Knowledge , Attitude and Practices of Mothers Regarding ' Oral Rehydration Therapy ' in Jammu Slums

JMS 2012;15(2):111-14 During diarrhoea attack, majority of mothers (58%) opined to consult a health personnel, one fourth (22.2%) wanted to start ORS and only small fraction (9.1%) believed in 'wait and watch policy' for self recovery (Table 2). Regarding reasons of giving ORS to their children during diarrhoeal episode. 59 percent mothers were using it because it was cheap, easily available and prevented dehydration, while 41% mothers could not give any reason (Table 3). In this study, only 26.88 percent mothers expressed their satisfaction on being prescribed only ORS, while 73.12 had faith in medicines and ORS in combination(Table 4). Regarding methods of preparation of SSS and ORS, only 12.54% and 22.93% mothers could prepare them correctly, respectively (Table 5,6). Only 24.1% mothers new that freshly prepared ORS was fit for consumption within 24 hours only (Figure 1). Feeds were withheld by 155 (27.7%) mothers during diarrhoeal episode, while 403 (72.3%) continued feeding (Figure 2). The benefits of reduced osmolarity ORS are: reducing stool volume by 25%, reducing vomiting by nearly 30% and 11 reducing need for IV fluid therapy by 33%. There is additional recommendation for zinc 12 supplementation for the management of diarrhoea. It reduces severity and duration of diarrhea, and is strongly recommended as supplement with ORS in dehydrated children.

During diarrhoea attack, majority of mothers (58%) opined to consult a health personnel, one fourth (22.2%) wanted to start ORS and only small fraction (9.1%) believed in 'wait and watch policy' for self recovery (Table 2).
Regarding reasons of giving ORS to their children during diarrhoeal episode.59 percent mothers were using it because it was cheap, easily available and prevented dehydration, while 41% mothers could not give any reason (Table 3).In this study, only 26.88 percent mothers expressed their satisfaction on being prescribed only ORS, while 73.12 had faith in medicines and ORS in combination(Table 4).
Regarding methods of preparation of SSS and ORS, only 12.54% and 22.93% mothers could prepare them correctly, respectively (Table 5,6).Only 24.1% mothers new that freshly prepared ORS was fit for consumption within 24 hours only (Figure 1).Feeds were withheld by 155 (27.7%) mothers during diarrhoeal episode, while 403 (72.3%) continued feeding (Figure 2).The benefits of reduced osmolarity ORS are: reducing stool volume by 25%, reducing vomiting by nearly 30% and 11 reducing need for IV fluid therapy by 33%.
There is additional recommendation for zinc 12 supplementation for the management of diarrhoea.It reduces severity and duration of diarrhea, and is strongly recommended as supplement with ORS in dehydrated children.

Methods
The study was conducted among the mothers of children suffering from acute diarrhoeal attacks in the Jammu urban slums.A total of 750 mothers formed the sample size, which was selected by systematic random sampling technique out of the total 3000 mothers of children suffering from diarrhoea.Mothers were contacted by house to house visits and in anganwari centers.Study period was from May 2009 to September 2010.
A pre-tested, semi-structured, oral questionnaire comprising of 14 MCQs were administered to mothers to ascertain their knowledge, attitude and practices regarding ORT.The first question to 750 mothers was: Have you ever heard of Oral rehydration solution?Only 558 mothers (74.4%) were aware of ORS and they were our target population for finding out the results of our objectives, while the other 192, who had neither heard nor were aware of ORS (25.6%) were not put to any further questioning and deleted from the study.Analysis of data was conducted using SPSS.The questionnaire introduced was, recommended by NICD.

Results
Majority of mothers received first information about ORS from health personnels (68.81%) and 17.92% from mass-media(Table 1).Majority considered it to be a remedy for diarrhea (40.50%).Approximately one fifth mothers (17.20%) knew that these ORS packets which were available from chemist/health care workers were useful for diarrhea.However, a small number (11.82%) did not have a clear idea about ORS, even though they had heard of it previously.Mothers' knowledge about HAF was limited to rice-ORS 23.29%, Lemon-water 19.7%, pulses water/tea 18.63%, yogurt-water 9.86%.However 8.9% mothers looked amuck.

Discussion
Awareness of ORS among the study group was 74.4% and 25.6% were ignorant of the same.This lack of awareness among one fourth of the target mothers could be due to their illiteracy or lack of health campaigns.In a study by Bhan MK 13 et al 86.2% of mothers were aware of ORS and 38.7% had already used it during diarrhea.So our results are similar to this study.
In present study first information of ORS was from health personnels (68.81%) and 17.92% from mass media and the rest from relatives, peer group and neighbors (Table 1).In 14 a study conducted by chaturvedi et al , the response was 69.5% from health personnels, 15.9% TV/radio, 4.9% peer group and 1.2% print media.
Mothers were knowing some forms of HAFs.The 15 study of Victoria CG et al , showed that 95% of the mothers had knowledge of at least one of the rehydration solution.Majority of mothers (58%) opined to consult a health personnel, 22.2% wanted to start ORS at the first signal of diarrhea and 9.1% believed in waiting for self recovery (Table 16 2).In a study conducted by Sood AK et al the practice of mothers was to consult health personnel (57.66%); 30.5% wanted to start HAF.So, our study agrees with the author.17 Banakappa DG et al in their study observed that only 25% mothers were in favour of starting ORS.
Three hundred twenty nine (59%) mothers were using ORS, because it was cheap, easily available and prevented dehydration, while 41% mothers could not give any reason (Table 3).In this study, only 26.88% mothers used exclusive ORS while 73.12% wanted ORS and medicines together (Table 4).UNICEF reports on the "state of world children" 18 gave 25 percent utilization rate of ORS.Kumar V et al showed that 57.8% mothers were satisfied regarding ORS and remaining 42.2%, had faith in medicines.Our study results agree with UNICEF, but not with the latter.
We found, only 12.54% and 22.33% mothers could prepare SSS and ORS correctly (Table 5, 6).In one study it was observed that only few mothers could prepare ORS 19 20 correctly.Gopal Das et al also revealed similar results.15 Victoria CG et al revealed that correct knowledge of preparation of SSS by pinch method was only 16.6% and WHO-ORS only 41%.In the present study only 24.1% mothers knew that freshly prepared ORS was fit for consumption within 24 hours only (Figure 1).
We found that feeds were withheld by 155 (27.8%) mothers during diarrhoeal episode of their children, while 21 558 (72.2%) continued feeding (Figure 2).Green et al in their study observed restriction of food items by 75% mothers.Our study results do not agree with the author.
We conclude, that after extensive endeavors of the study, covering the entire vista of the problem of relationship of dehydration, diarrhoea and mortality, a consensus has developed to liberal use of ORS rather than undue and unwarranted antibiotics.

FIGURE 2 .
FIGURE 2. Mothers attitude of feeding of children during diarrhoea

TABLE 3 . Reasons for giving ORS by mothers
FIGURE 1. Knowledge of using of ORS after preparation