Thesis /iv > 4437629 ADPM/M: MAJOR: PRIMARY HEALTH CARE MANAGEMENT M.P.H.M PRIMARY HEALTH CARE MANAGEMENT KEY WORDS: | DIARRHEA/HOME PRACTICES/ CHILDREN/VIETNAM NGUYEN MANH DUNG: FACTO
Rationale and justification of study cccecscsssececceeeseeceeeseeveceeeveneeeraees 1
Magnitude of diarrhea among children Worldwide and Vietnam
of many diseases and inadequate nutrition In some countries, more than one in five children die before they reach their birthday, and many of those who do survive are unable to grow and develop to their full potential Seven out of ten childhood deaths in developing countries can be attributed to just one main cause, or often to a combination of diseases such as pneumonia, diarrhea, measles, malaria and malnutrition (1)
Diarrheal diseases are a leading cause of childhood mortality in developing countries and an important cause of malnutrition On average, children below 3 years of age in developing countries experience three episodes of diarrhea each year In 1993, an estimated 3.2 million children below 5 years died from diarrhea
(2) Diarrheal disease is related to more than 3 million deaths and more than 4 billion episodes in 1995, of which more than 80% were among children under five years old About 50% of deaths from diarrhea are due to acute watery stool, 35% to persistent diarrhea and 15% to dysentery (3.)
In 1999, causes of 10.5 million deaths among children under five years in developing countries were pneumonia 18%, diarrhea 15%, malnutrition 49%, measles 8%, malaria 7% and HIV/AIDS 3% One in every two-child death in developing countries is due to the above infectious diseases and malnutrition (4).
Fac of Grad Studies, Mahidol Univ M.P.H.M (PHC Management)/ 2:
Dehydration caused by diarrhea is a major cause of death among children in Vietnam In 1998, as recorded in hospitals among the children, diarrhea is the second disease in ten leading causes of morbidity and it is the ninth in ten leading causes of death (5) Especially, in the Mekong delta diarrheal diseases are prevalent, ubiquitous and the mortality and morbidity rates are the highest compared to other areas in Vietnam Gastrointestinal diseases (including diarrhea diseases) represent
60% among the total number of cases for 24 communicable diseases reported to the
Ministry of Health (MOH) Among gastroenteritis, diarrhea contributes approximately
90% of cases In 1998 there were 2701.6 diarrhea cases per 100 thousand children, which was rather high (6) |
Diarrhea is not the only direct cause of death, but also the cause of malnutrition, especially in infants and children under five years old Repeated episodes of diarrhea contribute to malnutrition and are more likely to cause death in children who are malnourished Therefore, diarrheal diseases and malnutrition constitute a vicious cycle leading to increased rate of child morbidity and mortality
Diarrhea also presents an economic burden for the developing countries In many of these countries, children with diarrhea occupy a large amount of hospital beds each year They also require expensive intravenous fluids, which in the long run affect the country's economy by reducing the health of its work force (7) ,
Case management of acute diarrhea .::ccsccesesesssessesseeenes 2
measles, malaria, and malnutrition Around the world, three out of every four children who seek health care suffer from at least one of these conditions However, better health management can prevent many of these deaths World Health Organization
(WHO) recommends the Integrated Management of Childhood Hlness (MCD approach in the management of these diseases. pane, = pes ave ie tnd ME RAE cụ Marae! be fe at dea
Fac of Grad Studies, Mahidol Univ M.P.H.M (PHC Management) /3
World Health Organization's treatment guidelines are based on the major features of the disease The following principles guide the treatment of the diarrhea include:
- Watery diarrhea requires replacement of fluids and electrolytes, regardless of the cause of the diarrhea For most patients, this can be accomplished with an Oral Rehydration Salt (ORS) solution or Sugar Salt Solution (SSS) Severely dehydrated patients can be rehydrated intravenously with Ringer's Lactate solution
- Feeding should be continued during all types of diarrhea to the greatest extent possible It also should be increased after the diarrhea stops to avoid the effects of malnutrition
- Increase fluids as soon as diarrhea starts and continue feeding These two keys can ensure that 90% of diarrhea cases can be treated successfully at home, without requiring the assistance of health workers (1)
- Drugs should not be used routinely Drug treatment does not help in most episodes of diarrhea, including severe diarrhea with fever The only exception to this is dysentery (with bloody stool), suspected case of cholera and some cases of persistent diarrhea The WHO recommendation is that antidiarrheal and antiemetic drugs should never be used to treat diarrhea in children None of these drugs has practical value and some are dangerous (2)
1.1.3 Practice of mother on management of acute diarrhea in children at home
Practice of mother on management of acute diarrhea in children at home or home care for acute diarrhea in children under five years old was defined as the following included 3 rule as:
Fac of Grad Studies, Mahidol Univ M.P.H.M (PHC Management) / 4
- Rule 1: Give extra fluids intake,
- Rule3: Recognize danger signs and bring the child to the health worker for check up Six danger signs of acute diarrhea in children under five years old are: fever, repeated vomiting, bloody stool, not able to drink or breast-feed adequately, does not better (the passage of many watery stool)(2) a
And recommendation: do not give a child any antidiarrheal preparation, antibiotic drugs and adopt significant preventive behavior
1.1.4 Problem statement Many children die because their parents do not recognize warning signs that indicate their children might be suffering from one or more of the above iliness Changing family habits and the kinds of food offered to children is an important element of Integrated Management of Childhood Illness (MCI) approach, Correct management of diarrhea could save the lives of up to 90% of children who currently die from the effects of the disease
An important element of IMCI approach is the encouragement of a healthier home life Through IMCI, health workers can counsel parents on how to improve care for their sick children Workers teach them how to administer drugs to combat pneumonia, how to follow the three rules of home care for diarrhea- increase fluids, continue feeding and recognize the danger signs that mean their children needs further treatment in a health facility (7)
More than 20 countries have begun to implement the IMCI strategy at regional and local levels since treatment guidelines and training materials first became available in 1996 Representatives of many of these countries have reported in conferences their success in reducing child mortality rates Other 20 countries have expressed interest in IMCI approach (8).
Fac of Grad Studies, Mahidol Univ — ˆ M.P.HM HC Management) / 5
Acute watery diarrhea is the most common form and the most easily treated It may cause dehydration, which can usually be avoided by giving extra fluids and food with a little extra salt Oral Rehydration Salt solution can safely correct
‡ dehydration without the need for intravenous therapy in all but the most severe cases
The situation of diarrhea in Vietnam with a population of 78.7 million, diarrhea in children is a major public health problem Although mortality rates attributable to diarrheal diseases have been progressively decreasing in recent years
Morbidity rate has been one of the most important health problems Mortality rate of children under five years old is 40 per 1,000 live births (9) Only 18% of rural households have access to proper sanitation facilities Poor environmental sanitation, lack of knowledge and failure to put knowledge into practice contribute significantly to this problem (10)
In Vietnam, mothers are mainly responsible in taking care of children during the childhood and hence they are the ones who mostly influence the health of their children The health beliefs of mother toward diarrheal disease in children play a crucial role in their practice of child feeding, drinking, personal hygiene, sanitation and care of their children when they have acute diarrheal disease at home
Therefore, the study of factors related to mothers' home practice on management of acute diarrhea among children under five years old, in Namdinh City,
Vietnam is plausible and a priority
It is important to explore the factors related to correct and incorrect practice of mothers on management of acute diarrhea in children at home This information can be used as baseline data for future diarrheal prevention and treatment program in this area.
Fac of Grad Studies, Mahidol Univ M.P.H.M (PHC Management) / 6
‘To study factors related to mothers’ home practice on management of acute diarrheal disease among children under five years old, in Namdinh City,
1.2.2 Specific objectives 1.2.2.1 Determine Socio-Demographic factors of mothers who have children under five years old with acute diarrhea
1.2.2.2 Identify perception of mother about diarrhea in children 1.2.2.3 Identify the cues to action toward managing acute diarrhea-in children
1.2.2.4 Identify practice of mother on management of acute diarrhea in children at home
1.2.2.5 Determine association between Socio-Demographic factors of mother with their perception of diarrhea and their practice on managing acute diarrhea in children, under five years old at home
Fac of Grad Studies, Mahidol Univ
Socio-demographic factors of mothers
Perception of mothers toward diarrhea in children under five years old Susceptibility Severity Benefit Barrier
Mass media campaigns Advice from family member or other Experiences of mothers with diarrhea in children (diarrheal episodes of children in the last 6 months)
Practices of mothers on management of acute diarrhea in children under five years old athome ‹ Increasing fluid:
- Behaviors of hygiene practice wie det ie dl En SE oo ea clk te
Fac of Grad Studies, Mahidol Univ M.P.H.M (PHC Management) / 8
Diarrhea: Diarrhea is a group of signs and symptoms which describes how frequent “defecation” is and what are characteristics of the fecal matter It is a usually defined as the passage of three or more loose or watery stool in 24-hour period (11)
Classification of diarrhea, according to World Health Organization, there are three main types of diarrhea ‹