Lactating Mothers’ Perception Toward Diarrheal Disease in Bench-Maji Zone, Southwest Ethiopia: Mixed study design

Introduction Acute diarrheal diseases are the leading cause of preventable death, especially among children under-five in developing countries. Worldwide and nationwide diarrheal disease is the second leading cause of death in under-five year children. Therefore, the aim of this study is to assess perception of lactating mothers' toward diarrheal disease in Mizan-Aman District, South-West Ethiopia. Methods Community based cross-sectional quantitative study supplemented by qualitative study was employed. A total of 383 selected households with the lactating mothers were involved in the study. Data was collected through face-to-face interview technique by trained data collectors. Data was entered and analyzed using SPSS version 16. Multiple logistic regressions analysis was used to identify the independent predictors. Odds ratio, with 95% confidence level and P < 0.05 were used to determine statistically significant association. Results The majority of the respondents had primary education (44.4%) and from rural area (52.2%). Multiple logistic regression analysis showed that the residence area [AOR = 4.79, CI (1.33,7.78), P<0.003], educational status [AOR = 0.72, CI (0.55,1.29), P<0.045], Wealth index [AOR = 8.9, CI (0.99,17.45), P<0.001], knowledge [AOR = 2.34, CI (1.2-4.3) P<0.023]. Perceived susceptibility [AOR = 0.44, CI (0.33,11.33), P<0.001] and perceived severity of their child towards diarrheal disease [AOR= 0.24, CI (1.23,7.99), P<0.033] had significant associations with the perception of the diarrheal diseases among lactating mothers. Conclusion Lactating mothers' perceptions toward their children of getting diarrheal disease and danger of the disease with primary education and above were better protected than mothers with no education. Thus, implementing effective information educational communication (IEC) programs that emphasize on the benefit of complying with nationally recommended practice to prevent diarrheal disease is important to reduce the risk.


Introduction
Globally acute diarrheal disease remains a major public health problem. In developing countries, an estimated 12 or more diarrheal episodes per child per year occur within the first 5 years of life.
Every year, approximately 4.6 million pediatric deaths, about 25 to 30% of all deaths among children less than age 5 years, can be attributed to acute diarrhea. According to WHO and UNICEF report almost 2.5 billion episodes of diarrhea occur annually in children under five years of age in developing countries with more than 80% of the episodes occurring in Africa and South Asia (46% and 38% respectively) [1]. The study showed in sub-Saharan African countries children under-five years of age experience about five episodes of diarrhea each year. The analysis also showed that prevalence of childhood diarrhea ranged from 10.5 to 19%. The risk factors contributing to diarrheal disease were age of the child, quality and quantity of water, availability of toilet facilities, housing conditions, maternal level of education, household economic status, place of residence, feeding practices and general sanitary condition around the house [2,3]. Study conducted in Eritrea shows that availability toilet facility in the household was associated with 27% reduction of diarrhea in under-five children. The prevalence of diarrhea in under-five children in Botswana is 10% and 40% each in Senegal and Liberia. Each child in sub-Saharan Africa has 5 episodes of diarrhea per year and 8 million die each year due to diarrhea and dehydration [4,5].
A study done in indigenous and resettlement community in Assosa district showed that 94.7% mothers from indigenous community and 88.1% of mothers from settlement community reported diarrhoea to be a "serious health problem." The difference between responses from participants of the two areas was not, however, statistically significant. Other finding from Finote Gojam, Ethiopia showed that the maternal educational status showed significant association with the childhood diarrheal management diarrheal management [6,7]. According to the 2012 Ethiopian Demographic and Health Survey (EDHS 2012), Diarrhoea was most common among children age 6-23 months (23-25 percent). Diarrhoea prevalence is highest among children residing in households that drink from unprotected wells (18 percent), those residing in rural areas (14 percent) and children residing in Benshangul-Gumuz and Gambella (both 23 percent) [8]. Recent studies at the national level tried to assess knowledge; attitude and practice about diarrheal disease, treatment seeking and preventive measures but studies on household perceptions specially on lactating mothers are limited.
This will call further research efforts since diarrheal disease related perception varies not only among different cultures but also among individuals depending on their socioeconomic background.  English for analysis. Primary theme was produced through manual coding using pen of different colors. Then it was pooled into broader concepts to form main themes. Besides, quotes of participants that exemplify key concepts were used directly during analysis. Finally, the result was triangulated with that of the quantitative one.

Methods
Data quality management: Study questionnaires were adapted from previous similar studies as per the local context. The instrument was prepared in English first, then translated to Amharic and finally back translated to English by different individuals to keep consistency. Training was given for qualified data collectors and supervisors. The entire process of data collection was assisted and guided by supportive and close supervision. The collected data were checked frequently at the field by the supervisors for its completeness and consistency. Pretesting on 5% of respondents outside the study area but of the similar background was done to for cultural sensitivity and clarity of the questionnaire.

Results
Socio-demographic characteristics: A total of 383 lactating mothers where sampled using Fisher's formula. Two hundred sixtyseven (69.7%) were Orthodox Christians while 12(3.1%) were Muslims. Almost all respondents were married (96.9%) and housewife (37.6%), most had primary education (44.4%) and were from rural area (52.2%). Mean month of the respondent after giving birth was 19.6 ± 12.5 months ( Table 1). done in Assosa district Ethiopia of in the rural and lesser than urban than the urban areas this difference may be due to difference sources of information richness in the urban areas [6,9]. In total, 229(59.9%) of study participants had heard of diarrheal disease;

Knowledge
this result is consistent with study finding of Eritrea 60.1% of study participants ever heard of diarrheal disease [4]. About 37.9% of our study participant knew the correct cause of diarrheal disease and 41.7% attributed to child teething as cause diarrheal disease. It is higher than study result of, Nigeria which is 3.2% of participants able to mention it as cause diarrheal disease [10].
The residence of the lactating mothers' living in urban were 4.79 times more likely experienced diarrheal disease in one of their child ((AOR = 4.79,95% CI (1.33,7.78)). This finding is also consistent with the study done in Benshangul-Gumuz [12]. This is because lactating mothers' living in urban areas were probability of getting more information than rural areas. Finding from this study shows that educational status of mothers was significantly associated with the past experience of diarrheal disease at the household level.
Those mother with elementary and above were less past child diarrheal experience when compared with no Education. The finding is similar with the study done in Ethiopia and Eritrea [7]. Regarding the wealth index of the lactating mothers, low indexed lactating mothers had 8.9 times more likely had past child diarrheal disease experiences than those with better wealth index. The finding of the study is similar to other studies done in Ethiopia [8] and contrary to the study done in India, were income of the lactating mothers were not associated this may be socio-economic difference between two countries [13]. This study revealed the importance of diarrheal disease related knowledge was significantly associated with the past experience of diarrheal disease in the household, the finding of this study is consistent with the study done in Ethiopia, Eritrea, India [14,15]. This study also shown that the perceived susceptibility and perceived severity of lactating mothers above the mean score were associated with their past diarrheal disease experience. Those lactating mothers with high perceived susceptibility and severity had less likely their child experienced diarrheal disease at household level. The finding of this study is consistent with the study done in India and contrary to the study done in Ghana this difference may due to socio-cultural and socio-economic status [16,17]. goes to mothers for their participation to provide us valuable information without which this cannot at all be possible.