CHAPTER ONE

1.0 Introduction.

This chapter present the background , objectives, problem of statement ,questions, scope of study,

significance of study, justification, and definition of terms (both operational and conceptual)

Diarrhea is defined as the passage of three or more loose or liquid stools per

day or more frequent passage than normal for the individuals(WHO,2017).Diarrhea

disease is the second leading cause of death in children under 5 years old and

is responsible for killing around 525000children every year(Abdulrashid et

al.,2019 ). Diarrhea can last several days and can leave the body without the

water and salts that are necessary for survival. In the past for most people,

severe dehydration and fluid loss were the main cause of diarrhea death. Other

are Caused by septic bacterial infection which are likely to account for an

increasing proportion of all diarrhea associated deaths, children with weak

immunity as well as people living with HIV are most at risk of life threatening

diarrhea (Bello et al., 2020). Diarrhea is usually a symptom of an infection in

the intestinal tract which can be caused by a variety of bacterial, viral and

parasitic organisms and this infection is spread through contaminated food or

drinking water, or from person to person as a result of poor hygiene. Diarrhoeal

disease is one of the main public health problems, although recent findings show that deaths

due to diarrhoea among children less than 5 years decreased by 34·3% between 2005 and

2015 and decreased by 20·8% among people of all ages( Epidemiol, 2010 )Diarrhoea still
remains an important preventable burden of disease, especially in south Asia and sub-

Saharan Africa ( Stanlya et al.,2015) About 94% of the diarrhea diseases burden is attributed

to the environment and linked with risk factors such as unsafe drinking-water and poor

sanitation.( Samina.M ,2009)The most of diarrhoeal diseases can be prevented by use

of rotavirus vaccine along with the implementation of water sanitation and hygiene (WASH)

programmes .Presently, the global mortality figure is about 1.5 million per year, (Wardlaw

et al.,2010) . Diarrheal disease is a leading cause of child mortality and morbidity in the

world, and mostly results from contaminated food and water sources. Worldwide,

780 million individuals lack .sanitation. Diarrhoea is due to infection is widespread

throughout developing countries. In low-income countries, children under five years

old experience on average three episodes of diarrhea every year. Each episode

deprives the child of the nutrition necessary for growth. As a result, diarrhea is a

major cause of malnutrition and malnourished children who are more likely to fall ill

from diarrhea ( Grimwood et al., 2009) indicated that indigenous industrialized communities of
northern Austria were affected by acute and persistent diarrhea due to poor socio-

economic and environmental circumstances with limited access to safe

drinking water, sewage disposal, and health care, reduced opportunities for personal sanitation,

hygiene, and unsafe food preparation. In Africa, the introduction of Oral Rehydrating

Therapy , which is a simple home made salt, and sugar solution

which has potentials of saving the lives of million of children with diarrhea .

( has the potential of sathmillions of children with diarrhea, (Kassegne et al; 2011). (Munos

et al; 2010), the efficacy and effectiveness of Oral rehydrating therapy

against diarrhea mortality in homes, communities, and health facilities settings have remained

unquestionable he suggested that most over 90% of diarrhea deaths were prevented by the

use of Oral rehydrating therapy .Water borne disease is of Water sanitation and hygiene is also

known as wash and it is the process of purifying water so that it can be safe for

use(WHO,2010),Water borne disease is of public significant in both developed and developing

nation ,about six million individuals become ill or even died due to the consumption of

contaminated water which is said to be estimated of 65% of diarrhoea disease (Bastein ét al, 2008),

Improved hygiene practices are essential if transmission routes of water and sanitation related to

diseases are to be cut off ,the provision of adequate sanitation services is equally important for

proper disposal of all waste as well as control of the carriers of communicable disease including

mosquitoes, rats, mice, and flies is crucial to mitigate health risk and prevent epidemics (UN,2013).

Africa and Asia show a highest share of diarrhea morbidity (Africa 50% and Asia 64%) ,which

might lead to death of many under age children in Cameroon. There is an increase rate of diarrhea
morbidity in Africa which ranges from 49.7million in 2017 and 57.5million in 2019(Jayala et

al.,2015) In Cameroon the disease burden from unsafe water sanitation and hygiene is estimated at

the global level taking into account various diseases outcome principally diarrhea diseases(Dipeolu

et al., 2011). Inadequate water sanitation and hygiene contribution to the prevalence of infectious

diseases such as diarrhea, and respiratory diseases. In 2018 poor access to water supply, sanitation

and hygiene (WASH) was the seventh highest cause of death in Cameroon off which children of

under 5years died every week .The risk factor includes multiple factors such as the ingestion of

contaminated water, Inadequate water supply water linked to poor personal and domestic

hygiene, Also This study was aimed at assessing mothers knowledge, risk factors prevention and

management of diarrhea in children age 0 to 5 years (Olopha et al.,2017) Despite the vulnerability

to malnutrition the nutritional status of the Mbororo children in the region remains unknown ,

Moreover the persistent problem of water-borne diseases in Cameroon may not be tackled

adequately if high -risk sub-population disparities are not thoroughly assessed, this is why the study

was conducted to fill the knowledge gap of diarrhea home management among mothers having

children of under five years.

1.2 Statement of the problem

According to Marie et al.,(2019) most children in the world experience recurrent Diarrheal disease.

The most reported causative bacterium is E-coli which is responsible for 70%-90% of bacterial

infection caused by Salmonella and Campylobacter which causes diarrhea infection among 5-15%

of young children. In 2012 diarrhea caused by bacteria infection accounted for over 500,000

hospital administration with an estimated cost of 62.8billion in the united states (US) .An updated
2019 survey found that diarrhea caused by bacterial infections are mostly acquired due to food

poisoning and commonly cause fever and blood in the stool, of over 2.8% and 625,000

hospitalization yearly in the US ,comprising 1.8% of all admissions.

According to CDC (2020) , the highest prevalence of diarrhea bacteria infection in Africa Report

shows that about 3million people suffer from diarrhea in Africa with a majority (90%) of theses

cases being children ,Again according to Vanithida (2018), over 60% of children in Africa have at

least on symptomatic of bacteria infection caused by diarrhea during their life time.

In Cameroon, the burden of diarrhea disease in children is understudied (Wague ,2020) Again, in

Cameroon studies on the knowledge of risk factors and preventions of diarrhea on children age 0 to

5 years have not been carried out( Egbe and Enow –Orocko 2020) the researcher has also noticed

that most cases presented with diarrhea disease which affects children probably could be as a result

of poor personal and food hygiene, access to safe drinking water, exclusive breast feeding for the

first six month of life ,use of improved sanitation, hand washing with soap and health education

about how infection spread and rotavirus vaccination. It is therefore because of this reasons that the

investigator felt the need to conduct a study to investigate if the mother have knowledge on risk

factors and preventives measures of diarrhea disease and if they do have knowledge on diarrhea

disease, the researcher seeks to investigate their level of awareness on risk factors and prevention of

diarrhea diseases caused by bacteria infection .

Rationales

The Rationales of this study will lead to better understanding planning, Implementation and

prevention of diarrhea generally and related to children less than or under five years in particular.it
would also provide the frame work by which specific factors could be used to assess the risk of

diarrhea in children thereby implementing the appropriate measures to prevent it. This research will

help create awareness to mothers of under five on the preventive and management of diarrhea.

1.3 Research Objectives

1.3.1 General Objective

To assess Mothers knowledge on the prevention and management of diarrhea in children age 0 to

5years in the Mutengene community.

1.3.2 Specific Objectives

 To assess mothers knowledge on diarrhea in children age 0 to 5year in the Mutengene

community.

 To identify the preventives measures of diarrhea in children age 0 to 5 years in the

Mutengene community.

 To assess mothers knowledge on the management of diarrhea in children age 0 to 5 years

in the Mutengene community.

1.4 Research Questions

General Research Questions

What is knowledge on the prevention measures and management of diarrhea in children age 0 to

5years in the mutengene community?

1.6 Specific Research Questions

  Do mother have adequate knowledge on diarrhea in children age 0 to 5years in the

Mutengene community?

 What are the preventives measures of diarrhea in children age 0 to 5year in the Mutengene

community.

 What are the methods put in place in the management of diarrhea in children 0 to 5years

in the Mutengene community.

1.6 Significance of the study.

TO the participants . This study will increase their scope concerning diarrhea that is on how to

prevent diarrhea disease.

TO the health professional. It helps them bring out the various measure to be out in place to save

live by educating mothers on the cause, prevention of diarrhea and its complication accompany

them.

To the Ministry of public health . This study could help facilitates the evaluation of the current

occurrence of diarrhea disease.

TO the community. It will create awareness to the people concern the disease (diarrhea) and how

the frequency can be reduced.

IT would also help me and other researcher .To expand our scope of knowledge in regards to the

topic.

1.7 Scope of study

Methodologically
This research will be carried out in the Mutengene community using a cross sectional descriptive

study design conducted on the children age 0- 5years living in the Mutengene community, to assess

mothers knowledge , on the risk factors, prevention and the management of diarrhea with the use of

self- structured questionnaires .

Conceptually

It is aimed at gaining and sharing knowledge about diarrhea disease and creating awareness among

the people of the community.

Geographically

Mutengene community is located in the Fako Division , in the south west Region of Cameroon.

The Mutengene community is a cosmopolitan community with different culture and it is a home to

diverse population including the Mbo, Bamelike and Bassa who are the indigenes, Mutengene is

found along the Tiko- Douala high way and has a population of about 500,000 inhabitants which

are made mostly women and children.

1.8 Justification

Due to the fact some children suffer from diarrheal is because their mothers lack adequate

knowledge, it is a call for concern and also some mothers don’t know how to prevent this problem

or even know the risk factors . Thus, the researcher saw it necessary to research on the knowledge

of risks factors prevention and management of diarrheal i. Children age 0 to 5years also result of

this research is useful in showing whether the mothers have adequate knowledge on the risk factors

prevention and management of diarrheal in the Mutengenue community.

1.9 Conceptual Definition Of Key Terms

 Assessing.it is the process of selecting, desinging, collecting analyzing interpreting and

using information to increase student’s learning and development.

 Diarrhea.it is the passage of three or more loose or liquid stool per day by an individual or

more frequent passage than is normal for the individual (WHO,2018)

 Knowledge.it refers to the understanding of the principles and relationship that underlie a

domain (Baroody,2003).

 Management.it refers to an art or science of getting work done through people.

 Prevention.it refers to an action taken to increase the likelihood that people will stay health

and wellfor as long as possible.

 Operational definition of terms.

 Assessing. It refers to the process of evaluating, analyzing and the collection of data to

describe or better understand an issue.

 Diarrhea. It refers to the passage three or more loose or liquid stool per day which is more

frequent than is normal for an individual.

 Knowledge.it is a justified statement that is most probable in comparison to other

possibilities.

 Management.it an analytical method of problem solving and decision making that is useful

(Juan Pablo Calle,2020) .

 Prevention. It refers to identifying and assessing risk and protective factors.

 CHAPTER TWO

Literature Review

2.0 Introduction

This chapter will review the literature with respect to objectives and

abstracts of related studies.

2.1 Theoretical review

The Health Belief Model (HBM) is a tool that scientists use to try and predict health behaviors

to Originally developed in the1950s and updated in the 1980s.This Model is based on the theory

that at a person’s willingness to change their health behaviors( Croyle RT,2005) is

primarily due to the following factors;

 Perceived susceptibility : People will not change their –health behaviors unless they

believe that they are at risk.

Perceived severity: The probability that a person will change his/her health behaviors to avoid

a consequence depends on low serious he or she considers the consequence to be.

.Perceived Benefits: It is difficult to convince people to change their behavior if there isn’t

something in it for them . People don’t want to give up something they enjoy if they don’t also get

something in return.

Perceived Barriers: One of the major reasons people don’t change the health behavior is that they

think that doing so is going to be difficult sometimes it is not the matter of physical difficulties

but social difficult as well. Changing your health behaviors can cost effort, money and time.

Cues to action are external events that prompt a desire to make-a health change. Cue to action is

something that helps move someone from waiting to make a health change to actually Making

the change(Kelli ,2011)

Application of the health belief model

The mode rivets mother’s knowledge and acceptance of oral rehydration

therapy in themanagement of diarrhea in children.This is influenced and modified by the individual

socio-demographic variables such as age, religion, values, ethnicity, educational status and cue

to action such as adequate knowledge from media, hospital, friends, family members There is

likelihood that the mothers will show adequate knowledge and accept oral rehydration
therapy as a means of-diarrhea management in their children(Mullu G et al., 2017), if in managing

diarrhea to outweigh the barrier.

2.1 Conceptual Review

Diarrhea is defined as the passages of three or more loose or liquid stools per day

or more frequent passage than is normal for the individual (WHO,2017).

Diarrhea disease is the second leading cause of death in children under 5 years old, and is

responsible for killing around 525,000 children every year.

Diarrhea is responsible for 7,600,000 deaths, worldwide,among children aged less than5 years.

Survival of children suffering from hypovolemic shock depends greatly on the promptness of the

treatment. Poorly managed cases have been reported with organ damage, acidosis, kidney

failure, and death. Diarrhea- associated hypovolemia is the

second leading cause of death among the children aged below 5 years.

According to the World Health Organization (WHO) and United nations children's funds

(UNICEF) There are about 2billion cases of diarrhea diseases world

every year, and1.9billion children younger than 5 years of age perish form diarrhea each

year, mostly in developing countries. This-amounts to 18%

of all thedeaths of children below the age of 5years.

This implies that >5000 children are dying every day as a-result of diarrhea, 78% occur in the

African and SoutheastAsia regions. Each child below 5 years of age experiences an-average of 3

annual episodes of acute diarrhea. Globally acute diarrhea is the second leading cause of

death (after pneumonia), and both the incidence and the risk of mortality are the

greatest among children in this age group, particularly

during infancy. Which this rates decline. Other direct consequences of diarrhea

in children include growth faltering malnutrition and impaired cognitive development in resource

limited countries. During the past 3 decades, changes in water

supply, sanitation, and personal hygiene are believed to have contributed to a decline in the

mortality rate in developed countries (Ramakrishna et al, 2013).

Based on the1991censusa Nigerian child under five has an-average of 4.3 episodes ofdiarrhea each

year. Nigeria records300,000 diarrhea related deaths each year in children and 315,000 deaths of

preschool children are recorded annually as a result of diarrhea disease. Various studies

had been carried out in Africa and indeed other developing countries

where diarrheal disease continue to be a health nuisance) on the incidence of childhood

diarrhea and Oral rehydrating therapy.

Diarrhea is a disease of the gastrointestinal tract, characterizedby abdominal fluidity andfrequently

of fecal evacuation, three-or more or at least one bloody stool in a 24 hours’ period. It is not

unusual to also find mucus in the stool, (Drenka et al, 2017).

A recent hospital based survey(TamiruD,2014) in Jos, Nigeria showed that the-

incidence of acute diarrhea disease in children had not-declined; though a

substantial reduction in annual diarrheal deaths from 4.5 mmillion in the

1980s to the present level of about out 2 million children is attributed to the

19promotion of Oral rehydrating therapy. The mother usually is the person

responsible for the care of the baby during illness and her

attitude and disposition towards the use of Oral rehydrating therapy during an episode

of diarrhea are important factors which influence the-course of the illness. The primary strategy

reducing child mortality from diarrhea had been and remains as Oral Rehydrating Solution. Most-

infectious cause of diarrhea in children are self-limiting. It has-been long

recognized that fluid replacement or rehydration in a child with watery

diarrhea can prevent or correct dehydration and can be lifesaving. Researchers have

found and revealed that some countries showed a wide gap between knowledge and the

usage of Oral Rehydrating Therapy.

A significant population of mothers surveyed, could demonstrate the preparation of Oral

Rehydration Solution[ORS] correctly whereas only a small population of these mothers used

ORS for treating diarrhea in their children under age five. However, the problem of error in

preparation of rehydration drinks is quite prevalent as most mothers prepare the salt and sugar

solution with dangerously high salt concentration. This led to Wealth Health

Organisation discouraging the use of home-made Salt Sugar Solution (SSS) ,rehydration drinks on

the ground that they are often not safely and correctly prepared and the introduction of the already

prepared Oral Rehydration Salts sachets with its own peculiar problems which include cost

and availability. Amidst these findings,home-

made SSS rehydration has in the recent past been the-mainstay in the prevention and treatment of
diarrhea in-developing countries. It is based on this background that the

researcher decided to survey the knowledge and utilization of ORT by mothers in the

management of childhood diarrhea in Seventh Day Adventist Hospital (SDAH) Ife, Osun.

Types of diarrhea.

Diarrhea may be classified into four general types,based on the mechanism including osmotic

diarrhea, secretory diarrhea, exudative diarrhea and motility disorder diarrhea. Based on clinical

syndrome diarrhea could be classified in four types each reflecting a different pathogenesis

including acute watery diarrhea dysentery persistent or prolonged diarrhea and chronic diarrhea .

Acute watery diarrhea. This term refers to diarrhea characterized by abrupt onset of frequent

watery, loose stools without visible blood,lasting less than two weeks. usually (Rajathi et

al.,2018) acute watery diarrhea episodes subsides within 72hours of onset.it can be accompanied

by flatulence, malaise and abdominal pain. Nausea, vomiting and fever may present.The common

cause of acute watery diarrhea are bacterial virus parasitic infections. Bacteria also can cause

acute food poisoning. The enteric pathogens causing this diarrhea in developing countries but

their proportion are different. In general bacterial pathogens are more important in countries with

poor hygienic conditions. The most important causes of this diarrhea in developing countries are

Rota virus, shigellae, entro toxigenic E. coli, vibrio cholerae, salmonella.

The most dangerous complication is dehydration that occurs when there is excessive loss of fluid

and minerals (electrolytes) from the body. with vomiting dehydration becomes more serve.

Dehydration is especially dangerous in infants and young children due to rapid body water

turnover, high body water content and relatively large body surface.
Dysentery, it defined as diarrhea containing blood and mucus in feces. The illness also includes

abdominal cramp, fever and rectal pain .the most important cause of blood diarrhea is shegella.In

developing countries the main causative agent of dysentery are s. flexneri, s bodyii whereas

S.sonneri is the main cause in the developed countries.

Persistent diarrhea, is defined as diarrheal episodes of presumed infectious etiology that have an

unusually long duration and last at least 14 days, about 10% of diarrhea in children from

developing countries become persistent especially among those less than three years and more so

among infants.it may begin acutely either as watery diarrhea or dysentery. this diarrhea causes

substantial weight loss in child and individuals, it may be responsible for about one-third to half

of all diarrhea related deaths. Since persistent diarrhea is a major cause of malnutrition in the

developing countries even the milder non- fatal episodes contribute to the overall high mortality

rates that are frequently associated with malnutrition in these

countries .

Chronic diarrhea. It refers to diarrhea which is recurrent or long lasting due to mainly non-

infectious causes. chronic diarrhea may be caused by gastrointestinal disease, may be secondary

to systemic diseases. Also chronic diarrhea may be may be categorized as inflammatory diarrhea

(caused by regional enteritis, ulcerative colitis), osmotic or mal absorptive diarrhea which result

from lactose intolerance, Secretory diarrhea which is been caused by medications, bowel resection

and dysmotility diarrhea is caused by conditions such as diabetic neuropathy .

 Explosive Diarrhea. Watery diarrhea is expelled violently along with gas . Bacterial

infections are the-common culprits of this type of diarrhea.

BurningDiarrhea: As its name implies, this type of diarrheacauses of painful and burning

sensation while passing stools,burning diarrhea typically develops after eating spicy foods, The

burning feeling arises because the capsaicin is not broken down properly before it leaves the body.

Other possible causes of burning diarrhea include Failure to break down stomach acids,

digestive enzymes and bile. Eating large, rough and seed containing foods that may

damage rectal tissues. Physical trauma such as increased wiping of the buttocks when

passing stool.

Laxative abuse.

OsmoticDiarrhea

Absorption of water in the intestines isdependent on adequateabsorption of solutes. If excessive a

mounts of solutes areretained in the intestinal lumen, water will not be absorbed anddiarrhea will r

esult. Osmotic diarrhea typically results from one of two situations:

i.Ingestion of a poorly absorbed substrate: The offending molecule is usually a carbohydrate

or Common examples include mannitol or salt (MgSO4) and some antacids (MgOH2).

ii.Malabsorption: Inability to absorb certain carbohydrates is the most common deficit in

this category of diarrhea, but it can result virtually any type of malabsorption. A

common example of malabsorption, afflicting many adults’ humans and pets is lactose

intolerance resulting from a deficiency

in the brush border enzyme lactase. Insuch cases, a moderate quantity of lactose is consumed
 (usually as milk), but the intestinal epithelium is deficient in

lactase, and lactose cannot be effectively hydrolyzed

into glucose and galactose for absorption. The osmotically-active lactose is retained in the

intestinal lumen, where it "holds" water. the unabsorbed lactose

passes into the large intestine where it is fermented by colonic bacteria, resulting in

production of excessive gas.

A distinguishing feature of osmotic diarrhea is that it stops after the

patient is fasted or stops consuming the poorly absorbed solute.

Secretory Diarrhea: Large volumes of water are normally secreted into the small intestinal

lumen, but a large majority of this water is efficiently absorbed before reaching the large

intestine. Diarrhea occurs when secretion of water into theintestinal lumen exceeds absorption.Ma

ny millions of people have died of the secretory diarrhea associated with cholera .The

responsible organism, Vibrio cholerae, produces cholera toxin, which strongly activates adenylyl

cyclase, causing a prolonged increase in intracellular concentration of cyclic AMP

within crypt enterocytes. This change results in prolonged opening of the chloride channels

that are instrumental in secretion of water from the crypts, allowing uncontrolled secretion of

water. Additionally, cholera toxin affects the enteric nervous system, resulting in an independent

stimulus of secretion. Exposure to toxins from several other types of bacteria (e.g. E. coli heat-

labile toxin) induce thesame series of steps and massive secretory diarrhea that is often lethal

unless the person or animal is aggressively treated to maintain hydration.

In addition to bacterial toxins, a large number of other agents can induce secretory diarrhea by

turning on the intestinal secretory machinery, including:

some laxatives

1. hormones secreted by certain types of tumors (examples .vasoactive intestinal peptide)

2. a broad range of drugs (e.g. some types of asthma medications, antidepressants, cardiac

drugs)

3. certain metals, organic toxins, and plant products (e.g. arsenic, insecticides, mushroom

toxins)

In most cases, secretory diarrheas will not resolve during a 2-3 day fast.

Etiology of Diarrhea

According to Ashley (2018), diarrhea can be caused by a

number of factors. The most common cause of diarrhea includes the following;

INFECTION

1. Virus infections including rotaviruses, coronaviruses,parvoviruses (canine and feline),

norovirus. Viruses, such as rotavirus, replicate within the villous epithelium of the small

bowel, causing patchy epithelial cell destruction and villous shortening. The loss of

normally absorptive villous cells and their temporary replacement by immature,

secretory, crypt-like cells causes the intestine to secrete water and electrolytes. Villous
 damage may also be associated with the loss of disaccharides enzymes,leading to

reduced absorption of dietary disaccharides,especially lactose. Recovery occurs when the

villi regenerate and the villous epithelium matures.

2. Bacterial infections, which can enter the body through

contaminated food or water eg Salmonella, E. coli,Campylobacter. Mucosal adhesion. Bacte

ria that multiply within the small intestine must first adhere to the mucosa

to avoid being swept away. Adhesion is caused by superficial hair-

like antigens, termed fimbriae that bind to receptors on the intestinal surface; this occurs, for

example, with enter toxigenic E. coli and

V. cholerae 01.In some instances, mucosal adherence causes changes in the gut epithelium

that may reduce its absorptive capacity or cause fluid secretion (e.g., in infection with entro

pathogenic or entero adherent E .coli .

3. Toxins that cause secretion. Enterotoxigenic E. coli, V.cholerae

and possibly other bacteria, e.g.,Salmonella, cause intestinal secretion by

producing toxins that alter-epithelial cell function; these toxins reduce the absorption of

sodium in the villi and may increase the secretion of chloride in the crypts, resulting

in net secretion of water and electrolytes. Recovery occurs when the

intoxicated cells are replaced by healthy ones after 2-4days. Mucosal invasion. Shigella,

C. jejuni and entero invasive E. coli cause bloody diarrhoea by invading

and destroying mucosal epithelial cells. This occurs mostly

in the colon and the distal part of the ileum.Invasion is followed by the formation of micro

abscesses and superficial ulcers, and hence the presence of red and
 white blood cells, or frank blood, in the stool. Toxins produced by

these organisms cause tissue damage and possibly also mucosal secretion

of water and electrolytes. Common bacteria that cause diarrhea include Campylobacter,

Escherichia coli, Salmonella, and Shigella.

4.. Parasitic infections, in which parasites enter the body through food or water and settle

into the

digestive tract. Commonparaasitesthat cause bacteria includecryptosporidium entries Entamo

eba

histolytic andGiardia lambia. Giardiasis is adiarrheal disease causedby the microscopic para

site Giardia duodenalis .Once a person or animal has been infected with

Giardia, the parasite lives in the intestines and is passed in stool (poop). Once outside

the body,Giardia can sometimes survive for weeks or even months.

5. Protozoa Mucosal adhesion. G. lamblia and Cryptosporidium adhere to the small

bowel epithelium and cause shortening of the villi, which may be how they cause diarrhoea.

amusing micro abscesses and ulcers, in much the same way as Shigella. This

only happens,however, when the infecting strain of E. histolytica isviulent. In about

90% of human infections the strains are non-virulent; in such cases there is no mucosal

invasion and no symptoms occur, although amoebic cysts are present in the faeces
Malnutrition: Children who die from diarrhea often suffer from underlying

malnutrition, which makes them more vulnerable to diarrhea. Each diarrheal

episode, in turn, makes their malnutrition even worse. Diarrhea is a leading cause of

malnutrition in children under five years old.

Source: Water contaminated with human feces for example, from sewage, septic

tanks and latrines, is of particular concern. Animal feces also contain microorganisms

that can cause diarrhea.

Other causes: Diarrheal disease can also spread from person-to-person, aggravated

by poor personal hygiene. Food is another major cause of diarrhea when it is

prepared or stored in unhygienic conditions. Unsafe domestic water storage and

handling is also an important risk factor. Fish and seafood from polluted water may

also contribute to the disease

Pathophysiology of diarrhea

(Mustafa et al., 2003) describes the pathophysiology when causative organisms gain entrance into

the gastro-intestinal tract they irritate or even inflame the tract. The toxin produced by these

organisms irritates the nerve endings in the mucosal leading to mild or severe abdominal cramp

makes the child restless.The irritation of the gastric mucosa by the bacteria and toxin may cause

vomiting while the inflammation of the intestinal mucosa, the bacteria enterotoxin cause

release of excessive amount of fluid and electrolytes by the small intestine leading

to frequent passage of explosive watery offensive stool called diarrhea.

Large volumes of water are normally secreted into the

small intestinal lumen, but a large majority of this water is effectively absorbed before reaching

the large intestine. Diarrhea occurs when secretion of water into the intestinal

lumen exceeds absorption.

Fluid forming the body is usually pumped into the intestine lumen during digestion. The fluid

is usually osmotic with blood because it contains a high concentration of sodium (approximately

142m EG/L). A healthy individual will secrete20-

30gram of sodium per daythrough intestine secretions.Nearly all of these are reabsorbed by the

intestines helping to maintain constant sodium level in the body

( Hall John E. 2006). Because there is so

much sodium secreted by the intestines without intervention, heavy continuous diarrhea can be

very dangerous and pot infec

tious bolus life threatening condition within hours- this is

because liquid secreted into intestinal lumen during diarrhea passes

through the gut so quickly that very little sodium levelsi n the body (severe hyponatremia)

(Guyton Author C.; HallJohn E. 2006). It is the motivation for sodium and water replacement

through ORS Sodium absorption through

intestines occurs in 2 stages. The first is the out most cells

(intestinal epithelial cells) at the surface of the intestinal lumen- sodium passes into these

outermost cells by co-transport facilitated by diffusion through the cells (Basal side)and into

the extracellular space by active transport through the sodium potassium pump.

Clinical Manifestation

The following are most common symptoms of diarrhea. However each child may experience

symptoms differently. The symptoms including the following;

Cramping: is a painful involuntary, contraction of a muscle, typically caused by

some risk factors which may include poor physical condition ,dehydration and

muscle fatigue

26
Abdominal pain: Abdominal pain is pain that you feel anywhere between your chest

and groin. This is often referred to as the stomach region or belly.

Bloating: Bloating occurs in your abdomen (stomach). It happens when your

gastrointestinal (GI ) tract is filled with air or gas . The GI tract runs from

the mouth to the anus (bottom). It includes your entire

digestive system. When you are bloated you feel as ifyou have eaten a big meal and

there is no room in your stomach. Your stomach feels full and tight. It can be

uncomfortable or painful. Your stomach may actually

look bigger. It can make your clothes fit tighter.

Nausea: a feeling of sickness in the stomach,especially when accompanied by

a loathing for food and an involuntary impulse to vomit

Urgent need to use the restroom which is Also called Tenesmus is the frequent and

urgent feeling that you need to pass stool, even if your bowels are alreadyempty. It may

involve straining and discomfort during bowel movements, only to

produce a small amount of stool.

Dehydration: Dehydration occurs when your bodyloses more fluid than you take in

Incontinence Inability to control the flow of the escapeof stool from the rectum(fecal inco

ntinence)

Weight loss: Weight loss refers to a decrease in your overall body weight from muscle,

water, and fat losses.

Dry, sticky mouth: A dry mouth can occur when thesalivary glands in your
 mouth do not produce enough saliva. This is often the result of dehydration, which

means you don't have enough fluid in your body to produce the saliva you need

Loss of appetite for liquid: This occurs when you do not feel hungry or thirsty.

Urinates less frequently or this is when someone is urinating lesser than normal

Frequent vomiting: is an often forceful contraction of the stomach that propels

its contents up the esophagus and

out the mouth .Extreme thirst: Thirst is normally just the brain's

way of warning that you're dehydrated because you are not drinking enough fluid"

Depressed fontanelle (soft spot) on infant’s head:is a sign that the infant does not

have enough fluid in its body.

2.1.5 Consequence of Diarrhea

Diarrhea disease may have a negative impact on both physical fitness and mental development.

Early childhood malnutrition ofanysource reduces physical fitness and development of children. D

iarrhea is primarily the cause of childhood malnutrition. Further, evidence suggests that diarrhea

disease has significance impact on mental development and health: it has been shown that

even when controlling for helminthes infection and early breastfeeding, children who had

experienced severe diarrhea had significantly lower scores on a series of test of

intelligence. Diarrhea can cause electrolyte imbalances, rental impairment, dehydration, and

defective immune system responses by( Gueriant el al 2008).

Dehydration can be life threatening if untreated. Dehydration is particularly

dangerous in children, older adults and those with weaken immune systems. Indications of

dehydration in infants and young children include:

1. Not having a wet diaper in three or more hours

2. Dry mouth and tongue

3. Fever above 102F (39oC)

4. Crying without tears

5. Drowsiness, unresponsiveness or irritability

6. Sunken appearance to the abdomen, eye

Risk factors of diarrhea

Some of factors that have been identified as risk factor for diarrhea are:

Personal hygiene by care givers;

1. Poor water storage practices

2. Lack of hand washing

3. Eating uncover food

4. food poisoning

Environmental hygiene:

1. Unsatisfactory garbage disposal

2. Shorter using water from river

4. Poor sanitation

5. (Thomas et al.,2018)

Genetically, There are congenital diarrheal disorders linked to specific

genes. These disorders usually comeon in the first few monthsof a child's life. They are ofte

n most common in certain populations, Some other conditions

that may causechronic diarrhea also tend to run in families, including celiac disease, some

forms of lactose intolerance, and food allergies.

Prevention of Diarrhea
 Childhood diarrhea is the most common infections in origin for effective prevention of

diarrhea, the following could be applied.

1. Breast-feeding introduction. Exclusive breastfeeding(EB) means that an infant receives

only breast milk from his or her mother or a wet nurse, or expressed breast milk, and

no other liquids or solids, with the exception of oral rehydration solution, drops or

syrups consisting of vitamins, minerals supplements or medicines. The American

Academy of Pediatrics and the World HealthOrganization also recommend exclusive

breastfeeding for about the first 6 months, with continued breastfeeding along with

introducing appropriate complementary foods for up to 2 years of age or longer.

2. Breast milk has immunological properties (especially antibodies) that protect the infant

from infection and especially from diarrhea these are not present in animal milk or formula.

3. Personal hygiene and environmental sanitation

4. Food hygiene

5. Washing of hands before and after defecation

6. Proper child health education should be taught to mothers and health care givers.

7. Early detection and diagnosis of signs and symptoms ofdiarrhea and simple treatment

medication.

8. Immunization.

Treatment of Diarrhea
Diarrhea usually clears up quickly without treatment to help you cope with your symptoms until the

diarrhea goes away, try to do the following:

 Drink plenty of liquids, including water and juices ,Avoid caffeine and alcohol.

 Add semisolid and low-fiber foods gradually as your bowel movements return to normal

try soda crackers, toast, eggs, rice or chicken.

 Don't eat certain foods such as dairy products, fatty foods, high-fiber foods or highly

seasoned foods for a few days.

 Ask about anti-diarrheal medicines. Non prescription anti-diarrheal medicines, such as

loperamide and bismuth sub salicylate, might help reduce the number of watery bowel

movements and control severe symptoms.

Certain medical conditions and infections bacterial and parasitic can be worsened by these

medicines because they prevent your body from getting rid of what is causing the diarrhea. Some of

these medicines are not recommended for children. Check with your doctor before taking these

medicines or giving them to a child.

 Rehydration: with oral rehydration salts (ORS) solution. Oral Rehydrating

Solution is a mixture of clean water, salt and sugar, Oral Rehydrating Solution
is absorbed in the small intestine and replaces the water and electrolytes lost

in the faeces.

 Zinc supplements: zinc supplements reduce the duration of a diarrhea

episode by 25% and are associated with a 30% reduction in stool volume.

 Rehydration: with intravenous fluids in case of severe dehydration or shock.

 Nutrient-rich foods: the vicious circle of malnutrition and diarrhea can be

broken by continuing to give nutrient-rich foods including breast milk during

an episode, and by giving a nutritious diet including exclusive breastfeeding

for the first six months of life to children when they are well.

 Consulting a health professional, in particular for management of persistent

diarrhea or when there is blood in stool or if there are signs of dehydration.

 Consider taking probiotics. These microorganisms may help restore a healthy balance to

the intestinal tract by boosting the level of good bacteria. However, it is not clear if they can
 help shorten about of diarrhea. Probiotics are available in capsule or liquid form and are also

added to some foods, such as certain brands of yogurt. Further research is needed to better

understand which strains of bacteria are most helpful or what doses are needed.

 In Most cases of acute diarrhea which clear off on their own within a couple of days

without treatment. If you have tried lifestyle changes and home remedies for diarrhea

without success, your doctor might recommend medicines or other treatments like.

Antibiotics or anti-parasitics

Antibiotics or anti-parasitic medicines might help treat diarrhea caused by bacteria or parasites. If a

virus is causing your diarrhea, antibiotics won't help.

Treatment to replace fluids

Your doctor likely will advise you to replace the fluids and salts. For most adults, that means

drinking water with electrolytes, juice or broth. If drinking liquids upsets your stomach or causes

vomiting, your doctor might recommend getting Intra -venous fluids.

Water is a good way to replace fluids, but it doesn't contain the salts and electrolytes — minerals

such as sodium and potassium that are essential for your body to function. You can help maintain

your electrolyte levels by drinking fruit juices for potassium or eating soups for sodium. But certain

fruit juices, such as apple juice, might make diarrhea worse.

For children, ask your doctor about using an oral rehydration solution to prevent dehydration or

replace lost fluids.

Adjusting medicines you're taking

If your doctor determines that an antibiotic caused your diarrhea, they might lower your dose or

switch to another medicine.

Treating underlying conditions

If your diarrhea is caused by a more serious condition, such as inflammatory bowel disease, your

doctor will work to control that condition. You might be referred to a specialist, such as a

gastroenterologist, who can help devise a treatment plan for you.

Diagnosis

Your health care professional will ask about your medical history, review the medications you take

conduct a physical exam and may order tests to determine what is causing your diarrhea. Possible

tests include:

 Blood test. A complete blood count test, measurement of electrolytes and kidney function

tests can help indicate the severity of your diarrhea.

 Stool test. Your doctor might recommend a stool test to see if a bacterium or parasite is

causing your diarrhea.

 Hydrogen breath test. This type of test can help determine if you have a lactose intolerance.

After you drink a liquid that contains high levels of lactose, your breath is measured for

hydrogen at regular intervals. Breathing out too much hydrogen indicates that you aren't

fully digesting and absorbing lactose.

 Flexible sigmoidoscopy or colonoscopy. Using a thin, lighted tube that is inserted in your

rectum, your doctor can see inside your colon. The device is also equipped with a tool that

allows your doctor to take a small sample of tissue, called a biopsy, from your colon.

Flexible sigmoidoscopy provides a view of the lower colon, while colonoscopy allows the

doctor to see the entire colon.

 Upper endoscopy. Doctors use a long, thin tube with a camera on the end to examine your

stomach and upper small intestine. They may remove a tissue sample for analysis in the

laboratory.

2.4 CONTEXTUAL REVIEW

A child nutritional status reflects the combined effects of many factors including nutrient

intake, health, birth order and behavioral factors governed by parental preferences (Merga

N,2019)

. In recongnition of interrelated variables are expressed child’s nutritiona production

function ,they represented as child’s nutritional status= f( nutrition

al input ,child’s health, child’s death, births, biological factors, childcare time ,technology

factors) Cameroon conducted a study in 2011 to guage diarrhea disease within the

country.The study found that of children under five years old ,thirty three percent (33%) of

them suffered from chronic diarrhea and fourteen percent (14%) of them were severely

malnourised

.
There are several theories as to why Cameroon experiences such high rate of diarrhea

disease. Cameroon’s Ministry of public health believes that diarrhea is

Linked to Cameroon’s complex climate. They cite certain regions with dry,semi- arid

climates having higher rates of nutritional deterioration in children than in other

regions.Additionally, it is believed that the influx of refugees from chad and central African

Republic has added an increased strain to Cameroon.TheNorthern and far Northern regions

of Cameroon experiences the highest rates of childhood diarrhea disease .Unfortunately

diarrhea exists throughout the entire country and just in the North.This is believed to be due

to the lack of food in certain seasons, and in certain region as previously

Explained (Rubini et al.2016) .Cameroon has inadequate food variety,creating a deficiency

of

certain vitamins and minerals in many children’s diets .Cameroon’s problem is

not food insecurity. The country is capable and does not produce enough food to sustain its

population and does not need to Import food. However, poverty is a severe roadblock to

battling malnutrition which causes diarrhea .poverty keeps

a large portion of Cameroon from having access to balanced diet. (UNICEF ,2017) has

estimated that 57,616 children under the age of five are at risk of serve acute malnutrition in
the North and Far North regions of Cameroon. Additionally UNICEF believes 145,000

children under the age of five will experience stunted growth. Very few children in

Cameroon are breastfed after birth which lead to such inflated statistics. UNICEF has

partnerned with the nineteen feeding centers in the country to prevent complications

associated with malnutrition and seek medical help when they are noticed.
2.5 EMPIRICAL REVIEW

In a research study on mother's knowledge of Oral Rehydrating Therapy and its usage in Ibadan

Metropolis, Nigeria revealed that more than average of the population was knowledgeable about the

therapy as indicated by describing the treatment correctly, recognizing the packet or reciting the

home recipe, although areas of knowledge deficits include prevention of dehydration and where the

Oral Rehydrating Therapy packets could be purchased (Alex et al., 2010).

In another study on the knowledge and utilization of oral rehydration therapy among mothers in the

management of childhood diarrhea in General Hospital Kwoi, Kaduna State, Nigeria revealed that

all the mothers were having adequate knowledge on Oral Rehydrating Therapy, they have heard and

are aware of Oral Rehydrating Therapy.

Areas of knowledge deficit was on the preparation of Oral Rehydrating Solution

(Solomon et al.,2016). According to these studies, intensive Oral Rehydrating Therapy training

should be organized for community/village health works, standard cups for water, salt and sugar

measurement should be provided to all households as a ready means of ensuring the correct

preparation of Oral Rehydrating Solution, mothers should be educated on the correct preparation of

Oral Rehydrating Solution and also mothers should be encouraged to make use of already prepared
Oral Rehydrating Solution sachets. According to these studies, intensive ORT training should be

organized for community/village health works, standard cups for water, salt and sugar measurement

should be provided to all households as a ready means of ensuring the correct preparation of Oral

Rehydrating Solution, mothers should be educated on the correct preparation of Oral Rehydrating

Solution and also mothers should be encouraged to make use of already prepared Oral Rehydrating

Solution sachets.

This article was published by (Nair on the 3 August 2014) tittle Risk factors of diarrhea among

preschool children in Terengganu, Malaysia: a case control study

This study shows that a total of 247children with 137 cases and 137 controls were recruited. All

respondents were Malays. Among the cases, a larger proportion of them were females and income

families. After adjusting all confounders, childhood diarrhea was significantly associated with

number of children (aOR:5.86, 95% Cl: 1.96, 17.55), child hunger(aOR; 16.38, 95%Cl:

1.34,199.72), dietary energy intake(aOR: 0.99,95%), protein intake(aOR: 1.06,95% Cl;1.01,1.12),

vitamin A intake(aOR: 0.999,95% Cl: 0.997,1.00), low birth weight(aOR:6.83,95% Cl:1.62,28.89),

frequent illness(aOR:2.79,95% Cl:1.06,7.31) and history of warm infection(aOR:3.48,95%

Cl:1.25,9.70). In addition, another article was published by Samuel Nambile Cumber, Nkengateh

Babara Ankraleh and Nina Monju on the 2 November 2016 tittle Mothers knowledge on the effect

of diarrhea in children 0-5years in the Mutengene community. The results obtained shows that 73%

of mothers had knowledge on the risk factor diarrhea, 50% had knowledge on the preventives

measures of diarrhea in children while 50% of mothers had insufficient knowledge on the diarrhea

in children. Their knowledge increases with the number of children and their level of education.
Moreover, another article was published by Phillips Edomwonyi Obasohan, Stephen J. Walters,,

and Khaled Khatab on the 31 July 2020 on the tittle Risk factors Associated with diarrhea among

children under-five years in Sub Saharan African Countries: A Scoping Review. The study shows

that a total of 229 papers were identified, of which 26 studies that have been included in the review.

The risk factors for diarrhea identified were classified as child-related, parental/household-related

and community or area-related. Furthermore, an article was published by Mohammad Mohseni on

the 7 March 2019 on the tittle prevention of diarrhea among under 5 years old in Iran: a policy

analysis. Which state that growth monitoring, oral dehydration, breastfeeding, immunization,

female education, family spacing, food supplementation, nutrition for children under five years of

age, and control of nutritional deficiencies. Lastly, this (Wegbom and Amit Arora on the 16

November 2022 )Tittle measuring the uptake of growth monitoring and nutrition promotion among

under- 5 children: findings from the Rwanda population- based study. This study shows that the

prevalence of growth monitoring and nutrition promotion among under-5 children was 33.0%

(95%Cl: 30.6-35.6%). Older children, caregivers who were native residents, those with a health

insurance, in a marital relation, employed, and residing in rural areas had higher odds to participate

in growth monitoring and nutrition promotion compared to their counterparts. Rwanda has a low

rate of coverage for growth monitoring and nutrition promotion among children less 5.

CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION.
This chapter focuses on description of study Research design, study area, study population ,

Target population ,Accessible population, Sample size, Sampling technique, Inclusive and

exclusive criteria, Instrumentation, Data analysis and Ethical consideration.

3.1 Research Design

The research design is a cross-sectional study ( community –based) will be used where

information will be gotten from interested participants, analysed and presented using frequencies

samples, piechart and tables. that will last between Novermber 2023 and January 2024.

3.2 Study area

The study will be carried-out at the Mutengene community, this community is located in the

Fako Division south west Region of Cameroon, The Mutengene community is a cosmopolitan

community with different cultures but dominated by diversed population by the Mbo, Bassa, and

who are indigenes ,The Mutengene community is found along the Tiko –Douala high way ,It has a

population of approximately 500,000 inhabitants which are made mostly of women and

children .The soil is Clay in nature and the people practice farming as a result of fertile soil even

though traders is also significant among other members of the community .

3.3 Study population

The study population involves some of the mothers having children from 0 to 5years in the

Mutengene community.

3.4 Target population

The target population involves 80 mothers having children within the age range 0 to 5 years in the

Mutengene community.
3.5 Accessible population

The accessible population involves mothers having children from 0 to 5 years in the Mutengene

community.

3.6 Sample Size Determination

The estimated sample size was calculated using the Cochran’s formula where; N=Z2PQ/D2

Where;

N = Sample size

Z= Constant of Confidence interval ( 1.96)

P= Past prevalence (5.5%)=5.5/100=0.055

Q = 1- P(1-0.055)

Q= 0.945

D= arrow mark constant(0.05)

Therefore

Sample size(n)=1.96 x0.055x0.945/0.0025 = 79.8 which is equal to 80

3.6 Inclusion criteria

This study will involves 80 Mothers having children from 0 to 5 years in the mutengene

community .

Exclusion criteria
Mothers that will not give their consent

Mothers who were not available at the time of study were excluded.

3.7 lnstrumentation

The researcher used questionnaires to collect data. The questionnaire contents a brief letter of

introduction to explain the purpose of the study to ask for cooperation of students in completing the

questions .Other tools that will be used in the collection of data include .pen, pencil ,and computer.

3.8 Validation of instrument . A well- structured questionnaires will be presented to my

supervisor for correction and validation. It will be re-structured and after correction, the

questionnaires were taken to the Mutengene community

3.9 Data Analysis

Data will be edited , cleaned, coded, entered and analysed using Microsoft Excel 2010. Data will

be summarized by means of descriptive statistics including the frequency table ,pie chart and bar

chart.

3.10 Ethical consideration

This study will receive ethical clearance and approval from the school which will be meant

to assure the respondents that the data will be used strictly for the study and the source of the data

will remain anonymous as the respondents will give no private information such as their names and

contacts .The researchers will confirm the principle of voluntary consent where respondent will

willingly be ready to participate in the study. The language that will be used for this research will be

very simplified to the understanding of all readers. The research is been produced for the
Cameroonian society and the world at large in the advancement of Knowledge. This is because no

individual has monopoly of

 Appendix 1. Questionnaires

Dear Respondents

I am NDONGMBEI SHELLA NGWO a Bachelor degree student of Redemption Higher Institute of

Biomedical and Management Sciences Molyko Buea carrying out a research on ‘ ASSESSING

MOTHERS KNOWLEDGE ON THE RISK FACTORS ,PREVENTION AND MANAGEMENT

OF DIARRHEA IN CHILDREN AGE 0 TO 5YEARS OLD. This research work is being

conducted in partial fulfillment of the requirement awards of BACHELOR DEGREE PROGRAM.

I am pleading on your maximum cooperation in answering the questions below with honest

answers. The survey will take

Approximately 5-10minutes
Certification of consent

I have read the above information (or it has been read to me).I have had the opportunity to ask

questions and was explained in detailed on the procedure, purpose and requirements to ask

questions and was explained in detail on the procedure, purpose and requirements for this study ,I

voluntarily give my consent to take part in this research.

Signature of participants…………………….

Date………………………………..

SECTION A .DEMOGRAPHIC DATA

1)AGE

 15-20

 21-25

 26-30

 31-35

2) EDUCATIONAL LEVEL

 Advance level

 Ordinary level

 Masters

 Others not mention

3) RELIGION

 Christian
  Muslim

 Others not mentioned

4) MARITAL STATUS

 Married

 Widow

 Divorce

 None of them above

5) Occupation

 Business

 Farmer

 Student

 Others specify

SECTIO N B. KNOWLEDGE ON DIARRHEA

1) Have you ever heard of diarrhea before

A)yes (B) No

2) If yes where…………………………..

3) What do you understand by diarrhea

A)When your stools are loose and watery B) When your stools are loose and watery for days C)

watery stools but at times hard D) hard stools

4) Have you ever had someone who had diarrhea

A) yes B) No

5) If yes who

A) your child B)Niece C) Neighbour’s child D)None of the above

SECTION C. KNOWLEDGE ON THE PREVENTION OF DIARRHEA

1) Were you told that poor personal and food hygiene like not washing your hands after using the

toilet and not washing vegetables or fruits before eating can trigger the transmission of diarrhea

A)Yes B)No

2) Do you know that lack of safe drinking water can cause the transmission of diarrhea

A) Yes B)No

3) Do you know that appropriate exclusive breastfeeding for the first six months trigger

A) Yes B)No

4) Do you regularly honour appointment dates with the healthcare providers based on your child’s

health condition

A) Yes B)No

5) Do you give your child the medication prescribed by the healthcare providers
A)Yes B)No

SECTION D. KNOWLEDGE ON THE MANAGEMENT OF DIARRHEA

1) Can diarrhea be managed in children

A) Yes B)No

2) If yes how do you manage diarrhea in children

A) With Oral rehydrating solution

B) With salt and water

C) water only

D) Sugar and water only.

3) What is Oral Rehydrating Solution(ORS)

A) Salt

B) Anti-diarrhoeal

C) Drug

D) I don’t know

4) How long should oral rehydrating solution be used

A) Same day

B) Till cure

C) Everyday

D) I don’t know
5)Do you know how to prepare Oral Rehydrating Solution, if yes how do you do it

A)I Litter of water, half teaspoon salt and 9teaspoon sugar

B)one litter of safe water, half small teaspoon of salt ,eight small teaspoon sugar and stir the sugar

and salt until it dissolve.

C)1.5Litter of water with one big spoon sugar

D)I don’t know