ABSTRACT
Introduction: Diarrheal disease is a major cause of morbidity and mortality among under-fives especially in rural and peri-urbancommunities in developing countries. Home management of diarrhea is one of the key household practices targeted for enhancement in the Community Integrated Management of Childhood Illness (C-IMCI) strategy. Objective: The aim of this study was to determine the perceptions of mothers/caregivers regarding the causes of diarrhea among under-fives and how it was managed in the home before seeking help from Community Health Workers or health facilities. Design: A household longitudinal study was conducted in Nyando district; Kenya in 2004-2006 adopting both qualitative and quantitative approaches. Subjects: A total of 927 mothers/caregivers of under-fives participated in the study. Main outcome measures: Perceived causes of childhood diarrhoea; action taken during diarrhea; fluid intake; recognition of signs of dehydration; feeding during convalescence; adherence to treatment and advice. Results: Majority of the respondents 807(87.1) reported that their children had suffered from diarrhea within the last 2 weeks before commencement of the study. Diarrhea was found to contribute to 48of child mortality in the study area. Perceived causes of diarrhea were: unclean water 524(55.6); contaminated food 508(54.9); bad eye 464 (50.0); false teeth 423(45.6) and breast milk 331(35.8). More than 70of mothers decreased fluid intake during diarrhea episodes. The mothers perceived wheat flour; rice water and selected herbs as anti-diarrheal agents. During illness; 239(27.8) of the children were reported not to have drunk any fluids at all; 487(52.5) drunk much less and only 93(10.0) were reported to have drunk more than usual. A significant 831(89.6) withheld milk including breast milk with the notion that it enhanced diarrhea. Conclusion: Based on these findings; there is need to develop and implement interactive communication strategies for the health workers and mothers to address perceptions and miscon- ceptions and facilitate positive change in the household practice on management of diarrhea among under-fives