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 Table of Contents  
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 186-193

Impact of structured educational program on maternal knowledge, attitude, and practice toward diarrhea management in children <5 years age in Anantapur District

1 Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, K.R.Palli Cross, Anantapuramu, Andhra Pradesh, India
2 Department of Pediatrics, RDT Hospital Bathalapalli, Anantapur, Andhra Pradesh, India
3 Department of Clinical Pharmacology, Batterjee Medical College, Jeddah 21442, Kingdom of Saudi Arabia
4 Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research, Andhra Pradesh, India

Date of Web Publication13-Jul-2017

Correspondence Address:
Guddeti Sunanda
Raghavendra Institute of Pharmaceutical Education and Research, K.R.Pali Cross, Anantapuramu - 515 721, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_121_16

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Introduction: Maternal knowledge, attitude, and practices (KAP) toward management and prevention of diarrhea in children <5 years age is essential as it maintains good quality of life by reducing the morbidity and mortality. Aim: A study is designed to assess the KAP of mothers before and after the structured educational program on management of diarrhea in children less the 5 years of age. Settings and Design: Quasi-experimental design without control was preferred to test the effect of education on KAP toward diarrheal management among mothers at a rural secondary care referral hospital situated at resource challenged settings of south India. Subjects and Methods: A total of 384 mothers were enrolled and given education regarding the childhood management and prevention of diarrhea. A prevalidated KAP questionnaire toward management and prevention diarrhea was used to assess maternal KAP levels before and after the structured educational program. Statistical Analysis: Epi-Info-7 statistical software was used for data analysis. Descriptive statistics such as frequency and proportion were calculated for demographic characteristics. Chi-square test was used to test differences between the pre- and post-intervention KAP levels. Results and Discussion: The majority of women (56.7%) were belonging to the age group of 20–29 years. Among all the participants, nearly 85.4% were illiterate. Most of the women were of lower socioeconomic status (69.7%). There is a significant effect of structured educational program on maternal knowledge (χ2 = 577.2; P < 0.05), attitude (χ2 = 326.3; P < 0.05), and practice (χ2 = 347.3; P < 0.05) toward diarrhea management and prevention. Conclusion: Structured educational program targeting health-care providers and mothers primarily focusing on management and prevention of diarrhea shall improve the clinical outcomes in children <5 years of age.

Keywords: Diarrhea, educational program, knowledge, attitude and practices, mothers

How to cite this article:
Sunanda G, Ramaiah D, Sadiq MM, Narayana G. Impact of structured educational program on maternal knowledge, attitude, and practice toward diarrhea management in children <5 years age in Anantapur District. CHRISMED J Health Res 2017;4:186-93

How to cite this URL:
Sunanda G, Ramaiah D, Sadiq MM, Narayana G. Impact of structured educational program on maternal knowledge, attitude, and practice toward diarrhea management in children <5 years age in Anantapur District. CHRISMED J Health Res [serial online] 2017 [cited 2021 Apr 12];4:186-93. Available from: https://www.cjhr.org/text.asp?2017/4/3/186/210477

  Introduction Top

Diarrhea is a condition associated with the passage of three or more watery or loose stools in a single day.[1] Diarrhea is the second leading cause of death in children <5 years in low- and middle-income countries.[2] It causes 1.5–2.5 million deaths in children <5 years, around 60–70% of deaths are due to loss of water and essential minerals. In time and proper usage of oral rehydration salts (ORS) will prevent deaths associated with diarrhea.[3] As per the World Health Organization guidelines, Government of India promotes oral rehydration therapy as one of the top priority activities for ensuring child survival during diarrhea.[4] Globally, mother plays a vital role in feeding and providing care for their children irrespective of environment and sources available to them, including identification of dehydration symptoms, amount and type of liquid feed to the baby, which are vital for pediatric survival.[5] Most of the studies explain that the maternal awareness regarding proper diet, causes, symptoms, management, and prevention strategies for childhood diarrhea is very less.

The current study was performed at a nonbenefit and service providing secondary care referral hospital situated at a resource challenged settings of south India. The people lack formal education, low earning income, par below and unsatisfied living standards leads to recurrent ill health. even basic supplies of facilities like safe and pure drinking water, lacks the knowledge on the benefits of hand washing, maintaining cleanliness and practices the improper disposal of fecal matter. This kind of circumstances may lead to the development of deadly diseases such as diarrhea, which is the major cause of death in children.[6] Conducting health education programs and campaigns to mothers who are residing in this area will improve knowledge about management of diarrhea in children which reduces mortality and morbidity.[7] This study aims to provide a structured educational program to the mothers bearing children below the age of 5 years with an aim to improve knowledge, attitude, and practice (KAP) toward childhood diarrheal management and prevention.

  Subjects And Methods Top

The study was carried out for 6 months at a secondary care referral hospital situated at Anantapur district, south India. The study protocol was approved by the Institutional Review Board (IRB) and was provided with “RIPER/IRB/2016/015” as a reference number.

A quasi-experimental design without control was used to distinguish maternal KAP levels before and after the structured educational program on prevention and management of childhood diarrhea. To determine the number of the mothers to be included in the study, Epi-Info 7 software was used and sample size determined with a confidence limit of 5%, confidence interval of 95%, with 384 participants. A systematic random sampling was used to include the mothers into the study. All the mothers who were attending pediatric outpatient department bearing children with age <5 years were counseled and included in the study after obtaining the informed consents from them. Mothers with mental complications and seriously ill and those who had hearing and speaking difficulty were excluded from this study.

The educational program was provided by volunteers from nursing and pharmacy background who were having previous experience in providing health educational to the participants. The work was divided into three phases. Phase 1; a suitable data collection form was used to get mothers sociodemographic details and educational status. Mother's baseline KAP levels toward management and prevention of childhood diarrhea was assessed using suitable KAP questionnaire (Annexure I [Additional file 1]). The training to the volunteers was given including definition, causes, symptoms of dehydration, complications, ORS use, and management of diarrhea. They were also trained for the use of safe drinking water, maintaining hygienic measures and safe disposal of fecal matter to prevent diarrhea. Methods of training were lectures, group discussion, a video show, role plays, and clinical sessions using mother cards. Volunteers were evaluated by supervisor through conducting interview.

In Phase 2, all mothers were divided into different groups, which comprise ten in each. Volunteers were provided with one structured educational program session for each group in a month for 3 months. The whole sessions were supervised by project supervisor to resolve if any health issues arise during the educational program.

In Phase 3, the women had no instructions for 3 months, and then they were given the postintervention interview. The postintervention survey was conducted using the same preintervention [Questionnaire] to assess the KAP toward management and prevention of childhood diarrhea.

The Epi-Info 7 software (Epi-Info 7 for Dos version 3.5.1software, Centers for Disease Control and Prevention, Clifton Road Atlanta, USA) was used for data analysis. Frequency distributions were obtained and descriptive statistics was calculated. Furthermore, the Chi-square test was used to test the differences between the pre- and post-intervention KAP levels.

  Results Top

A total of 384 mothers who are having <5 years' child were enrolled in outpatient department of rural secondary care referral hospital of Anantapur district. The majority of women (56.7%) were between the age group of 20–29 years. Out of total population, 85.4% of population were illiterate homemaker. Around 69% participants belong to low socioeconomic status followed by middle (29.1%) and high economic group (1%). The statistics indicates the need of education regarding appropriate use of resources in reducing childhood diarrhea is needed for the mothers who are residing at rural areas of Anantapur district.

Most of the mothers were bearing four children (16.9%), three children (15.4%), and two children in their family (38%) followed by one child (29.7%) <5 years. Nearly, 94.3% of mothers were believers of Hinduism, 3.6% were Muslims, and 1.8% were Christians [Table 1].
Table 1: Background characteristics of mothers

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Out of 384 mothers, before attending structured educational program, 12.2% answered correctly the questions bearing KAP in relation to diarrhea in children less than years of age and the results with percentages are explained in [Table 2],[Table 3],[Table 4] with their relative significance.
Table 2: Maternal knowledge levels before and after structured educational program

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Table 3: Maternal attitude levels before and after structured educational program

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Table 4: Maternal practice levels before and after structured educational program

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  Discussion Top

India accounts more than half a million deaths in children <5 years' age due to diarrhea. Diarrhea effects majorly in children who are residing at rural areas and poor literacy, hygiene, unawareness about causes. The current study identified that most of the study participants were devoid of formal education, and belongs to lower socioeconomic status, which is a prerequisite for the control of diarrheal diseases and its management. A similar study revealed that the education plays a vital role in improving health outcomes irrespective of their formal education.[7]

The National Family Health Survey has revealed that though 63% of mothers are aware about ORS usage in diarrhea only 27% of these are using the ORS in management. This suggests that there is large gap is existing on knowledge of ORS usage in mothers. Thus, repeated structured educational programs are required to improve the use of ORS in children suffering with diarrhea to deaths associated with dehydration.[8] The present study identified that most of the mothers are unaware of ORS use in diarrhea, even if they had known the importance of ORS in diarrhea management, they have poor skills in preparation and administration of ORS. Some mothers have a practice of giving sugar salt solution, cooked pulses water, and a mix of rice and lentils but they were unaware about ORS use, parallel results were found in the study published by Rehan et al.[9] After providing the structured educational program with KAP toward ORS preparation and administration, the usage of ORS was significantly improved with P < 0.05, which are similar to study results published by Gloria et al.[10]

Maternal knowledge about feeding of children <5 years was very poor before initiation of educational program. Most of the mothers are believed that breast milk was responsible for diarrhea, so breastfeeding was paused for as long as diarrhea continued. This misconception was strongly existing before educational program, only 8.8% of population are aware about breastfeeding and frequency of feeding during diarrhea which also points the similarity with results of Shah et al.[11] after providing structured education program to target population, KAP toward feeding pattern in diarrhea were significantly improved with P < 0.05 which are similar to results of Haroun et al.[12]

Before initiation of structured educational program, mothers had very poor awareness regarding causes, symptoms of dehydration, warning signs to seek medical advice, and hygienic measures to prevent diarrhea. After program, KAP levels toward management and prevention of diarrhea were significantly improved with P < 0.05 this supports that repeated education of the mothers will improve the skills and practices toward the management of childhood diarrhea.[13],[14]

The incidence of Epilepsy,[15] Cancer,[16] diarrhea are increasing day by day in India, which may be directly attributed to the under educated society, under socioeconomic conditions of the regions of India. Moreover, rational drug use [17] can be promoted either through the counseling giving activity to the patients at the time of hospital visit either by the physician, pharmacist, nurses to the mothers or the child guardians in their native language may impact for the better outcome in the future cases.

However, there are major confounders that attribute to the improvement of KAP levels related to age, educational status, economic status, and occupation. This confounding effect can be minimized using suitable matched control to assess the association of confounding variable on outcome.

  Conclusion Top

This study concludes that structured educational program will have a positive impact on maternal knowledge toward the management of diarrhea. Significant improvement in knowledge of mothers will improves attitude and practice toward diarrhea management and prevention. In developing countries like India diarrhea is the major leading cause of death in children <5 years' age, a simple measure such as hand wash, maintenance of hygienic conditions, safe drinking water, exclusive breastfeeding, and ORS administration can reduce morbidity and mortality in children. The government of India should take an initiation to bring awareness programs for the use of ORS, its method of preparation and continue feeding during diarrhea. Health-care professionals should serve a readily available health information sources to their patients to improve the practice of diarrhea management.


The authors would like to thank all participants, Pharmacy and Nursing volunteers who helped in this research. We also thank Dr. Sudheer Kumar, Director, RDT Hospital, Anantapur for his support to organize the educational program in the study site. All the authors are wholeheartedly thankful to the people who are directly or indirectly responsible for the completion of the work.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ghasemi AA, Talebian A, Masoudi Alavi N, Mousavi GA. Knowledge of mothers in management of diarrhea in under-five children, in Kashan, Iran. Nurs Midwifery Stud 2013;1:158-62.  Back to cited text no. 1
Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003;81:197-204.  Back to cited text no. 2
Amare D, Dereje B, Kassie B, Tessema M, Mullu G, Alene B, et al. Maternal knowledge and practice towards diarrhoea management in under five children in Finote Selam Town, West Gojjam Zone, Amhara Regional State, Northwest Ethiopia. J Infect Dis Ther 2014;2:1-9.  Back to cited text no. 3
Duggan C, Santosham M, Glass RI. The management of acute diarrhea in children: Oral rehydration, maintenance, and nutritional therapy. Centers for Disease Control and Prevention. MMWR Recomm Rep 1992;41:1-20.  Back to cited text no. 4
Jamiu MO, Odili VU, Abu SK, Abu SB. Assessment of mothers' knowledge of home management of childhood diarrhea in a Nigerian setting. IJPRBS 2012;1:168-84.  Back to cited text no. 5
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Chauhan SR, Chauhan AS, Shukla A. A study on the effect of skill-based health education on management of acute diarrheal diseases. Int J Med Sci Public Health 2015;4:81-4.  Back to cited text no. 8
Rehan HS, Gautam K, Gurung K. Mothers need to know more regarding management of childhood acute diarrhoea. Indian J Prev Soc Med 2003;34:40-5.  Back to cited text no. 9
Gloria V, Laura A, Katherine J, Karina M, Etilvia M, Carolina O. Educational intervention for the prevention of diarrheal diseases in the Mano de Dios neighbourhood, Sincelejo, Colombia: A success experience. Colomb Med 2011;42:319-26.  Back to cited text no. 10
Shah MS, Ahmad A, Khalique N, Afzal S, Ansari MA, Khan Z. Home-based management of acute diarrhoeal disease in an urban slum of Aligarh, India. J Infect Dev Ctries 2012;6:137-42.  Back to cited text no. 11
Haroun HM, Mahfouz MS, El Mukhtar M, Salah A. Assessment of the effect of health education on mothers in Al Maki area, Gezira state, to improve homecare for children under five with diarrhea. J Family Community Med 2010;17:141-6.  Back to cited text no. 12
Shah D, Choudhury P, Gupta P, Mathew JL, Gera T, Gogia S, et al. Promoting appropriate management of diarrhea: A systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr 2012;49:627-49.  Back to cited text no. 13
Pahwa S, Kumar GT, Toteja GS. Performance of a community-based health and nutrition-education intervention in the management of diarrhoea in a slum of Delhi, India. J Health Popul Nutr 2010;28:553-9.  Back to cited text no. 14
Srujana MP, Vigneshwaran E, Kumar GS, Jyoshna K, Sadiq MM. Assessment of quality of life in children with epilepsy in rural settings of South India: A cross sectional study. CHRISMED J Health Res 2017;4:110-6.  Back to cited text no. 15
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Reddy YP, Chandrasekhar KB, Sadiq MJ. A study of Nigella sativa induced growth inhibition of MCF and HepG2 cell lines: An anti-neoplastic study along with its mechanism of action. Pharmacognosy Res 2015;7:193-7.  Back to cited text no. 16
Prasad PS, Rudra JT, Vasanthi P, Sushitha U, Sadiq MJ, Narayana G. Assessment of drug use pattern using World Health Organization core drug use indicators at Secondary Care Referral Hospital of South India. CHRISMED J Health Res 2015;2:223-8.  Back to cited text no. 17
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  [Table 1], [Table 2], [Table 3], [Table 4]

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