PREVENTION AND TREATMENT RESPONSIVENESS OF CAREGIVERS OF UNDER-5 YEAR OLDS, TOWARDS DIARRHEA ILLNESS, IN DAYCARE CENTERS, IN ABEOKUTA, OGUN STATE, NIGERIA

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. 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:

1. identify the socio-demographic characteristics of caregivers in daycare centers in Abeokuta, Ogun State;
2. identify daycare center benefits and constraints faced by caregivers of under-5 year olds in daycare centers in Abeokuta, Ogun State;
3. determine the level of knowledge of diarrhea illness among caregivers of under-5 year olds in daycare centers in Abeokuta, Ogun State;
4. determine the attitude of caregivers of under-5 year olds towards diarrhea illness in daycare centers in Abeokuta, Ogun State;
5. determine the perception of diarrhea illness among caregivers of under-5 year olds in daycare centers in Abeokuta, Ogun State;
6. assess the responsiveness towards diarrhea illness among caregivers of under-5 year olds in daycare centers in Abeokuta, Ogun State;
7. identify which of thevariables in this study predicts responsiveness more significantly;
8. 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;
9. determine if a significant relationship exists between the level of knowledge and responsiveness towards diarrhea illness among the respondents in this study;
10. determine if a significant relationship exists between the attitude and responsiveness towards diarrhea illness among the respondents in this study and
11. determine if a significant relationship exists between the perception and responsiveness towards diarrhea illness among the respondents in this study.