E-ISSN 1858-8360 | ISSN 0256-4408
 

Original Article 


SUDANESE JOURNAL OF PAEDIATRICS

2020; Vol 20, Issue No. 2

ORIGINAL ARTICLE

Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan

Hiba M. A. Mohamed (1), Faiza S. M. Mohammed (2)

(1) Family Medicine MSc Program Student, University of Medical Science and Technology, Khartoum, Sudan.

(2) Pediatric Department, Faculty of Medicine, National University, Khartoum, Sudan.

Correspondence to:

Faiza S. M. Mohammed

Pediatric Department, Faculty of Medicine National University, Khartoum, Sudan

Email: Faiza0122 [at] gmail.com

Received: 24 March 2020 | Accepted: 14 May 2020

How to cite this article:

Mohamed HMA, Mohammed FSM. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudan J Paediatr. 2020;20(2):136–143.

https://doi.org/10.24911/SJP.106-1585043373


ABSTRACT

Dehydration is a significant depletion of body water and electrolytes. The awareness of dehydration signs is essential, and in-home mothers’ practice and responses towards professional medical help are crucial. The study is a cross-sectional study enrolled 222 mothers with children under 5 years, and 198 of them participate in a semi-structured questionnaire that involves information of dehydration signs, oral rehydration solution and preparation and in-home practice and remedies used by mothers in the management of dehydration. Fifty-eight participants (29.3%) were found in the age group of 26–30 years, 78 participants (39.4%) received primary school education and 92 (46.5%) had one child under 5 years, whereas 17.7% received educational workshop or counselling. Main management practices performed by the mothers were over-the-counter medications (36.4%) and rice water (33.8%). The majority (88%) of the participants were aware about dehydration signs, which were significantly associated with educational levels, and workshop or counselling received from professional.


KEYWORDS

Awareness of the mothers; Signs of dehydration; Under 5 years; Omdurman; Sudan.


INTRODUCTION

The World Health Organisation defines dehydration as a condition that results from the excessive loss of water and salt [1]. Dehydration causes a decrease in total body water (TBW) in both the intracellular and extracellular fluid volumes. Volume depletion closely correlates with the signs and symptoms of dehydration. The degree of dehydration between an older child and infant is slightly different as the infant could have TBW content of 70%–80% of the body weight, and older children have TBW of 60% of the body weight [2].

Since paediatric dehydration is frequently the result of gastroenteritis, characterised by vomiting and diarrhoea [3], this article will be limited in most part to dehydration resulting from gastroenteritis. Worldwide, children whose age is less than 5 years’ experience on average, 3.2 episodes of diarrhoea every year and, consequently, 1.87 million children will die from dehydration associated with diarrhoeal disease, particularly in the countries of Asia, Africa and Latin America [4]. Hypernatraemic dehydration as a complication of diarrhoeal disease contributes to the morbidity and mortality of affected patients, with a prevalence of 6.4% and 13.75%, respectively in developing countries [5,6]. In Sudan, diarrhoeal diseases ranked the second prevalence disease, the annual reported deaths of children less than 5 year due to diarrhoea were 10.3% [7].

Volume depletion denotes the reduction of effective circulating volume in the intravascular space, and since sodium constitutes the main extracellular solute, sick children may have isonatraemic, hyponatraemic and hypernatraemic dehydration depending on the differential loss of sodium and water [3,8]. The first step in caring for a child with dehydration is to assess the degree of dehydration which was categorised into three types as follows. Mild dehydration occurred in <5% of infant and <3% of older children, in which there was normal or decrease pulse, decrease urine output, thirsty and normal physical finding. Moderate dehydration occurred in 5%–10% of infant and 3%–6% of older children, in which tachycardia, little or no urine output, irritable/lethargic, sunken eyes and fontanel, decrease tear, dry mucous membrane, mildly delay in skin elasticity (skin turgor), delay capillary refill (>1.5 seconds), coolness and paler are noted. Severe dehydration occurred in >10% of infant and >6% of older children, in which peripheral pulses either rapid and weak or absent, decrease blood pressure, no urine output, very sunken eyes and fontanel, no tears, parched mucous membrane, poor skin turgor, very delayed capillary refill (>3 seconds), cold and mottled, limp and depress conscious were noted [9]. The World Health Organisation (WHO) classified dehydration into severe dehydration, some dehydration and no dehydration [1,10]. The oral rehydration solutions (ORS) are a type of fluid replacement used to prevent and treat dehydration, mainly mild to moderate hypo-/hypernatraemic type. The WHO and United Nations Children’s Fund (UNICEF) jointly have developed official guidelines for the manufacture of ORS. A basic oral rehydration therapy solution can also be prepared. Rehydration project recommends a homemade ORS consisting of one liter of water with one and half teaspoon of salt (1.5 g) instead of one teaspoon recommended by the WHO and two tablespoons of sugar (18 g) added, stating that this more dilute approach is less risky with very little loss of effectiveness [11,12]. For patients who are severely dehydrated, the rapid restorations of fluids are required. The magnitude of dehydration in children under 5 years as reported by the WHO is quite alarming. Despite the scope of the severity, it is considered as a treatable disease and can be managed easily if it is detected early. The improper knowledge, poor practice and negative attitudes of mothers and their misdirected approach during diarrhoea lead to a high degree of severe dehydration and finally death [13,14]. Therefore, the main objective of this study was to assess awareness and attitude regarding dehydration and practice towards it management amongst mothers in children under 5 years old at Omdurman locality, Khartoum.


MATERIALS AND METHODS

This was a descriptive cross-sectional hospital-based study. It was conducted in two major paediatric hospitals in Omdurman locality, Khartoum, Sudan: Muhammad Alamin Hamid children emergency hospital and Al-Bulok specialise children hospital. They are national hospitals giving medical care to people coming from all parts of Sudan in addition to delivering medical education to the students of medical colleges and other health institutions. Muhammad Alamin Hamid children emergency hospital is located in southeast of Omdurman city. It contains general paediatric ward, Pediatric intensive care unit (PICU), nursery and renal unit. Al-Bulok specialise children hospital is located in North Omdurman. It contains a general paediatric ward and nursery unit. The study was carried out during the period from 1st June to 31st December 2019. It included all mothers of the admitted children in the paediatric wards and those at outpatient clinic at the time of the study, who wished to participate and having at least one child less than 5 years who had diarrhoea. Mothers who refused to participate or had a critically-ill child were excluded from the study.

The sample size was calculated by statistician, and the participants were enrolled by using simple random sampling. It was calculated as follows:

n = N 1 + N e 2

where n is the number of total mothers attended (500), and e is margin error for calculation n=5001+5000.052=222.2~222 mothers.

The sample was divided into two hospitals equally based on the hospitals’ monthly patient flow report that was used as a sampling frame. A semi-structured questionnaire was designed and refined to collect the data on sociodemographic, knowledge, attitudes and practices of mothers towards dehydration, how they manage dehydration for their affected children and whether they had been trained or counselled for dehydration before. A direct interviewing of mothers was done after they were well informed about the nature of the study, and the attribute variables include age, educational qualification and number of children. Data were analysed using the Statistical Package for the Social Science program version 21.0. Based on the objectives of the study, descriptive statistics in the form of frequency and percentage were used to quantify the level of awareness, attitudes and practice. A Chi-square test was applied for the qualitative variables. In this study, p-value < 0.05 was considered as statistically significant. The study was approved by the Ethical Committee of the Sumasri Institution Review Board University of medical science and technology (UMST), Ministry of Health of Sudan. Permission was taken from hospitals’ administrations, and a verbal consent from the participants was obtained.


RESULTS

A total of 198 mothers out of 222 enrolled mothers of under-five children have participated with a response rate of 89.1%. Less than one-fifth of the respondents (29.3%) were in the age group of 26–30 years. The sociodemographic characteristics of the study group are shown in Table 1.

Mothers’ age was not found to be significantly correlated with awareness of dehydration signs (p-value = 0.745). A total of 135 (68.2%) respondents were not aware about dehydration classification. The detection rate of dehydration signs amongst respondents was 88%, where 174 mothers identified more than 50% of the signs. The dehydration signs are shown in Table 2.

Table 1. The sociodemographic characteristics of the respondents.

Mother’s age (years) N %
15–20 17 8.6
21–25 56 28.3
26–30 58 29.3
31–35 37 18.7
36–40 22 11.1
>40 8 4.0
Education
Illiterates 66 33.3
Primary education 78 39.4
Secondary education 37 18.7
University education 17 8.6
Total number of educated mothers 132 66.6
Number of Childs under 5 years
One child 92 46.5
Two children 79 39.9
More than two 27 13.6

Regarding attitude of respondents towards the management of dehydration, 76 (38.4%) of them sought medical advice when home managements fail, 60 (30.3%) sought advice at the beginning of symptoms, 36 (18.2%) after child condition deteriorate, whereas only 26 (13.1%) initiated home management and then sought medical help. Regarding the factors affecting respondents’ attitude, 84 (42.4%) of mothers has a manner of depending on home management, 38 (19.2%) distance issues, 28 (14.2%) financial issues and 5 (2.9%) other issues. On the practice of respondents towards feeding intake during dehydration, 46 (73.7%) of mothers increased oral intake and 52(26.3%) stopped feeding. Regarding knowledge and administration of ORS amongst respondents, 172 (87%) of mothers knew ORS, 24 (12.1%) administered it and 113 (57.1%) prepared it correctly. On initial in-home practice and type of fluids/herbs used by respondents during dehydration, 36.4% of mothers used over-the-counter medications, 33.8% used rice water and 17.7% of them used others, as shown in Figures 1 and 2.-

Table 2. Signs of dehydration detected by mothers.

Urine output N %
Decreased 75 37.9
Normal 33 16.7
No urine in 12 hours 12 6.0
Not notice 78 39.4
Activity levels
Lethargic 129 65.2
Irritable 54 27.3
Very lethargic or unconscious 8 4.0
Not notice 7 3.5
Fontanel
Sunken 110 55.6
Normal 8 4.0
Very sunken 2 1.0
Not notice 78 39.4
Eyes
Sunken eyes, no tears 166 83.8
Decreased tears 18 9.1
Very sunken eyes, no tears 10 5.1
Not notice 4 2.0
Mucous membrane
Dry 170 85.9
Moist 28 14.1
Skin Turgor
Normal 55 27.8
Slow 46 23.2
Very slow 7 3.5
Not notice 90 45.5
Ability to drink
Eager to drink 124 62.6
Normal 34 17.2
Unable to drink 25 12.6
Not notice 15 7.6

The association between sociodemographic characteristics (maternal ages and number of children under-five) was tested, and no significant association was found with a p-value of more than 0.05. Mothers’ awareness of dehydration signs and educational qualification were significantly correlated at p = 0.041. Seventeen university qualified mothers were aware in a rate of 100%, followed by a secondary school in the rate of 94.6%, as shown in Table 3.

Chi-square test was used

Educational workshop/professional counselling received by the mother was correlated significantly with the awareness of dehydration at p = 0.034. Amongst 35 attenders, only one mother (2.9%) was not aware compared to 23 (14.1%), in whom no chance of educational session was given (the Chi-square test was used).


DISCUSSION

This study has assessed mothers’ awareness, attitude and practices towards dehydration and its management in under-five children. Based on sociodemographic data, most of the respondents were in the age group of 21–30 years. Similarly, a study conducted in AL-Gezeria [15] reported the age of 23–29 years. Most of the mothers were educational level of primary school followed by illiterate so as that found in a study conducted in Sudan [7]. About half of the respondents (46.5%) had single child. The majority of the participants (68.2%) were not aware about dehydration classifications. This could be justified by the fact that these mothers are not trained as only 17.7% of them received educational session.

Awareness regarding dehydration signs amongst mothers in under-five children was high, and 88% of them were able to detect more than 50% of the signs. The international studies conducted in Pakistan [16] reported that 40% of mothers gave unspecific signs, 26% responded with sunken eye as the only sign and 35% answered two signs. Another study in India [17] reported that only 34% of mothers were able to evaluate danger signs in dehydration. This variation might be due to differences in culture, sociodemographic and information access.

Figure 1. Over-the-counter medication and remedies used by respondents in initial dehydration management.

Figure 2. Types of fluids/herbs used in-home during dehydration.

Table 3. Correlation between mothers’ awareness of dehydration and educational qualification.

Mothers aware of > 50% of dehydration signs Mothers aware of <50% of dehydration signs p-value
Education 0.041*
Illiterates 54 12
81.8% 18.2%
Primary 68 10
87.2% 12.8%
Secondary 35 2
94.6% 5.4%
University 17 0
100.0% 0.0%

*p-value is sig (<0.05).

There was a misdirected practice amongst mothers during dehydration status, and 38.4% of them sought medical advice when home management fails and 18.2% after child condition deteriorate. Similarly, a study conducted in Iran reported that 46.3% of caregiver sought health care when home management fails [18]. About 73.7% of mothers increased the frequency of feeding intake, and 26.3% stopped feeding. This was high compared to Kenya result (19), where >70% of mothers reduced children’s fluid intake during illness. This might be attributed to mothers’ education in addition to the cultural and social belief. Despite the knowledge regarding ORS, 87% have high knowledge, only 12.1% used it and 57.1% of them can able to prepare it correctly. Similarly, to a study done in Sudan [7], where (14.3%) used ORS, 57.1% prepared it correctly.

Regarding in-home management and fluid made, 36.4% of respondents used over-the-counter medications, 33.8% rice water, 31.8% custard and others like soda drink, extract hashab, etc. Doreen et al. in Kenya [19] reported that 45% of mothers used wheat flour, rice water and selected herbs as anti-diarrhoeal agents. Reem in Sudan [7] reported that most of the mothers prefer to give juices and custard. This practice of giving fluids is quite important since it replaces the losses during diarrhoea. Giving medication without a prescription is hazardous to child health and indicates an urgent need for reviewing and auditing pharmacy system in Sudan.

There was a statistically significant correlation between mothers’ awareness and educational qualification at p = 0.041. While the percentage of awareness amongst primary qualified mother was 87.2%, it increments to 94.6% and 100% amongst secondary and university qualified one, respectively, compared to 81.8% of illiterates. Every 1 year in mothers’ education reduces the mortality of children under 5 years old about 7%–9% [20,21].

Furthermore, a significant association is found between mothers’ awareness and attending workshop/counselling (p-value = 0.034), as only one participant (2.9%) out of 35 (97.1%) respondents was not aware, i.e., did not benefit compared to 14.1%, in whom no chance of education was given.


CONCLUSION AND RECOMMENDATIONS

The current study showed that despite the high knowledge about ORS amongst mothers, most of them did not use ORS or able to prepare it correctly. The majority of respondents were able to detect dehydration signs, but they were not able to classify it, and they did not receive an educational session on it. There was a misdirected attitude in seeking medical advice and malpractice in the management of dehydration amongst mothers, using over-the-counter medications and homemade fluids as common practice.

The authors recommended the following to improve mothers’ awareness:

  • Local health authority should increase awareness of mothers regarding dehydration and malpractices through different health levels and media.
  • Avoiding incorrect practice ‘‘traditional remedies alternate to professional treatment’.
  • Promote awareness of mothers about ORS usage and correct method for preparation and avoid giving medication without medical prescription.
  • Further studies towards traditional methods and malpractice in dehydration.
  • Review and audit prescription dispense and pharmacies system in Sudan is urge.

ACKNOWLEDGEMENTS

The authors would like to acknowledge all the staff of Muhammad Alamin Hamid and Al-Bulok Hospitals for their assistant and help. Our thanks are due to parents and their children who kindly agreed to participate in the study.


CONFLICT OF INTEREST

None.


FUNDING

None.


ETHICAL APPROVAL

Approved by the Ethical Committee of Sumasri Institution Review Board (UMST) and Ministry of Health, Sudan. Permission was obtained from hospitals’ administration, and verbal consent from participants was obtained.


REFERENCES

  1. Who. MCI Distance Learning course. Module4. Dirrhea2014, available at: http://www.who.int/maternal_child_adolescent/documents/9789241506823/en/
  2. Falszewska A, Szajewska H, Dziechciarz P. Diagnostic accuracy of three clinical dehydration scales: a systematic review. Arch Dis Child. 2018;103(4):383–8.
  3. Takayesu JK, Lozner AW. Pediatrics, Dehydration. eMedicine Emergency Medicine; (2017). Available from: http://emedicine.medscape.com/article/801012-print [Google Scholar] / J Front Pediatr 2018; 6:28[online] doi:10.3389/fped.2018.00028.
  4. World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers. Geneva, Switzerland: WHO, 2005. WHO/CDD/SER/80.2; 2013.
  5. Workie HM, Sharifabdilahi AS, Addis EM. Mothers’ knowledge, attitude and practice towards the prevention and home-based management of diarrheal disease among under-five children in Diredawa, Eastern Ethiopia, 2016: a cross-sectional study. BMC Pediatr. 2018; 18(1):358.
  6. Greenland K, Chipungu J, Chilengi R, Curtis V. Theory-based formative research on oral rehydration salts and zinc use in Lusaka, Zambia. BMC Public Health. 2016;16(1):312.
  7. Reem A. Knowledge, Attitude and practice of women regarding diarrheal diseases in children under five years old, in emergency pediatric hospital, Khartoum, Sudan, 2017. Int J Ped Neo Heal. 2019; 3(1):7–26.
  8. Bhave G, Neilson EG. Volume depletion versus dehydration: how understanding the difference can guide therapy. Am J Kidney Dis. 2011; 58(2):302–9. https://doi.10.1053/j.ajkd.2011.02.395
  9. Greenbaum LA. Electrolyte and acid-base disorder. 20th ed In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, editors. Nelson Textbook of Paediatrics. Philadelphia: Saunders; (2016). p. 388.
  10. World Health Organization. Diarrhea. Fact Sheet 104. 2014.
  11. Oral rehydration salts and solutions and rice-based solutions worldwide manufacturers and suppliers. Archived 7 December 2014 at the Wayback Machine Rehydration Project website. [cited 2014Jan 3].
  12. Rehydration Project, “Diarrhoea, diarrhea, dehydration, oral rehydration, mother and child nutrition, water, sanitation, hygiene – rehydration project”. Archived from the original on 8 June 2015. [cited 2015 June 22]. Homemade Oral Rehydration Solution Recipe.
  13. Hackett KM, Mukta US, Jalal CS, Sellen DW. Knowledge, attitudes and perception on infant and young child nutrition and feeding among adolescent girls and young mothers in rural Bangladesh. Matern Child Nutr. 2015;11(2):173–89.
  14. Mumtaz Y, Zafar M, Mumtaz Z. Knowledge attitude and practices of mothers about diarrhea in children under 5 years. J Dow Uni Health Sci. 2014;8(1):3–6.
  15. Mahfouz M, El Mukhtar M, Salah A, Haroun H. 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 Fam Community Med. 2010;17(3):141.
  16. Yasmin M, Mubbashir Z, Zara M. Knowledge attitude and practices of mothers about diarrhea in children under 5 years. J Dow Uni Health Sci. 2014;8(1):3–6.
  17. Sadasiba P, Rajesh K, Narendra B. Mother’s knowledge, attitude and practice regarding prevention and management of diarrhoea in children in Southern Odisha. Int J ContempPediatr. 2017;4:966-71.
  18. Manijeh K, Mirshahi M, Zarghami A, RajabniaChenari M, Farahmand F. Maternal knowledge and practice regarding childhood diarrhea and diet in Zahedan, Iran. Health Scope. 2013;2(1):19–24.
  19. Othero DM, Orago ASS, Groenewegen T, Kaseje DO, Otengah PA. Home management of diarrhea among underfives in a rural community in Kenya: household perceptions and practices. East Afr J Public Health. 2008;5(3):142–6.
  20. Mohammed S, Tamiru D. The burden of diarrheal diseases among children under five years of age in Arba Minch District, Southern Ethiopia, and associated risk factors: a cross-sectional study. Int Sch Res Notices. 2014;2014:1–6.
  21. Birtukan Dereje D. Maternal Knowledge and Practice Towards Diarrhea Management in Under Five Children in Fenote Selam Town, West Gojjam Zone, Amhara Regional State, Northwest Ethiopia, 2014. Journal of Infectious Diseases and Therapy. 2014;2(6).1000182. Doi:10.4172/2332-0877.1000182.


How to Cite this Article
Pubmed Style

Mohamed HMA, Mohammed FSM. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudan J Paed. 2020; 20(2): 136-143. doi:10.24911/SJP.106-1585043373


Web Style

Mohamed HMA, Mohammed FSM. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. http://www.sudanjp.com/?mno=94843 [Access: October 29, 2020]. doi:10.24911/SJP.106-1585043373


AMA (American Medical Association) Style

Mohamed HMA, Mohammed FSM. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudan J Paed. 2020; 20(2): 136-143. doi:10.24911/SJP.106-1585043373



Vancouver/ICMJE Style

Mohamed HMA, Mohammed FSM. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudan J Paed. (2020), [cited October 29, 2020]; 20(2): 136-143. doi:10.24911/SJP.106-1585043373



Harvard Style

Mohamed, H. M. A. & Mohammed, . F. S. M. (2020) Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudan J Paed, 20 (2), 136-143. doi:10.24911/SJP.106-1585043373



Turabian Style

Mohamed, Hiba M. A., and Faiza S. M. Mohammed. 2020. Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudanese Journal of Paediatrics, 20 (2), 136-143. doi:10.24911/SJP.106-1585043373



Chicago Style

Mohamed, Hiba M. A., and Faiza S. M. Mohammed. "Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan." Sudanese Journal of Paediatrics 20 (2020), 136-143. doi:10.24911/SJP.106-1585043373



MLA (The Modern Language Association) Style

Mohamed, Hiba M. A., and Faiza S. M. Mohammed. "Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan." Sudanese Journal of Paediatrics 20.2 (2020), 136-143. Print. doi:10.24911/SJP.106-1585043373



APA (American Psychological Association) Style

Mohamed, H. M. A. & Mohammed, . F. S. M. (2020) Awareness and attitude towards dehydration and its management amongst mothers and factors influence on in under-five children of Omdurman locality, Sudan. Sudanese Journal of Paediatrics, 20 (2), 136-143. doi:10.24911/SJP.106-1585043373





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