COVER PAGE

STRATEGIES FOR THE PREVENTING DIARRHEAL DISEASE AMONG

UNDERFIVE CHILDREN LIVING IN YAN MANGWARORA

AREA GUSAU ZAMFARA STATE.

AISHA SANI JANGERU

INDEX NO:2022/3601/119179/M

ZAMFARA STATE SCHOOL OF NURSING MIDWIFERY, GUSAU

1
 SEPTEMBER, 2022

TITLE PAGE

STRATEGIES FOR THE PREVENTING DIARRHEAL DISEASE AMONG

UNDERFIVE CHILDREN LIVING IN YAN MANGWARORA

AREA GUSAU ZAMFARA STATE.

BY

AISHA SANI JANGERU

SCHOOL OF BASIC MIDWIFERY

ZAMFARA STATE SCHOOL OF NURSING MIDWIFERY, GUSAU

IN PERTIAL FULFILLMENT OF THE REQUIREMENT OF NURSING AND MIDWIFERY

COUNCIL OF NIGERIA FOR THE AWARD OF “REGISTED MIDWIFE” CERTIFICATE

2
 SEPTEMBER, 2022

DECLEARATION PAGE

This is to declare that this Research Project Titled Strategies For The Prevention of
Diarrheal Disease Among Under five Children Living in Yan Mangwarora Area Gusau.
Was carried out by Aisha Sani Jangeru I solely the result of my work except where
acknowledged has being derived from other person(s) or resources.

EXAMINATION NUMBER: ______________________________________

(DEPARTMENT/ SCHOOL) SCHOOL OF MIDWIFERY

SIGNATURE: ____________________________________________

DATE: __________________________________________________

3
 CERTIFICATION PAGE

This is to certify that, this research work was conducted by Aisha Sani Jangeru and was
supervised by Malam Habibu Muhammad Gummi for the Award of Basic Midwifery
Certificate by Nursing and Midwifery council of Nigeria.

Exam No: ____________________

Sign: ____________________ Date: __________

Name: Malam Habibu Muhammad Gummi

Project Supervisor

Sign: __________________ Date: __________

Name: Inno Umar R/Doruwa

Head of Department

Sign: __________________ Date: __________

Chief Examiner

4
 DEDICATION

This project is dedicated to Almighty Allah, the sustainer and marciful who gave me the
opportunity to initiate and complete this work, may his (Allah) blessings and peace be opon our
prophet Muhammad (SAW).

Also to my parents, Alhaji Sani Muhammad Jangeru and Hajiya Saudatu Abubakar for their endless Love,
moral and spritual support. May Allah reward them abundantly in the present and in the hereafter
Aameeen.

ACKNOWLEDGEMENT

To almighty Allah be the glory and honor for strength, protection and guidance given to me
during the period of my training. May peace and blessings of Allah be upon his noble prophet
Muhammad (SAW), his family, companions and those who follow his path till the last day.

My sincere gratitude goes to my parents Alhaji Sani Muhammad Jangeru and Hajiya Saudatu
Abubakar for their enendless love, care , financial contributions and prayers towards my
success. I really feel honoured and blessed to have them as parents May Allah ( SWA) reward
them with jannatul Firdausi Aameeeen.

Special appreciation goes to my able supervisor, Malam Habibu Muhammad Gummi for his
untiring guidance, support and encouragement in the course of this research. My special thanks
to the principal midwifery department Malama inno umar ruwan doruwa.

5
Special thanks to my able class coordinator Malama Hadiza mustapha for her support, prayers
and guidance through thick and thin to ensure our success May Allah (SWA) bless and reward
her with jannatul Firdaus Ameeen.

Words cannot express my gratitude to my one and only Grandmother Hajiya Halimatu
Abdullahi Shinkafi for her love, care, advice, continues prayers and words of encouragement
through out the period of my training. Also a big and great thanks goes to my beloved mummy
Hajiya Bilkisu Muhammad for her prayers and support during my study period.

Exceptional thanks goes to my beautiful family members especially Zulkifilu, Imrana, Nafisa,
Fatima, Al'ameen, Abdul azeez, Amina, Asma'u, Hassana and Hussaina, Nusaiba, Ahmad, Aliyu
and Anas for their love and prayers may Allah continue to guide and protect you all

Great thanks to my colleagues and friends especially Zainab mahe, Halimatu, Hawwah,
Hussaina, Rabi'atu, Amina, Maryam, Faiqa, Hafsa, Sha'awa, Shamsiyya (Dan nana) and all the
entire BM/19 thanks and loves you all.

Also, I wish to express my appreciation to my lovely and caring brother Dr. Ibrahim Abubakar
for his love, care, support and prayers throughout the course of this study. Words cannot
describe how important he is to me.

ABSTRACT

This study was carried out to find out the strategies for the prevention of diarrhoeal disease Among
underfive children in Yan mangwarora area gusau zamfara state. The objectives of the study are to find
out the possible causes of diarrhoea among under five children. To find out the effects of diarrhoea
among under five children. To determine the strategies that can be adopted in preventing diarrhoea
among under five children. Descriptive survey design was used for the study, the target population were
people of Yan mangwarora area gusau zamfara state and the sample size was 240 mothers, simple
random sampling was used to select the sample size. the instrument for data collection was a set of
structured questionnaires consisting of four (4) sections A - D and had 22 items, section A was on socio

6
demographic data while section B - D were constructed based on the research questions that guided the
study. Mean while 245 questionnaires were distributed by the researcher and 240 questionnaires were
retrieved. The data was analyzed using frequency distribution table. Based on the findings the researcher
recommended that:- Health care facilities should be fully equipped with man powerWorking condition
should be made conducive to provide job satisfaction,Capacity building of health workers,Government
should improve health care system capacity by ensuring a health facility has a reliable supply of drugs
and equipments for health care delivery. Mass media sensitization of parents on the importance of going
to hospital early for medical treatment.

TABLE OF CONTENT

7
Title page

Declaration page

Certification page

Dedication

Acknowledgement

Abstract

Table of contents

Appendixes

CHAPTER ONE: INTRODUCTION

1.1 Background to the study

1.2 Statement of problem

1.3 Objectives of the study

1.4 Research questions

1.5 Significance of the study

1.6 Scope of study

1.7 Operational definition of terms

CHAPTER TWO: LITERATURE REVIEW

8
2.1 Conceptual Review

2.2 Theoretical Review

2.3 Empherical review

CHAPTER THREE: METHODOLOGY

3.1 Research Design

3.2 Research setting

3.3 Target population

3.4 Sampling Size

3.5 Sampling technique

3.6 Instruments for data collection

3.7 Validity of instrument

3.8 Reliability of Instrument

3.9 Method of data collection

3.10 Method of data analysis

3.11 Ethical considerations

CHAPTER FOUR: RESULTS

DATA ANALYSIS AND INTERPRETATION

9
CHAPTER FIVE: DISCUSSION OF FINDINGS

5. 1 Discussion of findings

5. 2 Key Findings

5.3 Discussion of Findings and Relationship with Literatures

5.4 Implications of findings to Nursing

5. 5 Limitations of the Study

5.6 Summary of the study

5.7 Conclusion

5.8 Recommendations

5.9 Suggestions for Further Studies

REFERENCES

APPENDIX A

CHAPTER ONE

INTRODUCTION

10
1.0 Background of the study

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more

frequent passage than is normal for the individual). Frequent passing of formed stools is not

diarrhoea, nor is the passing of loose, "pasty" stools by breastfed babies (Lucas, 2019 )

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a

variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food

or drinking-water, or from person-to-person as a result of poor hygiene (UNICEF, 2014 )

Diarrhoeal disease is the second leading cause of death in children under five years old, and is

responsible for killing around 525 000 children every year. Diarrhoea can last several days, and

can leave the body without the water and salts that are necessary for survival. In the past, for

most people, severe dehydration and fluid loss were the main causes of diarrhoea deaths. Now,

other causes such as septic bacterial infections are likely to account for an increasing proportion

of all diarrhoea-associated deaths. Children who are malnourished or have impaired immunity as

well as people living with HIV are most at risk of life-threatening diarrhea (WHO, 2014 ).

Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly

results from contaminated food and water sources. Worldwide, 780 million individuals lack

access to improved drinking-water and 2.5 billion lack improved sanitation. Diarrhoea due to

infection is widespread throughout developing countries (Colegero. 2013 ).

Diarrheal diseases which is one of the leading reason behind global mortality and morbidity is

more threatening for infants and young children. Childhood diarrhoea is becoming increasingly

prevalent disease in developing countries like India. Moreover, it is a major cause of malnutrition

that contributes towards third major cause of under 5 mortalities (WHO, 2020 ). 

11
In low-income countries, children under three years old experience on average three episodes of

diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a

result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to

fall ill from diarrhea ( Unicef, 2014).

Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is

of particular concern. Animal faeces also contain microorganisms that can cause diarrhea (Gilles,

2019 ).

The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and

electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit,

sweat, urine and breathing. Dehydration occurs when these losses are not replaced (Rajagopalan,

2013 ).

Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms,

most of which are spread by faeces-contaminated water. Infection is more common when there is

a shortage of adequate sanitation and hygiene and safe water for drinking, cooking and cleaning.

Rotavirus and Escherichia coli, are the two most common etiological agents of moderate-to-

severe diarrhoea in low-income countries. Other pathogens such

as cryptosporidium and shigella species may also be important. Location-specific etiologic

patterns also need to be considered (WHO, 2014 ).

Children who die from diarrhoea often suffer from underlying malnutrition, which makes them

more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes their malnutrition even

worse. Diarrhoea is a leading cause of malnutrition in children under five years old ( Warner,

2016).

12
In the developing countries, on an average three times in a year an under 5 child suffer from

diarrhoea. Five countries India, Nigeria, Congo, Pakistan and China together contribute for half

of the diarrhoea death among children (4.249 Million) in 2008 (Johnson, 2018).

The National Family Health Survey shows that the prevalence of childhood diarrhoea has

increased from 9% to 9.2% from 2016 to 2020 in India. It is the third most common responsible

disease for under five mortality.Profound studies have revealed that under five mortality persists

due to diarrhoea in India. It is, thus, clear that this disease is a major public health issue in India.

A study shows that under-five mortality and infant mortality (IMR) has been reduced to 50% and

41% in 2016 from 74% and 57% in 2005 (Souris, 2020)

Furthermore, Kamath et al. (2018), have mentioned that among the states Uttar Pradesh and

Assam have shown more prevalence of childhood diarrhoea deaths than rest of the states of

India.Some more studies have shown mother's age, age of child, social class, religion, residence

and wealth index have influence on childhood diarrhea cases in India.

In Nigeria, the prevalence of childhood diarrhea is 10 percent, with 26 percent of cases treated

with oral rehydration salts (ORS) solution. Diarrhea also accounts for more than 16 percent of

deaths, estimated at 150,000 annually, among children under five years old (NPC, 2013).

In Nigeria, north-south regional variations have been reported in the prevalence of diarrheal

disease, with northern Nigeria being more severely affected.The estimated childhood mortality

secondary to diarrhea in Nigeria is about 151, 700–175,000 annually (NPC, 2014).

The high prevalence of childhood diarrhea and its associated mortality rate in the northern part of

Nigeria, especially sokoto, Kebbi and Zamfara is what motivated researcher to carry out a

13
research work on finding out the strategies for prevention of diarrhea disease among under five

children in rowan dorowa village of Maru local government of Zamfara state, Nigeria

1.1 Statement of the Problem

The current prevalence of childhood mortality associated with diarrhea in gusau local

government and yan mangwarora area is unprecedented. Under five year children are dying

every day, with many currently on admission in both gusau PHC and General Hospital gusau

respectively. This is what stimulated the researcher to embark on finding out the strategies that

can be adopted in preventing diarrhea disease among under five children. The diarrhea

prevalence rate in Nigeria is 18.8%. Diarrhea account for over 16% of child death in nigeria and

estimated 150,000 deaths mainly amongst children under five year occur annually due to this

diseases mainly caused by poor sanitation and hygiene practice. (WHO Global reporters for

research in infection diseases of poverty 2015). In Nigeria diarrhea is responsible for almost all

child’s death in every year, Nigeria was estimated to have a total number of annual child death

due to diarrhea to be 151,700 (WHO 2013). Diarrhea was the most commonly reported cause of

water borne infection in the North West in Nigeria which include Kano, Jigawa, Katsina, Sokoto,

Kebbi, Zamfara and Kaduna with prevalence rate of 10%. (Unicef State of World children 2013).

1.2 Objective of the StudyStudy

1.To find out the possible causes of diarrhea among under five children

2.To find out the effects of diarrhea among under five children

14
3.To determine the strategies that can be adopted in preventing diarrhea among under five

children

1.3 Research Questions

1. What are the causes of diarrhea among under five children

2. What are the effects of diarrhea on under five children

3. What are the possible strategies that can be use to prevent diarrhea disease among under five

children

1.4 Significance of the Study

The study will be beneficial to under five children in particular because there will be strong

strategies that will prevent them from getting diarrheal disease, therefore, increase their chances

of survival if the suggestions made by the researcher are implemented

The study will be beneficial to the community because there will be decrease in under five years

mortality if the suggestions made by the researcher are implemented

The state government will also benefit from the study because there will be less financial burden

on the government on management of diarrheal disease among under five years children if the

suggestions made by the researcher are implemented

1.5 Scope of the Study

The study covers the community based –Strategies for prevention of diarrhea diseases among

under five years children. The scope of this study is limited to children under five years of age

15
while the data collection is also limited to ‘yan mangwarora area gusau local government

Zamfara state.

1.6 Operational Definition of Terms

Strategies- ways of stopping something or doing something

Prevalence -is a statistical concept referring to the number of cases of a disease that are present

in a particular population at a given time, whereas incidence 

Diarrhea -is characterized by loose, watery stools or a frequent need to have a bowel movement.

Disease - a disorder of structure or function in a human, animal, or plant, especially one that

produces specific symptoms or that affects a specific location and is not simply a direct result of

physical injury

WHO- world Health Organization

ORS- Oral Rehydration Salt

ORT- Oral rehydration Therapy

Salt solution- mixture of salt and water

CHAPTER TWO

16
 LITERATURE REVIEW

This chapter deals with related literature on diarrhea among under five children. It was discussed

under the following subheadings;

 Conceptual Review

 Empirical Review

 Causes of diarrhea among under-five children

 Effects of diarrhea among under five years’ children

 Possible strategies that can be use to prevent diarrhea disease among under five years’

children

 Theoretical Frame Work

2.1 Conceptual Review

Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more

frequent passage than is normal for the individual). Frequent passing of formed stools is not

diarrhoea, nor is the passing of loose, "pasty" stools by breastfed babies (Molback, 2014).

Diarrhoeal disease is the second leading cause of death in children under five years old, and is

responsible for killing around 525 000 children every year. Diarrhoea can last several days, and

can leave the body without the water and salts that are necessary for survival. In the past, for

most people, severe dehydration and fluid loss were the main causes of diarrhoea deaths. Now,

other causes such as septic bacterial infections are likely to account for an increasing proportion

of all diarrhoea-associated deaths. Children who are malnourished or have impaired immunity as

well as people living with HIV are most at risk of life-threatening diarrhea (WHO, 2014).

17
Globally, an estimated 2 billion cases of diarrheal disease occur each year. Also, around 1.9

million children under the age of 5 years — mostly in developing countries — die from diarrhea

every year (WHO, 2013).

Diarrhea is characterized by abnormally loose or watery stools. Most cases of diarrhea are due to

bacteria, viruses, or parasites. Digestive system disorders can also cause chronic diarrhea.

If a person frequently passes stools but they are of a normal consistency, this is not diarrhea.

Similarly, breastfed babies often pass loose, sticky stools. This is normal (Santosham et’al,2011).

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a

variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food

or drinking-water, or from person-to-person as a result of poor hygiene (UNICEF, 2014).

Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and

hand washing with soap can reduce disease risk. Diarrhoea should be treated with oral

rehydration solution (ORS), a solution of clean water, sugar and salt. In addition, a 10-14 day

supplemental treatment course of dispersible 20 mg zinc tablets shortens diarrhoea duration and

improves outcomes (UNICEF, 2014).

There are three clinical types of diarrhoea: acute watery diarrhoea – lasts several hours or days,

and includes cholera; acute bloody diarrhoea – also called dysentery; and persistent diarrhoea –

lasts 14 days or longe (WHO,2014)

Diarrhoeal disease is a leading cause of child mortality and morbidity in the world, and mostly

results from contaminated food and water sources. Worldwide, 780 million individuals lack

18
access to improved drinking-water and 2.5 billion lack improved sanitation. Diarrhoea due to

infection is widespread throughout developing countries (UNICEF, 2014).

In low-income countries, children under three years old experience on average three episodes of

diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a

result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to

fall ill from diarrhea (UNICEF, 2014).

The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and

electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit,

sweat, urine and breathing. Dehydration occurs when these losses are not replaced (Bryce,

Terreriet’al, 2015).

The Millennium Development Goals (2018) calls for a reduction of child mortality by two third

between 1990 and 2015, the reality is that although progress is being made, much more remains

to be done. The prevalence rate of diarrhoea in Nigeria is 18.8% and is a menace in sub-Sahara

Africa; and in this part of West African it accounts for an estimated 150,000 deaths yearly

amongst children under five due to poor hygienic and sanitary practices.

Diarrhoea’s status as the second leading killer of children under five is an alarming reminder of

the vulnerability of children in Nigeria, saving the lives of millions of children at risk of death

from diarrhoea is possible with a comprehensive strategy that ensures all children in need receive

critical prevention and treatment measures. This report is written with the intent to let our

government re-focus her attention on the prevention and management of diarrhoeal diseases as

central to improving child survival in the country and justify the need to embrace Sustainability

Development Goals (SDGs) set by WHO to achieve universal access to clean water and basic

19
sanitation, which is the primary preventive measures to reduce the burden of diarrhea in the

country (WHO, 2014 ).

Diarrhoea is a form of gastrointestinal infection caused by a variety of bacterial, viral and

parasitic organisms or through contaminated food or drinking water, or from person to person as

a result of poor hygienic practices. If Left untreated, diarrhea can typically last several days.

Diarrhoea remains a major cause of mortality among under-age children (mostly under 5years)

around the world, especially in developing world (Black, Cousens et’al, 2018 ). 

The burden of Diarrheal disease seriously affects young children in developing countries whose

incidence rates is high due to inadequate water, poor sanitation and suboptimal breastfeeding,

zinc and vitamin A deficiency (Lambati, fisher et’al, 2011 ).

Vulnerable children living in impoverished and undeveloped areas also have higher fatality rates

compared to children living in developed countries due to lack of access to quality health care

and timely intervention and effective treatment with oral rehydration solution (ORS) and zinc

(Beaton et’al). 

Diarrhoea has been described as an increment in the volume, fluidity of stools and increased rate

of defecation with slight changes in consistency. The measurement of stool fluid content is an

indicator for diagnostic purposes and taking into account the assessment of stool frequency

(Baqui, Black et’al, 2013).

World Health Organization (2019), placed criteria for diarrhoea to occur if there is an excretion

or passage of watery stools at least two-three times in a 24 h period, but factors such as stool

consistency, stool frequency, and the usefulness of parental discernment in determining whether

children have diarrhoea or not is clearly important to pin down if diarrhoea has occurred or

20
not. Acute diarrhoeal illnesses or dysentery is often easily recognized by appearance of blood in

the stool, irrespective of frequency or consistency.

A diarrhoeal disorder is often divided into acute, chronic and persistent. The most common of

diarrhoea disorders, acute diarrhoea often starts abruptly, are caused by infections and are

subdue/resolved within 14 days. Chronic diarrhoea is majorly a product of congenital defects of

digestion and absorption in the body system and last for at least 14 days (WHO, 2013).

Persistent diarrhoea usually arises due to secondary infections in the presence of complications

such as malnutrition (Brown et’al, 2019).

Each year, an estimated 2.5 billion cases of diarrhoea occur among children under five years of

age, and estimates suggest that overall incidence has remained relatively stable over the past two

decades (Boschiet’al, 2018).

More than half of these cases are in Africa and South Asia where bouts of diarrhoea are more

likely to result in death or other severe outcomes. The incidence of diarrhoeal diseases varies

greatly with the seasons and a child’s age. The youngest children are most vulnerable: Incidence

is highest in the first two years of life and declines as a child grows older.

Exposure to diarrhoea-causing pathogens is frequently related to the consumption of

contaminated water and to unhygienic practices in food preparation and disposal of excreta. The

combination of high cause-specific mortality and the existence of an effective remedy make

diarrhoea and its treatment a priority concern for health services (WHO, 2013).

According to the World Health Organization (WHO, 2018), Globally, there are nearly 1.7 billion

cases of diarrhoea every year among children under five, diarrhoea is the second-leading cause

21
of death in children under five and is responsible for killing around 760,000 children every year.

Diarrhoea kills more children than AIDS, malaria and measles combined; diarrhoea is a leading

cause of malnutrition and stunting in children. Mortality from diarrhoea has declined over the

past two decades from an estimated 5 million deaths among children fewer than five to 1.5

million deaths in 2004, despite these declines, diarrhoea remains the second most common cause

of death among children under five globally.

Diarrheal disease is the third leading cause of infant and child mortality in developing

countries and about 1.8 million children die per annum from this disease (Black et’al, 2018) 

The number of diarrhoeal deaths is ridiculously on the high side despite a fall in childhood

diarrhoeal diseases from 4.6 million to 0.8 million over the last three decades (Fontaine et’al,

2019) 

According to ministry of demographic and health survey (2013), the prevalence of childhood

diarrhea in Nigeria is 18.8%, with 26% of cases treated with oral rehydration salts (ORS)

solution. Amongst children below five years old, diarrhoea accounts for over 16 % of deaths,

estimated at 150,000 annually. 

Exposure to diarrhoea-causing pathogens is frequently related to the consumption of

contaminated water and to unhygienic practices in food preparation and disposal of excreta. The

combination of high cause-specific mortality and the existence of an effective remedy make

diarrhoea and its treatment a priority concern for health services (UNICEF, 2013)

The Sustainability Development Goals (SDGs) was enacted by W.H.O after the MDGs time-

frame elapsed and still some countries couldn’t meet up. SDGs becomes useful tool in focusing

achievement of specific development gains for the development activities of a country, for

22
national priority-setting and for mobilization of stakeholders and resources towards common

goals, therefore remaining firmly committed to its goals and achievement (WHO, 2013).

Now the era of MDGs has come and gone and a blue print of SDGs initiated by WHOis laid out

for every government to achieve within a time frame. These goals address and incorporate in a

balanced way all three dimensions of sustainable developments and their inter linkages which is

coherent with and integrated into the United Nations development agenda beyond the time

frame. The development of these goals should not divert government focus or effort from the

achievement of the Millennium Development Goals, however it will be inhumane and deceptive

on the part of the government to neglect the blue print of SDGs laid down by WHO, if truly the

country wants to win the war against the burden of diarrhoeal diseases claiming the lives of

innocent children each year (WHO, 2014).

2.2 Empirical Review

1. Causes of Diarrhea Among Under Five Years Children

UNICEF and WHO (2013) Outlined the causes of Diarrheal disease as follows;

Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic

organisms, most of which are spread by faeces-contaminated water. Infection is more common

when there is a shortage of adequate sanitation and hygiene and safe water for drinking, cooking

and cleaning. Rotavirus and Escherichia coli, are the two most common etiological agents of

moderate-to-severe diarrhoea in low-income countries. Other pathogens such

as cryptosporidium and shigella species may also be important. Location-specific etiologic

patterns also need to be considered

23
Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition,

which makes them more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes their

malnutrition even worse. Diarrhoea is a leading cause of malnutrition in children under five

years old.

Source: Water contaminated with human faeces, for example, from sewage, septic tanks and

latrines, is of particular concern. Animal faeces also contain microorganisms that can cause

diarrhoea.

Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by poor

personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in

unhygienic conditions. Unsafe domestic water storage and handling is also an important risk

factor. Fish and seafood from polluted water may also contribute to the disease

The most commonly identified causes of acute diarrhea in the United States are the

bacteria Salmonella, Campylobacter, Shigella, and Escherichia coli.

Some cases of chronic diarrhea are called “functional” because although all the digestive organs

appear normal, they are not functioning as they ideally should. In the developed world, irritable

bowel syndrome (IBS) is the most common cause of functional diarrhea.

IBS causes many symptoms, including cramping, abdominal pain, and altered bowel habits,

which can include diarrhea, constipation, or both.

Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. IBD describes

either ulcerative colitis or Crohn’s disease. Both conditions can also cause blood in the stool.

Some other major causes of chronic diarrhea include:

24
  Microscopic colitis: This is a persistent type of diarrhea that usually affects older adults.

It develops due to inflammation and occurs often during the night.

 Malabsorptive and maldigestive diarrhea: The first is due to impaired nutrient

absorption, and the second is due to impaired digestive function. Celiac disease is one

example.

 Chronic infections: A history of travel or antibiotic use can be clues in chronic diarrhea.

Various bacteria and parasites can also be the cause.

 Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger

diarrhea.

 Endocrine-related causes: Sometimes, hormonal factors cause diarrhea. This is the case

in Addison’s disease and carcinoid tumors.

 Cancer-related causes: Neoplastic diarrhea is associated with a number of gut cancers.

Risk factor according to World Health Organization (2014),is any attribute, characteristics or

exposure of an individual that increases the like hood of developing a diseases or injury. Some

examples of the more important risk factor for diarrhoeal affecting children under age 5 includes

unsafe water, humanitarian crises, contaminated foods, direct contact with causative

microorganisms (bacteria, viruses & protozoan) and unhygienic environment etc.

The burden of diarrhoeal illness sits firmly in the developing world, both for morbidity 6–7

episodes per child per year compared with 1 or 2 in the developed world and mortality (Griggs,

2015).

25
Malnutrition and the wholly inadequate provision of safe water, sanitation, and hygiene highlight

the stark inequalities that exist within our world. A quarter of children in developing countries

are still malnourished, 1·1 billion people do not have access to safe drinking water, and 2·4

billion are without adequate sanitation (Boschi, et’al, 2018)

Medicins Sans Frontiers Doctors without border (2016) outlined the following causes of

Diarrhea;

Humanitarian crises: Diarrhoea is a leading cause of death during complex emergencies and

natural disasters. Natural or Man-made disaster often leads to displacement of populations into

temporary and overcrowded shelters; which is often associated with polluted water sources,

inadequate sanitation, poor hygiene practices and contaminated food. This all affect the spread

and severity of diarrhoea in the country. At the same time, the lack of adequate health services

and transport reduces the likelihood of prompt and appropriate treatment of diarrhoea cases.

Nigeria as a case study is battling with “Boko haram” insurgency in the North-East region, which

have led to the displacement of many families leading to the creation of IDP camp all around the

region. According to Medecins Sans Frontieres/Doctors without border (MSF) in 2016, a report

on Dalori IDP camp in Maiduguri, the capital city of Borno State was given in which women

with long faces were seen seated outside a two-room clinic that serve about 19,000 Internally

Displaced People (IDP), holding their weak and dying children in their hand. The children

looked weak and dehydrated from severe diarrhea triggered by cholera outbreak in the camp, 16

children were reported to have died due to acute diarrhea while 172 others were left in critical

condition battling for their life. Hence, reducing the burden of childhood diarrhoeal in the

country depend on the readiness of the government to tackle the insurgency and take the “bull by

the horn”.

26
Lack of adequate breastfeeding: The literature on breastfeeding practices and risk of diarrhoea

has been extensive. Generally, the lowest morbidity of diarrhoea is recorded in adequately

breast-fed children while the highest morbidity is clearly marked in partially weaned children. A

particular risk of diarrhoea is also recorded with bottle-feeding. Numerous studies have shown

the stern defensive effect of breast feeding; the risk of diarrhoea following the colonization with

enteric pathogens is reduced by a concentration of antibodies, cells and other mediators in breast

milk. Nutrients, antioxidants, hormones and antibodies needed for the survival and development

of a child are contained in breast milk; government effort should therefore be doubled on

campaigns relating to adequate breast feeding by engaging different NGOs in the country.

Poor personal, domestic hygiene: As a result of efforts put into meeting the MDG sanitation

target which the country fails to achieve (to halve, by 2015, the proportion of the population

without sustainable access to basic sanitation). About 30million people (67% of whom are

concentrated in the Northern part of the country) still use unimproved sanitation facilities,

practice open defecation which increases the risks of diarrhoeal diseases. Some sanitation

factors, like indiscriminate or improper disposal of children's stool and household garbage,no

existence of latrineor unhygienic toilet,sharing latrine, house without sewage system, increased

the risk for diarrhea in children under five years.

Diarrhoeal deaths attributable to inadequate sanitation has been shown to be higher in several

studies, since improved sanitation and even sewered connections may not include full safe

management of human waste. Exposure to untreated sewage and faecal sludge in wider

populations is likely to cause significant amounts of disease especially diarrhoeal diseases

amongst children less than five years. Hence government should formulate policies which must

have implication on all housing unit in the country such as; Provision of improved sanitation in

27
households (flushing to a pit or septic tank, dry pit latrine with slab, or composting toilet) which

will significantly reduce diarrhoea in the country at large.

Lack of access to safe drinking-water supplies: Drinking-water, even from an improved

source, is not necessarily free of faecal pathogens and safe for health. Water was considered as

non-contaminated when complying with the guideline values for microbial quality, i.e.

containing zero E. coli or thermo tolerant coliforms in 100mL water sample. In order to

conceptualize the risk of diarrhoea from drinking-water, drinking-water sources were categorized

into five groups, namely, viz Unimproved, Improved source (other than piped), Basic piped

water on premises, systematically managed piped water (continuous and safe supply) and

Effective household water treatment and safe storage. Based on the distribution of use of the

different types of water sources and the associated risks of diarrhoea, about 502,000 diarrhoeal

deaths in LMICs (Low and Middle Income Countries) can be attributed to inadequate drinking

water. Somewhat larger health gains can be gained by shifting to basic schemes for piped water

on premises. Effective household water treatment combined with safe storage can provide

significant protection against diarrhoeal diseases in the country. Sustained and consistent

application is necessary to realize these gains.

Eating habits:This is also a significant risk factor. Diarrhea can also be acquired by eating

contaminated foods such as fruits, vegetables, seafood, raw meat, water, and ice cubes. Eating

with the hands; eating raw foods; or drinking unboiled water, may increase the risk of diarrhea in

children.

2. Effects of Diarrhea Among Under Five Years Children

28
According to World Health Organization (2018), the leading cause of childhood morbidity and

mortality in developing countries remains diarrhoea. Diarrhoea diseases, a third leading cause of

child mortality and infant deaths in low and middle income countries is a major cause of illness

and death among young children, even though the condition can be easily treated with oral

rehydration therapy (ORT)

The number of deaths caused by diarrhoea, 2.5 million yearly is a large burden. In addition,

many time this number have long-term, lasting effects on nutritional status, growth, fitness,

cognition, and school performance ( Tumwine, Thompson et’al, 2012)

Some studies have revealed the impact of diarrhoea on growth.It is believed that diarrhoea have a

significant impact on growth due to reduction in appetite, altered feeding practices and decreased

absorption of nutrients (Molbak, 2012)

 Patwari(2013) quoted that there was a marked negative relationship between diarrhoea and

physical growth and development of a child. Each day of illness due to diarrhoea produces a

weight deficit of 20-40grams.

Molbaket’al (2012) found that infants who spent more than 20% of their time with diarrhoea had

a weight deficit of approximately 370 grams at follow-up after 1 year of age.

According to Checkley (2011) children ill with diarrhoea in the first 24months of birth were

1.5cm shorter than children who never had diarrhoea. Hence, the adverse impact of diarrhoea on

a nation like Nigeria cannot be farfetched with various scientific findings and correlation over

the years.

29
Deaths caused by diarrhoeal illness in developed nations are rare accounting for 4% of all

hospital admissions (Santoshamet’al, 2019)

Santoshamet’al (2019) further stressed that;

• Diarrhea can have a detrimental impact on childhood growth and cognitive development.

• About 88% of diarrhea-associated deaths are attributable to unsafe water, inadequate

sanitation, and insufficient hygiene.

• Rotavirus is the leading cause of acute diarrhea and causes about 40% of hospitalizations for

diarrhea in children under 5.

• Most diarrheal germs are spread from the stool of one person to the mouth of another. These

germs are usually spread through contaminated water, food, or objects.

• Water, food, and objects become contaminated with stool in many ways:

◊ People and animals defecate in or near water sources that people drink, Contaminated water is

used to irrigate crops, Food preparers do not wash their hands before cooking, People with

contaminated hands touch objects, such as doorknobs, tools, or cooking utensils.

3. Possible Ways That can be Use to prevent diarrhea disease among under five years’

children

Diarrheal diseases account for 1 in 9 child deaths worldwide, making diarrhea the second leading

cause of death among children under the age of 5. For children with HIV, diarrhea is even more

deadly; the death rate for these children is 11 times higher than the rate for children without HIV.

30
Despite these sobering statistics, strides made over the last 20 years have shown that, in addition

to rotavirus vaccination and breastfeeding, diarrhea prevention focused on safe water and

improved hygiene and sanitation is not only possible, but cost effective: every $1 invested yields

an average return of $25.50. (WHO, 2014)

The goals of treatment are to maintain hydration, treat the underlying causes and relieve the

symptoms of diarrhoea. Rehydration and its correction of any electrolyte imbalance are critical in

the treatment of diarrhoea while WHO’ s control of diarrheal deaths (CDD) programme and

other organizations (UNICEF, USAID) have given first priority to the prevention of diarrheal

deaths, rather than prevention of cases, and focused on promotion of ORT. It is estimated that

90% of the child diarrheal disease burden is the result of poor sanitation conditions and

inadequate personal, household and community hygiene behaviors (Pascual, Rodo, 2012)

Therefore, understanding environmental, behavioral risk factors and their interactions is a

prerequisite for devising effective preventive approaches (UNICEF, 2016)

Since the 1970s, oral rehydration therapy, pioneered by the International Centre for Diarrhoeal

Disease Research, Bangladesh, has been at the forefront for fighting diarrhoeal diseases and

proposing treatment packages. The treatment package focuses on two main elements, as laid out

in the UNICEF & WHO joint statement viz Fluid replacement to prevent dehydration and Zinc

treatment (UNICEF & WHO, 2014).

The greatest medical invention of the 20th century is the ORT which exemplifies the transfer of

technology from developing to developed countries.Based on instructions; ORT solutions are

produced by adding sodium, glucose, potassium, chloride, and alkali (bicarbonate or citrate) in

specific concentrations in clean/pure water. Using the WHO formula, ORT is useful for the

31
management of all types of dehydration. It has contributed a great deal to the reduction of

childhood mortality from diarrhoeal disease because it’s extreme effectiveness in treating acute,

persistent and watery diarrhoea.ORS-WHO (oral rehydration salts) can be regarded as a

universal and all-purpose solution; nevertheless, it is pertinent to have a conventional formula

that can be recommended and as well promoted globally (Sanderson, 2014).

World Health Organization (2014), ORS is an extremely safe therapeutic tool. More than two

billion units of ORS have been administered without serious complications. Symptomatic

antidiarrheal drugs should not be recommended for the treatment of acute diarrhoea in

children. Antimicrobials are also not effective in uncomplicated acute diarrhoea and their use

should be discouraged. In contrast, antimicrobials are indicated in dysentery, cholera, typhoid

fever and diarrhoea caused by parasites, such as Giardia lamblia, Cyclospora spp and E.

hystolytica.ORT administered through mouth or nasogastric tube has shown to be effective in the

treatment of chronic dehydration caused by diarrhoea;even though the intravenous route is

always recommended in the presence of shock. A sodium content of single oral rehydration

solution (ORS) is now recommended by W.H.O (75mmol/L)

If ORS are not available to treat diarrhoea, a set of appropriate homemade fluids are also

effective in preventing dehydration, Different countries have different policies on what

constitutes an appropriate homemade fluid, and these policies are not always clearly defined. For

example, the general acceptable homemade fluids in Nigeria are the mixture of salt and sugar in

a solution. Other fluids will also serve in prevention of dehydration among children with

diarrhoea, even though they are not as effective in treating children who have become

dehydrated. A homemade fluid is always made at home using available and ready-made low-cost

32
solutes. Cereal-based oral therapies and Home-made fluids has proven to be effective in

checkmating diarrhoeal dehydration (Pierce, 2012).

Probiotics are microorganisms that are claimed to provide health benefits when consumed, they

are considered generally safe, but may cause bacteria-host interactions mostly strains

of lactobacillus spp. This live microbe works to improve intestinal-microbial balance by creating

unfavorable environment through the production of antimicrobials and thereby compete with

pathogens for essential nutrients and binding sites in the intestinal mucosa for the metabolism of

nutrients and bile acids. This kind of immune action induced by probiotics is generally regarded

as mucosa-associated immune defences (Hilton, 2013)

According to Akinrotoye (2014),Lactobacillus GG, a probiotics involved and associated with a

reduced risk of contracting traveller’s diarrhoeahas been a major probiotics researcher have

identified as the best microbe to induce defences in a host.

Two research studies which focus on in-vitro study of fermented Palm wine on diarrhoeagenic

bacteria showed that it had antibacterial activities against those organisms; hence it is suggested

that it can be used as an alternative measure for the control of the diarrhoea produced by these

organisms in the absence of antibiotics. It has also been proven that Probiotics reduced the

frequency of diarrhoea in children under five of age (Bhandari, Mazumderet’al, 2018)

Zinc is critical for overall health, growth and development. It also supports proper functioning of

the immune system. Though widely found in protein-rich and other food sources, zinc deficiency

is widespread throughout the developing world and has been associated with higher rates of

infectious diseases, including diarrhoea, and deaths from these illnesses. Zinc supplementation as

a part of treatment programmes is critical for replenishing the body’s reserves–helping children

33
to recover from illness and stay healthy afterwards. Relation between poor feeding and

diarrhoeal illnesses has been correlated over time and it is evident that many of the affected

children suffering from diarrhoea shows deficiency in vital vitamins and trace elements required

by the body system, which are relevant to reducing the burden of diarrhoea in the world. Zinc

play a major role in the healing process of damaged skin and it also help to boost the immunity

of children less than 5 years; while vitamin A participates in maintaining the epithelium cross-

linkage. It has been shown that children who receive zinc supplementation earlier do record low

incidence, frequency and persistence of diarrhoeal illnesses; zinc also appears to increase ORS

uptake and reduces inappropriate drug use with antibiotics and anti-diarrhoeal medications.

Children receiving zinc tablets appeared to recover more quickly, had increased strength and

appetites, and were less ill than other children in their communities (Rahman, Vermund,

Wahedet’al, 2014)

UNICEF (2014) Outlined the following key measures for preventing diarrhoea;

Key measures to prevent diarrhoea include:

 access to safe drinking-water;

 use of improved sanitation;

 hand washing with soap;

 exclusive breastfeeding for the first six months of life;

 good personal and food hygiene;

 health education about how infections spread; and

 rotavirus vaccination.

34
Key measures to treat diarrhoea include the following:

 Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water,

salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine

and replaces the water and electrolytes lost in the faeces.

 Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25%

and are associated with a 30% reduction in stool volume.

 Rehydration: with intravenous fluids in case of severe dehydration or shock.

 Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by

continuing to give nutrient-rich foods – including breast milk – during an episode, and by

giving a nutritious diet – including exclusive breastfeeding for the first six months of life

– to children when they are well.

 Consulting a health professional, in particular for management of persistent diarrhoea or

when there is blood in stool or if there are signs of dehydration.

WHO works with Member States and other partners to: promote national policies and

investments that support case management of diarrhoea and its complications as well as

increasing access to safe drinking-water and sanitation in developing countries; conduct research

to develop and test new diarrhoea prevention and control strategies in this area; build capacity in

implementing preventive interventions, including sanitation, source water improvements, and

household water treatment and safe storage; develop new health interventions, such as the

rotavirus immunization; and help to train health workers, especially at community level.

What Can Be Done

35
Use effective interventions and proven treatment for diarrhea.

Governments and ministries of health can:

 Provide rotavirus vaccination

 Invest in safe drinking water, hygiene, and sanitation infrastructure

 Monitor progress and needs through the collection, analysis, and reporting of quality data

 Support clear and targeted health promotion and behavior change programs

Non-governmental/aid organizations can:

 Increase the adoption of proven measures against diarrhea

o Rotavirus vaccination

o Breastfeeding

o Oral rehydration therapy

o Household and community systems for treating and storing water

 Educate communities on the importance of safe water, sanitation, and hygiene

 Enhance and support government initiatives that invest in safe drinking water, sanitation,

and hygiene infrastructure

 Ensure the sustainability of interventions

 Focus on the provision of safe water, sanitation, and hygiene when responding to

emergency and conflict situations

Health care providers and clinical facilities can:

36
  Ensure availability of adequate medical supplies such as oral rehydration solution

 Improve training programs for health workers and educate them on the proper treatment

of diarrhea

 Ensure that facilities for handwashing, provision of safe water, and proper disposal of

human waste are provided at ALL healthcare facilities

 Encourage appropriate antibiotic use

 Meet demand for health workers

 Support community health workers

o Improve training programs

o Seek creative ways to motivate them

• Vaccinate for rotavirus

• Provide Safe water, Adequate sanitation and human waste disposal

• Promote Handwashing with soap, Breastfeeding to reduce exposure to contaminated water

• Treat appropriately with oral rehydration therapy and antibiotics

• Train health care providers and community health workers on diarrhea treatment

• Educate mothers and caretakers about caring for ill children and when to seek medical

assistance

• Build laboratory diagnostic capability and identify the causes of diarrhea

37
Communities can:

 Support and promote the importance of community health workers

 Ensure safe water is provided close to people’s homes

 Discourage/eliminate open defecation

 Develop strategies for proper disposal of human waste

 Construct basic sanitation facilities

 Promote handwashing

2.3Theoretical Frame Work

Theory of pathogenesis: Diarrhea, to public, means liquid stools with increased frequency. Its

biomedical definition is stool weight > 200 grams/day. (not useful clinically)

Chronic Diarrhea is diarrhea lasting > 3 to 4 weeks. Biomedicine proposes 5 different causative

mechanisms.

1. Secretory diarrhea is abnormal fluid and electrolyte transport across mucosa of small intestine

and colon, with large volume loose stools which usually persist despite fasting. Its causes are a)

laxative abuse, or b) decreased funtional surfaces for absorption ( crohn's disease, resection of

intestines, chloridorrhea or chloride rich watery diarrhea due to defective CL/HCO3 mucosal

exchange, and hormones from tumors causing production of intestinal secretagogues ). 

2. Osmotic Diarrhea means that osmotically active solutes enter colon and draws fluids

exceeding the resorptive capacity of colon (which may be 3.2 liters/day, and thus,this type of

38
diarrhea is not severe unless the colonic transit time is very shortened usually from autonomic

dysfuntion). Its causes are a) osmotic laxatives (Magnesium), b) lactase deficiency.

3. Fat malabsorption with greasy stools and nutritional deficiency are usually diagnosed.

4. Inflammatory mechanisms include mucosal exudation, hypersecretion of electrolytes and

fluids, and hypermotility of colon. Its most common cause is inflammatory bowel disease

including ulcerative colitis, and are usually diagnosed.

5.Dysmotility of bowel with rapid transit due to visceral autonomic neuropathy (“diabetic

diarrhea"), or disordered neurohormonal regulation of colonic and anorectal function ( " Irritable

bowel syndrome").

Chronic Idiopathic Diarrhea is functional diarrhea where all the biomedical diseases and over

usage of medications are ruled out, and are quite common. Biomedical treatments are permanent

usage of opiodlike drugs such as imodium or peptobismol, and may not work.Chronic diarrhea

can be explained by the theory of physicians herbal formula combining the concepts of eastern

herbal medicine and pathophysiology. She can also be diagnosed and healed by eastern herbal

medicine.

According to eastern herbal medicine, chronic diarrhea is caused by 2 major categories of

mechanisms;

1) is chronic retention of pathogenic factors in bowels which cause hypersecretory mucosa,

exudative inflammatory mucosa, and disordered motility of colon.

39
1A), called damp heat in colon, causes foul smelling yellow diarrhea with frequency, abdomenal

discomfort, and burning anus. Treated by Acute Diarrhea ( it treats also chronic diarrhea due to

damp heat)

1B), called blood stasis often shows blood in stools. Not a common syndrome.

1C), called liver Qi stagnation with some heat in colon, treated by Irritable Bowel

2) category is Qi / Yang (“bioenergy and warming bioforce”) deficiency of spleen, stomach,or

kidney. Deficiency of bioenergy is manifested by the hypofuntioning of enteric and autonomic
nervous system. Submucosal nervous plexus which controls absorption and secretion of
electrolytes and fluids are devoid of energy, and fail to control chloride ion channels and produce
watery diarrhea. Sympathetic nervous system (“active Qi/ Yang" ) which provide inhibitory
control on the smooth muscles of colon may fail and hypermotility of colon ensues.

2A) called Spleen Qi deficiency results in chronic loose or watery stools and fatigue. Treated

by Chronic Diarrhea

2B) called Kidney and spleen Yang deficiency is not a common cause of diarrhea in western

culture, except in very elderlies.

CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter deals with the methods used in conducting the research work. This chapter was

discussed under the following subheadings;

 Research Design

40
  Research Settings

 Target Population

 Sample and Sampling Technique

 Instrument for Data Collection

 Validity of the Instrument

 Reliability of the Instrument

 Method of Data Collection

 Method of Data Analysis

 Ethical consideration

3.1 Research Design

The research design adopted for this study was descriptive survey design. Descriptive survey

design was choosing because it’s the study design that attempts to establish the range and

distribution of some social characteristics, such as education or training, occupation, location and

to discover how these characteristics may be related to certain behavior or attitudes. It is very

effective in seeking the view of people about a particular issue.

3.2 Area of the Study

The research was carried out in Yan mangwarora area gusau local government, Zamfara State.

3.3 Target Population

41
The target population consist of people of Yan mangwarora area, those within the main area of

Yan mangwarora. There are about 1200 people residing in the main area of mangwarora the

surroundingding areas were excluded. (District head. 2021).

3.4 Sample Size

Two hundred and forty (240) respondents will be selected to represent the entire population. The

sample size was sorted using 20% of the population as suggested by Nwana (2010) who said

“20-30% is used to calculate sample size where target population is in hundreds”.

20%/100x target population

That is;

20%/100=0.2

0.2x1200=240

3.5 Sampling Technique

Simple Random sampling technique was used to obtain sample from the respondents. This

method is choosing because it involves a single random selection and requires little advance

knowledge about the population.

3.6 Instrument for Data Collection

The instrument for data collection in this study was structured questionnaire. The questionnaire

consists of twenty-one (21) items divided into four sections. Section A has three (1-3) items

42
developed for sociodemographic data. Section B has seven (4-10) items developed for causes of

diarrhea among under five children. Section C has five (11-15) items developed for effects of

diarrhoea among under five children. Section D has six (16-21) items developed for possible

ways that can be use to prevent diarrhoeal disease among under five children.

3.7 Validity of the Instrument

The instrument was given to two facilitators including the project supervisor for content and face

validity. The view of the validators will be use to improve the content and quality of the

questionnaire

3.8 Reliability of the Instrument

Test-retest method will be use in determining the internal consistency of the questionnaire. The

instrument will be use on twenty (20) respondents in the study area, after a week the same

instrument will be given to the same respondents. The first data collected will be compared with

the second data to determine the internal consistency of the instrument.

3.9 Method of Data Collection

The method of data collection will be by the use of structured questionnaire. The questionnaires

will be distributed to get adequate information from the respondents.

3.10 Method of Data Analysis

43
Data will be analyzed using simple percentage, mean statistics where a cut off points of 2.5 will

be use in which any item with cut off mark above 2.5 will be considered agreed, while below 2.5

will be considered disagreed. Below is how the researcher arrived at the cut off point;

4+3+2+1=10/4=2.5

3.11 Ethical Consideration

Introduction letter will be collected from the school to the district head of yan mangwarora Area

Alll information collected from the respondents will be confidential.

CHAPTER FOUR

REASULT

This chapter deals with data presentation and analysis. Socio-demographic data of the

respondents was analyzed first followed by other responses.

44
SECTION (A):Socio-Demographic Data

Table 1: Personal Data

SN Description Frequency Percentage (%)

1 Age
21-30 100 41.7%
31-40 100 41.7%
41-50 40 16.6%
50 and Above - -

Total 240 100%

2 Educational status

Primary 40 16.7%
Secondary 120 50%
Tertiary 60 25%
Informal 20 8.3%
Total 240 100%
3 Sex of the Respondents
Male 60 25%
Female 180 75%

Total 240 100%

As shown in table 1, most of the respondents (100) representing 41.7% are between the age

range of 31-40. Majority of the respondents (120) representing 50% possessed secondary school

leaving certificate. Highest of the respondents (180) representing 75% are male.

SECTION (B): Research Questions: Causes of Diarrheal Disease among Under Five

Children

45
The data analysis to the research question one ispresented in table 2.

Table 2: Causes of Diarrheal Diseases among Under Five Children

S/N ITEMS SA A D SD (X) Remark

4 Diarrhea is caused by infection 150 5 20 20 3.4 Agreed

0

5 Poor food preparation can cause diarrhea 180 4 10 10 3.6 Agreed

0

6 Diarrhoea is transmitted from one person to 50 4 100 50 2.4 Disagreed

another 0

7 Poor absorption of food by the body can lead to 120 5 30 40 2.9 Agreed
diarrhea 0

8 Bad breast feeding practice can lead to diarrhoea 140 7 20 10 3.3 Agreed
0

9 Given children unsafe water can cause diarrhoea 150 5 20 20 3.2 Agreed
0

10 Feeding children with contaminated food lead to 180 2 20 20 3.4 Agreed

diarrhea 0

As shown in table 2, the respondents agreed with items 4, 5, 7, 8 and 10 as causes of diarrheal

disease among under five children. The respondents disagreed with item 6 ‘diarrhea is

transmitted from one person to another’.

This means that diarrhea is caused by infection, poor food preparation, poor absorption of food

by the body, bad breast feeding practice, given children unsafe water, feeding children with

contaminated food.

46
SECTION (C): Research Question Two:Effects of Diarrheal Disease among Under Five

Children

The data analysis to the research question two is presented in table 3.

Table 3: Effect of Diarrheal Diseases among Under Five Children

S/N ITEMS SA A D SD (X) Remark

11 Diarrhoea can lead to death 200 20 10 10 3.7 Agreed

12 Diarrhoea can cause growth impairment 50 10 50 40 2.6 Agreed

0

13 Diarrhoea can lead to dehydration 210 10 10 10 3.7 Agreed

14 Diarrhoea causes weight loss 210 10 10 10 3.7 Agreed

15 Diarrhoea can lead to malnutrition 180 50 5 5 3.6 Agreed

As shown in table 3, the respondents agreed with item 11, 12, 13, 14 and 15 as effects of

diarrheal disease among under five children.

This means that death, growth impairment, dehydration, weight loss and malnutrition are the

effects of diarrheal disease among under five children.

SECTION (D): Research Question three: Possible Ways That Can Be Use to Prevent

Diarrheal Disease Among Under Five Children

The data analysis to the research question three is presented in table four

47
Table 4: Possible Ways That Can Be Use to Prevent Diarrheal Diseases Among Under Five

Children

S/N ITEMS SA A D SD (X) Remark

16 Provide Safe water, Adequate sanitation and human waste 200 20 1 10 3.6 Agreed
disposal 0

17 Promote Handwashing with soap, Breastfeeding to reduce 180 50 5 5 3.6 Agreed

exposure to contaminated water

18 Vaccinate for rotavirus 190 20 2 10 3.4 Agreed

0

19 Educate mothers and caretakers about caring for ill 190 20 2 10 3.4 Agreed
children and when to seek medical assistance 0

20 Develop strategies for proper disposal of human waste 150 50 2 20 3.2 Agreed
0

21 Train mothers and care takers on how to take care of 200 20 1 10 3.6 Agreed
diarrhea children at home 0

As shown in table 4, the respondents agreed with item 16, 17, 18, 19, 20 and 21 as possible ways

that can be use to prevent diarrheal disease among under five children.

This means that provision of safe water, adequate sanitation, human waste disposal, hand
washing with soap, breastfeeding to reduce exposure to contaminated water, vaccination for
rotavirus, educate mothers and caretakers about caring for ill children and when to seek medical
assistance, develop strategies for proper disposal of human waste, train mothers and care takers
on how to take care of diarrhea children at home are the possible ways that can be use to prevent
diarrheal disease among under five children.

CHAPTER FIVE

48
 DISCUSSION, SUMMARY, CONCLUSION, RECOMENDATION

5.0 Introduction

This chapter deals with discussion of findings, relationship with other studies/literature, and

implication for nursing, summary, conclusion, recommendation and suggestions for further

studies.

5.1Key Findings

1. The study of the researcher revealed that diarrhea is caused by infection, poor food

preparation, poor absorption of food by the body, bad breast feeding practice, given children

unsafe water, feeding children with contaminated food.

2. The findings of the researcher show that death, growth impairement, dehydration, weight loss

and malnutrition are the effects of diarrheal disease among under five children.

3. The findings of the researcher shows that provision of safe water, adequate sanitation, human

waste disposal, hand washing with soap, breastfeeding to reduce exposure to contaminated

water, vaccination for rotavirus, educate mothers and caretakers about caring for ill children and

when to seek medical assistance, develop strategies for proper disposal of human waste, train

mothers and care takers on how to take care of diarrhea children at home are the possible ways

that can be use to prevent diarrheal disease among under five children.

5.2 Discussion of Findings and Relationship with other Studies

Research Question 1: what are the causes of diarrheal disease among under five children?

The study revealed that diarrhea is caused by infection, poor food preparation, poor absorption of

food by the body, bad breast feeding practice, given children unsafe water, feeding children with

49
contaminated food. This goes in line with the findings of the researcher in which

UNICEF/WHO(2013) Stated that “Diarrheal disease can also spread from person-to-person,

aggravated by poor personal hygiene. Food is another major cause of diarrhea when it is

prepared or stored in unhygienic conditions. Unsafe domestic water storage and handling is also

an important risk factor”.

Research Question 2:What are theeffects of diarrheal among under five children?

The study revealed that death, growth impairment, dehydration, weight loss and malnutrition are

the effects of diarrheal disease among under five children. This goes in line with finding of the

researcher in which World Health Organization (2018) states that “the leading cause of

childhood morbidity and mortality in developing countries remains diarrhea”

Research Question 3:What are thepossible ways that can be use to prevent diarrheal disease

among under five children?

The study revealed thatthat provision of safe water, adequate sanitation, human waste disposal,

hand washing with soap, breastfeeding to reduce exposure to contaminated water, vaccination for

rotavirus, educate mothers and caretakers about caring for ill children and when to seek medical

assistance, develop strategies for proper disposal of human waste, train mothers and care takers

on how to take care of diarrhea children at home are the possible ways that can be use to prevent

diarrheal disease among under five children. This goes in line with the finding of the researcher

in which UNICEF (2014) Outlined the following key measures for preventing diarrhoea;access

to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive

breastfeeding for the first six months of life, good personal and food hygiene, health education

about how infections spread and rotavirus vaccination.

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5.3 Implication for Nursing

The implication of this study for nurses cannot be over emphasized. Nurses play a significant

role more than any other health personnel in the hospital as they stayed with patients for a period

of 24 hours. Therefore, lack of nurses in the hospital has a tremendous effect to health care

delivery and may result to increase in life lost. Therefore, government should employ adequate

staff nurses that can competently take care of all cases of diarrhea. Nurses should be provided

with adequate personal protective equipments in case of an outbreak.

5.4 Summary of the Study

Diarrhea is a passage of three or more loose or liquid stools per day. Frequent passing of formed

stools is not diarrhea, nor is the passing of loose, ”pasty” stools by breastfed babies. The study

was carried out to find out the strategies for prevention of diarrhea diseases among under five

children in Yan mangwarora area gusau local government of Zamfara state, the objective of the

study is to find out the possible causes of diarrhea among under five children and to determine

the strategies that can be adopted in preventing diarrhea among under five children. The research

design adopted for this study was descriptive survey design. The sampling technique used was

Random sampling technique and 240 respondants participated in the study. Structured

questionnaire was used for data collection. Data were analyzed using descriptive statistic, simple

percentage and frequency distribution tables. The findings 0f the study shows that diarrhea is

caused by infection, poor food preparation, and poor absorption of food by the body. The effect

of diarrhea are death, growth impairement, dehydration, weight lossand malnutrition. Safe water,

adequate sanitation, human waste disposal, hand washing with soap, breastfeeding to reduce

exposure to contaminated water, vaccination for rotavirus, educate mothers and caretakers about

caring for ill children and when to seek medical assistance are the strategies for preventing

51
diarrhea. In conclusion, health care facilities should be fully equipped with man power and

affordable drugs.

5.5 Conclusion

The findings of this study revealed that infection, poor food preparation, poor absorption of food

by the body among others caused diarrhea disease. Death, growth impairment, dehydration,

weight loss and malnutrition are the effects of diarrheal disease among under five children. Safe

water, adequate sanitation, human waste disposal, hand washing with soap, breastfeeding to

reduce exposure to contaminated water and vaccination for rotavirus are the possible ways for

preventing diarrhea disease among under five children.

5.6 Recommendation

In view of the above findings, the following recommendation was made:

 Health care facilities should be fully equipped with man power

 Working condition should be made conducive to provide job satisfaction

 Capacity building of health workers

 Government should improve health care system capacity by ensuring a health facility has

a reliable supply of drugs and equipments for health care delivery.

 Mass media sensitization of parents on the importance of going to hospital early for

medical treatment.

5.7 Suggestions for Further Studies

Based on the recommendation stated, here are some suggestions;
 Complications of diarrhea disease
 Strategies for managing diarrhea disease
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APPENDIX

QUESTIONNAIRE

56
 School of Nursing and Midwifery,

Midwifery Department,

P.M.B 01179,

Gusau,

Zamfara State.

Dear Respondent,

The researcher AISHA SANI JANGERU is a student of the above named institutions currently

undertaking a research work on the topic “STRATEGIES FOR PREVENTING

DIARRHOEAL DISEASE AMONG UNDER FIVE CHILDREN IN YAN

MANGWARORA AREA"

The questionnaire is in four sections, section A, B, C, and D. Please you are required to tick the

appropriate answer. All your responses will be treated confidentially.

Yours Faithfully

Aisha Sani jangeru.

SECTION A: socio Demographic Data

Age of the respondent

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 a. 21-30 ( )

b. 31-40 ( )

c. 41-50 ( )

d. 50 and Above

1. Educational status

a. Primary ( )

b. Secondary ( )

c. Tertiary ( )

d. Informal ( )

2. Sex of the Respondents

a. Male( )

b. Female ( )

SECTION B: Causes of Diarrhoeal Disease Among Under Five Children

S/ ITEMS SA A D SD

58
N

4 Diarrhoea is caused by infection

5 Poor food preparation can cause diarrhoea

6 Diarrhoea is transmitted from one person to another

7 Poor absorption of food by the body can lead to diarrhoea

8 Bad breast feeding practice can lead to diarrhoea

9 Given children unsafe water can cause diarrhoea

10 Feeding children with contaminated food lead to diarrhoea

SECTION C: Effects of Diarrhoeal Disease Among Under Five Children

S/ ITEMS SA A D SD
N

11 Diarrhoea can lead to death

12 Diarrhoea can cause growth impairment

13 Diarrhoea can lead to dehydration

14 Diarrhoea causes weight loss

15 Diarrhoea can lead to malnutrition

SECTION D: Possible Ways That Can Be Use to Prevent Diarrhoeal Disease Among Under

59
 Five Children

S/N ITEMS SA A D SD

17 Provide Safe water, Adequate sanitation and human waste disposal

18 Promote Handwashing with soap, Breastfeeding to reduce exposure

to contaminated water

19 Vaccinate for rotavirus

20 Educate mothers and caretakers about caring for ill children and
when to seek medical assistance

21 Develop strategies for proper disposal of human waste

22 Train mothers and care takers on how to take care of diarrhea

children at home

60