Diarrhoea In The Under-Fives: Constraints Encountered By Care Providers In Its Management

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Authors : Bodzewan Emmanuel Fonyuy


Diarrhoea continues to be one of the major causes of dehydration in the under-five population especially in the developing countries; resulting in high infant mortality rate, particularly in sub-Saharan Africa. Diarrhoea resulting to dehydration kills more children under five years of age than malaria, AIDS, measles and tuberculosis. It is actually the second leading cause of death in children under five in the world and responsible for 1.9 million deaths per year, following pneumonia, which kills 2 million per year. As such deaths via diarrhea represent 17% of deaths among children under-five; out of a total of 11 million deaths annually. This mostly results from the consumption of contaminated food and drinking of water from doubted sources. World-wide, around 1 billion people lack access to improve water and 2.5 billion have no access to basic sanitation. The objectives of the study were:

ü  To assess the knowledge of care providers in identifying cases with dehydration in the under-fives.

ü  To assess their practices toward the adequate management of dehydration in the under-fives.

ü  To find out the difficulties encountered in its proper management.

ü  To propose practical solutions in order to curb its occurrence.

A descriptive cross-sectional design was employed, in which primary data was collected from a sample in the study population in order to collect baseline data to be a representative of the study population during the study period, in order to assess the knowledge of care providers of Mankon Medicalized Health Centre and Nkwen Medicalized Health Centre in the assessment and management of dehydration in the under-fives.

Data was collected from care-providers of both Mankon and Nkwen Medicalised Health Centres who had served in these health facilities for at least six months and who are versed with the causes of dehydration in the under-fives, its clinical manifestations and the adequate implementation of proper management.

The convenient sampling technique for this study in which all the eight (8) care providers managing clinical cases in the medical ward and the twelve (12) care providers managing clinical cases in the paediatric ward of both Mankon and Nkwen Medicalised Centres were involved in the study and questionnaire administered to them.

A structured questionnaire was designed to collect primary data from respondents. This instrument was structured as such to tailor the specific objectives of the study:

Results show that; out of the 22 respondents, 11 (50%) were Nursing Assistants (NA), 2.0 (9.09%) were State Enrolled Nurses (SEN), then 8.0 (36.36%) were State Registered Nurses (SRN) and 1.0 (4.54%) a Bachelor in Nursing Science degree (BNSc).

Six nurses have worked for between 6-12 months, 7 nurses for between 1-5 years, 3 nurses for between 5-10 years and 4 nurses for between 20 years and above. Out of the 22 Care–providers, 13 (59.09%) suggested that dehydration is excessive loss of fluid from the body, while 9.0 (40.90%) of the respondents thought that dehydration is loss of body fluids and electrolytes. However, all the 22 respondents presented similar causes and clinical pictures and state that dehydration is classified into 3 types in terms of severity.

All the 22 respondents identified 3 types of dehydration and offered specific solutions as to each of them. They equally attribute specific length of time required to manage each type of dehydration. The 22 participations also thought that to properly manage this condition, appropriate tools (urinary bag or any calibrated bowl) should be used to estimate the amount of fluid lost.

On the clinical manifestations of dehydration, 49 responses were gotten as follows, 11 (23.40%) could not distinguish signs and symptoms as to mild, moderate and severe dehydration, 12 (25.53%) stated difficulties as regard to management approaches, while 24 (51.06%) related their difficulties to mother’s compliancy.

All the respondents suggested similar causes and clinical pictures and classified it into three types. All of them above implies that with the knowledge on dehydration, nursing staff can easily reverse this condition with less fatality using specific management approach corresponding to the degree of dehydration, and prevent complications.

Health advice offered to mothers by nurses on the management approaches at home fall under four items viz: O.R.S., water and fluid, nutrition and hygiene. 18 (33.96%) provided health talks on hygiene. If faeco-oral infections should be avoided, hygienic measures must be implemented, 14 (26.41%) nurses advocated on the use of O.R.S which should be taken at home.

 Keywords: Sanitation, Diarrhoea, Dehydration, Under-fives, Oral Rehydration solution, Hypervolemia, Fluid Replacement Therapy


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