1. Josephat Nyagero, Moses Mwangi, Elijah Mbiti, Bob Akach, Jacqueline Kung’u, Stewart Kabaka, Christopher Wanyoike, John Nduba Safari Park Hotel, Nairobi November 25, 2014 Knowledge and practices on use of ORS/zinc in diarrhea management among under five year old children in Narok South, Kenya Knowledge on use of ORS/zinc in diarrhea management among under five year old children in Narok South, Kenya

2. Kenya unlikely to meet MDG goal 4 High impact child survival interventions implemented Diarrhea contributes >20% U5 child mortality (Black et al, 2010) Early management of childhood diarrhea through: –Breastfeeding, good hygiene practices and –ORS & zinc supplementation to avoid severe illness and death Background

3. Access to correct information and to ORS and zinc at community level remains a major bottleneck 39% of children with diarrhea received ORS treatment and <1% zinc yet 80% of mothers knew about ORS (KDHS 2008-9) Purpose of this paper is to assess the factors associated with the mother’s/ caregiver’s knowledge on diarrhea prevention and control Background

4. 58 sub-locations Sub-locations with CHU (18) Sub-locations without CHU (40) 11 sub-locations or clusters Simple random sample (SRS) 6 Comparison group clusters 5 Intervention group clusters 6 intervention group clusters 5 Comparison group clusters Randomization Eligible based on population size (15) Eligible based on population size (23) ORS/ zinc cluster randomized project design

5. Narok south district of Narok County in Kenya 22 sub-locations out of 58 (11 intervention, 11 control) Targeted all women with children U5s Information on 500 U5 children in each sub-location Household Questionnaires adapted UNICEF’s Multiple Indicator Cluster Survey tools used for 2009-2011 data Back translated into Maasai and Kipsigis and pretested Administered by trained research assistants locally recruited Data entry done using SPSS Logistic regression at the 95% confidence interval Methodology

6. Table 1: Selected socio-demographic characteristics of the study participants Variablesn=6683% Intervention/Control Intervention Cluster 330649.5 Control Cluster 337750.5 Gender of Respondent Male 3645.4 Female 631994.6 Age of Respondent Grouped <20 yrs 5167.7 20 to 29 yrs 323948.5 30 to 39 yrs 158223.7 40 to 49 yrs 4797.2 50 to 59 yrs 951.4 60 yrs and above 390.6 Not known 73311.0 Mother's highest level of education Primary 232034.7 Secondary 4566.8 College/university 1752.6 None 373255.8 Number of children One 344951.6 Two 234635.1 Three 83712.5 Four or more510.8

7. Table 2: Household hygiene and sanitation Variablesn=6683% Drinking water treated Yes104015.6 No564384.4 Water storage in the Household Open container72410.8 Covered container193829.0 Same fetching container402160.2 Utensils washed and put on a drying rack Yes436765.3 No231634.7 Compound clean or littered Clean335450.2 Littered332949.8 Dwelling Clean Yes443966.4 No224433.6

8. Table 3: Source of information on prevention and treatment of childhood diarrhea Variablesn=6683% Public Health facility423863.4 Family members167325.0 Private Health facility74011.1 Herbalists3345.0 CHWs3064.6 Community training2563.8 Radio newspapers2113.2 Church821.2 Written pamphlets681.0 AMREF20.03

9. What diarrhea is? – universal Ever heard of ORS - 70.8% Ever heard of zinc - 16.5% Action to take if diarrhea is identified –51.3% seek treatment immediately –45.7% seek treatment if persist –6.5% seek treatment if bloody Responses on selected knowledge issues

10. Figure 2: Overall Knowledge on prevention and control of diarrhea

11. Table 4: Knowledge on prevention and control of diarrhea in relation to selected socio-demographic characteristics Characteristics Adequate knowledge (n=4,378) Inadequate knowledge (n=2,305) ORp value n%n% Intervention/Control Intervention Cluster 218866.2111833.81.06 0.252 Control Cluster 219064.9118735.1 1.00 Age of the Respondent <20 yrs 31260.520439.51.780.083 20 to 29 yrs 215366.5108633.52.310.010 30 to 39 yrs 107367.850932.22.460.006 40 to 49 yrs 31866.416133.62.300.013 50 to 59 yrs 5557.94042.11.600.217 60 yrs and abve 1846.22153.8 1.00 Dont Know 44961.328438.71.840.064 Gender of Respondent Male 21358.515141.51.00 Female 416565.9215434.1 1.370.004 Mother's highest level of education None/Primary 389864.4%215435.6% 1.00 Secondary 33473.2%12226.8%1.51<0.001 College/university 14683.4%2916.6%2.78<0.001 Number of children per household One 225665.4119334.60.790.441 Two 153965.680734.40.790.459 Three 54765.429034.60.790.446 Four or more 3670.61529.4 1.00

12. Table 5: Knowledge on prevention and control of diarrhea in relation to Household hygiene and sanitation Characteristics Adequate knowledge (n=4,378) Inadequate knowledge (n=2,305) ORp value n%n% Drinking water treated Yes 78975.925124.1 1.80<0.001 No 358963.6205436.4 1.00 Water storage in the Household Open container 38453.034047.0 1.00 Covered container 124364.169535.9 1.58<0.001 Same fetching container 275168.4127031.6 1.92<0.001 Utensils washed and put on a drying rack Yes 296267.8140532.2 1.34<0.001 No 141661.190038.9 1.00 Compound clean or littered clean 231068.9104431.1 1.35<0.001 littered 206862.1126137.9 1.00 Dwelling Clean Yes 300667.7143332.3 1.33<0.001 No 137261.187238.9 1.00

13. Table 6: Factors associated with knowledge on prevention and control of diarrhea among the study participants VariablesAOR 95% CI of AOR p value LowerUpper Gender of the Respondent Male 1.00 Female1.491.191.85 0.001 Mother's highest level of education None/Primary 1.00 Secondary 1.461.171.830.001 College/university 2.331.543.53<0.001 Dwelling Clean Yes 1.241.111.38<0.001 No 1.00 Public Health facility Yes 1.881.672.10<0.001 No 1.00

14. being female and having secondary level of education, dwelling in HHs with clean compound and, obtaining information from public health facilities are associated with adequate knowledge on prevention and treatment of childhood diarrhea Conclusion

15. Long term supporting girl-child education in the area Short term concerted effort to promotion clean dwelling compounds through multiple approaches using community structures strengthen health facilities as sources of health information to care givers and diversify as may be appropriate Recommendation