Abstract

Diarrheal diseases due to infection constitute a major burden of disease. Dehydration resulting from diarrhea can be fatal. It is the cause of approximately 1.8 million deaths every year. The vast majority of these deaths are of children under five years of age living in low-and middle-income countries. Interventions to prevent diarrhea include provision of safe water, hand washing, the use of sanitation facilities, exclusive breastfeeding of infants and Rotavirus vaccination. Diagnosis is guided by symptoms into one of three categories: acute watery diarrhea, dysentery or bloody rehydration with a pre-formulated solution or with fluids that can be prepared and administered in the home. Zinc supplementation is recommended. Only in certain circumstances are antibiotics advised and anti-motility agents are discouraged. The lives of many children could be saved with proper case management of diarrhea. With immediate and sustained actions to decrease both the incidence and mortality attributed to diarrhea, the prominent public health threat could be dramatically reduced. The Cameroon government have employed many efforts to achieve diarrheal disease control. Prognosis of Diarrhea is good because most patients are treated on outpatient basis. (WHO/UNICEF. IMCI chart booklet for high HIV settings. Geneva: World Health Organisation; 2018.)

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diarrhea can be described as the passing of lose or liquid stools. it is generally defined as three or more loose or watery stools within a 24-hour period (World health organization. The global burden of disease,2004 update. Geneva, World health Organ 2008.), or a decrease in the consistency of the stool from that which is normal for the patient (World health organization, department of child and adolescent health and development. The treatment of diarrhea: a manual for physicians and other senior health workers ,4th rev, ED; Geneva: health organ).

Childhood diarrhea is defined as the passage of three or more loose or watery stools per 24hours or an increase in stool frequency or liquidity that is considered abnormal by the mother (Daniels DL, courses S; A case control study of the impact of the improved sanitation on diarrhea morbidity in Lesotho. Bull world health organ 1990,68(4):455-63).

Each year, an estimated 2.5billion cases of diarrhea occur among children under the age of five and estimates suggest that overall incidence has remained relatively, stable over the past two decades (Daniels DL, courses SN, Makoae LN. Bull world health organ 1990,68(4):455-63). Diarrheal diseases account for 1 in 9 or 9% of child deaths worldwide, making diarrhea the second leading cause of deaths among children under five (World Health Organization: children reducing mortality fact sheet). Globally from all causes of child deaths that occurs daily, diarrheal diseases accounts 15% more than 1600 children deaths under 5years of age (World health organization: children: reducing mortality fact sheet). It is estimated that about 17billion episode of childhood diarrheal occur annually and over 700000-800000 of these case result in preventable deaths.

Developing countries or economically disadvantaged regions carried the highest burden of under-five mortality rate in low-income countries was 73.1 deaths per 1000 live births, nearly 14 times the average rate in high-income countries (World health organization: children: reducing mortality fact sheet). Diarrheal diseases account for 1 in 9 or 9% of child deaths worldwide, making diarrhea the second leading cause of deaths among children under five (Estates of the global regional, and national morbidity mortality and aetiologies of diarrhea in 195 countries; a systematic analysis for the global burden of disease study 2016” the lancet infectious disease 18.11(2018):1211-235.). Many of risk factors for contracting diarrheal illnesses are associated with poor socioeconomics conditions, such as lacking access to safe water and sanitation, poor hygiene practices and unsafe human waste disposal (World health organization: Global Health Observatory (GHO) data under-five mortality). Low socioeconomic status can limit access to health care and education, and can affect diet, housing conditions and other factors increase likeliness of exposure to infectious organisms or reduce resistance to infectious diseases.

The deaths rate from diarrheal diseases is highest in the world’s poorest countries. The death rate from diarrheal disease in many of the poorest countries is higher than 100 annual deaths per 100.000 children. In countries with the worst health including Madagascar, Chad and Central African Republic. The rate is higher than 300 per 100.000. At lower levels of income risk factors for diarrheal diseases such as lock of access to clean water, rotavirus vaccine availability, undernutrition, stunting and others are the most prevalent (Gidudu J, Sack D, Pina Hudson M, Kohi K, bishop pet al/ Diarrhea: case definition and guidelines for collection, analysis and presentation of immunization safety data. Vaccine 2011,29(5):1053_1071). In Cameroon, paucity of data on diarrhea morbidity and mortality exists and these epidemiological studies have indicated the community-based prevalence of acute diarrhea to range from 16% to 23% among under-five under depending on the study site (Bilal Nk, Herbst CH? Zhao F, Soucat A, Lemiere C: Health center, yeka sub city, Addis ababa, Ethiopia: a case control study).

There are two main reasons why the number of children dying from diarrhea-associated risk factors and the lack of access to essential treatment.

Children in households with lower socioeconomic status receive oral rehydration therapy (fluid taken by mouth to prevent or treat dehydration) less often than children in households with higher socioeconomic status (Tsinuel G,Habtamu F,Goitom GY,:paediatrics and child health lecture note for health science students unpublished source.).

Diarrhea case management can be divided into assessment, treatment and follow up. The assessment aims to classify patient’s level of dehydration and determine the type of diarrhea illness (acute, dysentery or persistent diarrhea). Treatment may include oral rehydration, zinc treatment, antibiotics for selected cases, intravenous fluids for the most severe cases. Follow-up may range from hourly observations of a severely dehydrated patient, to reassessment after 4 hours for a patient with some dehydration. A patient may require follow-up after a number of days of treatment if they presented with persistent or bloody diarrhea.

Strategies to optimize the management of diarrhea need to focus on improving the communication between staff and ensuring effective treatment is implemented. Nurses find some challenges while managing childhood conditions (UNICEF, committing to child survival a promise renewed, progress report.2013). One of the main challenges for the laboratory diagnosis of diarrheal infections is that there are over 40 causative pathogens that include bacteria, viruses, parasites and eventually fungi. Conventional microbiologic detection techniques require multiple modalities (eg: bacterial culture, antigen detection and specific staining followed by microscope) along with the need for specifically trained laboratory staff, various programs for quality assurance and the ability to source multiple reagents.

1.2 Problem Statement

According to WHO, diarrhea is one of the leading cause of deaths in children under-five I the world. In Cameroon efforts to reduce the mortality rate of children under-five due to diarrhea depend on the management of patients by medical personnel’s (nurses) in hospitals (WHO. Pocket book of hospital care for children: guidelines for the management of common illness with limited resources. Geneva: World Health Organization; 2016). In spite the WHO guidelines of treatment for childhood diarrhea in all hospitals facilities, very little has been achieved in rolling back the rising number of care of childhood diarrhea and related complications in one health settings. This problem could be due to lack of implementation of the prescribed treatment guidelines hence the need to assess the knowledge of nurses on the management of childhood diarrhea from the central role they play in health care delivery.

1.3 Research questions

1. How do nurses of the St Veronica Polyclinic Buea manage childhood management?
2. What are the challenges faced by nurses during childhood management?

1.4 Research objectives

1.4.1 Main objective

Evaluate Nurses knowledge on the management of childhood diarrhea

1.4.2 Specific objectives

1. Assessment of nurses’ knowledge on the management protocol for childhood diarrhea
2. Identify the different challenges nurses face with management of childhood diarrheal patient