CHAPTER ONE

INTRODUCTION

BACKGROUND TO THE STUDY

Diarrhea is recognized as a major cause of child morbidity and mortality in developing countries (Banda et al., 2007; Gorter et al., 1998; Kosek, Bern, & Guerrant, 2003). It is the second leading cause of death among children under five years of age worldwide (BBS, Bangladesh Bureau of Statistics UNICEF, United Nations Children’s Fund, 2007; Larson, Saha, Islam, & Roy, 2006). Global deaths from diarrhea among children aged less than five years were estimated at 1.87 million in 2004 (Boschi-Pinto, Velebit, & Shibuya, 2008; Candy, 1987; Chiller et al., 2006; Khan et al., 2004; Larson et al., 2006). Seventy percent of these deaths are concentrated in 15 developing countries. Nigeria is one of these 15 countries and diarrhea is responsible for sixty-nine thousands diarrheal deaths (Boschi-Pinto et al., 2008). Diarrheal disease is still a major health problem in Nigeria. The government of Nigeria states that diarrhea kills an estimated 25,000 people annually, mostly children (IRIN, 2008). On a daily average, 180-200 diarrhea patients were admitted to the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDRB) hospital (IRIN, 2008). According to the ICDDRB hospital’s statistical surveillance from 2004 to 2008, the total number of children with diarrhea in this hospital was 5596. An average of 1119 diarrhea children (under five) was admitted there annually. Causes of diarrhea were viruses, bacteria and parasites (Mishra, Gupta, & Yadav, 2004). Contaminated foods play a

major role in the occurrence of diarrheal diseases. The transmission of infection occurs by direct contact with the agent, through oral–fecal transmission routes due to poor water quality, unhygienic behaviors, improper storage of food and inadequate sanitation practices (Halvorson, 2004). This may be because mothers lack of awareness about safe drinking water, hygiene practice, feeding children with hygienic food and defecation practices (IRIN, 2008).

Diarrhea is a disease that can be prevented by avoiding contacting with causative agents, but children under 5 years of age are unable to protect themselves from these agents. They are under the care of their mothers; therefore the maternal preventive behaviors for children are very important. There are many studies showing the incidence of diarrhea related to maternal behaviors including hygiene practices, child feeding practices, safe water and defecation practices (Banda et al., 2007; Chiller et al., 2006; Gorter et al, 1998; Khan et al., 2004; Nanan et al., 2003; Osumanu, 2008). Mothers are the closest persons to children. Their behaviors toward their children need to be explored, especially their preventive behaviors. A previous study showed that maternal behaviors were found to be related to their perceptions (Pancharuniti, Shiyalap, Dung, & Wongsawass, 2004). The results of Pancharuniti et al’s study carried out in Vietnam indicated that maternal health beliefs towards diarrheal diseases in children played a crucial role in their home management of acute diarrhea. Maternal perceptions on the susceptibility and severity of diarrhea and the benefits and barriers to maternal home care for diarrheal children were significantly correlated to maternal practices. Although diarrheal disease is recognized as a major problem in Bangladesh, no studies on maternal preventive behaviors of diarrhea in children and maternal perceptions have been conducted. Therefore, this study is carried out in order to explore maternal perceptions and preventive behaviors of diarrhea in children. The results of the study will be used to enhance maternal preventive behaviors of diarrhea in children, which will reduce the incidence of diarrhea in children under five years of age. It can also fulfill the gap in knowledge of maternal preventive behaviors in diarrhea of children in Nigeria. 

STATEMENT OF THE PROBLEMS

Despite much global effort, advances in research, and updated clinical management guidelines, diarrhea continues to be a leading cause of mortality and morbidity in humans worldwide. In Nigeria, diarrhea accounts for more than 50% of children deaths (United States Department of Agriculture [USDA], 2008) and results in significant economic losses. (Barrington, Gay & Evermann, 2002; Gunn, Naylor, & House, 2009). In children, diarrhea is the second leading cause of death due to infectious disease and kills more children than acquired immune deficiency syndrome (AIDS), malaria, and measles combined (United Nations Children’s Fund [UNICEF] & World Health Organization [WHO], 2009).

Based on this the research work intends to find out the causes of diarrhea and its effect on children between the ages of 5 and 10 years respectively.

OBJECTIVES OF THE STUDY

          The objective of this study is classified into general objective and specific objectives.

General objective

The general objective of the study is to determine the factors associated with diarrhea among children in Benin City.

Specific objectives

-         To determine the causes and effect of diarrhea among children.

-         To examine the relationship between maternal perceptions and maternal preventive behaviors regarding acute diarrhea in children.

-         To explore the association of the child socio-demographic, health care factors with diarrhea with children in Benin City

-         To explore the association between mothers hand washing habits and defecations behaviours and health service utilization factors with diarrhea among children in Benin City.

-         To explore the association between drinking water, sanitation and house characteristics factors and diarrhea among children in Benin City.

RESEARCH QUESTIONS

Ten research questions are formulated by the researcher. And they will be tested to ascertain their relationship and differences with the causes and effect of diarrhea among children in Benin City. The formulated research questions are as follows:

1.     Does poor toilet facilities causes diarrhea infection in children?

2.     Do contaminated water cause diarrhea among children? 

3.     Does poor child health care cause to diarrhea infection?

4.     Does washing of hands properly before eating help to reduce the risk of diarrhea?

5.     Does the provision of sufficient child health care help to reduce the risk of diarrhea among children?

6.     Does poor health care utilization by mothers causes diarrhea among children in Benin City?

7.     Does lack of washing of hands by mothers before feeding the child cause diarrhea infection among children in Benin City?

8.     Does poor environmental sanitation causes diarrhea among children in Benin City?

9.     Does poor defecation behaviour among mothers causes diarrhea among children in Benin City?

10.Does poor nutritional status of children causes diarrhea among children in Benin City?

SIGNIFICANCE OF THE STUDY:

The importance of this research work cannot be overemphasized. The study will be useful to the health workers, parents/guardians and the individual within the society. Firstly, this study will reveal some of the causes of diarrhea among children in Benin City and also ways to preventing the infection among children in Benin City.   

This study will also be of importance to the local community health workers in the rural areas where incidence of diarrhea is mostly rampant. It will also provide measures to prevent the outbreak of the diseases among children in our rural communities.

This study is also relevant to the government by providing the statistics of children infected with the deadly disease in Benn City in particular and in Nigeria as a whole. The information from this will help the government to swing into action in providing measures that can help reduce the cause of diarrhea.

SCOPE OF THE STUDY:

The study is set out to determine the causes and effect of diarrhea among children in Benin City. Therefore, the study is restricted to selected women in Benin City, community health workers, and other health related personnel in Benin City.

DEFINITION OF TERMS

Diarrhea: It is a disease characterized by water stool more than three (3) times a day, with the smooth or liquid feces consistency.

WHO:- World Health Organization.

Threat:-. An expression of an intention to inflict pain, injury, evil, or punishment. An indication of impending danger or harm. One that is regarded as a possible danger; a menace.

SANITATION:Is the hygienicmeans of promoting healththrough preventionof human contact with the hazardsof wastes. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems include human and animal feces, solid wastes, domestic wastewater (sewage, sullage, greywater), industrial wastes and agricultural wastes. Hygienic means of prevention can be by using engineering solutions (e.g. sewerageand wastewater treatment), simple technologies (e.g. latrines, septic tanks), or even by personal hygiene practices (e.g. simple handwashingwith soap).

According to World Health Organization states that:

"Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. The word 'sanitation' also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal

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