ABSTRACT
Diarrhea is a deadly disease affecting
both young and old, however causing high morbidity and mortality in children
under the age of five years around the world, particularly in sub-Saharan
Africa, with a recorded high prevalence among children who attend daycare
centers. In Ogun State, diarrhea prevalence
among children under age five was reported at 10.3%, the highest compared to
other South-Western states in Nigeria. This
main objective of this study was to assess the Prevention and Treatment
Responsiveness of Caregivers of under-5 year olds, towards Diarrhea Illness, in
Daycare Centers, in Abeokuta, Ogun State, Nigeria
Descriptive
cross-sectional design was used in this study. Data were collected using a
structured questionnaire. Simple random sampling technique was used to select
60 daycare centers within Abeokuta South LGA, Ogun State, from which
questionnaires were administered to 406 caregivers. The
data obtained from validated questionnaires were collated and analyzed using
Statistical Package for Social Science (SPSS) version 21.0. Correlation,
Regression, ANOVA and Cronbach’s Alpha test were the analyses that were done
for hypotheses testing and variable calculation.
The findings revealed
that the level of knowledge of respondents was low 5.49±1.69
(36.62%) on a 15-point rating
scale, attitude was average12.13±3.98 (67.37%) on an 18-point rating
scale, perception was low9.77±2.84 (40.71%) on a 24-point rating scale, prevention and treatment responsiveness was low13.75±3.64
(45.83%) on a 30-point rating
scale. Using regression analysis, the study showed that
there was a significant relationship between the daycare center
benefits/constraints (monthly salary) and responsiveness towards diarrhea
illness among the respondents in this study (R2 = 0.028; p<0.05), there was a significant
relationship between the level of knowledge and responsiveness towards diarrhea
illness among the respondents in this study (R2 = 0.22; p<0.05), and also
thatthere
was a significant relationship between the perception and responsiveness
towards diarrhea illness among the respondents in this study (R2 =
0.125; p<0.05). However, from the
analysis, level of knowledge of the respondents was the most significant
predictor of responsiveness at 22% compared to perception at 12.5% and daycare
center benefits/constraints (monthly salary) at 2.8%.
This study concluded that the level of
knowledge of the caregivers about diarrhea was the most significant predictor
of responsiveness compared to perception and daycare center benefits and
constraints (monthly salary). It is therefore recommended that public health
interventions should be targeted at daycare centers. Interventions should also
be designed as health education and promotion training modules, spanning across
effective childcare topics. Caregivers should then be routinely trained by
daycare center administrators and overseeing government authorities, to improve
their knowledge about diarrhea/other infectious diseases, and their overall
responsiveness to illness.
CHAPTER
ONE
INTRODUCTION
1.1 Background to the
Study
Diarrhea is a deadly illness that
affects both adults and children. It accounted for 9% of all deaths among
children under the age of 5 years in 2015. This percentage of mortality means,
over 1,400 young children die every day, or about 530,000 children every year (UNICEF, Diarrhoeal
Disease, 2016) .
The worldwide fight against diarrhea has been on for long as indicated by one
of the goals of the 1990 World Summit for Children. This goal is to ensure
childhood survival and healthy development through reduction by 50% in the
deaths due to diarrhea in children under the age of 5 years and 25% reduction
in the diarrhea incidence rate by the year 2000 (UNICEF, Information Publications,
1990) .
Most deaths from diarrhea occurred among
children of less than 2 years of age living in South Asia and sub-Saharan
Africa (UNICEF, Diarrhoeal Disease, 2016) . Among the low- and
middle-income countries in five WHO regions (Americas, Western Pacific, Eastern
Mediterranean, South East Asia and Africa Regions), Boschi-Pinto, Velebit, and Shibuya (2008), found that Africa and
South East Asia Regions assemble together 78% (1.46 million) of all diarrhea
deaths occurring in the developing world out of the model-based global point
estimate of 1.87 million (uncertainty range: 1.56–2.19). In 2015, Nigeria
contributed 15% to the global estimate of all death due to diarrhea among
children under the age of 5 years. This translates into 76,980 under-5
mortalities yearly, the second highest data recorded for a country (WHO & MCEE, UNICEF, 2016) .
The Millennium Development Goal (MDG) 4,
whose target was to reduce by two thirds, between 1990 and 2015, the under-five
mortality rate, achieved substantial progress with a worldwide decline in
under-five deaths from 12.7 million in 1990 to 5.9 million in 2015. The
remarkable decline in under-five mortality since 2000 saved the lives of an
estimated 48 million children. Despite these substantial gains, the progress
recorded were insufficient to achieve the MDG 4 target (WHO, Global Health Observatory (GHO) data: Child health, 2015) . Understanding that
diarrhea contributes 9% to this current rate means that a decrease in the
number of under-5 deaths caused by diarrhea in every WHO region, would result
in a corresponding decline in the global under-five mortality rate. This would
in turn contribute towards achievement of Sustainable Development Goal (SDG) 3,
with target 3.2 being to end preventable deaths of newborns and children under
5 years of age, with all countries aiming to reduce neonatal mortality to at
least as low as 12 per 1,000 live births and under-5 mortality to at least as
low as 25 per 1,000 live births by 2030 (UN, 2015) .
1.2 Statement of the Problem
A high incidence of diarrhea has been
observed amongst children attending daycare centers, as obtained from earlier
researches. Jensen, et al. (2016) found from their one year cohort study that 143
cases of diarrhea were reported by parent-based assessment from a sample size of 179 Danish children
attending daycare centers. The findings from a systematic review of other
daycare center researches between 1978 and 2005 showed
that children cared for at daycare centers exhibit a two to three times greater
risk of acquiring diarrhea and other infectious diseases, with rates of attacks
during diarrhea outbreaks varying between 50 to 71% (Nesti & Goldbaum,
2007). One key factor identified to be associated with diarrhea
prevalence and incidence amongst children under age 5 who attend daycare
centers is the poor infection prevention practices of caregivers resulting in
contamination of the daycare center physical environment with diarrhea-causing
enteric bacteria (Itah & Ben, 2004). In Ogun
State, the diarrhea prevalence among children under age five was reported at
10.3%, the highest compared to other South-Western states in Nigeria (National
Bureau of Statistics, 2015) . Diarrhea-causing enteric parasites
were also found to be more prevalent in the stool samples of children attending
daycare centers in Ogun (Olaitan & Adeleke,
2006)
and Oyo States (Mathew, et al., 2014) compared to children
who did not attend daycare centers.
This problem of diarrhea in daycare
centers can be viewed from different standpoints, however this research intends
to focus on the behavior of caregivers in daycare centers, with a mind to assessing
to what extent their knowledge, attitude and perception of diarrhea, as well as
benefits and constraints of the daycare establishment is associated with their
corresponding responsive health behavior in terms of diarrhea prevention and
treatment.
1.3 Objective of the
Study
The general objective of this study is
to assess the Prevention and Treatment Responsiveness of Caregivers of under-5
year olds, towards Diarrhea Illness, in Daycare Centers, in Abeokuta, Ogun
State, Nigeria. The specific objectives are to:
- identify
the socio-demographic characteristics of caregivers in daycare centers in
Abeokuta, Ogun State;
- identify
daycare center benefits and constraints faced by caregivers of under-5
year olds in daycare centers in Abeokuta, Ogun State;
- determine
the level of knowledge of diarrhea illness among caregivers of under-5
year olds in daycare centers in Abeokuta, Ogun State;
- determine
the attitude of caregivers of under-5 year olds towards diarrhea illness
in daycare centers in Abeokuta, Ogun State;
- determine
the perception of diarrhea illness among caregivers of under-5 year olds
in daycare centers in Abeokuta, Ogun State;
- assess
the responsiveness towards diarrhea illness among caregivers of under-5
year olds in daycare centers in Abeokuta, Ogun State;
- identify
which of thevariables in this study predicts responsiveness more
significantly;
- determine
if a significant relationship exists between the daycare center
benefits/constraints (monthly income) and responsiveness towards diarrhea
illness among the respondents in this study;
- determine
if a significant relationship exists between the level of knowledge and
responsiveness towards diarrhea illness among the respondents in this
study;
- determine
if a significant relationship exists between the attitude and
responsiveness towards diarrhea illness among the respondents in this
study and
- determine if a significant relationship exists between the perception and responsiveness towards diarrhea illness among the respondents in this study.
1.4 Research Questions
The
research questions that guided this study are:
- What
are the socio-demographic characteristics of the caregivers in daycare
centers in Abeokuta, Ogun State?
- What
are the daycare center benefits and constraints faced by caregivers of
under-5 year olds in daycare centers in Abeokuta, Ogun State?
- What
is the level of knowledge of diarrhea illness among caregivers of under-5
year olds in daycare centers in Abeokuta, Ogun State?
- What
is the attitude of caregivers of under-5 year olds towards diarrhea
illness in daycare centers in Abeokuta, Ogun State?
- What
is the perception of diarrhea illness among caregivers of under-5 year
olds in daycare centers in Abeokuta, Ogun State?
- What
is the responsiveness towards diarrhea illness among caregivers of under-5
year olds in daycare centers in Abeokuta, Ogun State?
- Which
of the variables in this study predicts responsiveness more significantly?
1.5 Justification for
the Study
The number of working mothers with
growing careers has increased over past decades, as seen from the increase in
the percentage of women joining the Nigeria Labor force from 34.1% in 1990 to
42.4% in 2014 (The World Bank, 2016). With mothers being the primary caregivers for
young children in homes, this labor force trend suggests a corresponding
increase in the use of non-parental care during early childhood, with a high
preference for Crèches or Day care centres, as shown by studies carried out
among different categories of working parents in South-Western States in
Nigeria (Akinnubi, 2016; Gbadegesin & Alabi, 2014). Labor Force
Forecast for Nigeria show that the female share of the labor force will
increase from its current 42.99% in 2016 to 46.01% in 2030 (International Futures, 2016) . This would
indirectly increase the number of children who will be enrolled in daycare
centers. It is therefore important to the young child, parents/guardian and
nation at large for an assurance of the highest possible level of care by
caregivers in daycare centers.
Unfortunately, previous studies have
shown that children who were often looked after by people other than their
mothers – as is the case in daycare centers - had higher diarrhea incidence
rates than those whose primary care-givers were their mothers (Oni, Schumann, & Oke, 1991) .
The generally poor health-seeking
behavior of these care-givers which comprise both prevention and treatment
practices have been identified to contribute largely to diarrhea transmission
in the daycare centers. (Itah & Ben,
2004).
Despite the volume of researches that
have been done in daycare centers, nothing has been done to measure the
responsiveness of daycare center caregivers towards diarrhea, as well as trying
to determine what modifying factors determine this responsiveness. Many studies
on diarrhea and other communicable diseases carried out in daycare centers have
primarily focused on clinical approaches and enrolled the parents or guardians
of the daycare attendees as respondents during data collection. The data
obtained from some other research work show results of laboratory analysis of
body fluid samples obtained from children under age 5 attending the daycare
centers.
The unique approach being proposed by
this study is the application of health education and health promotion model in
diagnosing and showing linkages between behavioral concepts that make up the
research hypotheses. This research would primarily focus on caregivers in
daycare centers and how their knowledge, attitude, perception and other
socio-demographic factors determine their responsiveness to diarrhea illness.
Results from this study will release information that would inform future
interventions on diarrhea prevention and treatment particularly in daycare
centers.
1.6
Hypotheses
The hypotheses for the study are:
H1 There
is a significant relationship between the daycare center benefits/constraints
(monthly income) and responsiveness towards diarrhea illness among the
respondents in this study
H2 There
is a significant relationship between the level of knowledge and responsiveness
towards diarrhea illness among the respondents in this study
H3 There
is a significant relationship between the attitude and responsiveness towards
diarrhea illness among the respondents in this study
H4 There
is a significant relationship between the perception and responsiveness towards
diarrhea illness among the respondents in this study.
1.7 Operational
Definition of Terms
Diarrhea: Three
or more loose or liquid stools per day (or more frequent passage than is normal
for the individual) (UNICEF, Diarrhoeal Disease, 2016) .
Daycare Center: This
is sometimes otherwise called creches or nursery homes, and refers to a
childcare setting where children are cared for by caregivers other than their
parents for the period during which the parents are at work.
Caregivers: For
the purpose of this study, caregivers refer to either male or female employees
of daycare center owners. Their primary duty is to provide care for the
children enrolled in the
Responsive behavior:
This refers to the rights of individuals to adequate and timely preventive and
treatment healthcare. Responsive behavior has been defined by a previous study
as ‘a sequence of remedial actions that individuals undertake to rectify
perceived ill- health’ (Mahmood, Iqbal, &
Hanifi, 2009).
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