The Correlation of Mothers’

nowledge of Childhood Diarrhea and

Early Management of Acute Diarrhea in Children under Five

in Aceh, Indonesia

Sufriani

, Asri Ayuningtias

and Sinta Nelysa

Department of Pediatric Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Undergraduate Program of Nursing Science, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Department of Family Health Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Keywords: Children under five, Mother’s knowledge, Diarrhea management.

Abstract: The increasing death rate of children under-five associated with diarrhoeal diseases has urged people to

make efforts in order to decrease the children’s mortality and morbidity rate. Mother as primary caregiver to

children under five, is playing an important role to minimize the effects of acute diarrhea. This research

aims to investigate the correlation of mothers’ knowledge of childhood diarrhea with early management of

acute diarrhea in children under five in Aceh, Indonesia. This descriptive-correlational study was conducted

with 86 mothers of children aged 2 to 5 years using purposive sampling. The results showed that there was a

correlation of the mothers’ knowledge and the early management of acute diarrhea in children under five (p-

value = 0.005). The mother’s knowledge associated with the intake of oralite (p-value = 0.019) and nutrition

(p-value = 0.000). However, there was no correlation of the mothers’ knowledge and zinc intake (p-value =

0.089). It is suggested to maintain health promotion related to early management of acute diarrhea in

children under five. In addition, the importance of zinc provision is proposed to increase the knowledge and

create positive attitude among mothers.

1 INTRODUCTION

Diarrhea is the second cause of death in children

under five years (toddlers) and major health

problems in children around the world, especially

children under five years old (Unicef, 2018).

Globally, around 1.7 billion cases of diarrhea occur

in children every year (WHO, 2017). In Indonesia,

diarrhea is an endemic disease and is also a potential

disease of extraordinary events which is often

followed by death. In 2016, there were outbreaks in

3 provinces and 3 districts with a total of 198 cases

and 6 deaths reported with 3.04% Case Fatality Rate

(CFR) for diarrhea (Indonesian Ministry of Health,

2017). This means that there was an increasing

number of CFR by 0.57% in 2015 with 18 outbreaks

of diarrhea spread in 11 provinces, 18 districts/

cities, with a total of 1.213 people and 30 CFR

deaths (2.47%) (Indonesian Ministry of Health,

2016). In 2016, there were 584 cases of diarrhea and

increased to 738 cases in 2017 in Kuta Baro Public

Health Centre; ranked second highest in Aceh Besar

District (Aceh Besar District Statistic Bureau, 2018).

There are several causes of diarrhea such as

infection of microorganisms that are mostly carried

by water contaminated with faeces, malnutrition,

and unhealthy sources of drinking water (WHO,

2017). Other factors such as exclusive breastfeeding,

latrine feasibility and mother's knowledge of

diarrhea also influenced the incidents of diarrhea in

children under five (Setiawan & Luh, 2017). The

management of diarrhea in health facilities is

conducted through the five-step program to treat the

diarrhea (Lintas Diarrhea) which includes providing

the “Oral Rehydration Therapy” ORT (oralite),

providing zinc, continuing the breastfeeding and

food, giving antibiotics selectively and providing

health education to mothers / caregivers. The health

education provided to mothers related to how to

administer ORS, zinc, breast milk / food and signs to

immediately refer the children to the health workers

(Ministry of Health RI, 2011).

Sufriani, ., Ayuningtias, A. and Nelysa, S.

The Correlation of Mothers’ Knowledge of Childhood Diarrhea and Early Management of Acute Diarrhea in Children under Five in Aceh, Indonesia.

DOI: 10.5220/0008396200002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 181-187

ISBN: 978-989-758-413-8

181

Early treatment for children with acute diarrhea

(without blooding) can be conducted in the

household by the mother/caregiver aimed to prevent

dehydration and malnutrition. Mother is a primary

caregiver for toddler and is very instrumental in

preventing and handling diarrhea at home (Hutasoit,

Soenarto, & Widiyandana, 2017). Improper

management both at home and in health facilities is

the main cause of death from diarrhea. Therefore,

reducing the number of deaths due to diarrhea, need

a rapid and appropriate management in order to

reduce the occurrence of dehydration due to the

excessive fluid loss (Kosasih, Sulastri, Suparto, &

Sumartini, 2015)

In order to reduce the incidence of diarrhea in

infants, the role of the mother is very important so

that knowledge is needed in the management of

diarrhea. In fact, good knowledge of diarrhea is not

necessarily capable of managing diarrhea in

toddlers. The purpose of this study was to identify

the relationship of mother’s knowledge about

diarrhea with the early management of acute

diarrhea in infants in the working area of Kuta Baro

Health Centre in Aceh Besar District.

2 METHODS

This is a quantitative research with descriptive

correlative method. The study population was

mothers who had 2 - 5 years old children in Kuta

Baro sub-district, the work area of Aceh Besar

Health Centre. Kuta Baro Sub district is an area with

the second largest number of diarrhea cases in Aceh

Besar district. Sampling is conducted by

proportional random sampling, where sampling from

each villages is balanced or proportional to the

number of subjects in the village. Researchers

determined sampling in five villages with the highest

number of toddlers in the working area of Kuta Baro

Health Centre with a total population of 348

toddlers. Furthermore, the researchers determined

the subject to be respondent using the inclusion

criteria. There were 86 mothers with children aged 2

- 5 years who had diarrhea in the last six months was

participated in the study.

Data collection was conducted on 19 May to 2

June 2018 using questionnaires designed by the

researchers. The questionnaires had passed the

validity and reliability test. There were 2

questionnaire’s sections utilised for this study, a

section to measure the variables of mmothers’

knowledge about diarrhea and another section to

measure the early management variables for diarrhea

in the last 6 months. The second questionnaire’s

section consisted of 3 parts, the first part was to

measure the administration of ORS, the second part

was to measure zinc administration in children when

diarrhea, and the third was to measure nutrition

provided to children when diarrhea. The data were

analysed statistically by Chi-Square analysis to

determine the relationship of mothers’ knowledge

about diarrhea and early management of acute

diarrhea in infants in Kuta Baro Aceh Besar Health

Centre. Data analysis also conducted to determine

the correlation of mothers’ knowledge about

diarrhea and the behaviour of providing ORS, zinc

supplement and food to infants during diarrhea.

3 FINDINGS

Based on the demographic data, 60.5% of

respondents were in the age range of 26 - 35 years,

60.8% were at the secondary education level, 90.7%

of respondents are stay at home mothers and 79.1%

had toddlers aged 2 - 3 years. The knowledge

variables are categorized based on the total value of

100. The knowledge of mothers about diarrhea is

categorized good if the value obtained is ≥ 76%,

moderate if the value is 56 - 75% and less if the

value is <56% (Notoatmodjo, 2010b). While the

management variables are categorized according to

the minimum standard of administering’s behaviour

of ORS, zinc and nutrient administration. The

categorized considered good if the respondent's

value reaches the maximum value and categorized

less if the respondent's value is below the maximum

value.

The analysis showed that 46.5% of respondents

had good knowledge about diarrhea and 88.4% of

respondents had poor ability in the early

management of acute diarrhea in infants. The early

management variables for toddlers examined based

on three steps of early management of diarrhea,

administration of ORS, zinc and nutrition.

Univariate analysis results for these three steps

showed that 52.3% of respondents had poor scores

in providing ORS, 86% of respondents were not

good at giving zinc supplementation and 57% of

respondents were not good enough in the step of

providing nutrition or food for toddlers when

diarrhea.

AINC 2018 - Aceh International Nursing Conference

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Table 1: Early diarrhea management practice frequency

distribution.

Early diarrhea

management

Result F %

Providing ORS Adequate 41 47.7

Inadequate 45 53.3

Providing zinc

supplementation

Adequate 12 14

Inadequate 74 86

Providing food/nutrition Adequate 37 43

Inadequate 49 57

Table 2: The correlation of mothers’ knowledge and early

diarrhea management.

Knowledge Practice Total

Adequate Inadequate

F % F % F %

Good 9 22.5 31 77.5 40 100

Poor 1 2.2 45 97.8 46 100

Table 2 shows that 40 mothers had good

knowledge about early diarrhea management.

However, only 22.5% of respondents practiced the

early management of diarrhea in children under five

adequately. Whereas the 46 respondents who had

knowledge, there were 45 (97.8%) respondents who

did the early management of diarrhea in under-five

children were inadequate category.

Chi square test results with CI = 95% (α = 0.05)

obtained p-value = 0.005, which means that there is

a correlation of mother’s knowledge about diarrhea

and the early management of acute diarrhea in

infants.

Table 3. The correlation of mothers’ knowledge and

ORT administration

Knowledge ORT Administration Total

Adequate Inadequate

F % F % F %

Good 25 62.5 15 37.5 40 100

Poor 16 34.8 30 65.2 46 100

Table 3 shows 40 respondents who had good

knowledge and there were 25 (62.5%) respondents

who took steps to administer ORS to toddlers in

adequate category. Whereas, among 46 respondents

with poor knowledge. 65.2% of them were not good

enough in administering ORT to their children. Chi

square test results with CI = 95% (α = 0.05) obtained

p-value = 0.019, which means that there is a

relationship of mother’s knowledge about diarrhea

and the ability to give ORT to infants when diarrhea.

Table 4 shows that there were 40 respondents

who had good knowledge and only 22.5%

respondents were providing zinc supplementation.

Whereas 7 respondents who had poor knowledge

also had inadequate practice in providing zinc

supplementation. Chi square test results with CI =

95% (α=0.05) obtained p – value = 0.089 means

there is no correlation of giving zinc

supplementation for children and diarrhea in

children under five.

Table 4: The correlation of mothers’ knowledge and Zinc

Supplementation.

Knowledge ORT Administration Total

Adequate Inadequate

F % F % F %

Good 9 22.5 31 77.5 40 100

Moderate 3 7.7 36 92.3 39 100

Poor 0 0 7 100 7 100

Table 5: The correlation of mothers’ knowledge and

providing food/nutrition.

Knowledge ORT Administration Total

Adequate Inadequate

F % F % F %

Good 27 67.5 13 32.5 40 100

Poor 10 21.7 36 78.3 46 100

Table 5 shows that of the 40 respondents who

had good knowledge, 67.5% of respondents were

giving food adequately for their children. While

from 46 respondents with poor knowledge, most of

them were not able to provide adequate nutrition for

diarrhea children. Chi square test results with CI =

95% (α = 0.05) obtained p-value = 0,000, which

means that there is a significant relationship of

mothers’ knowledge about diarrhea and providing

food/nutrition practice for diarrhea children.

4 DISCUSSION

The knowledge of mothers about diarrhea and early

management of diarrhea in children under five were

good (46.5%), moderate (45.3%) and the rest were

poor (8.1%). The results of the statistical test using

Chi Square revealed that there was a relationship of

the knowledge of mothers with the early

management performed by mothers in children with

acute diarrhea (p value 0.005). This shows that the

better of the mother's knowledge about diarrhea, the

better the mother's management of children under

five during diarrhea. On the other hand, the less

knowledge of the mother, the least the mother's

management will be. So that mothers who have

insufficient knowledge improperly administer early

childhood diarrhea.

The Correlation of Mothers’ Knowledge of Childhood Diarrhea and Early Management of Acute Diarrhea in Children under Five in Aceh,

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183

Mothers’ knowledge about diarrhea influencing

the behaviour of mothers in providing appropriate

diarrhea

management. The results of the study on

early management found that 62 (72.1%) mothers

gave the ORT to their toddlers whom had the

diarrhea. 52 mothers (60.5%) provide ORT until

diarrhea in toddlers stopped and 64 mothers (74.4%)

replaced ORT with sugar and salt solution if ORT is

not available at home. This shows that the mothers’

early management of acute diarrhea based on the

administration of ORT is in the good category

according to the knowledge of the mother. However,

the management of the zinc administration step has

not been conducted properly by the mother.

The mothers’ behaviour of managing the

diarrhea at home is influenced by several factors

such as the mothers’ level of knowledge. The better

the knowledge, the better their actions in managing

the diarrhea (Kosasih et al., 2015). Meanwhile, the

mothers’ knowledge is influenced by several factors

such as education level, socio-economic factors,

feeding practices and previous experience factors in

managing the disease and ethnicity (Rani et al.,

2016; Ansari, Izham, Ibrahim, & Shankar, 2011).

The research conducted by Khasanah and Sari

(2016).

Diarrhea is a disease that can be prevented and

managed. However, the mothers’ less knowledge

and their inadequate management can result in

toddlers experiencing severe dehydration and the

worst lead to death. However, this situation can be

reduced through the prevention and treatment of

dehydration with ORT and other fluids that available

at home. Moreover, continuing breastfeeding and

feeding also the administration of zinc for 10 -14

days would also help the infants with diarrhea

(Bham, Shah, & Saeed, 2015).

Good management is inseparable from the

mothers’ knowledge in caring for toddlers with

diarrhea. It is necessary to provide the health

education to increase the mothers’ knowledge,

especially regarding the early management of

diarrhea in toddlers. Increasing the knowledge does

not always lead to changes in attitudes and

behaviour but has a positive relationship. By

increasing knowledge, there is a change in attitude

such as the incidence of diarrhea that should be

handled properly (Rahmah, Firmawati, Dwi, &

Lestari, 2016)

The relationship of mother’s knowledge of

diarrhea and the administration of ART showed that

there was a relationship of the mothers’ knowledge

about diarrhea and administration of ORT to

children under-five (p-value = 0.019). This study is

inherent with the research conducted by Rani et al.,

(2016) regarding the mothers’ knowledge of

diarrhea has a significant influence on the practice of

using ORT in diarrhea. The result showed that the

majority of mothers found that ORT was the early

treatment when toddlers had diarrhea. The mothers

knew ORT could replace the fluids and electrolytes

lost due to diarrhea and knew that ORT could be

replaced with a solution contains salt and sugar. The

use of ORT is depend on mothers’ knowledge which

help mothers taking appropriate steps to reduce the

intensity of diarrhea in children under-five and

prevented the dehydration (Padhy, Sethi, & Behera,

2017).

The inaccuracy of the mothers’ approach to

managing diarrhea causes toddlers to experience

severe dehydration. The toddler age group is very

susceptible to dehydration due to high fluid

requirements and muscle mass for storing the fluids.

The loss of 10% of body fluids in toddlers can lead

to death after 2 - 3 days of illness (Grafika, Sabilu,

& Munandar, 2017). Most mothers knew and were

able to prepare sugar - salt solutions. Therapy with

ORT is the right management to prevent dehydration

and effective in preventing deaths from diarrhea in

children under-five. ORT is given to replace fluids

and electrolytes in the body that come out through

the faeces. Most mothers are familiar with ORT as

the early management of diarrhea. Therefore, most

mothers have the ability to manage the diarrhea by

replacing the ORT with sugar and salt solution when

the ORT is not available at home.

In terms of relationship of mothers’ knowledge

of diarrhea and the zinc supplementation provision,

this study revealed that there was no relationship of

mothers’ knowledge about diarrhea and zinc

administration in children under-five (ρ-value =

0.089). This can be caused by a number of factors

such as the less information about the importance of

zinc supplementation. Although several mothers

knew that zinc was given to replace the lost of zinc

(88.4%), this knowledge did not encourage the

mothers to administer the ORT.

ORT are given to replace the lost of fluids and

prevent the dehydration, while zinc is given to

replace zinc lost due to diarrhea and prevent

recurrent of diarrhea (Olopha & Egbewale, 2017).

Zinc deficiency causes impaired immunity, which

can increase the risk of infections, especially

diarrhea. Therefore, it can increase the incidence and

duration of acute diarrhea in children, especially in

children under-five (Agarwal et al., 2018).

Some mothers have less understanding on

providing zinc for the treatment of diarrhea and does

not have zinc stock as well as supplies of ORT at

home. Generally mothers have better knowledge

AINC 2018 - Aceh International Nursing Conference

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about ORT compared to the knowledge about zinc

(Walker et al., 2015). Another study found that 82

mothers (39%) did not realize the importance of

zinc. 126 mothers (60%) did not use zinc tablets

even though the tablets were provided in health

facilities (Tobin, Isah, & Asogun, 2015). The

knowledge of mothers about providing zinc is still

lacking, where many mothers do not know about

zinc tablet and its relation to diarrhea (Humrah,

Safiyanthy, Wong, & Mukarramah, 2018).

The ignorance of the utilisation of zinc tablet is

not surprising since it has not spread widely among

the health workers. As the health care provider to

their children at home, the mothers need the health

information about the management of diarrhea

especially at home (Padhy et al., 2017).

The existing of relationship of mothers’

knowledge about diarrhea and the provision of

nutrition to children under-five implies that the

better the mothers’ knowledge, the better their

actions in providing nutrition to toddlers with

diarrhea. Based on the results of the study 40

respondents who have good knowledge, there are

67.5% who have conducted good management for

nutrition. While from 46 respondents who had

insufficient knowledge, there were 78.3% were in

the poor category for providing the nutrition.

The mothers consider that even though toddlers

experience diarrhea, their nutrition must be fulfilled

to prevent weakness and lose weight. Diarrhea

generally decreases the appetite and makes the body

weak, which causes children not to eat. The situation

will be worse when the children is fasting which

worsens the condition of dehydration and could lead

to death (Amare et al., 2014). In this study, the

majority of mothers (91.9%) persuaded the diarrhea

toddlers to keep eating. There were 60.5% of

mothers did not reduce the food intake and

continued their food during diarrhea. There were

82.6% mothers provide additional food after the

toddlers experienced diarrhea. Moreover, there were

90.7% of mothers provide intermittent food to

supplement the nutrition to their toddlers.

This study inherent with Gut et al., (2017), where

most mothers provide soft or liquid food to toddlers

when diarrhea. The provision of food continues

during the diarrhea such as breastfeeding, bottle

feeding or solid food (Padhy et al., (2017). The age

of the mother also effects them in caring for

toddlers. The majority of respondents were in the

range of 21 - 40 years (91.9%) where most mothers

tend to be active in seeking information, especially

regarding their toddlers’ health, including nutrition

that must have met when toddlers experiencing the

diarrhea. Continuing feeding the toddlers during and

after the diarrhea aims to fulfill the nutrition needed

by the toddlers during the recovery process.

Nutrition is needed in toddlers suffered from the

diarrhea since many nutrients are lost due to diarrhea

including the nutrients. There are no food

restrictions that must be consumed by children

under-five during the diarrhea recovering process.

5 CONCLUSIONS

The study revealed that there was a relationship of

mothers’ knowledge about diarrhea and the early

management of diarrhea in infants, especially for the

administration of ORT and nutrition. However, there

was no correlation of mothers’ knowledge about

diarrhea and the administration of zinc

supplementation.

This study also shows that mothers have

practiced good early management in children under

five with the acute diarrhea. Mothers had given ORT

and continue to provide the children with adequate

nutrition during diarrhea to prevent dehydration,

weight loss and speed up the recovery process of

diarrhea. This could not be achieved without good

knowledge. Therefore, mothers’ knowledge about

diarrhea is very crucial in increasing the early

management of acute diarrhea in children under five.

The mothers who had good knowledge will provide

good early acute diarrhea management. However,

the mothers’ knowledge regarding zinc

supplementation is expected to be improved through

the health promotion in the form of counselling and

demonstration. Therefore, the mother knows the

importance of zinc to manage the diarrhea as well as

the importance of ORT in managing the diarrhea to

children under five. Mothers who have good

knowledge will provide good early acute diarrhea

management. However the mother's knowledge

regarding zinc supplementation is expected to be

improved through health promotion in the form of

counselling and demonstration so that the mother

knows the importance of zinc to cure diarrhea as

well as the importance of ORS.

ETHICS APPROVAL

This study obtained the ethics approval from the

Ethic Committee of Nursing Faculty, Syiah Kuala

University in Banda Aceh Indonesia.

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