KNOWLEDGE, ATTITUDES and PRACTICES addressing YOUNG CHILD DIARRHOEA
in MORAMANGA, MADAGASCAR:
The MOSAIQUE CROSS CULTURAL QUALITATIVE STUDY
Karine RENAUDIE, Paediatric Nurse, Euro Msc in International Health, Centre for International Health, Bergen,
Norway & Pasteur Institute of Madagascar, 2011
Problem Statement/ Objective
Severe dehydration due to diarrhoea leads to 19.8% of deaths among children under 5 years of age in Madagascar
(1). The Ministry of Health identified infant diarrhoea as a public health priority. Several studies show that there is
an association between infant and young child feeding practices and diarrhoea morbidity (2,3). A conceptual
framework allowed a description of child undernutrition as immediately linked to poverty with diarrhoea as a shortterm consequence (4). A cultural construction of diarrhoeal illness one was proposed by Weiss with the KAP model
(5). Thus, there is a need to understand how young child diarrhoea is managed with regard to knowledge, attitudes,
feeding and treatment practices in the households of Moramanga (Madagascar).
Material and Methods
This study is a qualitative study and the following methods were used: 1) 5 focus groups discussions (FGDs) were
conducted with mothers, grandmothers and fathers in an area close to the Maternal and Child Health Centre
(CSMI); 2) 5 semi-structured interviews (SSIs) with health professionals (doctors, midwife and community health
workers) were made in Moramanga to supplement the information and explore the reality of caregivers during child
diarrhoea episodes with regards to the education. The information analyzed was triangulated between the data
provided by FGDs and SSIs. Reliability was improved by leading FGDs only in the local language and translating
from Malagasy to French with two independent local translators and then comparing the translations with two
independent doctors.
Findings
Health and diarrhoea treatment are not a priority requirement for people in Moramanga. Their opportunity to pay for
the health care is limited and the financial charge in relation with the illness leads them to a bigger poverty. Even
the cost of ORS is expensive for the population who prefere using traditional medicine. Health workers confirmed
sub-optimal treatment practices and varied acknowledgement of the socio-economic burden of diarrhoea was
seen.……………………………………………………………
Discussion and Conclusion
Considering all these results, most of the children could be treated at home with zinc and ORS or a family
preparation with salt and sugar. Population has to learn how to rehydrate properly the child. Health workers must
now implement a preventive programme involving people targeting the financial constraint of the population. This
programme will be differenciated for each group in the population and will not only implement a global programme.
Understanding the priorities of the population can assist in improving the diarrhoea programme in this region.
Key words: Diarrhea, Diarrhoea, Madagascar, Qualitative study, Rehydration, Socio-economic management