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In this study, 84.9% (n=326) mother responded that eating food with dirty hands can cause diarrhea among children. This reflects good knowledge of mothers ...

Knowledge Attitude and Practices Regarding Diarrhea Management among Mothers of Children Under 2 years dwelling in Goths of Gadap Town, Karachi

Submitted by: Dr. Asif Khaliq (08/2015/SI)

Supervised by: Dr.Nazia Jamil

BAQAI INSTITUTE OF HEALTH SCIENCES BAQAI MEDICAL UNIVERSITY

Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Knowledge Attitude and Practices Regarding Diarrhea Management among Mothers of Children Under 2 years dwelling in Goths of Gadap Town, Karachi

Submitted by: Dr. Asif Khaliq (08/2015/SI)

Supervised by: Dr.Nazia Jamil

BAQAI INSTITUTE OF HEALTH SCIENCES BAQAI MEDICAL UNIVERSITY

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Approval Letter:

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Supervisor Certificate This is to certify that Dr. Asif Khaliq s/o Syed Khaliq Ahmed, bearing student identity number 08/2015/SI has completed his thesis work, entitled: ““Knowledge Attitude and Practices regarding Diarrhea management among of mothers of children Under 2 years of age dwelling in Goths of Gadap Town, Karachi” under my direct supervision for the partial fulfillment of his MPH (Masters of Public Health) degree from Baqai Medical University, Karachi, Pakistan. I have personally reviewed all the contents, data and other supporting materials reported in this thesis report and certify their authenticity. I further certify that, to the best of my knowledge, the material included in this thesis have not been used or submitted anywhere in any institute for the conferment of any degree.

Dr. Nazia Jamil Assistant Professor, Department of Community Medicines, Baqai Medical University, Karachi, Pakistan

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Supervisor Comments __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Letter of Acknowledgement All the praises and commendation are for Almighty Allah, the most beneficial and the most merciful. It is the ALLAH, WHO has blessed me with all the blessings and benedictions. It is the ALLAH, WHO has made me able to think and read and made me able to differentiate among the good and bad. Without these blessing it would not be possible for me to think, learn and read and to do research about anything. This research project entitled: “Knowledge Attitude and Practices regarding Diarrhea management among of mothers of children Under 2 years of age dwelling in Goths of Gadap Town, Karachi” is a community based study, that was conducted in different Goths of Gadap Town, Karachi. This study is an insight about the diarrhea prevalence and diarrhea management in the community setting. For the success of this project my friends: Dr. Jahanzaib Sohail, Dr. Sayeeda Amber Sayed, Dr. Nosheen Zehra, Ms. Amreen Rao and Dr. Stefanie J. Krauth had helped in formulating my thesis methodology and have also guided me regarding sampling technique and objectives defining. Continuous support of Dr. Syed Imtiaz Ahmed Jaffery, Ms. Ghazala Asif, Ms. Naveeza Ali, Mr. Asadullah and other Baqai Medical University staff is commendable and I can’t forget the support which they provided me in term of data collection. Without their support it was not possible for me to assess the communities and collect data from household setting. I owe my deepest thanks and gratitude to Dr. Syed Zulfiqa Haider Naqvi for his continuous support and guidance which he offered continuously for statistical analysis. I would also like to express my cordial gratitude to my respected supervisor, Dr. Nazia Jamil for her inspiring attitude and skilled guidance. I would also like to show appreciation for her

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

insightful comments on the manuscript. Without her sincere efforts in supervising me, I might not have been able to accomplish this project on time.

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Dedication In our life we can’t achieve success without the support and motivation of our elders and sincere fellows who are close to our heart. . . . My humble efforts, I am dedicating to my sweet and lovely Mother and Siblings who have always supported my morally and financially when I am down. . . . . Continuous support and encouragement from my Friends and Teachers is a key for the accomplishment of this success. . . . . .

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Declaration I, Dr. Asif Khaliq bearing Student Identity number 08/2015/SI and Enrollment number 10-05006-15 solemnly declare that the research thesis project entitled: “Knowledge Attitude and Practices regarding Diarrhea management among of mothers of children Under 2 years of age dwelling in Goths of Gadap Town, Karachi” is an original work and was conducted for the partial fulfillment of MPH (Masters of Public Health) degree from Baqai Institute of Health Sciences, Baqai Medical University, Karachi, Pakistan. This work has not been submitted in any institute in any version and shall not be submitted in future for conferment of any other degree from any other Institutes or University. Student‘s Name: Dr. Asif Khaliq Signed: ______________________ Date: ________________________

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

TABLE OF CONTENT Approval Letter: ........................................................................................................................................ 4 Supervisor Certificate ............................................................................................................................... 5 Supervisor Comments ............................................................................................................................... 6 Letter of Acknowledgement...................................................................................................................... 7 Dedication ................................................................................................................................................. 9 Declaration .............................................................................................................................................. 10 Abstract: .................................................................................................................................................. 18 CHAPTER NO 1..................................................................................................................................... 20 INTRODUCTION .................................................................................................................................. 20 1.1.

BACKGROUND: ....................................................................................................................... 20

1.2.

PROBLEM STATEMENT: ........................................................................................................ 24

1.3.

RATIONALE:............................................................................................................................. 25

CHAPTER NO 2......................................................................................................................................... 26 LITERATURE REVIEW ........................................................................................................................... 26

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2.2.

SIGNIFICANCE: ........................................................................................................................ 35

2.3.

GOAL OF THE STUDY: ........................................................................................................... 36

2.4.

RESEARCH QUESTIONS: ....................................................................................................... 36

2.5.

SPECIFIC OBJECTIVES: .......................................................................................................... 36

2.6.

OPERATIONAL DEFINITIONS ............................................................................................... 37

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Diarrhea: ..................................................................................................................................... 37

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Management:............................................................................................................................... 37

Town: .................................................................................................................................................. 37

CHAPTER NO 3......................................................................................................................................... 38 MATERIAL AND METHODS .................................................................................................................. 38 3.1. STUDY DESIGN: ........................................................................................................................... 38 3.2. STUDY SETTING: ......................................................................................................................... 38 3.3. STUDY POPULATION: ................................................................................................................. 38 3.4. DURATION OF STUDY: ............................................................................................................... 38 Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

3.5. SAMPLE SIZE: ............................................................................................................................... 38 3.6. SAMPLING TECHNIQUE: ............................................................................................................ 39 3.7. SAMPLE SELECTION: .................................................................................................................. 40 3.7.1. INCLUSION CRITERIA:............................................................................................................. 40 3.7.2. EXCLUSION CRITERIA: ........................................................................................................... 40 3.8. DATA COLLECTION TOOL: ........................................................................................................ 40 3.9. DATA COLLECTION TOOL VALIDITY & RELIBILITY: ......................................................... 41 3.10. DATA COLLECTION PROCEDURE: ......................................................................................... 42 3.11. DATA MANAGEMENT: ............................................................................................................. 42 3.12. DATA ANALYSIS:....................................................................................................................... 43 3.12. ETHICAL CONSIDERATION: .................................................................................................... 43 CHAPTER NO 4: ....................................................................................................................................... 45 RESULTS ................................................................................................................................................... 45 4.1. DESCRIPTIVE STATISTICS: ........................................................................................................ 45 4.2. INFERENTIAL STATISTICS: ..................................................................................................... 121 CHAPTER NO 5....................................................................................................................................... 129 DISCUSSION ........................................................................................................................................... 129 5.1. DISCUSSION OF STUDY FINDINGS: ....................................................................................... 129 5.2. CONCLUSION: ............................................................................................................................. 134 5.3. RECOMMENDATION: ................................................................................................................ 135 5.4. STRENGTH OF THE STUDY: .................................................................................................... 140 5.5. LIMITATION OF THE STUDY: .................................................................................................. 142 REFERENCES: ........................................................................................................................................ 143 ANNEXURE-I .......................................................................................................................................... 155 DISCLAIMER .......................................................................................................................................... 155 ANNEXURE -II........................................................................................................................................ 156 INVITATION LETTER FOR INFORMED CONSENT ......................................................................... 156 ANNEXURE-III ....................................................................................................................................... 157 INFORMED CONSENT .......................................................................................................................... 157 Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

ANNEXURE-IV ....................................................................................................................................... 158 QUESTIONNAIRE .................................................................................................................................. 158 -‫اپینڈکس‬I ...................................................................................................................................................... 164 ‫ ڈس کلیمر‬...................................................................................................................................................... 164 -‫اپینڈکس‬II..................................................................................................................................................... 165 ‫ تحقیق کے لیے دعوت نامہ‬................................................................................................................................ 165 -‫اپینڈکس‬III ................................................................................................................................................... 166 ‫ اجازت نامہ‬.................................................................................................................................................... 166 -‫اپینڈکس‬IV ................................................................................................................................................... 167 ‫ سوالنامہ‬........................................................................................................................................................ 167

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

LIST OF TABLES Table No 1: Demographic profile of the respondents: ................................................................................ 45 Table 2: Family information of the participants: ........................................................................................ 49 Table No 3: Housing and sanitation condition of the respondents: ............................................................ 52 Table No 4: Diarrhea morbidity among children: ....................................................................................... 55 Table No 5: Knowledge of mothers regarding childhood diarrhea and its management: ........................... 58 Table No 6: Attitude of mothers regarding childhood diarrhea management: ........................................... 72 Table No 7: Practices of Mothers Regarding Childhood Diarrhea And Its Management: ......................... 79 Table 8: Mothers opinion and suggestions regarding diarrhea cause and control in children .................. 105 Table No 9: Categorization of mothers knowledge regarding childhood diarrhea and its management: . 108 Table No 10: Categorization of mothers attitude regarding childhood diarrhea and its management: ..... 112 Table No 11: Categorization of mothers practices regarding childhood diarrhea and its management: .. 115 Table 12: Knowledge attitude and practice score of mothers ................................................................... 119 Table 13: Testing Normal Distribution: .................................................................................................... 121 Table 14: Kruskal-Wallis One Way ANOVA for finding the difference in the knowledge score of mothers of 4 union councils of gadap town: ........................................................................................................... 123 Table 15: Kruskal-Wallis One Way ANOVA for finding the difference in the attitude score of mothers of 4 union councils of gadap town: ............................................................................................................... 124 Table 16: Kruskal-Wallis One Way ANOVA for finding the difference in the practice score of mothers of 4 union councils of gadap town: ............................................................................................................... 125 Table 17: Assessing the diarrhea prevalence with the knowledge level of mothers: ................................ 126 Table 18: Assessing the diarrhea prevalence with the attitude of mothers: .............................................. 127 Table 19: Assessing the diarrhea prevalence with the practices of mothers: ............................................ 128

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

LIST OF FIGURES Figure 1.1: Age of Mothers:....................................................................................................................... 47 Figure 1.2: Education of Mothers: ............................................................................................................. 48 Figure 2.1: Total Number of Children: ....................................................................................................... 50 Figure 2.2: Number of Under 2 year Children: ........................................................................................... 51 Figure 3.1: Source of Water Supply............................................................................................................ 53 Figure 3.2: Taste of water ........................................................................................................................... 54 Figure 4.1: Diarrhea Prevalence among Children under 2 years: ............................................................... 56 Figure 4.2: Age wise Distribution of Diarrhea Prevalence among Children under 2 years of Age ............ 57 Figure 5.1: Diarrhea and its transmission through Contaminated Water ................................................... 60 Figure 5.2: Diarrhea and lack of sanitary measures .................................................................................... 61 Figure 5.3: Diarrhea and Water Filtration ................................................................................................... 62 Figure 5.4: Diarrhea and Mother Milk Feeding among Children under 2 year of age: .............................. 63 Figure 5.5: Diarrhea and Water Disinfection via Chlorination: ................................................................. 64 Figure 5.6: Diarrhea and Bottle Feeding among Children under 2 year of age ......................................... 65 Figure 5.7: Diarrhea and Vaccination Role: ............................................................................................... 66 Figure 5.8: Diarrhea and ORS (Oral Rehydration Salt) Preparation: ......................................................... 67 Figure 5.9: Diarrhea and Banana use for Electrolytes imbalance management .......................................... 68 Figure 5.10: Diarrhea and Yogurt use as Probiotic:.................................................................................... 69 Figure 5.11: Diarrhea and Dirty Hands ....................................................................................................... 70 Figure 5.12: Diarrhea and Complete Food Abstinence ............................................................................... 71 Figure 6.1: Diarrhea and Children Hand Hygiene ...................................................................................... 73 Figure 6.2: Diarrhea and Hand-washing with Soap .................................................................................... 74 Figure 6.3: Diarrhea and Hand-washing before eating ............................................................................... 75 Figure 6.4: Diarrhea and Breast Feeding Protective Effects ....................................................................... 76 Figure 6.5: Diarrhea and Boil Water Use Attitude: .................................................................................... 77 Figure 6.6: Diarrhea and Bottle Milk in Boiled Water ............................................................................... 78 Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Figure 7.1: Diarrhea and Breast Feeding Practices ..................................................................................... 82 Figure 7.2: Diarrhea and Bottle Feeding Practices: .................................................................................... 83 Figure 7.3: Diarrhea and Cow Milk use practices....................................................................................... 84 Figure 7.4: Diarrhea and Formula Milk use practices................................................................................. 85 Figure 7.5: Diarrhea and Use of Boiling Water .......................................................................................... 86 Figure 7.6: Diarrhea and Bottle Boiling..................................................................................................... 87 Figure 7.7: Diarrhea and Feeder Boiling Practice Every time ................................................................... 88 Figure 7.8: Diarrhea and Food Abstinence Practices .................................................................................. 89 Figure 7.9: Diarrhea and Water Filtration practices.................................................................................... 90 Figure 7.10: Diarrhea and Chlorine Tablets use practices .......................................................................... 91 Figure 7.11: Diarrhea and Hand-washing Practices:.................................................................................. 92 Figure 7.12: Methods of Hand Washing .................................................................................................... 93 Figure 7.13: Diarrhea and Banana use practice .......................................................................................... 94 Figure 7.14: Diarrhea and Yogurt use practices.......................................................................................... 95 Figure 7.15: Diarrhea and Hand-washing practices after Defecation: ........................................................ 96 Figure 7.16: Diarrhea and ORS use practices: ............................................................................................ 97 Figure 7.17: Types of ORS for Diarrhea Management: .............................................................................. 98 Figure 7.18: Diarrhea and Typhoid Vaccination Practices ......................................................................... 99 Figure 7.19: Diarrhea and Diarrhea Vaccination Practices:...................................................................... 100 Figure 7.20: Diarrhea and Hand-washing Reminder Practices to Children .............................................. 101 Figure 7.21: Diarrhea and Hand-washing practice after bathing children ................................................ 102 Figure7.22: Diarrhea and Hand-washing practice after Diapers change .................................................. 103 Figure 7.23: Diarrhea and Hand-washing practice before touching children ........................................... 104 Figure8.1: Diarrhea Causes According to Mothers Interviewed .............................................................. 106 Figure8.2: Diarrhea Control Measures Proposed by Mothers Interviewed .............................................. 107 Figure 9.1: Mothers knowledge categorization regarding childhood diarrhea and its management: ....... 110

Dr. Asif Khaliq (08/2015/SI)

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Figure 10.1: Mothers attitude categorization regarding childhood diarrhea and its management: ........... 113 Figure 11.1: Mothers practices categorization regarding childhood diarrhea and its management .......... 117

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Knowledge Attitude Practices regarding Childhood Diarrhea and its management among Mothers of Children under 2 Year dwelling in Goths of Gadap Town Karachi

Abstract: Objectives: To measure difference in the knowledge attitude and practices of mothers of children under 2 year of age regarding diarrhea management and to determine the association of diarrhea prevalence with the knowledge attitude and practices scores of mothers of children under 2 year of age Study Design: Analytical Cross-sectional study Study Setting & Duration: This study was conducted in different Goths of 4 union councils of Gadap Town, Karachi, that were selected by cluster random sampling technique from November 2016 to May 2017. Methodology: In this study all the mothers of children under 2 year of age were interviewed regarding diarrhea management by means of a dichotomous questionnaire. The questionnaire has 40 items and each item represent the knowledge, attitude and practices of mothers regarding diarrhea management. The final data of the study was analyzed by SPSS version 20.0. Results: There is no difference in the knowledge and practices scores of mother dwelling in different union councils of Gadap Town Karachi, i.e. p-value > 0.05. The attitude and practices scores are different among the mothers whose children had diarrhea episodes from those whose children didn’t had diarrhea episodes, i.e. p-value

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