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Nigerian J Paediatrics 2018 vol 45 issue 2

Nigerian J Paediatrics 2018 vol 45 issue 2

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Mothers awareness and use of zinc in under five children with diarrhoea in North Western Nigeria
Niger J Paediatr 2018; 45 (2): 81 - 85
ORIGINAL
Gwarzo GD
CC Ė BY
Mothersí awareness and use of
zinc in under-five children with
diarrhoea in North-Western
Nigeria
DOI:http://dx.doi.org/10.4314/njp.v45i2.2
Accepted: 3rd May 2018
Abstract : Background: Zinc sup-
Results: Among the 212 mothers
plementation is recommended in
selected 55.7% were aware of zinc
Gwarzo GD (
)
the treatment of diarrhoea. It re-
in the treatment of diarrhoea and
Department of Paediatrics,
duces the severity, duration and
51.9% gave zinc to their children.
Bayero University Kano, Nigeria
recurrence of diarrhoea. Mothersí
Health facilities were the sources
knowledge and usage of zinc are
of information in 55.9% of them.
important.
Urban residency and motherís edu-
Objectives: This study assessed
cation were associated higher rate
mothersí knowledge and use of
of zinc utilization. Conclusion:
zinc in children with diarrhoea.
Awareness and use of zing among
Materials and Method: The study
the mothers were modest. Maternal
was descriptive cross sectional of
education and awareness cam-
mothers who brought their chil-
paigns are needed to improve its
dren to a tertiary health centre in
knowledge and usage.
Kano, Nigeria. Mothers were se-
lected consecutively from the
Keywords: Zinc, diarrhoea,
Outpatient Clinic. Data were col-
children, knowledge and practice,
lected using questionnaire, and
Nigeria.
analysed.
Introduction
zinc by the parents/caregivers of these children. In Nige-
ria, researches on the awareness and use of zinc among
Zinc deficiency is common among children in develop-
mothers of children with diarrhoeal diseases are lacking.
ing countries.
1,2
Diarrhoea, which worsens zinc defi-
In order to assess the success of zinc supplementation in
ciency is still common among children in these re-
diarrhoeal diseases, and to find ways of promoting it, a
gions.
3,4
Conversely, zinc deficiency may exacerbate the
study on the awareness and usage of zinc in children
passage of unusually loose or watery stools, through
with diarrhoea is needed. This study evaluated the
various mechanisms and may contribute to undernutri-
knowledge and use of zinc in mothers of children with
tion in these children.
5-7
diarrhoea brought to a tertiary hospital for care.
Studies have shown that zinc supplementation (10-20mg
daily for 10-14 days) in children with diarrhoea reduced
the duration by up to 24%,
8,9
stool volume by 30%,
10
and the incidence of diarrhoea in children by 15%
Materials and methods
to18%.
9,11
The benefits of zinc were observed in both
acute and persistent diarrhoea. Because of these bene-
2
The study was descriptive cross sectional conducted at
fits, the World Health Organization (WHO) and United
the Outpatient Clinic of Murtala Mohammed Specialist
Nations Childrenís Fund (UNICEF) recommend the use
hospital Kano, Nigeria. Consecutive mothers who
of oral zinc and ORS in management of diarrhoea in
brought their under-five children to the clinic for care
children.
7,10
were selected. Visitors who had been staying in the area
for less than 10 days were excluded from the study. In-
Awareness of the inclusion of zinc in the management of
vestigator administered questionnaire was administered
childhood diarrhoea among health care providers has
to the selected mothers between September and Decem-
13,14
been high in some countries and low in others.
12
In a
ber 2016. The children were examined thoroughly and
study in Nigeria, only two-thirds of healthcare workers
those who needed hospitalization were immediately sent
were aware of zinc supplementation, 35% of them pre-
to Emergency Paediatrics Unit (EPU). Information relat-
scribed zinc when managing childhood diarrhoea and
ing to biodata, diarrhoea and use of oral Zinc was ob-
10% of these do so for every case of childhood diar-
tained. The primary outcome indices were the percent-
rhoea.
15
But success in reducing diarrhoeal morbidity
age of caregivers who were aware that zinc is an appro-
and mortality by administering zinc to children with
priate treatment for diarrhoeal disease, and the percent-
diarrhoea depends on the knowledge and acceptance of
age of mothers/caregivers who actually administered
82
zinc to their children who had diarrhoea.
Table 2: Knowledge and administration of Zinc by the
All information obtained was recorded in the question-
mothers
naire, and confidentiality of the participants was kept.
Variable
Frequency
Percentage
The data obtained were entered into Excel Spreadsheet
Ever aware of Zinc supplementation
and analysed using Excel and SPSS statistical software.
in treatment of diarrhoea
Tables and charts were used to present the data.
Yes
118
55.7
Ethical clearance for the research was obtained from the
No
94
44.3
hospital Research Ethics Committee, and each partici-
Knowledge of use of Zinc
pant gave an informed consent for the study.
Did not know
100
47.2
As part of treatment of diarrhoea
112
52.8
Ever given Zinc to your child
Yes
110
51.9
No
102
48.1
Results
Reason for giving Zinc to your child
Diarrhoea
107
97.3
A total of 212 eligible mothers who brought their chil-
Vomiting
1
0.9
dren for care were interviewed. The demographic data of
Other
2
1.8
the mothers is shown in Table 1. Majority of the moth-
Acceptance of Zinc by the child
ers are unskilled self-employed, and resided in the urban
Refused/Force fed
6
5.5
areas.
Drank with difficulty
26
23.6
Drank easily
78
70.9
Table 1: Motherís demographic variables
Variable
Frequency
Percentage
Fig 1: Sources of information about Zinc in 118
mothers.
Motherís Educational Level
Illiterate or primary school
111
52.4
Secondary school
84
39.6
Tertiary school
17
8.0
Motherís Employment status
Unemployed
94
44.3
Employed
118
55.7
Place of Residence
Urban
160
75.5
Rural
52
24.5
As shown in Table 2, only a little over half of 212 moth-
ers who participated in the study were aware of Zinc as
Reasons given by 102 mothers who never gave Zinc to
part of treatment of diarrhoea in children, while the re-
their children with diarrhoea were variable. Ninety-two
maining 44.3% never heard of it before. Close to half of
percent of them did not give zinc to their children be-
the mothers surveyed did not know the use of Zinc in
cause they were not aware of it. Other reasons included
children, and 48.1% had never given zinc to their chil-
zinc not available (4%), mother did not like zinc (3%)
dren with diarrhoea. Among 118 mothers who knew
and mother believed zinc was not effective (1%). This is
about zinc, 110 (93.2%) of them gave zinc to their chil-
presented in Figure 2.
dren.
Out of 110 mothers who gave Zinc to their children, 107
Fig 2: Reasons for not giving Zinc by 102 mothers
(97.3%) of them were because of diarrhoea. As shown in
Table 2, majority (70.9%) of children accepted Zinc
easily as reported by 110 mothers who gave Zinc.
Health facility and Patent Medicine store were the main
sources of information about zinc. More than half
(55.9%) of 118 mothers knew about zinc from health
facilities while one-third (33.1%) of them from Patent
Medicine stores. Other sources of information about
zinc included news media (5.9%), health worker outside
health facility (3.4%) and friends (1.7%). None of them
got the information from books or social media. These
are shown in Figure 1.
Motherís educational level up to secondary school and
beyond, and residing in urban areas were significantly (p
values 0.01 and 0.00 respectively) associated with ad-
ministration of zinc to their children with diarrhoea.
Other variables such as motherís employment, fatherís
education, use of ORS, and presence of fever were not
83
significantly associated with the administration of zinc
means that health workers and PMS attendants are
to these children as shown in Table 3.
aware of zinc in treatment diarrhoea in children. This is
supported by Benin-City study where health workers
Table 3: Relationship between zinc administration and some
studied learnt about zinc from their colleagues (50.5%)
demographic variables
or from training workshops (39.6%).
[15]
With a signifi-
Variable
Adminis-
X
2
p value
cant number of mothers in the present study getting in-
tered Zinc
formation about zinc in PMS, efforts aimed at increasing
Yes
No
awareness and use of zinc should include PMS atten-
Mothersí education
dants since zinc formulations used for diarrhoea is a non
None /less than secondary school
49
62
5.6
0.01
Secondary school or more
61
40
-prescription drug.
Mothersí employment status
Employed
68
50
3.5
0.06
Only 5.9% of them learnt about zinc from news media
Unemployed
42
52
and none from social media. Since people in this area
Fathersí education
commonly utilise electronic media to get information
None /less than secondary school
30
38
2.4
0.12
(and news), adequate and sustain electronic media cam-
Secondary school or more
80
64
paign could be an important tool in educating caregivers
Place of residence
on the important of zinc in the treatment of diarrhoea.
Urban
*
94
66
12.3
0.00
Similarly, social media can be utilized since it is increas-
Rural
#
16
36
Number of under-fives in the family
ingly being used by people to get information.
1-3
98
83
2.5
0.11
Almost all (93.2%) mothers who knew about zinc also
More than 3
12
19
administered it, at least once, to their children. More-
Use of ORS
over, 97.3% of them administered it to children with
Yes
107
96
1.3
0.32
diarrhoea. Similarly, 84.3% of caregivers in a study in
No
3
6
the same zone earlier knew zinc is used in the treatment
Presence of vomiting
of diarrhoea.
[16]
The overwhelming majority (92.0%) of
Yes
22
29
2.1
0.15
the caregivers who did not give zinc was because they
No
88
73
did not know about it. This underscores the importance
Axillary temperature
Below 37.5 C
o
38
41
0.7
0.40
of enlightening people in this area, using effective meth-
37.5 C or above
o
72
61
ods available, about the use of zinc in diarrhoea. The
more caregivers know about zinc the more they use it in
* Metropolitan Local Government Areas (LGAs): Dala, Fagge,
Gwale, Kumbotso, Municipal, Nassarawa, Tarauni and Un-
the management of diarrhoeal disease in children.
gogo LGAs. # All the remaining 36 LGAs. ∂ORS is Oral Re-
Majority (70.9%) of the children easily accepted zinc
hydration Salt.
when offered by the mothers. They drank it easily
probably due to palatability of zinc tablets being used.
The proportion of mothers who gave zinc to their chil-
dren with diarrhoea was significantly higher in those
Discussion
whose level of education of at least secondary school.
An educated mother is more likely to take her sick child
Only 55.7% of the caregivers surveyed in this study ever
to health facility for care, and more likely to adhere to
aware of zinc supplementation, and just over half of
the prescribed treatment than less educated one. This
them knew zinc is used as part of treatment of diarrhoea.
further illustrates the importance of girl child education
This is in contrast to the lower level of awareness of
since todayís girls are the future mothers.
32% found by Ogunrunde et al in 2012 in North-
Western Nigeria. Higher awareness level in the present
16
The place of residence had significant association with
study may be due to increase awareness of use of zinc
the use of zinc in children with diarrhoea. Higher pro-
over the years, and difference in study population with
portion of mothers who lived in urban areas gave zinc
Kano state being more urban than states included in the
than those in rural areas. This may be due to easier ac-
previous study. Moreover, the educational level differed
cess to health facilities in urban than in rural areas of
since 85.1% of female respondents in the previous study
Kano state. There are more health facilities and PMSs,
had no formal education. Higher awareness rate (66.7%)
and more health workers in the urban than in the rural
of zinc supplementation in diarrhoea was found in a
areas. Significant number of mothers got their knowl-
study conducted in 2010 among health workers in Benin
edge about zinc from health facilities and PMSs. Fur-
city Nigeria.
15
It is not surprising that health workers
thermore, women in the urban areas are more educated
used in Benin study, some of whom had training work-
than their counterparts in rural areas.
shop on zinc, knew more about zinc supplementation
than mothers.
There is no significant difference in fatherís educational
status (p=0.1) and motherís employment (p=0.06) status
Majority of the caregivers learnt about zinc from either
between those who gave zinc and those who did not
health facilities or from patent medicine stores. This
give. In the study area, dispersible oral zinc tablets are
suggest that caregivers commonly take their children
given free to all children taken to health facility with
with diarrhoeal diseases to health facilities or patent
diarrhoea. Therefore, the child will get oral zinc as far as
medicine store (PMS) locally called ďchemist.Ē It also
he/she taken to a health facility for treatment irrespec-
84
tive of the fatherís educational status. Similarly, the
medications are usually given to these young children to
child will receive oral zinc in the health facility irrespec-
treat common illnesses such as malaria. In this situation,
tive of the motherís employment status.
zinc may wrongly be omitted even though there is diar-
There is no significant difference in the usage of zinc
rhoea.
between the mothers who gave ORS to their children
with diarrhoea and those who did not. This is surprising
because in the current treatment of diarrhoea in children
both ORS and zinc are given simultaneously. Therefore,
Conclusions
it is expected that those who gave ORS are also more
likely to administer zinc. This finding could be as a re-
In the study population, the awareness and use of zinc
sult of higher palatability of zinc compare to ORS solu-
by mothers of children with diarrhoea were moderate.
tion. The children may have been refusing ORS solution
Mothersí education and residence in urban areas were
and therefore the mothers no longer administer it. On the
associated with high rate of oral zinc administration to
other hand, some mothers still believe in giving
children with diarrhoea. Public enlightenment through
Ďdrugsí (tablets of syrups) rather than ORS solution to
electronic and social media may improve the acceptance
children with diarrhoea. These mothers probably gave
and usage of zinc in the study population. Girl child
zinc (but not ORS solution) because it is a tablet which
education may have a long term positive impact on the
is considered a Ďdrugí.
use of zinc in this population.
Administration of zinc to children with diarrhoea by the
mothers was not associated with presence of vomiting or
Conflict of Interest: None
fever (axillary temperature 37.5 C and above) in the
o
Funding: None
children. In the presence of vomiting or fever, other
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