Nigerian Journal of Paediatrics

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 – BY

Mothers’ 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. Mothers’

Health facilities were the sources

knowledge and usage of zinc are

of information in 55.9% of them.

important.

Urban residency and mother’s edu-

Objectives: This study assessed

cation were associated higher rate

mothers’ 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%,

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-

The study was descriptive cross sectional conducted at

fits, the World Health Organization (WHO) and United

the Outpatient Clinic of Murtala Mohammed Specialist

Nations Children’s 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.

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.

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

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

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

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

0.9

dren for care were interviewed. The demographic data of

Other

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

5.5

areas.

Drank with difficulty

23.6

Drank easily

70.9

Table 1: Mother’s demographic variables

Variable

Frequency

Percentage

Fig 1: Sources of information about Zinc in 118

mothers.

Mother’s Educational Level

Illiterate or primary school

111

52.4

Secondary school

39.6

Tertiary school

8.0

Mother’s Employment status

Unemployed

44.3

Employed

118

55.7

Place of Residence

Urban

160

75.5

Rural

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.

Mother’s 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 mother’s employment, father’s

education, use of ORS, and presence of fever were not

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-

p value

cant number of mothers in the present study getting in-

tered Zinc

formation about zinc in PMS, efforts aimed at increasing

Yes

awareness and use of zinc should include PMS atten-

Mothers’ education

dants since zinc formulations used for diarrhoea is a non

None /less than secondary school

5.6

0.01

Secondary school or more

-prescription drug.

Mothers’ employment status

Employed

3.5

0.06

Only 5.9% of them learnt about zinc from news media

Unemployed

and none from social media. Since people in this area

Fathers’ education

commonly utilise electronic media to get information

None /less than secondary school

2.4

0.12

(and news), adequate and sustain electronic media cam-

Secondary school or more

paign could be an important tool in educating caregivers

Place of residence

on the important of zinc in the treatment of diarrhoea.

Urban

12.3

0.00

Similarly, social media can be utilized since it is increas-

Rural

Number of under-fives in the family

ingly being used by people to get information.

1-3

2.5

0.11

Almost all (93.2%) mothers who knew about zinc also

More than 3

administered it, at least once, to their children. More-

Use of ORS

over, 97.3% of them administered it to children with

Yes

107

1.3

0.32

diarrhoea. Similarly, 84.3% of caregivers in a study in

the same zone earlier knew zinc is used in the treatment

Presence of vomiting

of diarrhoea.

[16]

The overwhelming majority (92.0%) of

Yes

2.1

0.15

the caregivers who did not give zinc was because they

did not know about it. This underscores the importance

Axillary temperature

Below 37.5 C

0.7

0.40

of enlightening people in this area, using effective meth-

37.5 C or above

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 today’s girls are the future mothers.

32% found by Ogunrunde et al in 2012 in North-

Western Nigeria. Higher awareness level in the present

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.

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 father’s educational

status (p=0.1) and mother’s 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 “chemist.” It also

he/she taken to a health facility for treatment irrespec-

tive of the father’s 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 mother’s 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

Mothers’ 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

‘drugs’ (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 ‘drug’.

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

Funding: None

children. In the presence of vomiting or fever, other

References

1. Brown, K., Peerson, J. Allen,

6. Roy SK, Tomkins AM. Impact

11. Bhutta ZA, Black RE, Brown

L. Effect of zinc supplementa-

of experimental zinc deficiency

KH, Gardner JM, Gore S,

tion on children’s growth: a

on growth, morbidity and ultra-

Hidayat A, et al. Prevention of

meta-analysis of intervention

structural development of intes-

diarrhea and pneumonia by

trials. Bibl. Nutr. Dieta.

tinal tissue. Bangladesh J Nutr

zinc supplementation in chil-

1998;54:76-83.

1989;2:1-7.

dren in developing countries:

2. Black RE. Zinc Deficiency,

7. World Health Organization.

pooled analysis of randomized

Infectious Disease and Mortal-

The treatment of diarrhoea. A

controlled trials. Zinc Investi-

ity in the Developing World. J

manual for physicians and

gators' Collaborative Group. J

Nutr 2003; 133:1485S-1489S.

other senior health workers.

Pediatr 1999;135:689- 97.

3. Murray C, Lopez A. The global

WHO 2005.

12. Larson CP, Saha UR, Nazral

burden of disease. A Compre-

8. Bhutta ZA, Bird SM, Black RE,

H. Impact monitoring of the

hensive assessment of mortality

Brown KH, Gardner JM, Hi-

national scale up of zinc treat-

and disability from diseases,

dayat A, et al. Therapeutic ef-

ment for childhood diarrhoea

injuries, and risk factors in

fects of oral zinc in acute and

in Bangledesh: Repeat Ecolo-

1990 and projected to 2020.

persistent diarrhea in children

gic Surveys. PLoS Med J.

Cambridge, MA: Harvard

in developing countries: pooled

2009;6 :e100175. http://

School of Public Health; 1996;

analysis of randomized control-

dx.doi.org/10.1371/

990.

led trials. Am J Clin Nutr

journal.pmed.1000175.

4. World Health Organization.

2000;72:1516- 22.

13. Fisher-Walker CL, Fontaine

Complementary feeding of

9. Baqui AH, Black RE, El

O, Young MW, et al. Zinc and

young children in developing

Arifeen S, Yunus M, Chak-

low osmolarity oral rehydra-

countries: a review of current

raborty J, Ahmed S, et al. Ef-

tion salts for diarrhoea: a re-

scientific knowledge. Docu-

fect of zinc supplementation

newed call to action. Bull.

ment ref. WHO/NUT/98.1.

started during diarrhoea on

World Health Organization,

Geneva: World Health Organi-

morbidity and mortality in

2009; 87: 780-86. http://

zation; 1998.

Bangladeshi children: commu-

dx.doi.org/10.2471/

5. Koo SI, Turk DE. Effect of

nity randomised trial. BMJ

BLT.08.058990.

zinc deficiency on the ultra-

2002;325:1-6. (DOI: 10.1136/

14. Hoekstra JA. Acute gastroen-

structures of the pancreatic

bmj.325.7372.1059.)

teritis in industralised coun-

aciner cell and intestinal epi-

10. World Health Organization.

tries: compliance with guide-

thelium in rat. J Nutr

Diarrhoeal disease Fact sheet

lines for treatment. J Paediatr

1977;107:896-908.

N°330. WHO. April 2013.

Gastroenterol Nutr

(http://www.who.int/

2001;33:531-5

mediacentre/factsheets/fs330/

en/)

15. Omuemu VO, Ofuani IJ,

16. Ogunrinde OG, Raji T,

Kubeyinje IC. Knowledge and

Owolabi OA, Anigo KM.

use of zinc supplementation in

Knowledge, Attitude and Prac-

the management of childhood

tice of Home Management of

diarrhoea among health care

Childhood Diarrhoea among

workers in public primary

Caregivers of Under-5 Children

health facilities in Benin-city,

with Diarrhoeal Disease in

Nigeria. Glob J Health Sci

Northwestern Nigeria. J Trop

2012;4:68-76.

Pediatr 2012; 58:143-46.