Knowledge and
on use
practices
of ORS/zinc
on useinofdiarrhea
ORS/zinc
management
in diarrhea
among
management
under among
five year
under
old children
five yearinold
Narok
children
South,
in
Narok South,
Kenya Kenya
Josephat Nyagero, Moses Mwangi, Elijah Mbiti,
Bob Akach, Jacqueline Kung’u, Stewart Kabaka,
Christopher Wanyoike, John Nduba
Safari Park Hotel, Nairobi
November 25, 2014
Background
• Kenya unlikely to meet MDG goal 4
• High impact child survival interventions implemented
• Diarrhea contributes >20% U5 child mortality (Black et al, 2010)
• Early management of childhood diarrhea through:
– Breastfeeding, good hygiene practices and
– ORS & zinc supplementation to avoid severe illness and death
Background
• Access to correct information and to ORS and zinc at
community level remains a major bottleneck
• 39% of children with diarrhea received ORS treatment and
<1% zinc yet 80% of mothers knew about ORS (KDHS 2008-9)
• Purpose of this paper is to assess the factors associated
with the mother’s/ caregiver’s knowledge on diarrhea
prevention and control
ORS/ zinc cluster randomized project design
58 sub-locations
Sub-locations with
CHU (18)
Sub-locations without
CHU (40)
Eligible based on
population size (15)
Eligible based on
population size (23)
Simple random
sample (SRS)
Simple random
sample (SRS)
11 sub-locations or
clusters
11 sub-locations or
clusters
Randomization
Randomization
5 Intervention
group clusters
6 Comparison
group clusters
6 intervention
group clusters
5 Comparison
group clusters
Methodology
• Narok south district of Narok County in Kenya
• 22 sub-locations out of 58 (11 intervention, 11 control)
• Targeted all women with children U5s
• Information on 500 U5 children in each sub-location
• Household Questionnaires adapted UNICEF’s Multiple Indicator
Cluster Survey tools used for 2009-2011 data
• Back translated into Maasai and Kipsigis and pretested
• Administered by trained research assistants locally recruited
• Data entry done using SPSS
• Logistic regression at the 95% confidence interval
Table 1: Selected socio-demographic characteristics of the
study participants
Variables
Intervention/Control
Intervention Cluster
Control Cluster
Gender of Respondent
Male
Female
Age of Respondent Grouped
<20 yrs
20 to 29 yrs
30 to 39 yrs
40 to 49 yrs
50 to 59 yrs
60 yrs and above
Not known
Mother's highest level of education
Primary
Secondary
College/university
None
Number of children
One
Two
Three
Four or more
n=6683
%
3306
3377
49.5
50.5
364
6319
5.4
94.6
516
3239
1582
479
95
39
733
7.7
48.5
23.7
7.2
1.4
0.6
11.0
2320
456
175
3732
34.7
6.8
2.6
55.8
3449
2346
837
51
51.6
35.1
12.5
0.8
Table 2: Household hygiene and sanitation
Variables
Drinking water treated
Yes
No
Water storage in the Household
Open container
Covered container
Same fetching container
Utensils washed and put on a drying rack
Yes
No
Compound clean or littered
Clean
Littered
Dwelling Clean
Yes
No
n=6683
%
1040
5643
15.6
84.4
724
1938
4021
10.8
29.0
60.2
4367
2316
65.3
34.7
3354
3329
50.2
49.8
4439
2244
66.4
33.6
Table 3: Source of information on prevention and treatment of
childhood diarrhea
Variables
n=6683
%
Public Health facility
4238
63.4
Family members
1673
25.0
Private Health facility
740
11.1
Herbalists
334
5.0
CHWs
306
4.6
Community training
256
3.8
Radio newspapers
211
3.2
Church
82
1.2
Written pamphlets
68
1.0
AMREF
2
0.03
Responses on selected knowledge issues
• What diarrhea is? – universal
• Ever heard of ORS - 70.8%
• Ever heard of zinc - 16.5%
• Action to take if diarrhea is identified
– 51.3% seek treatment immediately
– 45.7% seek treatment if persist
– 6.5% seek treatment if bloody
Figure 2: Overall Knowledge on prevention and control of
diarrhea
34.5%
65.5%
Adequate knowledge
Inadequate knowledge
Table 4: Knowledge on prevention and control of diarrhea in relation to selected
socio-demographic characteristics
Adequate knowledge
(n=4,378)
Characteristics
Intervention/Control
Intervention Cluster
Control Cluster
Age of the Respondent
<20 yrs
20 to 29 yrs
30 to 39 yrs
40 to 49 yrs
50 to 59 yrs
60 yrs and abve
Dont Know
Gender of Respondent
Male
Female
Mother's highest level of education
None/Primary
Secondary
College/university
Number of children per household
One
Two
Three
Four or more
Inadequate
knowledge (n=2,305)
n
%
n
%
OR
p value
2188
2190
66.2
64.9
1118
1187
33.8
35.1
1.06
1.00
0.252
312
2153
1073
318
55
18
449
60.5
66.5
67.8
66.4
57.9
46.2
61.3
204
1086
509
161
40
21
284
39.5
33.5
32.2
33.6
42.1
53.8
38.7
1.78
2.31
2.46
2.30
1.60
1.00
1.84
0.083
0.010
0.006
0.013
0.217
213
4165
58.5
65.9
151
2154
41.5
34.1
1.00
1.37
0.004
3898
334
146
64.4%
73.2%
83.4%
2154
122
29
35.6%
26.8%
16.6%
1.00
1.51
2.78
<0.001
<0.001
2256
1539
547
36
65.4
65.6
65.4
70.6
1193
807
290
15
34.6
34.4
34.6
29.4
0.79
0.79
0.79
1.00
0.064
0.441
0.459
0.446
Table 5: Knowledge on prevention and control of diarrhea in relation to Household
hygiene and sanitation
Adequate knowledge
(n=4,378)
Inadequate
knowledge (n=2,305)
n
%
n
%
789
75.9
251
24.1
3589
63.6
2054
384
53.0
Covered container
1243
Same fetching container
Characteristics
Drinking water treated
OR
p value
<0.001
36.4
1.80
1.00
340
47.0
1.00
64.1
695
35.9
1.58
<0.001
2751
68.4
1270
31.6
1.92
<0.001
Yes
No
Compound clean or littered
2962
67.8
1405
32.2
<0.001
1416
61.1
900
38.9
1.34
1.00
clean
littered
Dwelling Clean
2310
68.9
1044
31.1
<0.001
2068
62.1
1261
37.9
1.35
1.00
3006
67.7
1433
32.3
<0.001
1372
61.1
872
38.9
1.33
1.00
Yes
No
Water storage in the Household
Open container
Utensils washed and put on a drying rack
Yes
No
Table 6: Factors associated with knowledge on prevention and control of diarrhea
among the study participants
Variables
Gender of the Respondent
Male
Female
Mother's highest level of education
None/Primary
Secondary
College/university
Dwelling Clean
Yes
No
Public Health facility
Yes
No
AOR
95% CI of
AOR
p
Lower Upper value
1.00
1.49
1.19
1.85
0.001
1.00
1.46
2.33
1.17
1.54
1.83
3.53
0.001
<0.001
1.24
1.00
1.11
1.38
<0.001
1.88
1.00
1.67
2.10
<0.001
Conclusion
• being female and having secondary
level of education,
• dwelling in HHs with clean compound
and,
• obtaining information from public health
facilities
are associated with adequate knowledge
on prevention and treatment of
childhood diarrhea
Recommendation
Long term
• supporting girl-child education in the area
Short term
• concerted effort to promotion clean
dwelling compounds through multiple
approaches using community structures
• strengthen health facilities as sources of
health information to care givers and
diversify as may be appropriate