Josephat Nyagero

, Moses Mwangi, Elijah Mbiti, Bob Akach, Jacqueline Kung’u, Stewart Kabaka, Christopher Wanyoike, John Nduba

Safari Park Hotel, Nairobi November 25, 2014

Background

• Kenya unlikely to meet MDG goal 4 • High impact child survival interventions implemented • Diarrhea contributes >20% U5 child mortality (Black et al, 2010) • Early management of childhood diarrhea through: – Breastfeeding, good hygiene practices and – ORS & zinc supplementation to avoid severe illness and death

Background

• Access to correct information and to ORS and zinc at community level remains a major bottleneck • 39% of children with diarrhea received ORS treatment and <1% zinc yet 80% of mothers knew about ORS (KDHS 2008-9) • Purpose of this paper is to assess the factors associated with the mother’s/ caregiver’s knowledge on diarrhea prevention and control

ORS/ zinc cluster randomized project design

58 sub-locations Sub-locations with CHU (18) Sub-locations without CHU (40) Eligible based on population size (15) Simple random sample (SRS) 11 sub-locations or clusters Randomization 5 Intervention group clusters 6 Comparison group clusters Eligible based on population size (23) Simple random sample (SRS) 11 sub-locations or clusters 6 intervention group clusters Randomization 5 Comparison group clusters

Methodology

• Narok south district of Narok County in Kenya • 22 sub-locations out of 58 (11 intervention, 11 control) • Targeted all women with children U5s • Information on 500 U5 children in each sub-location • Household Questionnaires adapted UNICEF’s Multiple Indicator Cluster Survey tools used for 2009-2011 data • Back translated into Maasai and Kipsigis and pretested • Administered by trained research assistants locally recruited • Data entry done using SPSS • Logistic regression at the 95% confidence interval

Table 1: Selected socio-demographic characteristics of the study participants Variables Intervention/Control

Intervention Cluster Control Cluster

Gender of Respondent

Male Female

Age of Respondent Grouped

<20 yrs 20 to 29 yrs 30 to 39 yrs 40 to 49 yrs 50 to 59 yrs 60 yrs and above Not known

Mother's highest level of education

Primary Secondary College/university None

Number of children

One Two Three Four or more

n=6683

3306 3377 364 6319 516 3239 1582 479 95 39 733 2320 456 175 3732 3449 2346 837 51

%

49.5

50.5

5.4

94.6

7.7

48.5

23.7

7.2

1.4

0.6

11.0

34.7

6.8

2.6

55.8

51.6

35.1

12.5

0.8

Table 2: Household hygiene and sanitation Variables Drinking water treated

Yes No

Water storage in the Household

Open container Covered container Same fetching container

Utensils washed and put on a drying rack

Yes No

Compound clean or littered

Clean Littered

Dwelling Clean

Yes No

n=6683

1040 5643 724 1938 4021 4367 2316 3354 3329 4439 2244

%

15.6

84.4

10.8

29.0

60.2

65.3

34.7

50.2

49.8

66.4

33.6

Table 3: Source of information on prevention and treatment of childhood diarrhea Variables

Public Health facility Family members Private Health facility Herbalists CHWs Community training Radio newspapers Church Written pamphlets AMREF

n=6683

4238 1673 740 334 306 256 211 82 68 2

%

63.4

25.0

11.1

5.0 4.6

3.8

3.2

1.2

1.0

0.03

Responses on selected knowledge issues

• What diarrhea is? – universal • Ever heard of ORS - 70.8% • Ever heard of zinc - 16.5% • Action to take if diarrhea is identified – 51.3% seek treatment immediately – 45.7% seek treatment if persist – 6.5% seek treatment if bloody

Figure 2: Overall Knowledge on prevention and control of diarrhea 34,5% 65,5% Adequate knowledge Inadequate knowledge

Table 4: Knowledge on prevention and control of diarrhea in relation to selected socio-demographic characteristics Characteristics Intervention/Control

Intervention Cluster Control Cluster

Age of the Respondent

<20 yrs 20 to 29 yrs 30 to 39 yrs 40 to 49 yrs 50 to 59 yrs 60 yrs and abve Dont Know

Gender of Respondent

Male Female

Mother's highest level of education

None/Primary Secondary College/university

Number of children per household

One Two Three Four or more

Adequate knowledge (n=4,378) Inadequate knowledge (n=2,305) n % n %

2188 2190 312 2153 1073 318 55 18 449 213 4165 3898 334 146 2256 1539 547 36 66.2

64.9

60.5

66.5

67.8

66.4

57.9

46.2

61.3

58.5

65.9

64.4% 73.2% 83.4% 65.4

65.6

65.4

70.6

1118 1187 204 1086 509 161 40 21 284 151 2154 2154 122 29 1193 807 290 15 33.8

35.1

39.5

33.5

32.2

33.6

42.1

53.8

38.7

41.5

34.1

35.6% 26.8% 16.6% 34.6

34.4

34.6

29.4

OR

1.06

1.00

1.78

2.31

2.46

2.30

1.60

1.00

1.84

1.00

1.37

1.00

1.51

2.78

0.79

0.79

0.79

1.00

p value

0.252

0.083

0.010

0.006

0.013

0.217

0.064

0.004

<0.001

<0.001

0.441

0.459

0.446

Table 5: Knowledge on prevention and control of diarrhea in relation to Household hygiene and sanitation Adequate knowledge (n=4,378) Inadequate knowledge (n=2,305) % n % Characteristics Drinking water treated

Yes No

Water storage in the Household

Open container

n

789 3589 Covered container Same fetching container 384 1243 2751

Utensils washed and put on a drying rack

Yes No

Compound clean or littered

2962 1416 clean littered

Dwelling Clean

2310 2068 Yes No 3006 1372 75.9

63.6

53.0

64.1

68.4

67.8

61.1

68.9

62.1

67.7

61.1

251 2054 340 695 1270 1405 900 1044 1261 1433 872 24.1

36.4

47.0

35.9

31.6

32.2

38.9

31.1

37.9

32.3

38.9

OR

1.80

1.00

1.00

1.58

1.92

1.34

1.00

1.35

1.00

1.33

1.00

p value <0.001

<0.001

<0.001

<0.001

<0.001

<0.001

Table 6: Factors associated with knowledge on prevention and control of diarrhea among the study participants Variables Gender of the Respondent

Male Female

Mother's highest level of education

None/Primary Secondary College/university

Dwelling Clean

Yes No

Public Health facility

Yes No

AOR 95% CI of AOR Lower Upper p value

1.00

1.49

1.19

1.85

0.001

1.00

1.46

2.33

1.17

1.54

1.83

3.53

0.001

<0.001

1.24

1.00

1.11

1.38

<0.001

1.88

1.00

1.67

2.10

<0.001

Conclusion

• being female and having secondary level of education, • dwelling in HHs with clean compound and, • obtaining information from public health facilities are associated with adequate knowledge on prevention and treatment of childhood diarrhea

Recommendation

Long term

• supporting girl-child education in the area

Short term

• concerted effort to promotion clean dwelling compounds through multiple approaches using community structures • strengthen health facilities as sources of health information to care givers and diversify as may be appropriate