Australasian Medical Journal 2009, 1, 14, 235-238 235 REVIEW Please cite this paper as: Ansari M, Palaian S and Izham MIM. The role of mothers in the management of childhood diarrhoea in Nepal. AMJ 2009, 1, 14, 235-238 Doi 10.4066/AMJ.2009.131 Abstract Diarrhoea is a leading cause of childhood morbidity and mortality in Nepal, a developing country where the larger proportion of the population live in rural areas. Poverty, illiteracy, lack of health care facilities at local level, demographical distribution and traditional beliefs are the major obstacles for getting proper and timely healthcare. There is a necessity to consider the cultural beliefs of different ethnic communities before designing any educational protocol or guideline. Educational protocol or guidelines which respect the local cultural beliefs and stimulate the utilization of their locally available facilities can be easily accepted and would be more suitable to achieve the objectives. Introduction Diarrhoea is common in children under five years of the age in Nepal. There may be several reasons for the higher incidence of infant as well as maternal mortality in Nepal and other developing countries, but one of the main causes of child death in Nepal is diarrhoeal disease [1]. Childhood mortality rate is higher in families which are poor, living in rural areas and whose mothers lack basic education [2]. Diarrhoea is about 13% higher in rural children than urban in the age group between 6 to 23 months. Moreover, there is a higher incidence of diarrhoea in children with uneducated mothers as compared to those whose mothers have some primary education. It was further found that knowledge about ORS was less among younger mothers (15 to 19 years) than their older counterparts especially in rural settings [3]. Nepal Demographic and Health Survey (NDHS) 2006 found that about one half of the children with diarrhoea under the age of five are not taken to the health care centers [4]. Childhood morbidity and mortality due to diarrhea The prevalence of childhood diarrhoea is high especially in rural communities of Nepal. A study by Jha et al. indicated that about 45,000 children less than five years of the age die due to diarrhoea in Nepal annually [5]. Recently, hundreds died in far western districts of Nepal due to a diarrhoea epidemic. According to a news website in Nepal, Jajarkot district has been affected very badly with 150 dying in the month of July, 2009, with around 6,000 severely affected in Jajarkot and surrounding districts like Rukum, Dang, Rolpa and Salyan in the year 2009 [6]. Government action plan for diarrhoea in Nepal The government of Nepal has a long term health plan (1997-2017) targeted to benefit the most vulnerable populations, namely women, children and those who are poor, under-privileged, marginalized and live in rural areas. It also ‘aims at equitable access by extending quality services to remote areas with full community participation and gender sensitivity by technically competent and socially responsible health personnel’. The plans of the government are to increase the use of oral rehydration solution (ORS) & zinc and to increase awareness in the people to achieve the Millennium Development Goal-4 [7]. Research on childhood in Nepal The NDHS 2006 showed that the point prevalence of diarrhoea is higher in monsoon (April to August) [4]. It also added that about 50% of diarrhoeal cases were treated at home without any medication while only 13% received ORS. A comparison of NDHS 2001 and 2006 showed a decreasing order in the use of ORS for managing childhood diarrhoea. There is a common tendency among the mothers to seek health care only when the case becomes serious [8, 9]. Rehan et al. found an unsatisfactory level of knowledge, attitude and practice of mothers regarding diarrhoea and its management. There was less preference towards fluid consumption during diarrhea [10] and one of the reasons for this is the directive of child’s grandparents [8]. A study by Das et al. found that drug sellers are the major site of consultation (80%) for diarrhoeal illnesses and moreover, their knowledge about diarrhoea and its management was very unsatisfactory [11]. Beliefs and barriers about diarrhoea and its management Several studies have found that there are different traditional beliefs, barriers and practices about childhood illnesses and their management at local level as perceived by different communities. Practices such as reduction in breast feeding, restriction of foods and fluids, use of enema and selected herbs as well as belief on magical The role of mothers in the management of childhood diarrhoea in Nepal Mukhtar Ansari 1, 2 , Subish Palaian 2 , Mohamed Izham Mohamed Ibrahim 2 1. Department of Pharmacology, Nobel Medical College Teaching Hospital & Research Center, Biratnagar (Morang), Nepal 2. Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia Corresponding Author: Mukhtar Ansari, MPharm, Ph D Candidate Discipline of Social and Administrative Pharmacy School of Pharmaceutical Sciences Universiti Sains Malaysia 11800, Pulau Pinang, Malaysia mukhtar1998@yahoo.com