1.1 Background to the Study
Diarrhea is a deadly illness that affects both adults and children. It accounted for 9% of all deaths among children under the age of 5 years in 2015. This percentage of mortality means, over 1,400 young children die every day, or about 530,000 children every year (UNICEF, Diarrhoeal Disease, 2016). The worldwide fight against diarrhea has been on for long as indicated by one of the goals of the 1990 World Summit for Children. This goal is to ensure childhood survival and healthy development through reduction by 50% in the deaths due to diarrhea in children under the age of 5 years and 25% reduction in the diarrhea incidence rate by the year 2000 (UNICEF, Information Publications, 1990).
Most deaths from diarrhea occurred among children of less than 2 years of age living in South Asia and sub-Saharan Africa (UNICEF, Diarrhoeal Disease, 2016). Among the low- and middle-income countries in five WHO regions (Americas, Western Pacific, Eastern Mediterranean, South East Asia and Africa Regions), Boschi-Pinto, Velebit, and Shibuya (2008), found that Africa and South East Asia Regions assemble together 78% (1.46 million) of all diarrhea deaths occurring in the developing world out of the model-based global point estimate of 1.87 million (uncertainty range: 1.56–2.19). In 2015, Nigeria contributed 15% to the global estimate of all death due to diarrhea among children under the age of 5 years. This translates into 76,980 under-5 mortalities yearly, the second highest data recorded for a country (WHO & MCEE, UNICEF, 2016).
The Millennium Development Goal (MDG) 4, whose target was to reduce by two thirds, between 1990 and 2015, the under-five mortality rate, achieved substantial progress with a worldwide decline in under-five deaths from 12.7 million in 1990 to 5.9 million in 2015. The remarkable decline in under-five mortality since 2000 saved the lives of an estimated 48 million children. Despite these substantial gains, the progress recorded were insufficient to achieve the MDG 4 target (WHO, Global Health Observatory (GHO) data: Child health, 2015). Understanding that diarrhea contributes 9% to this current rate means that a decrease in the number of under-5 deaths caused by diarrhea in every WHO region, would result in a corresponding decline in the global under-five mortality rate. This would in turn contribute towards achievement of Sustainable Development Goal (SDG) 3, with target 3.2 being to end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030 (UN, 2015).
A high incidence of diarrhea has been observed amongst children attending daycare centers, as obtained from earlier researches. Jensen, et al. (2016) found from their one year cohort study that 143 cases of diarrhea were reported by parent-based assessment from a sample size of 179 Danish children attending daycare centers. The findings from a systematic review of other daycare center researches between 1978 and 2005 showed that children cared for at daycare centers exhibit a two to three times greater risk of acquiring diarrhea and other infectious diseases, with rates of attacks during diarrhea outbreaks varying between 50 to 71% (Nesti & Goldbaum, 2007). One key factor identified to be associated with diarrhea prevalence and incidence amongst children under age 5 who attend daycare centers is the poor infection prevention practices of caregivers resulting in contamination of the daycare center physical environment with diarrhea-causing enteric bacteria (Itah & Ben, 2004). In Ogun State, the diarrhea prevalence among children under age five was reported at 10.3%, the highest compared to other South-Western states in Nigeria (National Bureau of Statistics, 2015). Diarrhea-causing enteric parasites were also found to be more prevalent in the stool samples of children attending daycare centers in Ogun (Olaitan & Adeleke, 2006) and Oyo States (Mathew, et al., 2014) compared to children who did not attend daycare centers.
This problem of diarrhea in daycare centers can be viewed from different standpoints, however this research intends to focus on the behavior of caregivers in daycare centers, with a mind to assessing to what extent their knowledge, attitude and perception of diarrhea, as well as benefits and constraints of the daycare establishment is associated with their corresponding responsive health behavior in terms of diarrhea prevention and treatment.
1.3 Objective of the Study
The general objective of this study is to assess the Prevention and Treatment Responsiveness of Caregivers of under-5 year olds, towards Diarrhea Illness, in Daycare Centers, in Abeokuta, Ogun State, Nigeria. The specific objectives are to:
1.4 Research Questions
The research questions that guided this study are:
1.5 Justification for the Study
The number of working mothers with growing careers has increased over past decades, as seen from the increase in the percentage of women joining the Nigeria Labor force from 34.1% in 1990 to 42.4% in 2014 (The World Bank, 2016). With mothers being the primary caregivers for young children in homes, this labor force trend suggests a corresponding increase in the use of non-parental care during early childhood, with a high preference for Crèches or Day care centres, as shown by studies carried out among different categories of working parents in South-Western States in Nigeria (Akinnubi, 2016; Gbadegesin & Alabi, 2014). Labor Force Forecast for Nigeria show that the female share of the labor force will increase from its current 42.99% in 2016 to 46.01% in 2030 (International Futures, 2016). This would indirectly increase the number of children who will be enrolled in daycare centers. It is therefore important to the young child, parents/guardian and nation at large for an assurance of the highest possible level of care by caregivers in daycare centers.
Unfortunately, previous studies have shown that children who were often looked after by people other than their mothers – as is the case in daycare centers – had higher diarrhea incidence rates than those whose primary care-givers were their mothers (Oni, Schumann, & Oke, 1991).
The generally poor health-seeking behavior of these care-givers which comprise both prevention and treatment practices have been identified to contribute largely to diarrhea transmission in the daycare centers. (Itah & Ben, 2004).
Despite the volume of researches that have been done in daycare centers, nothing has been done to measure the responsiveness of daycare center caregivers towards diarrhea, as well as trying to determine what modifying factors determine this responsiveness. Many studies on diarrhea and other communicable diseases carried out in daycare centers have primarily focused on clinical approaches and enrolled the parents or guardians of the daycare attendees as respondents during data collection. The data obtained from some other research work show results of laboratory analysis of body fluid samples obtained from children under age 5 attending the daycare centers.
The unique approach being proposed by this study is the application of health education and health promotion model in diagnosing and showing linkages between behavioral concepts that make up the research hypotheses. This research would primarily focus on caregivers in daycare centers and how their knowledge, attitude, perception and other socio-demographic factors determine their responsiveness to diarrhea illness. Results from this study will release information that would inform future interventions on diarrhea prevention and treatment particularly in daycare centers.
1.6 Hypotheses
The hypotheses for the study are:
H1
There is a significant relationship between the daycare center benefits/constraints (monthly income) and responsiveness towards diarrhea illness among the respondents in this studyH2
There is a significant relationship between the level of knowledge and responsiveness towards diarrhea illness among the respondents in this studyH3
There is a significant relationship between the attitude and responsiveness towards diarrhea illness among the respondents in this studyH4
There is a significant relationship between the perception and responsiveness towards diarrhea illness among the respondents in this study.1.7 Operational Definition of Terms
Diarrhea: Three or more loose or liquid stools per day (or more frequent passage than is normal for the individual) (UNICEF, Diarrhoeal Disease, 2016).
Daycare Center: This is sometimes otherwise called creches or nursery homes, and refers to a childcare setting where children are cared for by caregivers other than their parents for the period during which the parents are at work.
Caregivers: For the purpose of this study, caregivers refer to either male or female employees of daycare center owners. Their primary duty is to provide care for the children enrolled in the
Responsive behavior: This refers to the rights of individuals to adequate and timely preventive and treatment healthcare. Responsive behavior has been defined by a previous study as ‘a sequence of remedial actions that individuals undertake to rectify perceived ill- health’ (Mahmood, Iqbal, & Hanifi, 2009).