1.1 BACKGROUND TO THE STUDY
Diarrhea is recognized as a major cause of child morbidity and mortality in developing countries (Banda et al., 2007; Gorter et al., 1998; Kosek, Bern, & Guerrant, 2003). It is the second leading cause of death among children under five years of age worldwide (BBS, Bangladesh Bureau of Statistics UNICEF, United Nations Children’s Fund, 2007; Larson, Saha, Islam, & Roy, 2006). Global deaths from diarrhea among children aged less than five years were estimated at 1.87 million in 2004 (Boschi-Pinto, Velebit, & Shibuya, 2008; Candy, 1987; Chiller et al., 2006; Khan et al., 2004; Larson et al., 2006). Seventy percent of these deaths are concentrated in 15 developing countries. Nigeria is one of these 15 countries and diarrhea is responsible for sixty-nine thousands diarrheal deaths (Boschi-Pinto et al., 2008). Diarrheal disease is still a major health problem in Nigeria. The government of Nigeria states that diarrhea kills an estimated 25,000 people annually, mostly children (IRIN, 2008). On a daily average, 180-200 diarrhea patients were admitted to the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDRB) hospital (IRIN, 2008). According to the ICDDRB hospital’s statistical surveillance from 2004 to 2008, the total number of children with diarrhea in this hospital was 5596. An average of 1119 diarrhea children (under five) was admitted there annually. Causes of diarrhea were viruses, bacteria and parasites (Mishra, Gupta, & Yadav, 2004). Contaminated foods play a major role in the occurrence of diarrheal diseases. The transmission of infection occurs by direct contact with the agent, through oral–fecal transmission routes due to poor water quality, unhygienic behaviors, improper storage of food and inadequate sanitation practices (Halvorson, 2004). This may be because mothers lack of awareness about safe drinking water, hygiene practice, feeding children with hygienic food and defecation practices (IRIN, 2008).
Diarrhea is a disease that can be prevented by avoiding contacting with causative agents, but children under 5 years of age are unable to protect themselves from these agents. They are under the care of their mothers; therefore the maternal preventive behaviors for children are very important. There are many studies showing the incidence of diarrhea related to maternal behaviors including hygiene practices, child feeding practices, safe water and defecation practices (Banda et al., 2007; Chiller et al., 2006; Gorter et al, 1998; Khan et al., 2004; Nanan et al., 2003; Osumanu, 2008). Mothers are the closest persons to children. Their behaviors toward their children need to be explored, especially their preventive behaviors. A previous study showed that maternal behaviors were found to be related to their perceptions (Pancharuniti, Shiyalap, Dung, & Wongsawass, 2004). The results of Pancharuniti et al study carried out in Vietnam indicated that maternal health beliefs towards diarrheal diseases in children played a crucial role in their home management of acute diarrhea. Maternal perceptions on the susceptibility and severity of diarrhea and the benefits and barriers to maternal home care for diarrheal children were significantly correlated to maternal practices. Although diarrheal disease is recognized as a major problem in Bangladesh, no studies on maternal preventive behaviors of diarrhea in children and maternal perceptions have been conducted. Therefore, this study is carried out in order to explore maternal perceptions and preventive behaviors of diarrhea in children. The results of the study will be used to enhance maternal preventive behaviors of diarrhea in children, which will reduce the incidence of diarrhea in children under five years of age. It can also fulfill the gap in knowledge of maternal preventive behaviors in diarrhea of children in Nigeria.