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  • Title: Diarrhoea among children in rural Somalia. Maternal perceptions, management and mortality.
    Author: Ibrahim MM, Aden AS, Omar HM, Wall S, Persson LA.
    Journal: Ann Trop Paediatr; 1994; 14(3):215-22. PubMed ID: 7825995.
    Abstract:
    Diarrhoea was the second most common symptom of disease in a longitudinal study of 431 children under 5 years of age in rural Somalia. Most mothers perceived diarrhoea as a condition in which oral rehydration therapy (ORT) and feeding were logical parts of its management. During 1 year of observation, ORT was used in the household in one-third of the episodes of diarrhoea, mostly by non-farming, young and literate mothers. Infants were treated more often than older children, as were also children in smaller households. In a 3-year demographic surveillance in the same area (1219 person years), the under-5 mortality from diarrhoea in children of literature and illiterate mothers was 43 per 1000 (95% CI 0-84) and 93 per 1000 (95% CI 60-101), respectively. The findings suggest that the use of ORT is associated with a mother's ability to allocate time to health care and her general position in the household. Diarrheal disease is a major cause of morbidity and mortality in Somali children. The use of oral rehydration therapy (ORT) in the household management of diarrhea was therefore strongly advocated in the 1989-91 national health plan. The mother is the major provider of health care in the home, particularly for children. This paper reports findings from a study conducted to determine maternal perceptions about and management of diarrhea in childhood at home, to analyze possible determinants of the use of ORT, and to assess its impact upon mortality from diarrhea. In this study, ORT had been promoted for use in the home by health services in two rural villages situated between the two Somali rivers. A cohort of 431 under-5 year old children was followed for one year to assess their morbidity and how health problems were managed in the home. A 3-year demographic survey in the same area allowed the estimation of overall under-5 mortality and diarrhea-associated under-5 mortality. Interviews were conducted with 220 women to learn of their perceptions about diarrhea in childhood and its treatment. Diarrhea was the second most common symptom of disease in this longitudinal study, with most mothers perceiving diarrhea as a condition in which ORT and feeding were logical approaches to its management. During the one-year observational period, ORT was used in the household in one third of diarrheal episodes, mostly by non-farming, young, and literate mothers. Infants were treated more often than older children, as were also children in smaller households. In the three-year demographic surveillance, under-5 mortality from diarrhea in children of literate and illiterate mothers was 43 per 1000 and 93 per 1000, respectively. These findings suggest that the use of ORT is associated with a mother's ability to allocate time to health care and her general position in the household.
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