSP).
11
2.3 HEALTH PROBLEMS:
It is more difficult to provide health services in the district due to the scattered population and the 
sparse human settlement pattern as well as the general lack o f adequate health infrastructure in the 
districts. Few patients attend the existing health facilities partly because o f the lack o f  health personnel, 
cost o f  health services and the peoples’ general strong beliefs in traditional medical care. The major 
health problems in the district include high infant, child and maternal deaths.
The Upper West region in general has had the highest infant, child and maternal mortality rates in the 
country since 1994. ( Source: M.O.H/XJWR Annual report 1995)
* Infant Mortality Rate -118 per 1000 livebirths
* Child Mortality Rate -199  per 1000 livebirths
* Maternal Mortality Rate - 452 per 100,000 births
( Source: G.O.G/UNICEF Survey Report 1993 UWR)
The major causes of deaths in the general population of the district are malaria, diarrhoea, upper 
respiratory tract infections, pneumonia, malnutrition and meningitis. The district has an annual malaria 
incidence o f 173 per 1000 population and Diarrhoea annual incidence o f 162 per 1000 population ( 
Source: M.O.H Annual Report 1994).
The major health problems o f public health concern include:-
- poor environmental sanitation
- high incidence o f diarrhoeal diseases among under 5 children
- high incidence o f malaria
- low family planning coverage and acceptance rate
- low immunization coverage.
Other issues of public health concern include:-
1. Inadequate health infrastructure
2. Poor accessibility and utilization o f health services
3. Inadequate manpower to deliver health services (both quality and number)
2.4 CHILD HEALTH SERVICES:
The major child health services include Immunization, child welfare services health education 
and school health services. Childhood immunization coverages have improved significantly for 
all antigens such as BCG, OPV, measles and T.T over the past three years though target levels 
have not been achieved.
TABLE SHOWING CHILD HEALTH INDICATORS 1994-1996:
1994 1995 1996
INDICATOR
Target Coverage Target Coverage Target Coverage
C.W.C
Attendance
60 35 60 38 60 31 I
IMMUNIZATION
B.C.G 70 58 80 58 80 45
O.P.V 60 45 60 31 65 34
D.P.T3 60 37 60 31 65 34
MEASLES 50 34 50 34 55 30
13
CHAPTER 3:
3.0 METHODS:
3.1 Study Design:
This was a descriptive and cross-sectional quantitative study to obtain information from mothers on 
diarrhoea in young children. This chapter describes the variables studied, how the study was designed 
and carried out to obtain answers to the study questions and also the constraints and limitations that 
were encountered.
3.1.1 VARIABLES:
The main variables for the study are:
VARIABLE INDICATORS
1. KNOWLEDGE
* Causes o f Diarrhoea
* Effects o f diarrhoea
* Treatment o f diarrhoea
* Prevention o f diarrhoea
Accurate information about childhood diarrhoea that mothers could 
describe such as food-related or water-related, or germs-related 
causes o f diarrhoea.
Dehydration and death as effects and dangers o f  diarrhoea,
2. MANAGEMENT PRACTICES
* Home & clinical management
* Traditional feeding practices
* Preventive practices
Administration of appropriate treatment and traditional feeding 
practices to the child during diarrhoeal episode by the mother, eg. 
Sending child to hospital/health centre,
Administration o f O.R.S and food-bases fluids and continued 
feeding and breast-feeding as home management practices.
3. SOURCES OF 
INFORMATION
Reliable persons or places where accurate information on diarrhoea 
could be obtained by the mother, eg. Hospital/Health centre, Health 
personnel or Pharmacy shop.
The specific variables were:
a) Respondents’ background information such as age, marital status, educational 
level and occupation.
14
b) Mothers’ knowledge and beliefs about the causes, effects treatment and 
prevention of diarrhoea.
\
c) Practices adopted by mothers in the treatment, feeding and prevention of 
childhood diarrhoea.
d) Sources o f information on diarrhoea.
Respondents were asked questions on:
* Causes o f childhood diarrhoea
* Effects of diarrhoea on the child
* Treatment o f childhood diarrhoea
* Home management practices o f diarrhoea
* Feeding practices during diarrhoeal episode
* Prevention
* Sources o f information on diarrhoea
3.1.2 THE STUDY POPULATION:
Although child care is usually the responsibility of both parents, in most African societies and Ghanaian 
cultures in particular, it is the mothers who are the real caretakers o f children’s health needs. The study 
population was therefore mothers o f children under two years o f age as at the period o f this study.
This population was chosen because of the assumption that most mothers o f children at that age would 
still be breast-feeding their children or weaning them and the weaning period has the highest incidence 
of diarrhoeal diseases among young children. Also between this age period, most mothers would not 
easily forget the last time their children had diarrhoeal episode and what they did to manage the 
disease.
15
3.2 SAMPLE SIZE:
The sample size for the study was 210 mothers from the study area who have children up to twenty- 
four (24) months o f age.
The sample size o f  210 mothers was obtained from the statistical formula 
N = z2 ,p . q /d2 
Where N  = sample size
Z = z score on normal distribution table at 5% confidence level = 1.96 
p = Annual Diarrhoea prevalence rate for the study district =162 per 1000 
population ( UWR Annual Report 1995, 1996). 
q = 1-p =1-0.162 = 0.84 
d = confidence level = 0.05 
N  = ( 1,96)2 * 0.162 * 0.84 /(0.05)2 = 210
3.3 SAMPLING METHOD:
3.3.1 Sub-districts:
The study was conducted through a household survey in six (6) o f  the fourteen (14) health sub- 
districts o f  the Wa district. These sub-districts were selected by simple random sampling method. 
In the first stage o f  the selection process, the list o f all the 14 sub-districts were written on pieces 
o f paper and folded. They were kept in a box and mixed together. The selection o f  the sub­
districts was done by picking one piece folded paper from the box without replacement The 
procedure was repeated until six papers were randomly selected from the box. The sub-districts 
selected for the study were: Wa, Holomuni, Busa, Gurungu, Loggu and Dorimon with a total 
population o f 138,026.
16
3.3.2 Communities:
Similarly, for the selection o f the communities, a compilation o f the list o f  communities within 
each o f the six selected sub-districts was done.
Three communities were randomly selected out o f  the list in addition to the sub-district capital 
towns. Thus in each sub-district, four (4) communities were selected making a total o f  twenty 
four (24) communities selected for the study. The sub-district capital towns were purposefully 
selected due to their heterogeneous population characteristics so that they are representative o f  all 
the various ethnic groups in the district.
3.3.3 Mothers: Two hundred and ten (210) mothers with children up to  twenty four months 
were interviewed through a household survey. Using Systematic random sampling, at least eight 
(8) mothers were interviewed from eighteen out o f  the 24 communities and at least ten (10) 
mothers were interviewed from each o f  the sub-district capital town. This method was used due 
to the difference in population size between the six sub-district capital towns selected and the rest 
o f the eighteen communities. In each o f the communities selected, households for the 
respondents (mothers) were determined by getting to  the centre o f the communities. A  pen was 
spun and the direction o f  the tip o f the pen was followed by the researcher. The first house 
reached became a reference point in the location o f other houses/compounds o f entry. The 
nearest houses to this first house were entered and the questionnaire administered until at least 8 
or 10 mothers with children up to 24 months were interviewed per community. Where there were 
more than one eligible mother in a compound, simple random sampling technique was used to 
select one eligible mother for the study.
3.4 DATA COLLECTION:
Data was collected over a period of 14 working days from 24th April to 12th May 1997 using 
one (1) research assistant.
17
3.4.1 DATA COLLECTION TOOLS:
A structured questionnaire was administered by interview. Data was collected from mothers on:
1. Mothers’ background variables such as age, marital status, educational level, 
occupation , the ages o f their youngest child and whether the child has ever had 
diarrhoea.
2. Knowledge o f  respondents on causes, effects, treatment and prevention o f 
diarrhoea.
3. Practices on traditional feeding and treatment during diarrhoeal episode
4. Sources o f  information on diarrhoea to respondents
3.4.2 THE RESEARCH ASSISTANT:
A young and hard working nutrition officer who has been very conversant w ith field research 
work was recruited to assist in the study as an interpreter o f the Sissali, Wali and the Dagaare 
languages o f  the study area to  facilitate communication between the researcher and respondents. 
The research assistant was thoroughly briefed on the details and purpose o f  the study and was 
taken through the data collection tool and technique for her understanding and interpretation. 
She participated in the designing o f the final protocol, and also assisted throughout the study 
period from the pre-testing o f the questionnaire, through to the data collection, storage and initial 
analysis.
3.4.3 PRE-TESTING AND REVIEW OF QUESTIONNAIRE:
The questionnaire for the study was pre-tested in the “Charia” sub-district which was not part o f 
the selected subdistricts for the study. Samples o f  thirty five mothers who have children under 
two years were interviewed from four communities in the sub-district. This was done to 
determine the respondents’ understanding o f  the questions and also to determine the efficiency of 
the interpreter. The pre-testing was also used to estimate the average time needed to interview 
respondents and complete a questionnaire.
18
liiis was necessary in determining the number o f respondents that could conveniently be handled 
by the research team in a day and within the duration o f the study. After the pre-testing, a few 
questions were rephrased and the sequence modified for the final questionnaire to be produced.
3.4.4 DATA COLLECTION TECHNIQUES:
The time table for the data collection was adhered to. Before the households were visited, permission 
was sought from the chiefs and opinion leaders and the purpose o f the study expl ained to them. This 
community entry approach enabled the research team enjoy the co-operation and participation o f the 
respondents. The researcher and his assistant had the support of the assemblymen and the community 
health volunteers from each community in locating the households within the communities with 
mothers who have children under two years. At each interview point, the researcher and his assistant 
were introduced to the respondents and the purpose o f the study was explained to the respondent. 
Respondents were assured by the research team of the confidentiality o f their identity in the study and 
they were also assured o f getting feedback through the sub-district health team on relevant issues 
raised in the study that needed action. Measures were put in place to ensure that the assemblyman or 
the health volunteer did not influence responses o f the respondents.
They usually left the research team after the initial introduction. The questionnaire was then 
administered to the mothers.
3.4.5 DATA QUALITY CHECKS:
The researcher and his assistant made sure that data collected were complete and accurate by checking 
through the questionnaires after each day’s field work. They also ensured that all completed 
questionnaire were enveloped and secured.
19
J.4.6 UATA STORAGE AND ANALYSIS:
The data collected on each day was summarised by the use of tally sheets according to the headings 
and sub-headings of the main variables of the study. Responses to open-ended questions were 
categorised and quantified and were also entered into master sheets with tables created. Data was 
further analysed into percentages and graphs created using EPI Info and Harvard graphics computer 
softwares. Data was stored on hard disc of the computer.
3.5 LIMITATIONS OF THE STUDY
The following limitations presented are considered to have had some effect on the study, however they 
do not underscore the outcome of the study.
3.5.1 COMMUNICATION:
There was the likelihood of interpreter bias and response errors in the interpretations given by the 
community health volunteers who were recruited as interpreters by the researcher, which the 
researcher could not take note of.
3.5.1 RESPONDENT BIAS:
Some respondents could have answered questions on the feeding practices and the treatment practices 
of their children during diarrhoeal episodes to satisfy the research team (some of which members were 
strangers to the respondents), instead of telling the truth of what they actually practise. Even though 
checks were made on some samples of completed questionnaire, this limitation could have been 
overcome by validating responses from respondents over sometime, but time was a limiting resource.
3,5.3 RECALL BIAS:
This could have occurred among respondents when questions were asked about their experiences with 
management practices with questionable accuracy of responses.
This limitation could be minimised by relying on information of their recent experiences of about four 
weeks duration.
20
3.5.4 TIME AND MOBILITY CONSTRAINTS:
This study was conducted during the rainy season. It was therefore not possible to assess communities 
which were very far distant from the sub-district capital due to poor road network and acute shortage 
o f fuel in the district at the time the study was done making mobility very difficult. This problem was 
overcome by making use o f motorbike to reach those selected communities where vehicles could not 
go due to their bad nature o f roads.
It was likely too that in a hurry to get to their farms, some respondents could have given responses just 
to be free to get away early. It is hoped that this as a limitation, was overcome by visiting respondents 
at their times o f convenience mostly very early in the morning before getting ready to go to their farms 
and in the afternoons after they had returned from their fanns for the interviews.
21
CHAPTER 4
4.0 ANALYSIS OF DATA
4.1 RESULTS:
Data collected was initially analysed manually on tally sheets and further analysed using an EPI INFO 
computer software programme. Responses on open-ended multiple response questions, were 
grouped into categories and the responses given by respondents were assigned into the appropriate 
category, and these were tallied.
4.1.1 KNOWLEDGE:
A respondent was considered knowledgeable if she could correctly describe diarrhoea, describe two or 
more causes o f diarrhoea, effects o f diarrhoea on the child, appropriate home management and 
methods o f preventing childhood diarrhoea.
4.1.2 DIARRHOEAL MANAGEMENT PRACTICES:
This variable entails appropriate home treatment o f childhood diarrhoea and feeding practices. 
Respondents who either sent the child to hospital/health centre or gave the child Oral Rehydration Salt 
(sachet) at home before taking the child to a health facility, as well as giving the child any locally 
prepared food-based fluids or breast-fed the child were considered as having adopted appropriate 
childhood diarrhoeal management practices. Those who had no idea at all about any o f these methods 
of diarrhoea management at home or those who gave inappropriate or wrong responses were 
considered as having no knowledge at all about diarrhoea management for young children. Such 
inappropriate or wrong responses include:
a) Administration o f locally herbal concoction to the child
b) Self medication with drugs particularly antibiotics and other perceived antidiarrhoeal preparations 
obtained from the local market.
c) Giving o f enema to the child during diarrhoeal episode
d) Withholding feeding the child during diarrhoeal episode
22
e) Delaying for a long time before sending the child to hospital after treating the child at home but 
his/her condition was not improving.
4.2 CHARACTERISTICS OF RESPONDENTS
4.2.1 AGE DISTRIBUTION OF RESPONDENTS
The correct ages of respondents were not easy to determine as almost all the respondents (95%) 
could not recall their actual date of birth. Nevertheless, major local and national events were used to 
estimate the ages o f the respondents. Nine percent (9%) o f the respondents were below 20 years. 
Majority of the women (80.9%) were between the ages of 20 - 39 years. Only 10 % o f the women 
were 40 - 44 years. None o f them was 45 years and above.
TABLE 1. AGE DISTRIBUTION OF RESPONDENTS
AGE GROUP FREQ %
15 -19 years 19 9.0
20 - 24 years 50 23.8
25 - 29 years 32 15.2
30 - 34 years 45 21.4
35 - 39 years 43 20.5
40 -44 years 21 10.0
45 & above 0 0
Total 210 100.0%
AGE DISTRIBUTION OF RESPONDENTS
15-19 20-24 25-29 30-34 35-39 40-44 45 +
AGE
23
4.2.2 RESPONDENTS’ MARITAL STATUS
The distribution o f respondents’ marital status by percentages showed that 98.6% o f the women were 
married, 1.0% were divorced, and 0.5% were widowed. All the respondents were either married or 
have ever married.
TABLE 2 RESPONDENTS’ MARITAL STATUS
MARITAL STATUS FREQ %
MARRIED 207 98.6%
DIVORCED 2 1.0%
WIDOWED 1 0.5%
TOTAL 210 100.0%
MARITAL STATUS OF RESPONDENTS
FREQUENCY
1-0% 0.5%
SjMRRIED 
® DIVORCED 
□  WIDOWED
98.6%
24
4,2.3 EDUCATIONAL LEVEL:
Eighty three percent (83.3 %) of the mothers had no formal education. Thirteen percent (13.3%) had 
formal education up to primary school level whilst 3.3 % had formal education up to secondary or 
vocational level.
TABLE 3: RESPONDENTS’ LEVEL OF FORMAL EDUCATION
EDUCATIONAL LEVEL FREQ %
NO EDUCATION 175 83.3
PRIMARY 28 13.3
SECONDARY/VOCATIONAL 7 3.3
TOTAL 210 100.0 %
EDUCATIONAL LEVEL OF RESPONDENTS
a  ELEMENTARY 
*  SEC/VOC
25
The predominant occupations o f the mothers were farming (53.9%) trading (45.2 %) and 0.9 % 
were government employees.
TABLE 4. DISTRIBUTION OF RESPONDENTS’ OCCUPATION
4.2.4 OCCUPATION OF RESPONDENTS:
OCCUPATION FREQ %
FARMER 113 53.9
TRADER 95 45.2
GOVERNMENT EMPLOYEE 2 0.9
TOTAL 210 100.0 %
26
4.2,5 AGES OF CHILDREN IN THE STUDY
Twenty Six percent (26.0 %) o f the children were 0 - 6  months, 28.3 %  were 7- 12 months, 21.3 % 
were 13 -18  months and 24.4 % were between 19 -24  years.
TABLE 5. AGE DISTRIBUTION OF CHILDREN IN THE STUDY
ACTUAL AGE OF CHILD FREQ %
0 - 6  months 55 26.0
7 - 1 2  months 59 28.3
13-18 months 45 21.3
19 -24  months 51 24.4
TOTAL 210 100.0 %
4.2.6 DIARRHOEAL EPISODE EXPERIENCE OF CHILDREN:
Eighty percent (80.0 %) o f the children have had at least one diarrhoeal episode whilst 19.2 % o f them 
have never had diarrhoea episode.
Among the children who have had diarrhoeal episode, 38.1% were within the age group 0 - 6  months, 
34.5% were between 7-12 months, 18.5% were between 13-18 months and 8.9% were between 19 - 
24 months. Greater number o f the children (72.6%) have had at least one diarrhoeal episode by the 
age o f one year.
TABLE 6. AGES AT WHICH CHILDREN EXPERIENCED DIARRHOEAL EPISODE
AGES FREQ %
0 -6  months 64 38.1
7 - 1 2  months 58 34.5
13-18  months 31 18.5
19 -24  months 15 8.9
TOTAL 168 100.0 %
27
4.3.1 CAUSES OF DIARRHOEA
A total o f 34.8 % o f the respondents mentioned that teething, eating o f contaminated food, food 
poisoning, or drinking o f dirty water could cause diarrhoea. Twenty one percent (21.4 %) o f the 
respondents mentioned that heat from the sun, sucking o f hot breast or dirty stomach could cause 
diarrhoea in children.
A significant number o f  the mothers ( 24.8%) believed that witches and evil spirits could cause 
childhood diarrhoea. Nineteen percent (19.0%) o f the respondents did not know any cause of 
diarrhoea. A total o f 170 mothers ( 80.9%) could mention at least one cause o f childhood diarrhoea 
out o f which only 27 (12.9 %) of them could mention more than one acceptable cause o f  childhood 
diarrhoea.
TABLE 7. MOTHERS RESPONSES ON CAUSES OF CHILDHOOD DIARRHOEA
4.3. MOTHERS KNOWLEDGE ABOUT DIARRHOEA:
CAUSES OF DIARRHOEA FREQ %
Teething 39 18.6 / ,
Eating contaminated food 13 6 2 it (1 A. \
Food poisoning 12 5.7
Drinking dirty water 9 4.3 |
Witches and evil spirits 52 24.8
Sucking hot breast 21 10.0
Heat from the sun 7 3.3
Dirty stomach 17 8.1
I don’t  know 40 19.0
TOTAL 210 100.0 %
28
i  AJtSL/J£8. NUMBER (JK CAUSES UJb CHILDHOOD DIARRHOEA KNOWN BY MOTHERS
Number of causes FREQ %
1 143 84.1
2 13 7.6
3 4 2.4
4 9 5.3
More than 4 1 0.6
TOTAL 170 100.0%
4.3.2 Mothers knowledge about Diarrhoea and it’s effects on the child:
One hundred and eighty one (181) out o f the 210 mothers interviewed representing 86.2% % could 
correctly describe diarrhoea as the passage o f frequent wateiy stool.
About 5.0% o f the respondents described diarrhoea as the passage o f mucoid stool, whilst 9.0 % did 
not know how to describe diarrhoea. With regard to the effects o f diarrhoea on the child, varied 
responses were given by respondents. Almost forty two percent (42.4%) o f  the respondents 
mentioned loss of weight due to malnutrition, as an effect of diarrhoea on the child. About thirteen 
percent (12.8%) o f the mothers believed that diarrhoea can cause the death o f  the child. About twenty 
two percent (21.9 %) considered growth failure in the child as the effect o f diarrhoea, whilst 22.9 % o f 
them did not know any effects o f diarrhoea on the child.
TABLE 9. MOTHERS RESPONSES ON EFFECTS OF DIARRHOEA ON THE CHILD
EFFECTS OF DIARRHOEA ON THE CHILD FREQ %
Loss o f Weight due to malnutrition 89 42.4
Death o f the child 27 12.8
Growth failure in the child 46 21.9
Don’t  know 48 22.9
TOTAL 210 100.0 %
29
Une hundred and eighty four (184) respondents (87.6 %) considered diarrhoea as a dangerous disease 
in children, whilst 12.4 % considered that diarrhoea is not a dangerous disease in children. Almost 
fifteen percent (14.7 %) out of those who considered diarrhoea as a dangerous disease, explained that 
diarrhoea makes the child grow lean. About nine percent (8.7 %) explained that diarrhoea makes the 
child become malnourished and dehydrated, whilst 5.9 stated that diarrhoea causes financial drain to 
parents. Among those who did not consider diarrhoea as a dangerous disease, 42. .3 % explained that 
the disease can easily be treated and prevented with medicines, whilst 57.7 % did not know any 
dangerous effects of diarrhoea on the child.
4.4 DIARRHOEA MANAGEMENT PRACTICES:
4.4.1 TREATMENT:
With regard to what mothers do when their children suffer from diarrhoea, 98 of the respondents (46.7 
%) mentioned that they send the child to hospital/health centre because diarrhoea cannot be treated 
easily at home. About half of the mothers (50.5 %) responded that they treat the child at home whilst 
6 ( 2.9%) do not take any action at all to treat the child during diarrhoeal episode.
TABLE 10. ACTION TAKEN BY MOTHERS TO TREAT CHILDHOOD DIARRHOEA
ACTION TAKEN FREQ %
Send child to hospital/ health centre 98 46.7
Treat the child at home 106 50.5
I don’t do anything 6 2.9
TOTAL 210 100.0 %
For those who treat the child at home, 65 (61.3 %) explained that they buy medicines from the local 
market and administer to the child, whilst 41 (38.7  %) give local herbal preparations to the child. 
Ninety four percent ( 94.3 %) of those who treat the child at home further explained that the child’s 
condition improves for a short period of time but the condition later becomes worse than before. Only 
(5.7 %) admitted that the child gets better when they treat at home with herbal preparations.
30
1 ABLE 11. SPECIFIC TREATMENT GIVEN BY MOTHERS TO THE CHILD
SPECIFIC TREATMENT FREQ %
Give enema 51 48.1
Give child medicine obtained from the local market 27 25.5
Give local herbal preparations ( concoctions) 28 26.4
TOTAL 106 100.0 %
4.4.2 Enema administration:
Almost half o f  the mothers interviewed (48.1%) give enema to the child during diarrhoeal episode, 
while 109 (51.9%) responded that they don’t give enema.
For those who give enema to the child, 76.2% explained that they do so to clear dirt from the child’s 
stomach, 22.8% said they do so to stop the diarrhoea whilst 1.0% o f the women do so to make the 
child’s stool less offensive.
TABLE 12. MOTHERS REASONS FOR GIVING ENEMA DURING DIARRHOEAL EPISODE
REASONS FOR GIVING ENEMA FREQ %
To clear dirt from child’s stomach 81 76.4
To stop the diarrhoea 24 22.6
To make child’s stool less offensive 1 1.0
TOTAL 106 100.0 %
For those who give medicines to the child, the common drugs usually given are Ampicillin, Flagyl, 
Kaolin, Septrin and sulfadimidine which are usually obtained from the local market.
31
4.4.3 O.R.S. M anagement
Greater proportion o f the rspondents (78.6%) have ever heard o f Oral Rehydration Salt (O.R.S) while 
a few (21.4%) have never heard o f it. Out of those who have ever heard o f O.R.S, 103 (62.4%) have 
ever used it to treat childhood diarrhoea while 37.6% have never used it to treat the child during an 
episode o f diaiThoea.
4.4.4 Feeding Practices
Majority o f the mothers (88.6%) feed their children during diarrhoeal episode. However, their 
reasons for feeding the child varied. Fifty percent (53.2%) o f the mothers do so to enable the child 
regain strength while 22.8% feed the child to stop the diarrhoea. A  few o f them (2.7%) responded 
that they feed the child to prevent dehydration. About 13% (12.9) o f the mothers who feed their 
children during an episode o f diarrhoea, could not assign reasons for their action. /
TABLE 13. MOTHERS’ REASONS FOR FEEDING THE CHILD DURING DIARRHOEAL EPISODE
REASONS FREQ. %
To enable child regain strength 99 53.2
To stop the diarrhoea. 41 22.0
To prevent dehydration 5 2.7
To replace loss o f fluid & electrolyte from the child’s body 17 9.1
I don’t  know 24 12.9
TOTAL 186 100.0%
The commonest traditional food usually given to the child by those mothers who feed the child during 
diarrhoea episode include, T.Z (a locally prepared food made o f maize or rice) , porridge, mashed yam 
and soup as well as kenkey water. Eighty six percent o f the women (86.1) give T.Z and/or Porridge 
as food to the child during diarrhoeal episode.
32
TABLE 14. TYPE OF FOODS GIVEN TO CHILD DURING DIARRHOEAL EPISODE
TYPE OFFOOD FREQ. %
T.Z 52 28.0
Pomdge 108 58.1
Mashed yam + Soup 2 1.1
Kenkey Water 4 2.1
Breastmilk 11 5.9
Rice and Soup 9 4.8
TOTAL 186 100.0%
4.4.5 Breast-feeding practices during Diarrhoea
Greater number o f the mothers (88.6%) breast-feed their children during diarrhoeal episode. Only 
11.4% o f the mothers do not breast-feed their children during diarrhoeal episode. However, their 
reasons for breast-feeding the child varied. About 45% o f the mothers who breast-feed their children, 
do so because breastmilk is considered to be good for the child while (4.3%) breast-feed to replace lost 
fluids and prevent dehydration in the child.
Only (9.7%) o f them explained that they breast-feed the child to stop the diarrhoea. A  little over 7% 
of the mothers do breast-feed to prevent the child from growing lean, (22.6%) breast-feed so that the 
child will gain energy whilst 11.3% o f the mothers could not give any reasons for breast-feeding the 
child. Thirty five percent o f the children in this study were breast-feeding at the time o f the study.
33
TABLE 15: MOTHERS REASONS FOR BREAST-FEEDING THE CHILD DURING AN EPISODE
REASONS FREQ. %
Breastmilk is good as food for the child 83 44.6
To replace loss fluids & Prevent dehydration 8 4.3
To stop the diarrhoeal 18 9.7
For the child to gain energy 42 22.6
To prevent child from growing lean 14 7.5.
I don’t  know 21 11.3
TOTAL 186 100.0%
4.5 MOTHERS KNOWLEDGE ON CHILDHOOD DIARRHOEA PREVENTION
Only (31.9%) o f the mothers believe that childhood diarrhoea can be prevented, (52.4%) stated that 
they do not think so whilst (15.7%) of them had no idea as to whether childhood diarrhoea can be 
prevented. Among those who think the disease can be prevented, 34.3% explained that only health 
personnel can prevent childhood diarrhoea, 23.9% responded that only God can prevent diarrhoea, 
25.4% believe that childhood diarrhoea can be prevented by the use o f medicines, whilst 16.4% had no 
knowledge at all concerning measures for childhood diarrhoea prevention.
TABLE 16. MOTHERS RESPONSES ON MEASURES TO PREVENT CHILDHOOD DIARRHOEA
PREVENTIVE MEASURES FREQ %
Only God can prevent childhood diarrhoea 16 23.9
Only health personnel can prevent diarrhoea 23 34.3
Use o f Medicines 17 25.4
I don’t  know any measures 11 16.4
TOTAL 67 100.0%
34
4.6 MOTHERS SOURCES OF INFORMATION ON DIARRHOEA
Majority o f the mothers (65.2%) obtained information about diarrhoea from either hospital or health 
centre, 7.1% obtained information from friends and family members, 1,9% o f them had information 
about diarrhoea from local pharmacy shop, 1.0 % obtained information from traditional birth 
attendants, 2.4 %  had it from radio and television whilst 20.5% had no source o f information at all on 
childhood diarrhoea.
TABLE 17. MOTHERS SOURCES OF INFORMATION ON CHILDHOOD DIARRHOEA
SOURCE OF INFORMATION FREQ %
Hospital/Health centre 137 65.2
Local Pharmacy shop 4 1.9
Traditional Birth Attendants 2 1.0
Friends & Family members 15 7.1
Radio & T.V 5 2.4
Newspapers 4 1.9
No source o f information 43 20.5
TOTAL 210 100.0 %
35
CHAPTER 5
5.0 DISCUSSIONS AND CONCLUSION
5.1 DISCUSSIONS:
An interview schedule was used to assess diarrhoeal knowledge and practices among two hundred and 
ten (210) mothers in the Wa district who have children under two years. The main objective o f the 
research study was to assess the knowledge o f the mothers about causes, effects and management of 
diarrhoeal ddiseases among children, as well as identifying the various practices they adopt at home in 
the management o f diarrhoea.
5.1.1 KNOWLEDGE ON CAUSES OF DIARRHOEA:
The knowledge o f mothers in the study area regarding causes o f childhood diarrhoea was not 
satisfactory. The fact that only 15.9% of the mothers could mention more than one acceptable cause 
o f diarrhoea ( Refer to Table 8) and 19.0 % did not know o f any cause o f diarrhoea ( refer to Table 7), 
implies that significant proportion o f the mothers lack knowledge or have little knowledge about the 
causes o f diarrhoea. Adequate knowledge of diarrhoea is an important factor for taking appropriate 
action to manage the disease during an episode. Also the fact that about 25 % (24.8%) o f the mothers 
consider witches and evil spirits as well as 21.4 % of the mothers believing that sucking o f hot breast 
and heat from the sun could cause diarrhoea, indicate the lack o f adequate information the women 
have on childhood diarrhoea. Almost all the mothers interviewed (86.2%) knew the appropriate 
description of childhood diarrhoea. This is encouraging in that, it offers mothers the opportunity to 
identify early, the onset o f the disease so that appropriate measures could be taken by her to manage 
the disease without delaying unnecessarily till the child’s condition becomes worse.
36
5.1.2 KiNOWI.K.nCK OF THE EFFECTS AND DANGERS ASSOCIATED 
WITH DIARRHOEA IN CHILDREN
It is encouraging that a large proportion of the mothers (7/. 1%) knew at least one major effect of 
diarrhoea on the child.
This is important in that the decision of a mother to take prompt and appropriate action in the 
management of childhood diarrhoea is mostly determined by the mother’s knowledge about the serious 
effects and the outcome of untreated diarrhoea on the child. If the mother knows that failure to take 
prompt and appropriate action to treat the child could result in the child’s death or severe dehydration, 
the mother is likely to act without delay to safe the child’s life. However, the fact that 22.9% of the 
mothers had no knowledge about the causes of childhood diarrhoea has serious diarrhoea 
management implications. It would not motivate the mother enough to take immediate action to seek 
treatment for the child and any delay in seeking treatment may aggravate the child’s condition 
Majority of the mothers who knew that diarrhoea is a dangerous disease could give correct reasons for 
thinking so. They knew that diarrhoea can easily kill the child fast due to dehydration It is equally 
disheartening that, among those who did not know any dangerous effects of diarrhoea on the child, a 
significant number of them (42.3%) think that the disease can easily be treated and prevented with 
medicines. This misconception can threaten the life of the child as the mother with such a belief, may 
not take any prompt action to treat the child appropriately during an episode.
5.1.3 KNOWLEDGE ABOUT DIARRHOEA MANAGEMENT
The mothers’ knowledge of appropriate diarrhoea management for young children was not 
encouraging. This is because although many of the mothers had the opportunity of obtaining 
information on diarrhoea from health institutions or health personnel, quite a sizeable number (50.5%) 
of the mothers mentioned inappropriate or wrong methods of diarrhoea management.
37
These inappropriate methods of management include the administration o f  enema, administration of 
local herbal preparations o f unknown efficacy, withholding o f food and the administration of 
various kinds o f medicines obtained from the local market. Moreover, among those who had the 
opportunity o f obtaining information on diarrhoea management from health personnel, none o f  them 
was able to mention three or more o f the appropriate methods o f diarrhoea management taught by 
health personnel.
Thus the mothers’ general knowledge about diarrhoea management for children was limited. This is 
unfortunate because the mother caring for a young child must know as many o f the methods of 
managing diarrhoea at home, so that at any period o f  a diarrhoea episode, she can draw on her 
knowledge, and use the method that is most convenient and appropriate to her at that particular time 
or she could even change methods if  one proves ineffective. Although it is not necessary to  know 
many methods, especially if  the mother is aware o f only one effective method such as fluids 
replacement, it is still better for a mother to know more than one method o f diarrhoea management. 
The inappropriate or wrong treatment' measures mentioned by mothers were, the administration o f 
enema, the administration o f self medication obtained from the local market, and the administration of 
locally prepared herbal concoctions. Diarrhoea causes rapid loss o f fluids and electrolytes from the 
body cells causing dehydration which is the main cause o f death in children. This can be prevented 
by replacing what is lost as early as possible. I f  delayed, the child is predisposed to dehydration. It is 
therefore necessary to  emphasise that early and adequate management o f diarrhoea, especially fluid 
replacement, is essential to prevent deaths due to dehydration. These interventions belong first and 
foremost to the home environment.
It is necessary that mothers caring for young children know more about these methods o f diarrhoea 
management practices at home. The danger with kaolin and other anti-diarrhoeal drugs is that acute 
diarrhoea is self terminating within three to five days, therefore attempts at using anti-diarrhoeal drugs, 
especially kaolin and antibiotics are wasteful and only diverts the mother’s attention from taking a 
more appropriate action to manage the child’s condition.
These drugs only give false impression of management (Adjei 1985). In addition, the organisms that 
cause diarrhoea in children are mostly viruses and they are not affected by antibiotics. Therefore the 
routine use o f antibiotics is also wasteful. However, antibiotics are administered in a few cases of 
proven bacterial infections such as shigellosis and dysentery.
Concerning diarrhoea management practices, it was found that 46.7 % o f the mothers would send their 
children with diarrhoea to the hospital or clinic without doing anything for the child at home. More 
than half (50.5 %) o f the mothers said they would initially manage the diarrhoea at home by various 
methods which were found by the study to be inappropriate. This is not satisfactory enough in that, it 
is essentially necessary for mothers to know how to manage childhood diarrhoea at home and when to 
send the child to a health facility when his/her condition does not get better after the home 
management. The fact that a greater proportion o f the mothers (50.5%) manage the diarrhoea at home 
by the use o f herbs and various kinds of medicines o f doubtful efficacy, indicates that either mothers do 
not have adequate knowledge on diarrhoea management probably because they have not been exposed 
to knowledge o f modem methods o f diarrhoea management , or health services are not easily 
accessible to them.
On the whole, it was realized that most o f the mothers failed to apply the method o f management they 
had heard from health personnel. Although 70.0 % of the mothers obtained information on diarrhoea 
from appropriate sources, 46.7 % o f these mothers would send their children to hospital or health 
centre for treatment without doing anything at home. It is however encouraging to note that many of 
the mothers ( 88.6 %) would continue to feed their children during diarrhoeal episode. Continued 
feeding during diarrhoeal episode, is essentially important because depriving the child with diarrhoea of 
food, aggravates the malnourished state o f the child, causing more severe dehydration and reduces the 
child’s resistance to other infections.
39
The commonest types ol food given by mothers to the child during diarrhoeal episode are porridge 
and “Tuo Zaafi” (T.Z). These are locally traditional cereal-based foods that are easily obtained and 
readily available in many homes.
5.2 HOME MANAGEMENT PRACTICES
5.2.1 Breast-feeding practices:
It is impressive to note that majority of the mothers (88.6%) breast-feed their children during 
diarrhoeal episode. Though the reasons given for doing so varied, most o f the reasons were 
appropriate. This is an indication that the mothers are aware o f the importance and value o f  breast­
feeding to the child in diarrhoea management. Though some o f the mothers admitted that in severe 
cases of the infection, the child refuses to breast-feed, they did not rule out the value o f  breastmilk and 
other foods to the child in such circumstances.
5.2.2 Enema Administration:
Almost half o f the mothers interviewed practise enema administration to the child during diarrhoeal 
episode. This is a dangerous practice in that during diarrhoea, there is increasing loss o f  body fluids . 
Therefore the administration o f enema aggravates the child’s condition by increasing bowel irritating 
and increasing bowel movement., More so, some o f the herbal preparations used as enema could be 
dangerous and o f  doubtful efficacy and therefore could worsen the child’s diarrhoea condition.
5.2.3 O.R.S Administration:
Remarkable enough 78.6 % of the mothers have ever heard of O.R.S however, the fact that 62.4 % 
have ever used it to treat their children with diarrhoea implies that either some o f the mothers underrate 
the value o f O.R..S as an effective treatment for diarrhoea or that it is not easily available to them as and 
when they need it.
The administration of Oral Rehydration Solution (O.R.S) at the onset of diarrhoea is essential to 
prevent dehydration which is the main cause of death in diarrhoea. Therefore the need for mothers to 
know and practise the administration of O.R.S to the child at home even before sending the child to a 
health facility cannot be over-emphasised.
This study supported the findings that supernatural forces such as witches and evil spirits are 
perceived to be causes of childhood diarrhoea as was found in the studies carried out in the rural or 
peri-urban North India States of Jammu and Kashmire (Gupte et al) and the survey of people’s 
perception done in India ( Kakar et al 1972) . This is an important factor in designing health education 
messages and interventions to diarrhoeal diseases control. Unlike the findings from the studies of 
Escobar et al (1983) and Kakar et al (1972), in which majority of the mothers in both studies 
mentioned dietary causes as underlying factors of childhood diarrhoea, only (31.5%) of the mothers in 
this study associated dietary causes as underlying factors of childhood diarrhoeal diseases. Also, unlike 
the study in rural Zimbabwe in which Zoyza et al reported that 6.0 % of the mothers took no remedial 
action whatsoever in cases of childhood diarrhoea, this study found that many of the mothers (97.1%) 
took an initial action in response to childhood diarrhoea, though the methods taken by many of them 
were inappropriate or wrong in some cases. On diarrhoea management practices, the findings in this 
study revealed no ritual purification or chants and other ceremonies. Neither did the management 
practices involve a prayer meeting nor the administration of purgatives.
In the research done at Jammu and Kashmire, Gupte et al reported that over half of the mothers 
restricted food and fluids intake in a child with diarrhoea before sending the child to a health facility. In 
this study however, continued feeding and fluid intake were practised by majority of the mothers. 
Even though generally, the knowledge about diarrhoea management in young children was limited 
among the women in this study, most of them were knowledgeable about the need for continued 
feeding of the child with diarrhoea and their reasons for doing so quite appropriate. This appropriate 
practice of feeding during diarrhoea episode should be reinforced in health education messages.
The findings o f  this study have revealed that diarrhoea was common among children in the study area, 
with 168 out o f 210 children having had diarrhoea within four weeks preceding this study.
It is also clear from this study that mothers in the study area o f the Upper West region, have limited 
knowledge about causes, effects and dangers o f childhood diarrhoea as well as appropriate methods o f 
treatment and prevention.
On diarrhoea management practices, the study has revealed that mothers in the study area adopt 
various kinds o f diarrhoea management practices. These include administration o f enema to  the child 
during an episode, administration o f herbal concoctions and various kinds o f drugs which are obtained 
from the local market. These methods are considered inappropriate or wrong practices because they 
tend to aggravate the child’s diarrhoea condition as some of these methods cause worsening o f fluids 
and electrolytes loss from the child’s body and in some cases lead to death.
It is however encouraging to leam from this study that mothers in the study area are aware and 
knowledgeable about the importance o f continued feeding and breast-feeding in diarrhoea 
management and therefore continue to feed the child even when he/she refuses to eat or drink. This 
practice is commendable due to the fact that it helps to prevent the child from becoming dehydrated 
and thus reduces the severity of child’s diarrhoea condition. The usual foods and fluids given to the 
child during diarrhoeal episode are appropriate as they contain most o f the food nutrients essentially 
needed by the child for rapid recovery and energy.
5.3 CONCLUSION:
42
This study also shows that mothers have strong beliefs in supernatural forces such as witches and evil 
spirits as causes o f  childhood diarrhoea. This could influence the mothers’ knowledge o f preventive 
measures. It is therefore important that mothers are given adequate information about appropriate 
actions for diarrhoea prevention so that they could make use o f such information to take the necessary 
actions to protect the child from diarrhoeal infections. The study could however, not establish any 
significant difference between what the few educated mothers know and practice about diarrhoeal 
management and what the uneducated mothers know and practice.
5.4 RECOMMENDATIONS:
This study has shown that there is high prevalence o f diarrhoeal diseases among young children in the 
study area. This is attributed to the fact that mothers caring for these young children have little or no 
knowledge about the causes, effects, dangers, home management and prevention o f  diarrhoeal diseases 
and therefore adopt wrong or inappropriate methods to manage the disease during episodes. Based 
on the findings o f this study, the following recommendations are suggested for implementation:
1. Health Education on Diarrhoeal diseases should emphasise on teaching mothers about the “germ” 
theory o f disease causation, effects and dangers as well as appropriate home management and 
prevention o f diarrhoeal diseases.
2. The value o f the use o f  Oral Rehydration Solution (O.R. S ) should be emphasised for mothers to 
appreciate the need for it’s use to treat their children with diarrhoea at home even before sending the 
child to a health facility.
43
* 3. Oal Rehydration Solution salt (Sachets) should be easily available so that mothers could
obtain it as and when they need it to treat their children with diarrhoea. This could be done by 
ensuring that all Traditional Birth Attendants (TBAs) and local Pharmacy shops in the 
communities and villages are supplied with O.R.S sachets for sale to mothers at affordable cost.
* 4. Outreach health services should be extended to those communities in the study area which are
far away from the existing health facilities, and that at each health service session, a brief 
teaching on childhood diarrhoeal diseases should be given to mothers by the health team for 
mothers.
* 5. Any misconceptions or beliefs about diarrhoeal diseases that mothers strongly hold should be
disabused with correct and adequate information.
* 6. Oral Rehydration Therapy comers or centres should be established in all health facilities
which could be used as training or teaching centres for all mothers who use the health facilities. 
Where possible, some o f the mothers should be used as resource persons in Oral Rehydration 
Therapy teachings.
* 7. Health personnel particularly Community and public health Nurses who do home visiting,
should use such opportunity to teach mothers in their own homes about diarrhoeal diseases and 
their appropriate home management.
* 8. Mothers’ clubs should be formed at all communities so that they could share together
information and experiences on diarrhoea management practices and other child survival skills.
44
it is hoped and anticipated that when these recommendations are implemented by the health services 
administration and other health-related agencies in the district, the prevalence o f childhood diarrhoeal 
diseases with it’s high mortality rate could be reduced.
45
APPENDIX A: QUESTIONNAIRE
ID # ....................................................
SUB D ISTR ICT ..........................................
\TLLAGE/COMMUNTTY..........................
D A TE :.....................................
SCHOOL OF PUBLIC HEALTH t SPm  
UNrVERSITY OF GHANA - LEGON.
QUESTIONNAIRE ON THE KNOWLEDGE AND PRACTICES OF DIARRHOEA 
MANAGEMENT FOR  YOUNG CHILDREN, AMONG MOTHERS OF THE WA 
DISTRICT.- UPPER  W EST REGION.
Self introduction: I  am Eric Owusu, a student o f the University o f Ghana, School 
of Public Health who is conducting a study on Diarrhoeal Diseases o f young 
children and it’s management among women of the Wa District
You are kindly requested to assist in the study of the above topic by answering some 
questions relating to the study.
You will not be identified as an individual and your responses will be treated as 
confidential
Thank you for your co-operation and participation.
A BACKGROUND INFORMATION OF RESPONDENTS:
1. Mother’s Age
a) 15-19 years
b) 20-24 years
c) 25-29 years
d) 30-34 years
e) 35-39 years
f) 40-44 years
g) 45 yrs and above
[ ]
2. Marital Status:
a) Never married
b) Married
c) Divorced
d) Separated
e) Widowed
46
3. Educational Level o f  Mother
a) Nil [
b) Elementary I
c) Secondary/Vocational [
d) University/Diploma [
4. Occupation o f Mother.
a) Farmer [
b) Trader [
c) Government Worker [
d) Other Specify.............................................................
5. Do you have a child up to 2 years of age ?
a) Yes [
b) No [
6. What is the actual age o f the child ?
a) 0 - 6mon th s  [
b) 7 - 1 2  months [
c) 13 -18 months [
d) 19 - 24 months [
7. Has he/she ever had diarrhoea ?
a) Yes [
b) No [
8. I f  yes, when was the last episode o f the diarrhoea ?
a) 0 - 2 weeks [
b) 2 - 4 weeks [
c) 2 -4  weeks [
d) More than 4 weeks [
B. INFORMATION ON KNOWLEDGE ON DIARRHOEA 
CAUSES:
9. What do you think can cause diarrhoea in a child ?
a) Teething [ ]
b) Eating contaminated food [ ]
c) Witches and Evil spirits [ ]
d) Drinking dirty water [ I
e) Food poisoning [ ]
f) I don’t  know [ ]
g) Other Specify................................................................................................
47
EFFECTS:
10. How do you know your child has diarrhoea ? ...................
11. What do you think are the effects o f diarrhoea on a child ?.
12 (a) . Do you consider diarrhoea as a dangerous disease o f children ?
a) Yes [ ]
b) No [ ]
1 2 ( b )  Give reasons for your answer........................................................
C: INFORMATION ON DIARRHOEA MANAGEMENT PRACTICES:
13. When your child has diarrhoea, what do you do to him/her ?
a) Send child to Hospital/Health centre [ ]
b) Treat him/her at home [ i
c) Other Specify...............................................................................................................................
14. I f  you treat at hom e, what do you give to the child ? ..........................................................
15. (a) Does the child get better ?
a) Yes [ ]
b) No [ ]
15 (b) I f  No, what else do you do ? ...............................................................................................
16.(a) Have you ever given enema to any o f your children who had diarrhoea ?
a) Yes [ ]
b) No [ ]
16. ( b) I f  Yes, what were your reasons ?......................................................................................
17. Have you ever heard o f O.R..S ?
a) Yes [ ]
b) No [ ]
18. I f  yes, have you ever used it to treat your child with diarrhoea ?
a) Yes [ ]
b) No [ ]
48
IX INFORMA TION ON FEEDING PRACTICES:
19. ( a) Do you feed your child during an episode o f diarrhoea?
a) Yes [ ]
b) No [ ]
19. ( b) Give reasons for your answer......................................................
20. If  yes, what types o f food do you give to the child ?
a) Breastmilk [ ]
b) T.Z [ ]
c) Porridge [ ]
d) Mashed yam and soup [ ]
e) Rice water [ ]
f) Kenkey water [ ]
Other Specify....................................................................................................
21.(a) Do you breast-feed your child during the episode o f diarrhoea ?
a) Yes [ ]
b )No [ ]
21. ( b) Give reasons for your answer.....................................................
E. INFORMATION ON DIARRHOEA PREVENTION:
22. Do you think diarrhoea in children is preventable ?
a) Yes [
b) No [
c) I don’t  know [
23. I f  yes, how can it be prevented ? [
a) Proper washing o f  hands before feeding the child [
b) Preparing the child’s meals in a clean environment [
c) Sanitary disposal of child’s waste products [
d) Adequate and proper feeding of the child [
e) Other, Specify.........................................................................................
F. SOURCES OF INFORMATION ON DIARRHOEA:
24. What have been your sources of information on diarrhoea ?
a) Hospital/Health centre [
b) Local Pharmacy shop [
c) Friends and Family members [
d) Radio and Television
e) Traditional Birth Attendant
f) No source o f information
49
OPERATIONAL DEFINITION OF TERMS
For the purpose o f this research, the operational definition of the terms used are as follows:
1. Knowledge
Any written and (or) verbal information o f what mothers know about diarrhoeal 
disease and it’s management for young children.
2. Practices and Management:
The verbal or demonstrable account o f what mothers do for their young children 
during diarrhoeal episodes or the measures the researcher will observe mothers taking 
when their children have diarrhoea.
3. Diarrhoea: The passage o f three or more frequent loose stools than usual to the child.
4. Young Children: This study defines young children as those aged 0-2 years.
These include both males and females.
5. Mother: Any woman or caretaker who has one or more children aged 0-2 years
under her care even if  they are not her own children.
50
APPENDTX B • TJST OF A BBREVIA TIONS
1- W.H.O .............................  World Health Organization
2. O.R.T ............................. Oral Rehydration Therapy
3. O.R.S ............................. Oral Rehydration Salt
4. T.Z ............................. “Tuo Zaafi”( local cereal-based food)
5. DHMT.............................  District Health Management Team
6. SDHMT............................  Sub-District Health Management Team
7. I.M.R .............................  Tnfant Mortality Rate
8. C.M.R ...............................Child Mortality Rate
9. M.M.R ............................... Maternal Mortality Rate
10. N.G.O ..............................Non Governmental Organization
11. HSSP .............................. DANIDA Health Sector Support Programme
12. GPRTU............................. Ghana Private Road Transport Union
13. S.T.C ..............................State Transport Corporation
14. O.S.A ..............................Omnibus Services Authority
15. G.O.G .............................. Government o f Ghana
16. UNICEF............................. United Nations Children’s Fund
17. M.O.H ............................. Ministry o f Health
18. TBA ............................. Traditional Birth Attendant
19. E.P.I .............................. Expanded Programme on Immunization
20. M.C.H .............................. Maternal and Child Health
LIST OF REFERENCES:
1 W .H .0 Manual for the planning and Evaluation of National Diarrhoeal Diseases 
Control programmes. WHO/CDD/ser/81.5. Page 3
2. The John Hopkins University: “ Oral Rehydration Therapy (ORT) for Childhood 
Diarrhoea “ Population Reports: Issues in World Health. U.S.A
The John Hopkins University Press, 1980, Vol. VUI. pages 1-41
3. Gupte, Suraji, Sansan, Avtar, Singh: “Maternal Beliefs and Attitudes concerning 
Diarrhoeal Diseases”. Journal of Diarrhoeal Diseases Research Vol. 1 No. 2(1983) 
pp 109, 1157.
4. Escobar etal  “Beliefs Regarding the Aetiology and Treatment o f Infantile Diarrhoea 
in Lima, Peru” Journal of Social Science and Medicine Vol. 17, No. 17 (1983) pp.
1153 and 1157.
5. Frankel S.J. and Lehmann D. “ People and Health: Oral Rehydration : What mothers Think” 
World Health Forum. Vol.6 (1985) PP 271-273.
6. Kakar D.M, Murthy S.K.S and Parker R.L: “Peoples perception o f illness and their 
uses of Medical Services in Punjab, India.” Journal of Education. Vol. 11, (1972)
pp. 286.
7. Isabelle De Zoyza, Carson, Richard Feachem, Betty Kirweed, Evan Lindsay, Smith 
and Rene Leewenson: “ Perceptions o f Childhood Diarrhoea and it’s Treatment in 
rural Zimbabwe.” An International Journal of Social Science Medicine. Vol. 19, No.
7, ( 1984) pp. 722 -734.
8. Edward C.Green: “Traditional Healers, Mothers and Childhood Diarrhoeal Diseases
in Swaziland: The Interface of Anthropology and Health”. Social Science Medicine, vol. 20, 
No. 3 (1985) pp. 277.
9. D. Mahalanabi, M .H Merson, D.Bamua: “ Oral Rehydration therapy- Recent 
Advances”, World Health Forum Vol. 2, No. 2 (1981) pp.245.
10. L.CChen: “ Control o f Diarrhoeal Diseases, morbidity and mortality: Some 
strategic issues” American Journal of Clinical Nutrition Vol. 31, (1978) 
pp. 2284.
11. Abraham S. Benenson, “ Control o f Communicable Diseases Manual” American 
Public Health Association. 16th Edition ( 1995) pp. 140-148.
12. UNICEF. The State of the world’s children (1993) pp. 6, 22-23
13. World Bank Publication: Better Health in Africa, Experience and Lessons Learned 
Published in 1994. pp. 15 -17.
52
14. D.B Jelliffe, Child Health in the Tropics: A Practical Handbook For Medical and 
Para-Medical Personnel. 4 Th. Edition. (1974) pp. 58-62.
15. SamAdjei. “ You and Your Health “ The Ghanaian Mirror November 16 (1985)
pp. 4
16. W.H.O. “The World Health Report” (1996) Fighting Disease Fostering
Development.
17. Appropriate Health Resources & Technologies Action Group Ltd.( AHRTAG) 
“Dialogue On Diarrhoea” . The International Newsletter on the control of Diarrhoeal 
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