Maternal Knowledge, Attitude and Practices Towards

Diarrhea and Oral Rehydration Therapy in Rural

Maharashtra
Vikram Datta, Rosy John, V.P. Singh and Pushpa Chaturvedi

Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India.

Abstract. Objective : A cross sectional hospital based survey was undertaken in rural area of Wardha District of Maharashtra
to assess the knowledge, attitutde and practices of mothers regarding diarrhea and oral rehydration therapy. Methods : 75
mothers of under-five children have been selected in the study. They were interviewed by an interviewer using a predesigned
and pretested questionnaire. 69.3% of them had a per capita income of less than rupees 500 where as 68% knew the correct
definition of diarrhea. Only 5.3% had aware that diarrhea leads to dehydration and 90.7% knew ORT and ORS was easily
available to the majority, but the rest practiced ORT. Results : Nearly 1/3rd of mothers were mixing ORS in the wrong fluid.
Nearly half of the mothers were not practicing adequate hand washing, 32% were using feeding bottles and 2/3rd of them were
not boiling the feeding bottles. Conclusion : The maternal knowledge towards diarrhea and ORS was inadequate in the
population studied and there was a big gap between actual and desired practices.
[Indian J Pediatr 2001; 68 (11) : 1035-1037]

Key words : Diarrhea; ORS; Practices.

Diarrheal disease is a serious health problem worldwide.
It is perhaps one of the most important causes of sickness
and death among infants and children in developing
countries. Recent global estimations suggest that diarrhea
kills about 3.2 million under five children every year with
a per child average of 3-4 acute episodes per year. 1
Though simple and effective treatment measures are
available which can markedly reduce diarrhea associated
morbidity and mortality, yet in developing countries due
to poor diarrhea and ORT related knowledge in the
community, diarrhea still continues to be a major public
health problem.
Based on the fact that k n o w l e d g e of mothers in
developing countries regarding diarrhea, its management,
adequate feeding practices and use of ORS is very limited,
this .study was planned to assess the knowledge, attitude
and practices of mothers towards acute diarrhea and oral
rehydration therapy and also to impart requisite health
education to them.
MATERIALS AND METHODS
The s t u d y was c o n d u c t e d in the Pediatric OPD of
Mahatma Gandhi Institute of Medical Science and related
Kasturba Hospital, which is a tertiary care teaching
Reprintrequests: Dr. V'tkramDatta,4, BirlaNivas MGIMSCampus,
Sevagram, Wardha, Maharashtra-442102.
E-mail : vikramdatta123 @rediff.com
hospital, catering to the rural population of Wardha and
adjoining areas of Rural Maharashtra.
A planned prospective study was carried out from July
to December 2000, the study population comprised of 75
mothers of under 5 children, who attended the Pediatric
OPD.
A single i nt ervi ew er i n t e r v i e w e d all of these 75
mothers on a pre-designed, pretested questionnaire. At
the end of the interview the mothers were handed over a
health education pamphlet in local dialect pertaining to
diarrhea to improve their knowledge and management
skills in future.
RESULTS
75 mothers of under-five children were enrolled in the
study. The age wise distribution and occupation of
mothers is shown in Table 1. Majority of the mothers
(69.3%) had a per-capita income of less than Rs. 500. The
educational status of mothers is shown in Table 2. Only
68% of the m ot hers knew the correct definition of
diarrhea, this knowledge was higher in mothers educated
till more than 10th grade, graduate and post-graduate
standards. Maternal knowledge regarding dehydration
was very poor and only 4/75 (5.3%) mothers were aware
that diarrhea leads to dehydration. Out of these 4 mothers
3 (75%) were not aware of the signs of dehydration. 84%
of the mothers were aware that the child has to be given

Indian Journal of Pediatrics, Volume 68~November, 2001 1035

 Vikram Datta et al

breast feeding during the episodes of diarrhea. 68/75 washing hands before preparing food and feeding the
mothers were aware of ORS, though only 45/75 were child.
u s i n g ORS in the h o m e m a n a g e m e n t of d i a r r h e a l
DISCUSSION
episodes. The ORS mixing techniques are shown in Table
3. 8.8% of the s t u d y p o p u l a t i o n c o m p l a i n e d of non- The observations of the present study were by and large
availability of ORS while 55.9% obtained it from PHC or in conformity with the observation of other workers on
hospitals, 30.9% bought it from Pharmacy and 4.4% from the subject. The diarrheal episode related knowledge is
practitioners. Only 8% of the mothers were using home deficient in familites with low literacy level and low
made ORS but none of them knew the correct preparation socioeconomic status. In a study by Ghosh 2 on maternal
or diluting technique. diarrheogenic behaviours, 70% of the families studied had
The use of hand pump and pond water was associated a per-capita income of less than Rs. 1000 per month.
with a higher incidence of diarrhea, out of the 6 children L i k e w i s e in the p r e s e n t s t u d y 69.3% of the s t u d y
with >4 episodes of diarrhea per year, (66.6%) were using population had a per-capita income of less than Rs. 500
water from hand pipe and 2 (33.3%) were using p o n d and 17.4% of mothers were illiterate. 30.6% of mothers
water, 32% were using feeding bottles and 2/3rd of those were not aware of the cause of diarrhea and more of the
who were using feeding bottles were not strelized. 59.1% mothers regardless of their educational status attributed
of mothers were practicing adequate hand washing with diarrhea to improper disposal of stools.
soap and water, while only 1/75 and 5/75 mothers were It was v e r y disheartening to note that only 4/75 of
mothers were aware that diarrhea leads to dehydration.
TABLE1. Age and Occupationof Mothers of Study Population
Out of these mothers 3 were not aware of the signs of
St. No. Age Number % d e h y d r a t i o n . It was o b s e r v e d t h a t the m a t e r n a l
educational status did not have any influence on maternal
1. > 20 2 2.7
knowledge regarding dehydration. In the present study
2. 20-25 18 24
education of m o t h e r did not have significance on the
3. 25-30 46 61.3
maternal knowledge, attitude and practices. This was
4. > 30 9 12 probably because of the reason that the rural population
Sr. No. Occupation Number % is quite h o m o g e n e o u s for schooling; only 19 mothers
were educated to more than 10th grade.
1. House wife 45 60 Breast feeding a child with acute diarrhea not only
2. Professional 6 8 helpful in preventing dehydration but also forms one of
3. Daily worker 20 26.7 the i m p o r t a n t p r e v e n t i v e measares r e c o m m e n d e d b y
4. Others 4 5.3 WHO. 1 The mean duration of diarrheal episode in infants
w h o are exclusively breast-fed is significantly low as
TASL~2. Education Status of Mothers and Fathers of Study compared to other babies; 3 in the present study 84% of the
Population mothers were aware that child has to be breast fed during
the episodes of diarrhea.
Education Mothers Fathers More than 90.7% of the mothers interviewed were
No. % No. % aware of oral rehydration therapy. ORS was available
easily to the majority of the study population and only
Nil 13 17.4 14 18.7
8.8% complained of non availability. But surprisingly only
<10 43 57.3 37 49.3
60% of mothers practiced ORT. Various reasons for the
>10 11 14.7 12 16
non-use of ORS, despite knowledge, included the fear that
Graduate 7 9.3 8 10.7
it w o u l d cause vomiting and w o r s e n diarrhea. Other
Post graduate 1 1.3 4 5.3
studies 4 have also found similar results, where more than
2/3rd mothers were aware of ORT but one third of them
TASL~3. Practice of ORS Mixing Technique Among the Mothers did not practice ORT. Similarly Rautanen et al in Finland
Mothers Using ORS to Manage Diarrhea Episodes f o u n d that t h o u g h 93% of m o t h e r s u n d e r s t o o d the
Practice Total Number % importance of giving increased amounts of fluids during
(n=45) diarrhea, only 37% of all children with diarrhea had
received ORS? This observation proves the point that
Mixed with how much water? widespread health education is needed to motivate the
1. Correct 17 37.8
2. Incorrect 26 57.8 mothers to freely use ORS in each and every diarrheal
3. Not aware 2 4.4 episode without hesitation.
Mixed with what fluid? P r e p a r a t i o n of ORS in the c o r r e c t m a n n e r is as
1. Correct 29 64.4 important as administering it correctly. Our finding that
2. Incorrect 15 33.3 nearly one third of mothers w e r e mixing ORS in the
3. Not aware 1 2.3
w r o n g fluids and diluting ORS inappropriately raises

1036 Indian Journal of Pediatrics, Volume 68--November, 2001