2nd Annual International Conference on Pharmacology and Pharmaceutical Sciences (PHARMA 2014)

"Diarrhea Care Program" as Effective Pediatric

Diarrhea Counseling Tool for Pharmacy Practice
Camellia, J.1, Pramestutie, H. R.2, Hariadini, A. L.3
1,2,3
Laboratory of Community Pharmacy, Study Program of Pharmacy
Medical Faculty University of Brawijaya
Malang, Indonesia
1
jcamellia@yahoo.com, 2hananditia@gmail.com, 3ayukhariadini@gmail.com
AbstractDiarrhea is one of diseases that considered at
dangerous level. A lot of diarrhea patients doesnt really
care about the right treatment of diarrhea. Therefore,
the pharmacist should have a duty to provide
counseling on the use of safety and effective drugs of
diarrhea. One of the counseling method tool by using
computerized-based audiovisual program called
"Diarrhea Care Program". This study aimed to
determine the effectiveness of "Diarrhea Care Program"
as a counseling tool in cases of diarrhea in children
under five years in the pharmacy. This study design is
cross-sectional survey. The sampling method of
pharmacies was stratified random based on district,
while the sampling method of respondents was by
purposive method obtained by 40 respondents. The
results was analyzed using Wilcoxon test that had
significance value of 0.000 (p <0.05) so it can be
interpreted that counseling tool "Diarrhea Care
Program" had significant differences between the scores
of knowledge before performed counseling and after
counseling. All 40 respondents shown that had changed
after counseled by "Diarrhea Care Program" tool. The
conclusion of this study is the use of pharmacist
counseling by audiovisual tool "Diarrhea Care
Program" has a positive influence on increasing the
knowledge of parents of infants with diarrhea.
Pharmacist
counseling;
pediatric
counseling tools; audiovisual (keywords)

diarrhea;

I.
INTRODUCTION
Diarrhea is an abnormal condition of faeces with
liquid consistency that marked by increasing
frequency of stools. Diarrhea can be defined as acute
diarrhea if it occurs in less than two weeks, persistent
diarrhea if it occurs between two and four weeks, and
is called chronic diarrhea when the duration is more
than four weeks (Fauci, et.al. 2008).
Diarrhea is one of diseases that considered at
dangerous level. A lot of diarrhea patients doesnt
really care about the right treatment of diarrhea
(Bizmummy, 2012). It is contrary to research
Copyright GSTF 2014
ISSN 2345-783X
doi: 10.5176/2345-783X_PHARMA14.27

conducted in 2010 that 19% of the total child deaths

worldwide are caused by diarrhea and nearly two
million child deaths caused by diarrhea, aged under
five years (Steven and Gabriel, 2010). Approximately
3% to 20% of all children in the world suffer from
chronic diarrhea (DiPiro et. al., 2008).
In 2006, diarrhea was the third of ten major
disease cause of death in the hospital, while based on
the pattern of the top ten most diseases inpatients in
hospitals, diarrhea ranks first (Ministry of Health,
2008). Compared with other diseases, the treatments
of diarrhea with the use of nonprescription drugs are
more dangerous if not handled properly. Patients with
diarrhea conditions require a more in-depth
counseling to anticipate the condition get worse.
Therefore, the pharmacist has a duty to provide
counseling on the use of drugs safely and effectively
for diarrhea. Patients efforts to treat themselves
known as self-medication. Self-medication usually
done to treat mild symptoms and ailments
experienced by many people, one of which is
diarrhea. Self-medication can be a source of
medication errors due to limited patients knowledge
of the drug and its use (Ministry of Health, 2006).
Good pharmacy services can better support the
goal of therapy. The goal is not only determined by
the diagnosis and the selection of the right drug, but
also patient adherence to therapy has been given.
There are several tools that can be used by
pharmacists for achieving the purpose of counseling,
such as a list of counseling, patient cards, brochures,
and props. One of counseling tools using props is the
audiovisual props and the pictures (Ministry of
Health, 2007).
"Diarrhea Care Program" is a computerized
program that is used to provide counseling to patients
about diarrhea completed with pictures and
audiovisual. The program discuss about the causes of
diarrhea, the symptoms of diarrhea, nonpharmacological therapy, pharmacological therapy,
and means of prevention. The program is expected to
get more patients understanding about diarrhea, how
to cope, and solve the existing problems in the

2nd Annual International Conference on Pharmacology and Pharmaceutical Sciences (PHARMA 2014)

community regarding medication errors due to

limited knowledge of diarrhea in infants and toddler.
II.
METHOD
This study was a pre-experimental with a crosssectional design. Sampling was done by random
pharmacies by first classifying based on sub districts
of Malang. The sampling method was purposive that
each patient must meet the inclusion criteria during
the period from March to April 2013 (Notoatmodjo,
2010).
The samples in this study were parents of
children by age below or equal to five years who
come to the pharmacy to buy medicine or told
symptoms of diarrhea or also have an infants and
toddler who had suffered diarrhea in the period
March-April 2013.
Inclusion criteria:
a. Parents who come to the pharmacy with
symptoms of diarrhea in children by age below
or equal to five years old
b. Parents who come to the pharmacy and have a
children by age below or equal to five years old
who had suffered from diarrhea
c. Parents can communicate both orally and in
writing
d. Parents willing to be a respondent
Exclusion criteria:
Patients undergoing certain drug therapies that
can lead to diarrhea.
The samples size was determined by calculating
the results of interviews with pharmacist in pharmacy
about the number of parents who come to the
pharmacy with symptoms of diarrhea in children by
age below or equal to five years old during the last
three months. Determination of the number of
samples by the judgment method.
The questionnaire used in this study have been
tested for validity and reliability. The formula used to
test the validity of the 12 questions are as follows:
(. ) (. )
=
((. 2 ) )((. 2 ) )
The results obtained from each question based on the
formula are:
TABLE I.

R VALUE IN VALIDITY TEST

Questions

R Value

Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7

0.905
0.905
0.907
0.910
0.910
0.924
0.906

Copyright GSTF 2014

ISSN 2345-783X
doi: 10.5176/2345-783X_PHARMA14.27

Questions

R Value

Question 8
Question 9
Question 10
Question 11
Question 12

0.949
0.916
0.905
0.912
0.949

Each question was valid because the value of the

correlation of the questions (R) in the questionnaire
was greater than 0.632 with 5% significance level.
Reliability of the questionnaire were analyzed
using alpha formula by dividing the total 12
questions into three parts, part 1 contains the number
of scores on questions 1, 4, 7, 10, part 2 contains the
number of scores on questions 2, 5, 8, 11 and part 3
contains the number of scores on questions 3, 6, 9,
12. Based on calculations using SPSS 15 reliability
test results are obtained:
RELIABILITY TEST RESULT

TABLE II.

Cronbach's Alpha(a)

N of Items

,839

12

The questionnaire revealed reliable because the

alpha value obtained from the calculation was greater
than the alpha coefficient (0.6).
III.

RESULT AND DISCUSSION

TABLE III.

THE CHARACTERISTIC OF RESPONDENTS

No.

Category

Total
n = 40

Percentage

5
6
8
17
4

12.5 %
15 %
20 %
42.5 %
10 %

8
25
7

20 %
62.5 %
17.5 %

0
1
8
31

0%
2.5 %
20 %
77.5 %

3
19

7.5 %
47.5 %

18

45 %

Age:
1.
2.
3.
4.
5.
1.
2.
3.

1.
2.
3.
4.

1.
2.
3.

0 1 year
1 2 year
2 3 year
3 4 year
4 5 year
Weight:
0 10 kg
10 20 kg
20 30 kg
Parents Level of
Education:
Elementary School
Junior High School
Senior High School
Bachelor Degree or
higher
Parents Total Income:
< Rp 1,000,000
Rp 1,000,000 Rp
2,500,000
> Rp 2,500,000

The highest percentage of respondents was

parents of children between the ages of 3-4 years

2nd Annual International Conference on Pharmacology and Pharmaceutical Sciences (PHARMA 2014)

because on these periods they have started entering

the toddler to school. The toddler may buy snacks or
meals around the school. In addition to the life span
of children between the ages of 3-4 years are able to
feed themselves so they less concerned about hand
hygiene and more susceptible to diarrhea. Not
washing hands thoroughly after defecation can also
cause diarrhea. Bacteria that are often caused diarrhea
such as Salmonella, E. coli, and the type of Shigella
(Ryan KJ and Ray CG, 2004).
Determination of the age is important in order to
provide a safe and appropriate medication so it does
not increase severity of diarrhea. This is because the
treatment of diarrhea in adults or children over five
years different from children by age below or equal
to five years old (Berardi, et. al., 2009).
The highest percentage of infants and toddler
weight was 10-20 kg (62.5%). Many pharmacists are
only asking age in determining the dose and do not
take into consideration with the weight.
Determination of the weight is also important in
order to provide a safe and appropriate medication so
it does not increase the adverse effects for toddlers
(Dooley, et.al., 2005).
"Diarrhea Care Program" contains the definition,
symptoms, causes, prevention, over the counter
products and non-pharmacological therapies to
accelerate healing and prevent recurrence of diarrhea
in infants. In accordance with the theory of
counseling coverage by Dooley (2005), this program
also contains about how to use, possible side effects,
and mechanisms of action of the drugs. After
understanding definition, respondents expected to
take action when their children had diarrhea that
lasting more than 72 hours (Dipiro, et. al., 2008).
After understanding symptoms, respondents expected
to be able to distinguish between infectious and noninfectious diarrhea. In infectious diarrhea, toddler
will have a fever and the stools also expend blood
and mucus (Koda-Kimble, et. al., 2009 and Ministry
of Health, 2006). It is used to predict the cause of
diarrhea and how to overcome them. The cause of
diarrhea also vary and the main thing is the parents
who are not washing their hands or toddlers who
cannot drink certain milk (Berardi, et. al., 2009 and
Ministry of Health, 2006). There are some way to
prevent diarrhea, such as breastfeeding, giving
complementary feeding of breast milk according to
age, immunization, and maintain a healthy
environment (Kliegman, et. al., 2008). Over the
counter drugs which can be used for children are
adsorbent, zinc supplements, probiotics, and ORS.
While antibiotics only prescribed for diarrhea caused
by infection or if the symptoms are severe and related
to immunity (Murphy, 2008). The nonpharmacological therapy contain how to make ORS
Copyright GSTF 2014
ISSN 2345-783X
doi: 10.5176/2345-783X_PHARMA14.27

at home and what foods should be given or not

(Berardi, et. al., 2009 and Ministry of Health, 2006).
The questionnaire was used to know the
respondents understanding about diarrhea in children
before and after counseling using "Diarrhea Care
Program". The questionnaire consisted of 12
questions aimed to determine the level of knowledge
about diarrhea, the prevention and treatment of
diarrhea, and drugs or supplements for diarrhea. The
level of knowledge about diarrhea can be seen from
the question about definition, causes, signs, and
symptoms of diarrhea. The prevention and treatment
of diarrhea can be seen from the question about the
prevention could be done, the food should be given,
and when parents should see the doctor. The
knowledge about drugs or supplements for diarrhea
can be seen from the question how to make ORS,
drug which should not be used for toddler, the dose
regimentation, anti-motility side effects, and when
antibiotics can be used.
TABLE IV.
Answer

PRE TEST RESULT

B

Total

Question
1
2
3
4
5
6

n = 40
24a
4
8

16

40

40

38

33

22

17

19

39

22

15

38

21

39

11

20

18

40

18

40

35

9
10

14
27
7

40

26

11

13

14

36

12

16

15a

38

The right answer

Based on Table IV, it can be seen that there are a

variety of responses, and not all respondents
answered the questions.

2nd Annual International Conference on Pharmacology and Pharmaceutical Sciences (PHARMA 2014)

35
30

25
20

15

10
C

Based on Table V, it can be seen that there was not

much variation in answers. The answers focused on
the correct one.

0
1

10

11

12

Question

Figure 1. Pre Test Result

Variations of responses was caused by a lack of

knowledge regarding diarrhea and there are some
respondents who prefer not to answer. In question
about signs of diarrhea, there were 17 respondents
who answered fussy and cry, it was because their
children are fussy too when suffered diarrhea, so they
assumed fussy was also a sign of diarrhea. For
questions regarding food that should be given, there
were 15 people who answer the chicken broth,
because they did not know that the chicken broth was
not good for children under five because of the high
sodium content. For questions about how to make
ORS only 11 people who answered correctly due to
lack of knowledge about making the correct ORS.
The question that was not answered was the
questions regarding the product should not be used
and the side effects of anti-motility. Then, question
about the use of antibiotics, there were many parents
answered when diarrhea accompanied by fever.
TABLE V.
Answer

POST TEST RESULT

B

Total

Question
1

38

37

40

38a

40

35a

39

39a

40

35a

40

7
8
9
10
11
12

37

40

40

37
38
1
2
3

40
a

40

37

40

40

38

1
a

37

Copyright GSTF 2014

ISSN 2345-783X
doi: 10.5176/2345-783X_PHARMA14.27

A
B
C

10

11

12

Question

Figure 2. Post Test Result

Less variation on the answer indicates that the

respondents had answered correctly because it had
been given counseling to increase knowledge use
"Diarrhea Care Program".
The distribution of the data needed to determine
for parametric testing. The method was ShapiroWilk. The results can be seen in table VI below.
TABLE VI. NORMALITY TEST RESULT BEFORE AND
AFTER COUNSELING USING DIARRHEA
CARE PROGRAM
No.
1.

40
a

45
40
35
30
25
20
15
10
5
0
1

n = 40
a

The right answer

2.

Data
Pre Test
Questionnaire for
Diarrhea Care
Program
Post Test
Questionnaire for
Diarrhea Care
Program

Sig.
0.013 < 0.05

0.000 < 0.05

Distribution
Not normally
distributed

Not normally
distributed

According to the table VI, it can be seen that the

significance level obtained is smaller than =0.05. It
means the samples come from populations that are
not normally distributed.
Wilcoxon test is a non-parametric statistical tests
were used because the population are not normally
distributed. The hypothesis is:
H0: there is no difference in knowledge scores
before and after counseling
H1: there is a difference in knowledge scores
before and after counseling
The test results were calculated using SPSS 15.

2nd Annual International Conference on Pharmacology and Pharmaceutical Sciences (PHARMA 2014)

TABLE VII.

WILCOXON TEST RESULT

Data

Wilcoxon Value

Patient Counseling
using Diarrhea Care
Program

0.000 < 0.05

H0 rejection

[4]

Because the significance value (0.000) was

smaller than =0.05, H0 was rejected. It means there
was a difference of knowledge scores before and
after counseling.
Increased knowledge scores occurred after
counseling showed that counseling goals and
objectives of the research to determine the
effectiveness of "Diarrhea Care Program" has been
reached. In accordance with theory, counseling aimed
to improve therapeutic efficacy and patient
compliance in taking medication (Ministry of Health,
2007). Therefore, it may encourage changes in
behavior of parents in giving the treatment of
diarrhea in infants and toddlers.
IV.
CONCLUSION
"Diarrhea Care Program" was effective as a
pediatric diarrhea counseling tool by pharmacist in
pharmacy at Malang city. This is evidenced by the
difference between the scores before and after using
"Diarrhea Care Program". The results of the analysis
using the Wilcoxon test showed that all respondents
were about 40 people changing the score higher after
they had been given counseling using "Diarrhea Care
Program".
"Diarrhea Care Program" is a counseling tool in
the form of audiovisual that can enhance the
understanding and interesting of the parents in
receiving counseling compared with conventional
methods orally.

ACKNOWLEDGEMENT
We thank to all of the pharmacist of the
pharmacy subjects in Malang for the encouragement
in this research.

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ISSN 2345-783X
doi: 10.5176/2345-783X_PHARMA14.27

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