Factors related to mothers home practicer on management of accute diarrhea in children under five years old, in nam dinh city, viet nam

FACTORS RELATED TO MOTHERS’ HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIET NAM _I NGUYEN MANH DUNG A A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PRIMARY HEALTH CARE MANAGEMENT FACULTY OF GRADUATE STUDIES MAHIDOL UNIVERSITY 2002 ISBN: 974-04-1355-2 COPYRIGHT OF MAHIDOL UNIVERSITY Thesis entitled FACTORS RELATED TO MOTHERS’ HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIET NAM was submitted to the Faculty o f Graduate Studies, Mahidol University for the degree of Master o f Primary Health Care Management on M arch2 ,2 0 Mr Nguyen M anh Dung Candidate Asst P ro f Nonglak Pancharuniti D.D.S., M.P.H., Dr.P.H Chair Kiitf Sliiyabp Lect Kitti Shiyalap B.Sc in Pharm., M.P.H., Ph.D Member Asst P ro f Junya Pattaraarchachai B.Sc., M.Sc., M.S.P.H., Sc.D M ember Asst Prof Somsak Wongsawass ngsawass B.Sc., M.Sc., M.P.H Member Prof Liangchai Limlomwongse Ph.D Dean Faculty o f Graduate Studies Mahidol University Prof Som-arch Wongkhomthong M.D., D.H.Sc Director ASEAN Institute for Health Development Mahidol University Thesis entitled FACTORS RELATED TO MOTHERS’ HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIET NAM Candidate Asst P ro f Nonglak Pancharuniti D D S , M.P.H., Dr.P.H Major-advisor ỈCTíHí Lect Kitti Shiyalap B.Sc.in Pharm., M.P.H., Ph.D Co-advisor Qjci Asst.Prof Somsak Wongsawass B.Sc., M.Sc., M.P.H Co-advisor a ẳ Prof Liangchai Limlomwongse Ph.D Dean Faculty o f Graduate Studies Nssvj^ Asst Prof Boonyong Keiwkamka Dr.P.H Chair i M aster o f Primary Health Care Mangement ASEAN Institute for Health Development iii ACKNOWLEDGEMENT This thesis would not have been possible without the help and support of many people First and foremost, it is my honour and pleasure to express my sincere gratitude to Asst Prof Nonglak Pancharuniti, my major-advisor, for her valuable guidance, support and inspiration throughout the thesis period Her effort, assistance and commitment made the entire thesis process an enjoyable time that I will always live to remember I am also grateful to Dr Kitti Shiyalap and Asst Prof Somsak Wongsawass, my co-advisors, for their kindly advice, guidance and encouragement during the thesis process More specifically, I appreciate their support and guidance with regard to thesis analysis and general review of my thesis that led to its successful completion Furthermore, I express my sincere thanks to Asst Prof Junya Pattaraarchachai, for her valuable suggestions and comments, especially during the last moments of my thesis I will always be grateful to you all Also, I express sincere thanks to the Vietnamese Ministry o f Health, and the Namdinh Medical College for selecting me to participate in the Master of Primary Health Care Management course at ASEAN Institute for Health Development My special thanks go to the Canadian International Development Agency (CEDA), and operated by the Association of Universities and Colleges o f Canada (AUCC), a partnership between the School of Nursing, Memorial University o f Newfoundland, Canada, and the Secondary Technical Medical School (STMS1), Ministry of Health, Vietnam The author would like to thank the project Director, Dr Lan Tran Gien, Professor, Nursing, Memorial University, Dr Hoang Dien Phan and Dr Vu Dinh Chinh (project Co-Directors) for their encouragement and support that enabled me to attend this course I am also grateful to the leaders o f Namdinh health center, all the health personnel and respondents for their cooperation and assistance during the time of data collection Their support and enthusiasm made the entire data collection process a memorable experience for me I am also grateful to all the professors and staff o f the AIHD, the MPHM office, the computer department, the library center as well as my classmates for supporting me to complete my thesis successfully I also thank the ASEAN house staff for their facilities during my stay in ASEAN house Last but not least, I express my gratitude to my family members, relative and friends for according me the moral support and motivation throughout my study at the ASEAN Institute for Health Development, Thailand Nguyen Manh Dung Trường đại học tống hợp Mahidol Thái lan Tóm tắt đé tài/iv SỐ 4437629: CHỦ ĐỀ: QUẢN LÝ CHĂM SÓC s ú c KHOẺ BAN ĐẦU ĐỀ TÀI THẠC SỸ QUẢN LÝ CHĂM SÓC s ú c KHOẺ BAN ĐAU TỪKHỌÁ : BỆNH TIÊU CHẢY/ THIJC HÀNH TẠI NHÀ/ TRẺ EM/ VIỆT NAM CHỦ ĐỀ TÀI: NGUYỄN MẠNH DŨNG TÊN ĐỀ TÀI: CÁC YÊU T ố LIÊN QUAN ĐẾN t h ụ c HÀNH TẠI NHÀ CỦA BÀ MẸ TRONG VIỆC X Ử TRÍ BỆNH TIÊU CHẢY CẤP Ở TRẺ EM DƯỚI T U ổI, TẠI THÀNH PHÓ NAM ĐỊNH, VIỆT NAM NHỮNG NGƯỜI HƯỚNG DAN: PGS TS NONGLAK P A N C H A R U N m , TS K i m SHIYALAP PGS THS SOMSAK WONGSAWASS MÃ SỐ XUẤT BẢN: 974-04-1355-2 Đề tài nghiên cứu thiết kế theo kiểu nghiên cứu cắt ngang,, thực để xác định yếu tố liên quan tới thực hành nhà bí mẹ việc xử trí bệnh tiêu chảy cấp trẻ em tuổi, thành phố Nam Định, Việt Nam 270 bà mẹ có bị bệnh tiêu chảy vòng tháng gần đây, vấn trực tiếp (thông qua câu hoi) để thu thập thơng tin, sử dụng nghiên cứu Nó bao gồm: Các đặc điểm nhân khẩu-xã hội học, nhân thức nhạy cảm, nguy hiểm bệnh tiêu chảy trẻ em với lợi ích, điều trở ngại điều gợi ý giúp đỡ bà mẹ thực hành việc thực hành nhà bà mẹ xử trí bệnh tiêu chảy cấp trẻ em Sự phân tích kết nghiên cứu rằng: Phần lớn bà mẹ độ tuổi từ 26-34, có trình độ VH hết phổ thơng trung học có thu nhập mức thấp Các bà mẹ nghiên cứu chủ yêú là: nội trợ, làm nghề tự có tổng số người gia đình khơng q người Số đông họ nhận thông tin liệu pháp bù nước điện giải từ nhân viên y tế Tồn bơ nhận thức họ phân loại trung bình: 52^6%, mức cao: 33% Có 38% bà mẹ (Ịạt mức cao điểm thực hành, 50% bà mẹ thực tăng lượng nước uống cho trẻ, 65.6% tiếp tục cho trẻ ãn, 54.8% không sử dụng loại thuốc nào, 55.2% có nhận thức dấu hiệu nặng bệnh họ bị tiêu chảy 67.4% bà mẹ có hành vi thực hành rửa tay chăm sóc trẻ Spearman correlation test đưa kết quả: mối liên quan có ý nghĩa thống kê điểm thực hành nhà bà mẹ với tổng số năm học (VHGD), tổng số thành viên gia đình, tổng số ưẻ tuổi gia đình, nhận thức bà mẹ bệnh tiêu chảy, điều gợi ý giúp đỡ bà mẹ thực hành với giá trị r, mong đợi tương ứng, 0.334, 0.305, 0.444, 0.277 0.380 Kết nghiên cứu rằng: Thực hành nhà bà mẹ xử trí bệnh tiêu chảy cấp trẻ em tuổi cao có ý nghĩa trong; nhóm bà mẹ làm việc quan, xí nghiệp nhà nước (p=0.005) Fac of Grad Studies, Mahidol Univ Thesis /iv 4437629 ADPM/M: MAJOR: PRIMARY HEALTH CARE MANAGEMENT M.P.H.M (PRIMARY HEALTH CARE MANAGEMENT) KEY WORDS : DIARRHE A/HOME PRACTICES/ CHILDREN/VIETN AM NGUYEN MANH DUNG: FACTORS RELATED TO MOTHERS' HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIETNAM THESIS ADVISORS: NONGLAK PANCHARUNITI D.D.S.,M P.H, Dr.P.H, KITTI SHIYALAP B.Sc IN PHARM , M.P.H., Ph.D., SOMSAK WONGSAWASS B.Sc, M.Sc., M.P.H., 103p ISBN: 974-04-1355-2 This thesis is a cross- sectional study, conducted to identify factors related to mothers' home practices on management o f acute diarrhea in children under five years old, in Namdinh City, Vietnam The subjects were 270 mothers who had children with diarrhea in the lasf six months A structured interview questionnaire was used to collect the information in this study This included their socio-demographic characteristics, perception to susceptibility, severity o f childhood diarrhea in accordance with benefit, barrier, cues to action to support mothers on home practices and mothers' home practices on management of acute diarrhea in children The analysis indicated that, the majority o f mothers were with the age between 26-34 years, graduated at secondary school, and having low income Most o f them were self-employed or housewives, and with small family size (< people in the family) M ost of them had received information o f Oral Rehydration Therapy from health personnel Over all o f their perception about childhood diarrhea and home practices on management o f acute diarrhea was classified to be moderate (52.6%) and up to high level (33%) About 38% o f mothers had high level of practice score, although 50% of them would feed the children with more fluid, 65.6% continue feeding, 54.8% didn't use any drugs, 55.2% recognized* dangerous signs, and 67.4% had hygiene behavior o f washing hands Spearman correlation gave the statistical significant results o f the relationship between mothers' home practices and total years o f education of mothers, total family members, family's income, total number children under five years old in the family, mothers' perception o f diarrhea and dies to action of mother with rs equal to, 0.334, 0.305, 0.444, 0.441, 0.277, and 0.380 respectively It was also found that the score o f mothers' home practices on management of acute diarrhea in children was significantly higher in the group o f mothers working for the government (p= 005) CONTENTS Page ACKNOWLEDGEMENT iii ABSTRACT iv LIST OF TA B LES ,vii LIST OF FIGURES ix LIST OF ABBREVIATIONS x CHAPTER I INTRODUCTION 1.1 Rationale and justification of study 1.1.1 Magnitude of diarrhea among children Worldwide and Vietnam 1.1.2 Case managementof acute diarrhea 1.1.3 Practice o f mothers on management o f acute diarrhea in children 1.1.4 Problem statem ent 1.2 Research obj ective 1.2.1 General objective .6 1.2.2 Specific objectives 1.3 Conceptual frame w o rk 1.4 Operational definition .'8 1.5 Usefulness of the study 11 1.6 Scope and limitations of the study 12 1.7 H ypothesis 12 H LITERATURE REVIE 2.1 Epidemiology o f diarrhea 13 2.1.1 Present global situation of diarrheal disease 15 2.1.2 Present situation o f diarrheal disease in Vietnam 17 2.2 Management o f diarrhea in children at home 18 2.2.1 Give the children more fluid than as u su al 19 2.2.2 Continue feeding the children 22 2.2.3 Take the child to a health worker i f 2.2.4 Using antibiotic and antidiarrheal drugs 27 2.2.5 Behavior o f hygiene practice of mothers 29 2.3 Health beliefs m odel »31 2.3.1 Perceived susceptibility .31 2.3.2 Perceived severity 31 2.3.3 Perceived benefit of taking action and barriers 31 vi CONTENTS (Cont.) Page 2.4 Factors related to mothers' home practice 36 2.4.1 Socio-demographic factors o f mothers 36 2.4.2 Perception of mother toward diarrhea in children .37 2.4.3 Cues to action support mother on managing acute diarrhea 40 III RESEARCH METHODOLOGY 3.1 Study design 42 3.2 Study population 42 3.3 Sample size estimation 42 3.4 Study area 43 3.5 Instrument 45 3.6 Data collection 47 3.7 Data analysis 48 IV RESULTS Results 49 V DISCUSSION Discussion 67 VI CONCLUSION AND RECOMMENDATIONS Conclusion 75 Recommendation 77 REFERENCES 80 APENDIX ‘ A Questionnaires .87 B The result o f test normal distribution 98 C Summary of the results 99 BIOGRAPHY 103 Vil LIST OF TABLES * TABLES Page The main types o f diarrhea 13 Estimates o f diarrhea associated death, 1995 16 Selected communicable disease in SEAR countries, 1995 16 Summary o f findings about using O R S 21 Summarized guideline of WHO/CDD about amount fluid supplied for children with acute diarrhea 22 Summary of findings about mothers' home practice on feeding children with diarrhea .25 Summary how to supply food for children with acute diarrhea 26 Number and percentage of respondents classified by socio-demographic characteristics 51 Percentage o f respondents classified by mothers' perception toward diarrhea in children 53 10 Number and percentage of respondents' by level o f perception 55 11 Number and percentage o f respondents classified by cues to action 57 12 Number and percentage of respondents' by level o f cues to | action 58 13 Number and percentage of mothers by their practice on home care management o f acute diarrhea in children 60 14 Number and percentage of mothers by their correct practice on home care m management o f acute diarrhea in children 61 15 Number and percentage o f respondents by level of their practice score 62 16 Association between mothers' home practice score and their occupation by Kruskal-Waliss test 63 17 Correlation analysis between test 64 18 Correlation analysis between practice sore and perception score by Spearman rank correlation te st 65 V lll LIST OF TABLE (Cont.) TABLES 19 Page Correlation analysis between cues to action score and practice score by Spearman rank correlation T est 66 20 The result test normal distribution ( Kolmogorov-Smirnov test) 98 21 Correlation analysis between socio-demographic factors and susceptibility by Spearman rank correlation te s t 99 22 Correlation analysis between other items o f perception and susceptibility 99 23 Correlation analysis between susceptibility and cues to action 99 24 Correlation analysis between barrier and socio-demographic factors 99 * 25 Correlation analysis between barrier and others items o f perception 100 26 Correlation analysis between and diarrheal episodes o f children 100 27 Correlation analysis between benefit and socio-demographic factors 100 28 Correlation analysis between benefit and other items o f perception 100 29 Correlation analysis between cues to action and socio-demographic factors by Spearman rank correlation test 101 30 Correlation analysis between cues to action and diarrheal episodes of children by Spearman rank correlation test 101 31 Correlatiion analysis between diarrheal episodes o f children and scociodemographic factors o f mothers by Spearman rank correlation te s t .101 32 Correlation analysis between diarrheal episodes o f children and practice .101 33 Correlation analysis between diarrheal episodes o f children and perception by Spearman rank correlation te s t 102 34 Correlation analysis between income and socio-demographic facto rs 102 35 Correlation analysis between total perception and m otivation 102 Fac of Grad Studies, Mahidol Univ M.P.H.M.(PHC.Management)/71 for their children The result of this study showed that there was statistical significant correlation between family income and total years of education o f the mother On the other hand, mothers who had been working in the government group, could have more opportunities to improve their perception of disease when they work together and put them into home care management o f acute diarrhea in children compared to other group This conclusion was interpreted by the result of Mann-Whitney test, the mean rank of Government group was higher than selfemployed and house wife group (in this study) The significant correlation between mothers' home practices score with total family members and total number of children under five years old in the family • It can be explained that more the people in the family, especially with more children under five years old would help mothers gain more skills on home care management o f acute diarrhea in children Following the study in Somalia, most young and literate mothers had high level o f practice on management of acute diarrhea in children In three-year demographic surveillance, under-5 years child mortality from diarrhea o f literate and illiterate mothers were 43 and 93 per 1000 (58) and another study in Vietnam found that family's income were significantly associated with diarrhea in children (59) In this study, age of mother was not significantly correlated with mothỗrs' home practice score on management of childhood diarrhea It was not the same with other previous studies This can be explained by some reasons as follows: - Most of mothers in this study were at the reproductive age (min = 20 years, max = 44 years), there was no mother in illiterate group Therefore it wasn't too difficult for them to receive significant perception o f diarrhea among children and put them into practice on management of acute diarrhea in children ¡equally effective among these age range Nguyen Manh Dung Discussion/72 - The study area, in this study was urban It was convenient to improve perception and practice o f mother with many health education programs It can be explained that 81.1% o f mothers received ORT information from health workers, 67.8% o f mothers received it from mass media campaigns 5.2.2 Association between mothers' perception about diarrhea and their home practice on management of acute diarrhea in children The perception of mothers about diarrhea was significantly correlated with their home practice on management of acute diarrhea in children This indicated that mothers who had higher level of perception of diarrhea would have higher practice level on management of acute diarrhea In this study, mothers' perceptions of susceptibility, severity, barrier, and benefit were significantly associated with their home practice score except perception o f motivation The study in Papua New Guinea found that children whose mothers did not perceive babies' feces to be important in causing diarrhea had 7.4 times greater risk o f getting diarrhea than those whose mothers recognized the relationship (63) According to the result of this study, mothers' perception o f diarrheal susceptibility was also significantly correlated with their practice score by Spearman rank correlation test Another study by Yoder PS, Hornik RC also showed that mother who had good perception o f diarrheal severity took care of their children more carefully and correctly (62) It agreed with the result of this study that there was a statistical significant correlation between mothers' perception about diarrheal severity and thenhome practice on management of acute diarrhea in children ♦ Mothers' perception about diarrhea in children is very important to make a decision on home care management of acute diarrhea in children W hen mothers had low perception score about benefit of home care management o f acute diarrhea in children, their practice score was also decreasing The conclusion w as not only the result o f this study but also the findings o f the study, in India It showed that Fac of Grad Studies, Mahidol Univ M.P.H.M.(PHC.Management)/73 perception regarding benefit o f ORS and its use in diarrhea and vomiting was very poor and significantly different in awareness observed between educated and illiterates The majority o f parents who had poor perception, didn't know the correct method o f preparation and uses o f ORS (64) Regarding the motivation to have home management of acute diarrhea, the result o f this study indicated that there was no statistically significant correlation between mothers' perception of motivation and their home practice on management of acute diarrhea in children It might be due to the fact that motivation for general perception o f health promotion activities for both mother and children are widely achieved, therefore it is not related to practice on management o f acute diarrhea 5.3 Association between mothers’ home practice and cue to action of mothers on management of acute diarrhea in children M ost o f mothers who carried out the home care management o f acute diarrhea in children under five years old correctly received the information about diarrhea in children that supported them on practice In this study, mothers who had more score o f cues to action had more practice score on management o f acute diarrhea in children It was illustrated by the result of Spearman rank correlation test Through home visits, village health volunteers are very important for making high knowledge o f mothers The result o f this study showed that 44.8% o f mothers perceived antidiarrheal drugs can relieve symptoms of diarrhea, 47% o f mothers agreed that giving ORS to children must depend on a doctor's prescription This can be explained by only 50.7% o f mothers received ORT information about the dose o f ORS, 53% o f mothers had information about avoiding antibiotic and antidiarrheal drugs for self-treatment o f acute diarrhea in children at home from health workers, mass media campaign or other people Indian study showed that mothers who were usually exposed-to electronic media and messages about childhood diarrhea had knowledge and use ORS more than another group (28) Besides mass media, person to person communication Nguyen Manh Dung Discussion/74 and diarrheal episodes of children are very important for promotion of mothers' home practice on management o f acute diarrhea The result of study in Bangladesh showed that household knowledge through social marketing campaigns or person to person communication necessitates the promotion of ORS used in urban as well as in rural area (66) This finding also indicated the association between cues to action with mothers' home practice on management of acute diarrhea in children 5.4 Discussion on research methodology This study was carried out under cross-sectional study design A structured interview questionnaire was used for data collection Pre-testing of questionnaire was conducted at Namdinh City and it was revised to be easily understood by interviewers and respondents However several limitations were still there in this study - This study was carried out in villages of the total 15 villages in Namdinh City - The target population was purposively selected among the mothers who had children under five years old with acute diarrhea It may not be representatives of population o f mother who had children under five years old - With regard to information in this study, it was based on the memory o f mothers There fore, some recall bias could occur, such as mothers didn’t remembers all action that had been done for their children when their children hàd diarrhea This might lead to overestimation o f the strength o f association between perception o f mothers and their home practice on management o f acute diarrhea in children - Concerning the interviewers, interviewers who were involved in the collection o f data were health workers, there was a potential for respondents to be influenced to give inaccurate or untrue answers For that reason, it might have resulted in some variation Fac.of Grad Studies, Mahidol Univ M.P.H.M.(PHC Management)/? CHAPTER VI CONCLUSION AND RECOMEMDATION 6.1 Conclusion A cross- sectional study was conducted at villages in Namdinh city, Vietnam in order to determine the factors related to mothers’ home practice on management of acute diarrhea in children under five years old A structured interview questionnaire was used for data collection The study sample size included 270 o f mothers who Had children with diarrhea, in the last months from Jun-December/2001 Data collection was carried out during month of January/ 2002 Based on the findings o f this study and the interpretation, the following conclusions were drawn: Regarding socio-demographic characteristics, most o f mothers, aged in range from 26-34 years (67.4%) There weren't mother in illiterate group, 59.3% o f the mothers had completed their secondary school education Based on the result of this study, more than half o f mother had family income at low level with less than or 200,000 VND/person/month There were many mothers in self-employed and housewives group, only one third of mothers had a large family size (more than people) M ost o f mothers (74.1%) had child under five years old j Perception of mothers about diarrhea in children was at moderate level There were only 33% o f mothers who had perception o f acute diarrhea in children at high level, in which perception of barriers on management o f acute diarrhea in children at home were very low, following by diarrheal susceptibility, and severity The findings in this study also showed that most o f informations about diarrhea in children mothers received were ORT, continue feeding for children with acute diarrhea Mothers who received information about how to recognize dangerous signs, avoiding antibiotic and anti diarrheal drugs, was at low level as expected Health Nguyen Manh Dung Conclusion and Recommendation/76 personnel were the people who usually give healthy information to mothers especially ORT and other information about diarrhea in children ♦ Mothers1 home practices on management of acute diarrhea in children under five years old was at moderate level (only 37.8% of mother at high level, 27.4% of mothers at low level) Following the guideline of home care management for children with diarrhea by WHO, the proportion of mothers who had correct practices were at low level (37.8%) as expected Only 50% of mothers experienced increasing fluid, 65.6% o f mother continue feeding, 54,8% of mothers did not use drugs, and 55.2% of mothers who knew how to recognize dangerous signs and 67.4% o f mothers had good hygiene behavior o f washing hands) According to factors related to mothers’ home practices on management* of acute diarrhea in children, the following conclusions were drown: - Mothers’ education, total number years for education o f mothers were significantly associated with their practice Mothers who had longer years of education had higher level o f practice Mothers who had shorter years o f education had lower level o f practice ii - Family income of mothers was significantly correlated with their practice Mothers who had low-income had lower level o f practice score and mothers whose family income was high they increased level of practice score - Mothers’ occupation was significantly associated with their home practice on management o f acute diarrhea in children Mothers who were in government group had high mean rank o f practice as compared to mothers who were working in other groups - There was also positive statistically significant correlation between mothers perception o f diarrhea in children and their home practice on management o f acute Fac.of Grad Studies, Mahidol Univ M.P.H.M.(PHC Management)/77 diarrhea in children The higher perception of diarrhea in children increased the home practice score in childhood diarrhea - Cues to action supporting the mothers for home practice was also significantly correlated with their home practice on management of acute diarrhea in children M others who received more information about management of acute diarrhea in children had higher level of practice 6.2 Recommendation 6.2.1 Recommendations for implementation With purpose o f improving mothers' home practices on management of acute diarrhea in children in Namdinh City, Vietnam, based on the findings discussed in chapter V, the following recommendations are suggested To continue development of effective prevention and control of childhood diarrhea through the Health communication and Education programs These programs should be focused on the low-income group, low education group, people in the housewife or self-employed group, and aim at helping them to improve their perception on diarrhea and put them into home practices as following - To help the people, especially mothers who have children under five years old or belong to a reproductive age, to be aware o f concept, susceptibility, severity o f diarrhea in children and also having perception o f benefit, barriers, motivation about child care and management of acute diarrhea in children at home Following the result o f this study 51.1% of mother perceived diarrhea wasn't harmful to children, only 76.3% o f mother found that diarrhea caused dehydration - In order to improve the appropriate knowledge about home care management o f acute diarrhea in children, the program should focus on the guideline o f WHO or national CDD program, especially how to prepare, to use ORS solution, Nguyen Manh Dung Conclusion and Recommendation/78 how to recognize the dangerous signs of disease and avoid using any drugs without doctor prescription The result of this study revealed that only 55.2% of mothers observed dangerous signs of acute diarrhea in children, 50% o f mothers experienced increasing fluid to children with diarrhea and 54.8% of mothers didn't use drugs for self-treatment o f childhood diarrhea - To support mothers better knowledge of hygienic practices, such as how to prepare hygienic food for children, hand-washing practice with soap especially hand-washing after using toilet and before preparing or serving food for children Because perception o f hand washing behavior in this study showed that 60% of mothers agreed with washing hands couldn't protect children from diarrhea - Making effectiveness use of mass media for health education, especially for people who have less opportunity to contact with others in the community (housewife, self-business) Because mass media is also one o f vehicle that transforms information to mother In this study only 67.8% of mothers who received information about how to prepare ORS, SSS from mass media compare with 84.4% o f mother received them from health works * One important component is to improve environmental sanitation in the residential areas by construction of better water and sanitation facilities According to the finding o f this study, 60.4% o f families had specified place for hand washing and sanitary latrines - From this situation, it suggested that the local government should take into consideration to assist and facilitate the community government and the community residents to solve the non-hygienic latrine, bathroom problem in this area Fac.of Grad Studies, Mahidol Univ M.P.H.M.(PHC Management)/? 6.2.2 Recommendations for further research This study was carried out in only villages, so that its result has limited generalizability and representatives Therefore, it is suggested to carry out an operational study and should be carried out in different areas (surroundings of the city) The further study should be carried out to measure before and after health education because health-seeking behaviors of mothers is also be important which be included in this study In this study, we could not go in-depth into childcare activities and practice activities of mothers on management of acute diarrhea in children at home Further research should concentrate on the observation of mothers' practice on childcare and management of acute diarrhea in children at home ! 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HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIET NAM was submitted to the Faculty o f Graduate... AM NGUYEN MANH DUNG: FACTORS RELATED TO MOTHERS' HOME PRACTICES ON MANAGEMENT OF ACUTE DIARRHEA IN CHILDREN UNDER FIVE YEARS OLD, IN NAM DINH CITY, VIETNAM THESIS ADVISORS: NONGLAK PANCHARUNITI... study o f factors related to mothers' home practice on management o f acute diarrhea among children under five years old, in Namdinh City, Vietnam is plausible and a priority It is important to explore