Discussion
This study assessed the knowledge of mothers about the critical signs of diarrhea. About 49% of the mothers stated that the passage of three or more loose stools with blood during the day is an obvious critical sign of diarrhea that require hospital or physician visit, and almost 23% reported no knowledge of any critical sign of diarrhea. These results showed low knowledge among Saudi mothers about the critical sings of diarrhea, but their knowledge of the critical signs of diarrhea were higher compared to other mothers in different communities. A study carried out in Ethiopia found that 39.5% of mothers stated that passage of three or more loose stools with blood during the day is mark of severe diarrhea.15 A similar study was done in rural setting of Kenya determined that majority of mothers (76.4%) did not identify the critical signs of childhood diarrhea.16 A study from Nepal reported that 20.8 % of mothers identified the red-colored diarrhea as “the most dangerous diarrhea”.2 The critical signs of dehydration have the similar importance of bloody diarrhea, and the participating mothers in our study were unable to identify the most common signs of dehydration. Only 32.1%, 11.6%, and 24.3% were able to recognize thirst/dry mouth, tearless eyes, and loss of strictness of skin respectively as the critical signs of dehydration secondary to diarrhea. The poor knowledge and unrecognized sings of dehydration among mothers are noticed globally. 2,17-19 Adequate knowledge of mothers about the critical sings of childhood diarrhea is essential as the early referral of child with severe diarrhea is fundamental for appropriate treatment. 15
Poor sanitation of food and water may lead to diarrhea with approximately 3000 deaths and 135,000 hospitalizations annually secondary to food-borne transmission of diarrhea causative pathogens in the United States.20 With the regards for the causes and transmission of diarrhea, nearly 50 % of participating mothers believed that eating polluted food is the most common cause of childhood diarrhea, and only 31 % of mothers identified drinking unclean water as the reason for childhood diarrhea. In consistent with our findings, many studies reported low level of mothers towards causes and transmission of diarrhea.2,16,22 A study from Nigeria reported that the most common causes for childhood diarrhea were contaminated food (24.1%) and unclean water (11.3%).8 Another study from Iran showed that only 24.66% of mothers knew that the unclean water can cause diarrhea.22 A study was carried out in Malawi reported that 55 % of mothers stated that unhealthy water is the main causes of diarrhea.23 The change in knowledge of childhood diarrhea could be due to variance in mothers’ education levels.
The misconception between teething and diarrhea seems disseminated widely. The results of present study showed that 66 % of mothers stated teething is a reason of their children diarrhea. These results come agreed with other studies from different countries.8,22 In addition to the wrong belief of association between diarrhea and teething, mothers tend to consider diarrhea secondary to teething as “non-serious diarrhea”, and they may deal with it loosely even if it’s accompanied by critical signs like dehydration.24 The efforts should be applied to educate the mothers about the critical signs of children diarrhea and to disassociate the belief link between diarrhea and teething.
The mothers’ sufficient knowledge on reasons, prevention and management of diarrhea utilizing proper therapies is the key for home management of childhood diarrhea.14,25 According to the Integrated Management of Childhood Illness (IMCI) guidelines, the use of ORS is the principle therapy of diarrhea 26. However, the use of ORS seemed not highly encouraging among mothers. Although of 62 % of our participating mothers knew about the ORS, only 23.5 % of them used it for their children. Similar findings were reported. A study from Nigeria reported that most of mothers (63%) were aware of ORS, but 27% of them used it for their children.8 In another study did in Pakistan mentioned that 58% mothers used ORS to treat their childhood diarrhea disease. 12 Also in our study, it was found the main resources of mothers regarding ORS usage were medical prescriptions (50.3%), family/relatives/friends (15.7%), and pharmacists (15.1%). In a similar study the two main resources of ORS information were families/friends (76%) and pediatricians (58%). 27Despite of 53.3 % of our participants reports that “ORS prevents a child from getting dehydrated”, few mothers are using ORS (23.5%). The reason for a few mothers used ORS could be due to their level of education and awareness of the mothers on diarrhea management due to inadequate public information on this issue.
Due to the high rate of literacy and social media usage among Saudis,28,29 and the aim of study to assess the knowledge, attitude, and practice of mothers towards childhood diarrhea from community perspective, the study was conducted online to diminish geographical dependence. The study was performed with significance that mothers’ knowledge of childhood diarrhea prevention and management would decrease the unnecessary hospital or clinic visits; however, most of the participating mothers (68.9%) seek treatment from medical doctor for their children with diarrhea. This practice of mother was observed in previous study. 15 In contrast, our subjects showed good preventive measure. The majority of mothers (70.9 %) believed that handwashing, which is one essential measure to decrease the prevalence of diarrhea, 30 prevents childhood diarrhea.
CONCLUSION
About of 40.3 % of participating mothers believed that childhood diarrhea is major problem in Saudi community. These beliefs are supported by reports mentioned the prevalence of diarrhea is high in some area of Saudi Arabia.1 However, insufficient knowledge of childhood diarrhea and its management were observed. Adequate knowledge of mothers about the critical sings, causes, transmission, prevention, and management of childhood diarrhea should be applied in simple language to communicate the health-related information in clear manner. Also, There is a lack between the understanding the role of ORS and its use. Understanding of ORS is not adequate and it needs reliable efforts to highlight on importance of ORS in resolving dehydration of childhood diarrhea.