Diarrhea: How a mother’s perception of feeding practices determines her child’s survival

Diarrhea accounts for one in five deaths amongst children in Nigeria. In-home management of childhood diarrhea, cultural diversity exists in people’s perceptions of appropriate feeding practices during and after diarrheal episodes.

Mothers’ perceptions of the type of food to be served to children, and the number of feeding times, during and after diarrheal episodes varied according to their social status and the food culture of their local environment.  However, mothers’ perceptions of feeding practices in home management of childhood diarrhea are influenced by culture, religion and socio-demographic factors.

Researchers who examined factors that influenced people’s perceptions of feeding practices in home management of childhood diarrhea in Ibadan North East Local Government Area, for instance, indicated that teething, poor sanitation and consumption of some foods were perceived as responsible for the high prevalence of diarrhea amongst children.

World Health Organisation says diarrhea is a health condition in which a child has 3 or more loose or liquid stools per day, or described as having more stools than is normal for that person.  Worldwide, diarrhea claims the life of 2 million children each year, 22% of which occur in Sub-Saharan Africa.

It is the second most important cause of childhood mortality in sub-Sahara Africa (SSA), and a report by UNICEF indicates that more than one in every 5 children in Nigeria dies before age five and that as high as 40% of these deaths are due to diarrhea. Most deaths from diarrhea are often due to loss of body fluid through dehydration.

Professor Adebola Orimadegun, a consultant paediatrician, University College Hospital (UCH), Ibadan said some perception of mothers about diarrhea explains the high morbidity and mortality rates of the disease amongst the under-fives.

He declared “if a child has diarrhea at home, mothers are expected to focus on replacing the lost fluid. What kills most children during diarrhea episode is the loss of excess fluid with the electrolytes that accompanies it.

“Second, feed the child as if there is no diarrhea. But if the child is not tolerating the food, you can then do it more frequently but little quantity at a time. There are times that diarrhea is accompanied by vomiting and every little thing that you put in the child’s mouth, the child will throw it up.  It can still be managed at home; if the vomiting is not too frequent, give a little fluid or liquid diet, maybe like watery pap.

“At times like that, it may be advisable to withhold the milk because there are some children who cannot digest milk when they have too frequent or prolonged diarrhea and the milk will worsen it. But it does not mean that feeding should be stopped totally. The best is actually to breastfeed because breast milk has enough water and sufficient calories for babies less than 6 months.

“If the child is refusing food or he has other accompanying symptoms like fever, they should treat that.  Lowering temperature may be by tepid sponging or exposing that child or given paracetamol but replace every body fluid lost. The salt-sugar solution, what is called oral rehydration solution (ORS), is a home remedy that is recommended and that is easy to prepare at home.

“Those are stop-gap measures before the child is taken to the hospital. In the event that prepared ORS is not available or you cannot make ORS, some home extra fluids from prepared meals like water from rice can help.”

Professor Orimadegun said although mothers talk about “my baby has diarrhea because he is teething”, or developed diarrhea because he eats a particular type of food, these are myths that cannot be explained scientifically.

He added, “most cases of diarrhea concede with the period of introducing complementary feeding or introduction of adult food and other foods. It is about that time also that the child also tries to bring out the first set of teeth. The link to all of these is poor hygiene in the process of introducing complementary feeds and sometimes some food intolerance.

“Before, the child has been sucking breast milk directly from the mother without any opportunity for microbes or organisms in the environment apart from the one the child is taken in from the mother’s skin.”

In some cultures, especially amongst the Yoruba of Southwestern Nigeria, diarrhea is believed to be caused by two factors: natural and man-induced. The type of diarrhea linked with childhood teeth formation is considered to be natural, while man-induced diarrhea is linked with dietary habits, such as consumption of sugary foods.

This perception explains the feeding during illnesses receive insufficient or no attention during common childhood illnesses such as diarrhea and acute respiratory infections. The type of food restriction/withdrawal also depends to a large extent on the food culture of the local community.

Classification of foods was based on food beliefs, as pure and impure food; hot, cold and neutral foods; beneficial or harmful foods; or curative foods. Most food substances commonly withdrawn are solid foods such as fruits, meat products, milk products and vegetables.


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