1) The study assessed the knowledge, attitudes, and practices of mothers in Bhilai, Chhattisgarh regarding diarrhea prevention and oral rehydration solution (ORS) use. 2) While knowledge of diarrhea definition and ORS was high, knowledge of specific causes and proper ORS preparation was low. Many mothers had poor hygiene and feeding practices during diarrhea. 3) Targeted efforts are needed to address the gaps identified, including demonstrations on danger signs, ORS preparation, and emphasizing exclusive breastfeeding and hygiene. Improving maternal education can help reduce diarrhea mortality in children under five.

1. ASK(Attitude, Skills, Knowledge) Mothers to
prevent Diarrhea
Ajay Agade
JLN HOSPITAL & RESEARCH CENTRE
BHILAI

2. Ask mothers to prevent diarrhea-Introduction
1. Diarrhea known medically “Gastroenteritis” is a major killer of children in
world.
2. One out of every four childhood death.
3. Drains life out of 3 million infants & young children every year
4. 99.6% children from Third World.
5. One in ten children die of diarrhea before age 5
The Impact
Loosing precious child
Malnutrition
Burden health services
 Socioeconomic burden
family
society
country

3. Ask mothers to prevent diarrhea-Chronolgy
Diarrhea is a disease of old civilization
Bibliocas (25000 yrs old) first reference
Pacillus (1472) 1st printed book of pediatrics
Broussais (1829) The term Gastroenteritis
H.E. Harrison (1954)The first ever ORS
WHO (1970) standardize formula of ORS
WHO (1978) promotion of formula
WHO,UNICEF(2001) low osmalarity ORS
ORS–The Magic Bullet for Child Survival
Simple, effective, cheap
Reduces number of diarrheal deaths
Reduces hospitalization rates
Prevents adverse effects like malnutrition
EVIDENCE –
Diarrheal mortality -5 million per year
1.5 million per year

4. Ask mothers to prevent diarrhea - Global scenario
Incidence
Mortality

5. “Ask mothers to prevent diarrhea”-Indian scenario

6. Ask mothers to prevent diarrhea -Chattisgarh
scenario
NFHS-3 (2005-2006) India Chattisgarh
Children with diarrhea 26.2% 42%
who received ORS
Chldren with diarrhea 58% 65.3%
taken to health facilities
NFHS-2 (1998-1999) India Chattisgarh
Children with diarrhea 26.9% 29.7%
who received ORS
Chldren with diarrhea 65.3 59.3%
taken to health facilities

7. Ask mothers to prevent diarrhea- Aims & Objectives
1. To assess maternal knowledge of diarrhea : its definition and causes
2. To assess maternal attitude towards diarrhea management
3. To assess the maternal skills and practices related to ORS
Settings
In patient department & out patient department of Jawaharlal Nehru
Hospital & Research Centre, Steel Plant Bhilai

8. Ask mothers to prevent diarrhea- material &
methods
Type- cross sectional study
Material- The mother, of children 0-5 years age group who presented with acute
diarrhoea in the pediatric inpatient & outpatient department of the J.L.N.H. & R.C.
Period - June 2008-May 2009
Method- 200 Mothers were questioned on a careful predesigned questionnaire in local
language. Proforma compramised of more than 30 questions. Exclusion & Inclusion
criterias were set.
Proforma –Covered various aspect like definition, causes, symptoms, fluids given, use of
ors, method of preparation of ors etc.
Analysis- Results of this study were compared & analyzed, by proportional method
keeping in view the results & reports of various other investigators by reviewing all
available literature

9. Ask mothers to prevent diarrhea-observations
knowledge about diarrhea & ORS
KNOWLEDGE PERCENTAGE
Correct definition of diarrhea 62
Cause of diarrhea as contaminated food & 29.6
water
Both fluids & foods to be given in diarrhea 55
Extra feeds should be given in diarrhea 0
Knowledge about ORS 72
Correct method of reconstitution of ORS 8.9
Correct ammount 7.3

10. Ask mothers to prevent diarrhea-observations
Practices regarding diarrhea & ORS
WRONG PRACTICE percentage
Didn’t wash hands hygienically with soap 20
Didn’t practice exclusive breast feeds 91
Gave diluted milk 70
Gave bottle feeds 30
Restricted food during diarrhea 13.8
ORS not used 52

11. Ask mothers to prevent diarrhea-observations
Attitude towards Diarrhea & ORS
Attitude percentage
Delayed health seeking 46.5%
ORS not used despite its knowledge 13.6%
Didn’t think of maintaining clean water 37%
Indifferent attitude for prevention 17%

12. Ask mothers to prevent diarrhea-Discussion
CORRECT DEFINITION OF DIARRHEA
62%
46%
24.10% Correct def’n
15%
k.Anand Niyaz(1995) Mangala Present study
(1992) S.(2001)

13. Ask mothers to prevent diarrhea-Discussion
KNOWLEDGE REGARDING DIARRHEA
consequences Danger signs
42%
36%
51.80% 38%
36%
27.40% 31.10% 29.60%
11%
k.Anand (1992) Niyaz(1995) Mangala Present study
s.(2001)

14. Ask mothers to prevent diarrhea-Discussion
PRACTICES IN DIARRHEA
Huygenic handwashing Cont. normal diet during diarrhea
Use of liquid supplements
50%
38%
79%
81%
48% 72%
24% 41%

15. Ask mothers to prevent diarrhea-Discussion
ORS-Knowledge & skills
Know ORS
Correct method of reconstitution
Use of liquid supplements
50%
8.50% 8.90%
48% 38%
3.30% 68.10% 72%
24% 29.70%
H.Vishwanthan(1990) K.Anand(1992) S. Mangala Present study

16. Ask mothers to prevent diarrhea-observations
PRACTICE REGARDING ORS
Of those having knowledge, ORS used by
46%
42%
33.30%
25.90%
Ahmed NFHS-2 (1998- NFHS-3 (2005- Present study
F.(1996) 1999) 2006)

17. Ask mothers to prevent diarrhea-Conclusion
Millennium Development Goal of decreasing childhood mortality can be
achieved by effective management of diarrhea by mothers. Assessment of
current maternal attitude, knowledge & practices of diarrhea & ORS is
cornerstone to achieve success in the prevention of this major killing
disease.
Mother is the person responsible for the care of her baby during illness. Her
knowledge & practices during an episode of diarrhea are important factors
which influence the course of the disease.

18. Ask mothers to prevent diarrhea - Conclusions
SIGNIFICANT IMPROVEMENT
Knowledge of correct definition 4 fold increased awareness
Practice of giving excess fluids
Reduction in practice of starvation
Knowledge of ORS
Practice of ORS
LESS SIGNIFICANT CHANGES & HENCE REQUIRING MORE FOCUS
Poor knowledge of causes (only 29.6% know correct causes)
Correct method of reconstitution (only 8.9% of knowledgeable)
Feeding practice (100% unaware of giving extra feeds)
Exclusive breast feeding, bottle feeding practices
Lack of preventive attitude(17% indifferent attitude)

19. Ask mothers to prevent diarrhea-
Recommendation
Targeted efforts to fill up lacunas detected through study
Face to face
demonstration-
danger
sign, preparing ORS
Reinforcement
etc.
through paramedical
sources
Implentation of Interaction in small
DDCP group
Nutritional Importance of
education & hygiene
rehabilitation

20. Ask mothers to prevent diarrhea-Bibliography
1.K. Anand et al. knowledge & practice regarding diarrhea in
mother of haryana,Indian pediatrics,1992,29:915-916
2.P. Kapoor, knowledge attitude & practices in diarrhea ,Indian
pediatrics, 1996,33:319-320
3.Niyaz A. et al. parental awareness & practices in acute diarrhea
Indian pediatrics, 1995,32: 77-78
4.S. Mangala, educational intervention on knowledge of mother
regarding home management of diarrhea, Indian journal of
pediatrics, 2001,68:393-397
5.National Family and Health Survey-2 (1998-1999)
6.National Family and Health Survey-3 (2005-2006)