CHAPTER ONE

1.1       BACKGROUND OF THE STUDY

Diarrheal disease is highly preventable, yet accounts for nine percent of all deaths among children under age five worldwide [Liu, 2013]. In 2013, this translated into about 580,000 child deaths, or, on average, 1,600 children dying each day due to preventable diarrhea [WHO, 2014].

Diarrhoea is the disturbance of the gastrointestinal tract comprising of changes in intestinal motility and absorption, leading to increase in the volume of stools and in their consistency [Ballabriga, et al 2000]. In diarrhoea, stool contains more water than normal stool and is often called loose or watery stool. In certain cases, they may contain blood in which case the diarrhoea is called dysentery [Obionu, 2007]. Any passage of three or more watery stools within a day [24 hours] is referred to as diarrhoea [Cairncross et al, 2010].

Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. Each year,third world countries of Asia, Africa and Latin America, record approximately five million deaths of children under five years of age from acute diarrhoea. About 80 per cent of these deaths are in the first two years of life [Lucas & Gilles, 2009]. In the developing world as a whole, about one-third of infant and child deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal deaths are caused by dehydration – the loss of large quantity of water and salts from the body, which needs water to maintain blood volume and other fluids to function properly [Gupta & Mahajan, 2005]. UNICEF [2002] summated that in Nigeria, infant mortality rates are twice as high in rural settings as they are in urban ones due to poor hygiene and poor sanitation. About three million infant births in Nigeria, approximately 170,000 result in deaths that are mainly due to poor knowledge and management practices of childhood diarrhoea. Several factors are likely to contribute to the high rate of diarrhoea morbidity and mortality in children under-five years these include poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services [Park, 2009]. Malnutrition is another established risk factor for mortality among children with diarrhoea disease. This may be due to inadequate case management. In 2004, WHO and UNICEF issued a joint statement on clinical treatment of acute diarrhea, recommending the use of low-osmolarity oral rehydration salts [ORS], zinc supplementation, increased amounts of appropriate fluids, and continued feeding [WHO; 2014]. Treatment of diarrhea with ORS is a simple, proven, high-impact intervention that can be provided in home settings by caretakers or by health care providers at community and facility levels to prevent dehydration due to diarrhea and decrease related deaths. The first line of management of diarrhoea is therefore, the prevention of dehydration. This can also be achieved at home using Oral Rehydration Therapy [ORT].

The consistency and the volume of stool constitute how to classify diarrhoea. World Health Organization – WHO [2014] classified diarrhoea as acute or persistent based on its duration. An episode of diarrhoea that lasts less than two weeks is acute diarrhoea, while diarrhoea that lasts more than two weeks is persistent. Calogero et al[2000] further classified diarrhoea according to its typology: Secretary Diarrhoea, osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from active process in the intestinal epithelium stimulated by the presence of toxin, chemical or nutritional product in the intestinal linning. Osmotic diarrhoea is caused by the presence in the intestinal linning of osmotically active solutes that are poorly absorbed by the injection of laxatives such as magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated with damage to the mucosa lining leading to outpouring of mucus, blood and plasma protein among other substances. However, it is important to note that the classification of diarrhoea does not influence the cause.

Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Diarrhoea in most cases is caused by three major groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites [Lucas & Gilles, 2009]. The main agents of diarrhoea are enteroviruses [e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera, salmonella [non typhoid], entamoeba histolytica, giardia lamblia, cryptosporidium]. These are further grouped in the following ways: Viruses

; Bacteria [e.g. shigella, escherichia coli, vibrio cholerae, salmonella non typhoid, campylobacter spp]. Parasites [e.g. entamoeba histolytica, crytosporidium and giardia lamblia]. All over the world, viruses especially rotavirus has been identified as the major cause of acute diarrhoea in children. Studies in Nigeria also found viruses as the major causes of diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20 per cent. Most of these pathogens are transmitted by faeco-oral route. Childhood diarrhoea within the context of this study refers to any type of loose, watery stool that occurs more frequently than usual in a child. The various causative agents vary according to the signs and symptoms manifesting from the disease.

The main consequence of diarrhoea are frequent loose or watery stools, the risk of dehydration, damage to intestine [especially when there is bloody diarrhoea] and loss of appetite with or without vomiting. However, Victoria, Bryce, Fountaine and Monasch [2000] asserted that signs of dehydration are not evident until there is acute fluid loss of approximately 4-5 per cent of body weight. The signs and symptoms of dehydration include sunken fontanels, dry mouth and throat, fast and weak pulse, loss of skin elasticity and reduced amount of urine. This loss leads to shock and untimely death of under-five. Werner [2001] noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan [2004] are passage of frequent loose watery stools, abdominal cramps or pain, fever particularly if there is an infectious cause and bleeding. Bacteria and parasites often can produce bloody diarrhoea [dysentary]. In addition, inflammatory bowel disease, polyps and colorectal cancer can cause blood and mucus in the stools, nausea and vomiting may also be present in the case of infection.

1.2       Problem Statement

The diarrhea prevalence rate in Nigeria is 18.8% and is one of the worst in sub-sahara Africa and above the average of 16%. Diarrhoea accounts for over 16% of child death in Nigeria and estimated 150,000 deaths mainly amongst children under five year occur annually due to this disease mainly caused by poor sanitation and hygiene practice. Various literature suggest 2.7%  of prevalence rate in Jos representing north central which include Nasarawa, Benue, Kogi and  Kwara State. (WHO Global Report for research in infection diseases of poverty 2012 Geneva)

In Nigeria diarrhoea is responsible for almost all child’s death in every year, Nigeria was estimated to have a total number of annual child death due to diarrhoea to be 151,700 (WHO, 2009). Diarrhoea was the most commonly reported cause of water borne infection in the North West in Nigeria which include Kano, Jigawa, Katsina, Sokoto, Kebbi, Zamfara and Kaduna with prevalence rate of 10%. (Unicef State of World Children 2013)

According to the manufacture instruction using G zard generation Rida Screen Elisa kit (R Biopharm AG Germany) and demographic data were collected via questionnaire to administered to parent/guardians of the subject and analysis was done using online easy chi-square (P<0.05) statistical package, show the prevalence rate of diarrhoeal in north east state including Borno, Bauchi, Adamawa, Gombe, Taraba and Yobe State is between 6.7% (40/600) and 5.0% (30/600) respectively across the north east region (2013-2014). An hospital base study in Lagos reported a prevalence rate of diarrhoea in South-West region of Nigeria that include Lagos, Oyo, Ondo, Osun, Ogun and Ekiti State was found in 4/50 (8% 2010-2015). (Unicef at glance Nigeria http//www.unicef.org/inferby conty)

Through World Health Organisation (WHO) Research International (2015-2017) at University of Nsukka on prevalence rate of diarrhoea across southeast which include Abia, Anambra, Ebonyi, Imo and Enugu which present with prevalence rate of 57% and the prevalence rate for diarrhoea in South South region of the country which include Akwa Ibom, Cross river, Bayelsa, Rivers and Delta states has prevalent rate of 15.6%. (WHO Geneva report for research on infection of disease of poverty 2012 Geneva). Despite the several studies highlighted above cutting across most or all of the geopolitical zones, diarroeal disease seem yet to be effectively controlled within the Nigerian society.

1.3       Justification

Community-based strategy for prevention and management of diarrhea disease among under five children appeared not to have received adequate research attention. Finding out these, certainly, will represent a positive step forward in the effort to promote the childhood diarrhoea knowledge and management practices. Following from these therefore, one is then inclined to ask, what are the community-based strategy adopted for prevention and management of diarrhea diseases among under five children in Oko-Erin community of Ilorin West local government? How effective are these strategy adopted by the community? What are the factors influencing the strategy towards achieving the desire goal?

1.       Research Objective

1.4.1    General Objective

To investigate strategies put in place by the community for prevention and management of diarrhoea among under five children.

1.4.2    Specific Objective

1. To assess the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment.
2. To assess different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area.
3. To assess the effectiveness of the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children.
4. To investigate the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area.

1.5       Research Questions

This research work aims at providing answer to the following questions;

1. What is the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment?
2. What are different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area?
3. How effective are the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children?
4. What is the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area?

1.6       Scope of the Study

This study covers the community-based strategies in the prevention and management of diarrhoea among under five in rural Nigeria using the study location as a case study. It therefore, examines various home remedies in the treatment and management of diarrhoea. This study gives attention to mothers and care givers who are directly involved in the subject matter, that is, those whose child or children are within the age bracket of this study and care givers including community health workers/practitioners. Little attention is given to hospital diagnosis and treatment of diarrhoea. The scope of this study is limited to children of under five years of age while the data collection is also limited to Oko-Erin community of Ilorin West local government of Kwara State.