Diarrheal diseases account for roughly 530,000 deaths a year, 9% of total deaths among children under-five years of age, making them the second most common cause of child deaths worldwide. Over half of the deaths occur in just five countries: India, Nigeria, Afghanistan, Pakistan and Ethiopia. Despite this heavy toll, progress is being made. From 2000 to 2015, the total annual number of deaths from diarrhea among children under 5 decreased by more than 50 percent from over 1.2 million to half a million. With each episode the child gets deprived of the necessary nutrition required for their growth. Thus diarrhea is one of the major causes of malnutrition and these children have a higher chance of getting infected by diarrhea. An estimated 801,000 children younger than 5 years of age perish from diarrhea each year, mostly in developing countries. This amounts to 11% of the 7.6 million deaths of children under the age of five and means that about 2,200 children are dying every day as a result of diarrheal diseases. In 2011, more children under the age of five died in India than anywhere else in the world. That’s 1.7 million children over 4,650 child deaths a day–according to a new report by the United Nations Children’s Fund. Africa and South Asia are home to more than 80 percent of child deaths due to diarrhea. Just 15 countries account for almost three quarters of all deaths from diarrhea among children under five years of age annually [1-5].

While it is of utmost importance that there should be improvement in the infrastructure, safe drinking water, good sanitation practices and facilities which only can be improved if they are coordinated with good hygiene practices. UNICEF had given 7-point prevention out of which 5 points emphasis on prevention. These points are early and exclusive breastfeeding and vitamin A supplementation, Rotavirus and measles vaccinations, Hand washing with soap, improved water supply and Community-based sanitation [6-9]. There is an importance of measles vaccination and vitamin A dosage for maintaining the integrity of epithelial cells. Against the backdrop of the importance attached to maternal literacy, this paper also asks if such literacy also delivers benefits in terms of protecting children from diarrhea [10].

This remarkable reduction in diarrheal cases and mortality was possible due to the inception and success of many universal programs like expanded program on immunization, program for the control of diarrheal diseases and acute respiratory infection. Oral Rehydration Therapy (ORS) have been used as a drug of choice for proper management of cases with diarrhea. Supplies of ORS packets to the states are being organized by the Govt. of India centrally. The demonstration that Oral Rehydration Therapy could prevent mortality due to diarrheal diseases was an important milestone [11-13].

Information on diarrheal diseases, its determinants in India and preventive and control strategies in light of recent developments need to be reviewed for better planning and organization of health services within the community. The knowledge of mothers regarding diarrhea is a determining factor for the treatment of diarrhea within a specific time period. The practice of the mother in diarrhea depends upon the income of the household, education, societal norms, has been found to be associated with the sociocultural beliefs in the society.

The special focus should be upon the education of the mothers related to the childhood diarrhea and other infections which are responsible for fatal outcomes in the children. Therefore the objective of the paper is to determine the knowledge, practices and attitude of mother about diarrhea disease in rural Wardha District, Maharashtra. The inadequate amount of knowledge about diarrhea among the mothers attributes to the sociocultural beliefs in the society, the practices in the society, the family pressure and low female autonomy. The woman is the one who takes care of the child mostly in the house and looks after the child around the day. She needs to be educated about the disease conditions in the child and the proper treatment options for the child. Thus, there is a low utilization of health care facilities in the area and most of the households go for the private health care and wait for a couple of days before visiting the health facility. There are negative attitudes prevailing among the mothers about diarrhea and the treatment of diarrhea from the public health facilities.

Study population, site and design

This study is conducted in the Talegaon block of Wardha district in the state of Maharashtra. Talegaon block is situated at a distance of 25 kilometers from Wardha city and located on a highway, midway between the Wardha city and Hinganghat block. The PHC is located in the Talegaon village and it is very difficult for the villagers in the Talegaon block to travel to the PHC for any treatment. This block consists of majority of Hindu population followed by Buddhists and Muslims. Talegaon is a large block considering the population and the coverage area in the Primary Health Center (PHC).

Since the study was conducted to find out the reasons and the factors associated with the health seeking behavior among 0-5 years’ children when they suffer from diarrhea with their mothers as the respondents, the universe was the mothers of the 232 children participated in the study from the Talegaon PHC area. District-Wardha, Maharashtra, India. The respondents were selected from the universe based on certain criteria and the objectives of the study. This study was done to assess the factors which are responsible for the health care seeking behavior among the mothers of the children between 0 to 5 years of children in the Talegaon block of Wardha district [13-16].

With the help of a quantitative design, a semi structured interview schedule was used among the mothers of the children to find out the factors responsible for the health care seeking behavior in diarrhea. In this study, there is a systematic collection and presentation of data which provides a clear picture of the situation of the problem in the area. The main source of data was the primary data which was collected on the field by the researcher by direct face to face interviews with the mothers of the children. Also the data about the households which had children below the age of five years was also collected from the Subcentres from the Village ANM and also the list of the children sought from the Anganwadi centers in the village.

Process for data collection

The researcher had selected 5 villages from the Talegaon block of the Wardha district for the study. Data collection permission has been taken from the District health officer from that area. Thereafter the researcher went to the respective villages and to the Subcentres and took the list of the children who are below the age of 5 years. Also the researcher went to the Anganwadi centres and took the same list from them and also cross checked with the list from the sub centre. Finally using simple random sampling eligible households has been selected. After visiting the house, the researcher sought the informed consent from the participants (mothers) and then direct face to face interviews with the mothers of the children were conducted in the local language. The interviews consisted of only the closed ended questions. In case if the mother had any questions, the researcher would clarify the doubts of the mother. Interviews were conducted in Marathi language which is locally spoken in the area. It took a time span of 45 days for data collection in year 2015.

Data processing and analysis plan

The researcher collected only the quantitative data from the respondents in the study.

Quantitative data was entered in Software statistical package for social sciences (SPSS) 20. Appropriate Univariate and bivariate analysis has been applied. Also to find out the significant association between dependent and independent variable of the study we have applied chi square test.

Knowledge of the mother about diarrhea disease

Table 1 shows the awareness about diarrhea disease with rise in income among the households. The Occupation of the mother has a significant impact (0.010) on the knowledge of the mother whether she considers diarrhea as serious phenomenon. Occupation of the mother has a significant association with the knowledge about whom the ORS is given. Thus the significant association between Occupation and Knowledge of the mother shows that the occupation of the mothers has an impact upon the knowledge of the mother whether she knows about whom the ORS is given. The occupation of the mother has an impact upon the knowledge of the mother whether the ORS can be prepared at home. The occupation of the mother has an impact upon the knowledge of the mother about the fever as a common health problem in the children below five years. Occupation of the mother has a significant association with the knowledge of the mother whether respiratory problem is a common health problem in the children below the age of five years. Thus the significant association between the two variables shows that the occupation of the mother has an impact upon the knowledge of the mother about the respiratory problems as a common health problem in the children below five years. Thus the association between the two variables shows that the caste of the household has an impact upon the knowledge of the mother regarding the seriousness of diarrhea in the children below 5 years of age. Household from the upper caste has higher percentage when asked about the seriousness of diarrhea, knowledge of the mother about the signs and symptoms of diarrhea in the children below the age of five years as compared to the household from lower caste [17-20].

Table 1: Knowledge of mother about diarrhea treatment according to background characteristics.

Attitude of the mother

Thus the significant association between the Income and Attitude of the mother shows that the income of the household has an impact upon the attitude of the mother about why she thinks that ORS is good for the children below the age of 5 years. Income of the household (0.000) has a significant association with the attitude of the mother about what would be her first reaction when her child gets diarrhea and it shows that with rise in income of the household there is a positive attitude among the mothers. Occupation of the mother (0.000) have a significant association with the attitude of the mother about why does she think that the ORS is good for children which shows that with every occupation of the mother, there is a positive attitude of the mother about why she thinks that the ORS is good for children below the age of 5 years. Occupation of the mother (0.001) has a significant association with the attitude of the mother about what will you do if your child does not get cured within 2-3 days of diarrhea which shows that every occupation of the mother has an positive impact upon the attitude of the mother about what will she do if child does not get cured within 2-3 days of diarrhea.

Caste of the household (0.015) does have a significant association with the attitude of the mother about why does she think that the ORS is good for children which shows within the castes of the household, there is a positive attitude of the mother is associated about why does she think that the ORS is good for children. Caste of the household (0.295) does not have a significant association with the attitude of the mother about does she think that ORS is the only means to control diarrhea which shows that within the castes of the household, there is a negative attitude of the mother about does she think that ORS is the only means to control diarrhea. Caste of the household (0.061) does not have a significant association with the attitude of the mother about what will she do if her child doesn’t get cured in 2-3 days of diarrhea which shows that within the castes of the household, there is a negative attitude of the mother about what will she do if her child doesn’t get cured in2-3 days of diarrhea. Education of the mother does not play a significant role in determining the attitude of the mother towards the treatment of diarrhea and the ORS use in children (Table 2).

Table 2: Attitude of the mother about oral rehydration therapy and diarrhea according to background characteristics.

Practice of the mother

The income of the household has an impact upon the practices of the mother about the reasons of visiting the health facility late when her child had diarrhea. Income of the household (0.000) has a significant association with the practice of the mother whether she had taken her child to any of the superstitious healer in the last 6 months which shows that the Mothers from low income group has taken her child to the superstitious healer in the past 6 months. Income of the household (0.021) has a significant association with the Practice of the mother whether she has ever used ORS for the child in the past which shows that the mothers in the low income household have not used the ORS in the past as compared to the mothers in the high income group. Income of the household (0.061) does not have a significant association between the practice of the mother whether they keep the ORS sachets in the house for emergency in the case of diarrhea which shows that with every income group, there are no practices of the mother to keep ORS in the house in case of emergency in diarrhea.

Occupation of the mother (0.017) has a significant association with the practice of the mother in the house to prevent diarrhea which signifies that with every income group, mothers in the household have the practice to prevent diarrhea. Occupation of the mother (0.450) does not have a significant association with the practice of the mothers for the reasons of visiting the health facilities late when the child had diarrhea which shows that the occupation of the mother does not have an impact upon the practice of the mother of reasons of visiting late in the health facilities in the case of diarrhea. Occupation of the mother (0.180) does not have a significant association with the practice of the mothers as they have sought treatment for their child in the past from the superstitious healer which shows that the occupation of the mother does not have an impact upon the practice of the mother of seeking the treatment for their child from the superstitious healer anytime in the past. Household practice of the mother for preventing diarrhea increases with higher education and ORS use has been increased with higher education (Table 3) [20-23].

Table 3: Practice of the mother about the treatment in diarrhea and ORS use according to background characteristics.

The health seeking behavior of the mother is mainly associated with the education of the mother, the income of the household, the caste of the household, occupation of the mother and the other family members. It is affected by the region in which the family lives and the cultural values of the society with the disease. Many of the cultures have a specific treatment of the disease and they prefer the local and household medicines rather than visiting the health facilities. It also depends upon the coverage of the health facilities in the concerned area. Health seeking behavior in diarrhea differs across the regions and it varies according to the caste, class and the other socio demographic factors which have an impact over the health seeking behavior in diarrhea. Especially in the rural areas, the severity of diarrhea in the children below the age of 5 years is not known to the mothers and diarrhea remains one of the major contributors to the morbidity and the mortality in the children below the 5 years of age. The households which are very far away from the health facilities do not wish to travel to the health facilities. Nowadays, awareness campaigns and Mobile medical units have been established but not enough awareness about diarrhea and its consequences have been realized to the society. In our study, it was found that the Income and caste of the household had a significant impact on the Knowledge of the mother about diarrhea. When the knowledge was compared with the occupation of the mother, more than the half of the mothers, whether they were in the farming occupation or the household work, the knowledge was enough in all the categories. The knowledge for the education of the mother was found to be good among the women who were less educated than the women who were more educated.

Non Educated mothers have a good amount of knowledge than the mothers who were non educated It was found that the attitude of the mother in the higher castes was low as compared to the backward classes. With every occupation, there was a positive attitude among the women for the treatment of diarrhea of the children. It was also due to the activities which are carried out in every village about various illnesses and programmes that are currently being organized in various parts. It was also affected by the regular visits by the health staff to the houses and counselling on one to one basis which helps in improving the knowledge of the mother and it helps in a positive attitude toward diarrhea. Thus, many of the women have heard of the ORS therapy but some of them do not know that it is specifically used in the treatment of the diarrheal diseases. It was found that the mothers in the higher castes seek more treatment from the superstitious healers as compared to the backward castes. The frequency of using ORS was high among the households belonging to the backward castes as compared to the higher caste. It was found that the education of the mother was associated with the hand washing practice of the mother [24-25].

A study done by Manna and nasrin shows that the primary education of the care providers to the children was associated with the health care seeking behavior among them. While in our study, it was found that the education of the mother was mostly not associated with the health care seeking behavior and the knowledge, attitude and the practices of the mother. It is mostly associated with the sociodemographic factors which were positively associated with the health care seeking behavior of the mother.

Our study shows that the knowledge about ORS was good enough among the participants. The practices for the prevention of diarrhea were quite well in the household like washing hands before eating was practiced by a majority of the households. Also, drinking boiled water was practiced in some of the households. Some of the participants were confused about the practices which have to be practiced in the prevention of diarrhea in the household.

A study done in the Assosa district of Ethiopia finds that the knowledge of the mothers regarding diarrhea in the area is very low and the attitude of the mothers towards diarrhea is also low. Thus the knowledge about the transmission and causes of diarrhea was also low among the participants in the study. In our study, it was found that the knowledge of the mothers was significantly associated with the income of the household, occupation of the mother, caste of the mother and the education of the mother. Whereas the household with the low income had a difficulty in reaching the health facilities and were low on knowledge of the signs and symptoms of diarrhea.

Considering the attitude of the mothers, it was found that with the increase in the education, there was an increase in Positive attitude of the mothers whether the ORS is good for the children, also there was a positive association between the education of the mothers and why do they think that it is important for the children in the diarrhea. Whether it was found that with the increase in the education of the mother there was a decrease in the attitude of the mothers to take their children to the hospital and admit them in the hospital in the case of diarrhea. Considering the caste of the household, it was found that the very less amount of respondents knew and had a positive attitude about the knowledge of the ORS and their tendency to take their child to the hospital in the case of diarrhea. This was due to the fact that many women think that the diarrhea can be controlled with the household medicines and is not required to take the child to the hospital in the case of diarrhea.

The study illustrates that the socio demographic factors play a major role in the health seeking behavior among the mothers. The study also depicts that lack of awareness among the masses about the severity and symptoms of diarrhea isn’t adequate which results into diarrheal illness. The findings from our study suggest that the mothers need to be made aware about the factors causing diarrhea and measures to prevent the illness. Efforts should also be put in to increase the knowledge about the illness of the caretakers whether home based care or hospital care is needed. The mothers or caretakers should improve hygiene through hand washing with soap; prevent dehydration through early administration of Oral rehydration salts. They should promote exclusive breastfeeding and increase breastfeeding after every episode of diarrhea. They should recognize the signs of dehydration and take the child to the nearby health facility for ORS for intravenous electrolyte solutions. Health workers also should counsel the parents about providing suitable oral fluids in diarrhea and reach out to the nearest health facility available.

Informed consent was obtained from the mother of each study participant aged 0-5 years old. The identity of the mothers and the children wasn’t revealed during anytime of the study. The privacy and confidentiality of the data was maintained throughout.

1. Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E (2010) Diarrhoea: Why children are still dying and what can be done. Lancet 375: 870-872.
2. Lakshminarayanan S, Jayalakshmy R (2015) Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med 6: 24-28.
3. Feachem RG, Hogan RC, Merson MH (1983) Diarrhoeal disease control: Reviews of potential interventions. Bull World Health Organ 61: 637-640.
4. Avachat SS, Phalke VD, Phalke DB, Aarif SM, Kalakoti P (2011) A cross-sectional study of socio-demographic determinants of recurrent diarrhoea among children under five of rural area of Western Maharashtra, India. Australas Med J 4: 72-75.
5. Merga N, Alemayehu T (2015) Knowledge, perception and management skills of mothers with under-five children about diarrhoeal disease in indigenous and resettlement communities in Assosa district, Western Ethiopia. J Health Popul Nutr 33: 20-30.
6. Breurec S, Vanel N, Bata P, Chartier L, Farra A (2016) Etiology and epidemiology of diarrhea in hospitalized children from low income country: A matched case-control study in central African Republic. PLoS Negl Trop Dis 10: e0004283.
7. Lamberti LM, Walker CL, Taneja S, Mazumder S, Black RE (2015) Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India. J Glob Health 5: 020410.
8. Walker CL, Taneja S, LeFevre A, Black RE, Mazumder S (2015) Appropriate management of acute diarrhea in children among public and private providers in Gujarat, India: A cross-sectional survey. Global Health: Science and Practice 3: 230-241.
9. Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, et al. (2014) Childhood diarrhoeal deaths in seven low- and middle-income countries. Bull World Health Organ 92: 664-671.
10. Das SK, Nasrin D, Ahmed S, Wu Y, Ferdous F (2013) Health care-seeking behavior for childhood diarrhea in Mirzapur, Rural Bangladesh. Am J Trop Med Hyg 89: 62-68.
11. Manna B, Nasrin D, Kanungo S, Roy S, Ramamurthy T (2013) Determinants of health care seeking for diarrheal illness in young children in urban slums of Kolkata, India. Am J Trop Med Hyg 89: 56-61.
12. Quadri F, Nasrin D, Khan A, Bokhari T, Tikmani SS, et al. (2013) Health care use patterns for diarrhea in children in low-income periurban communities of Karachi, Pakistan. Am J Trop Med Hyg 89: 49-55.
13. Omore R, O’Reilly CE, Williamson J, Moke F, Were V, et al. (2013) Health care-seeking behavior during childhood diarrheal illness: Results of health care utilization and attitudes surveys of caretakers in Western Kenya, 2007–2010. Am J Trop Med Hyg 89: 29-40.
14. Page AL, Hustache S, Luquero FJ, Djibo A, Manzo ML, et al. (2011) Health care seeking behavior for diarrhea in children under 5 in rural Niger: Results of a cross-sectional survey. BMC Public Health 11: 389.
15. Diaz T, George AS, Rao SR, Bangura PS, Baimba JB (2013) Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care: Results of a cross-sectional survey. BMC Public Health 13: 157.
16. Gao W, Dang S, Yan H, Wang D (2012) Care-seeking pattern for diarrhea among children under 36 months old in rural western China. PLoS One 7: e43103.
17. Wilson SE, Ouédraogo CT, Prince L, Ouédraogo A, Hess SY, et al. (2012) Caregiver recognition of childhood diarrhea, care seeking behaviors and home treatment practices in rural Burkina Faso: A cross-sectional survey. PLoS ONE 7: e33273.
18. Kahabuka C, Kvåle G, Hinderaker SG (2012) Factors associated with severe disease from malaria, pneumonia and diarrhea among children in rural Tanzania – A hospital-based cross-sectional study. BMC Infect Dis 12: 219.
19. Otieno GA, Bigogo GM, Nyawanda BO, Aboud F, Breiman RF, et al. (2013) Caretakers’ perception towards using zinc to treat childhood diarrhoea in rural western Kenya. J Health Popul Nutr 31: 321-329.
20. Saha D, Akinsola A, Sharples K, Adeyemi MO, Antonio M, et al. (2013) Health care utilization and attitudes survey: Understanding diarrheal disease in rural Gambia. Am J Trop Med Hyg 89: 13-20.
21. Mengistie B, Berhane Y, Worku A (2012) Predictors of oral rehydration therapy use among under-five children with diarrhea in Eastern Ethiopia: A community based case control study. BMC Public Health 12: 1029.
22. Nasrin D, Wu Y, Blackwelder WC, Farag TH, Saha D, et al. (2013) Health care seeking for childhood diarrhea in developing countries: Evidence from seven sites in Africa and Asia. Am J Trop Med Hyg 89: 3-12.
23. Sinmegn Mihrete T, Asres Alemie G, Shimeka Teferra A (2014) Determinants of childhood diarrhea among underfive children in BenishangulGumuz regional state, North West Ethiopia. BMC Pediatr 14: 102.
24. Farag TH, Kotloff KL, Levine MM, Onwuchekwa U, Van Eijk AM, et al. (2013) Seeking care for pediatric diarrheal illness from traditional healers in Bamako, Mali. Am J Trop Med Hyg 89: 21-28.
25. Bhattacharya SK (2000) Therapeutic methods for diarrhea in children. World J Gastroenterol 6: 497-500.