KAP STUDY ON DIARRHOEA A SUMMARY REPORT
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KAP STUDY ON DIARRHOEA
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KAP STUDY ON DIARRHOEA
A SUMMARY REPORT
QUANTITATIVE SECTION
Prepared for UNICEF
By INDIAN MARKET RESEARCH BUREAU
DELHI
IMRB/HV/ 40326
D
D
Indian Market Research Bureau
i
A KAP STUDY ON DIARRHOEA MANAGEMENT IN RURAL INDIA
A SUMMARY OF THE FINDINGS FROM THE
QUANTITATIVE STUDY
BACKGROUND AND METHODOLOGY
Diarrhoea is a major cause of malnutrition and death amongst
infants and children in India.
The first step towards
correcting this situation would be to educate mothers
with regard to correct management of diarrhoea.
Since
the majority of people in India live in its villages,
such communication and information would need to be addressed
to mothers of young children in rural India.
The need to design effective, clear and precise communication
messages on this subject in turn revealed a need to understand
current knowledge, attitude and practices with regard
to diarrhoea management in rural India.
With this objective,
a massive All India KAP study on diarrhoea management
was commissioned.
The study was designed and carried out in two phases.
The first phase, using the qualitative research techniques
of group discussions and depth interviews obtained extensive
data on the range of beliefs, attitudes and practices
that existed. Thus, it was learnt that diarrhoea was believed
to be caused by a myriad of possible reasons, most important
amongst them being food, climatic conditions, dirty water,
teething etc.
It was learnt that a rural mother handles
Indian Market Research Bureau
2
a diarrhoeal problem by waiting and watching to begin
with, in the hope that it would be self-curing; the next
step would be to modify the diet, try traditional remedies
at home, approach a faith healer or a traditional doctor
and finally, if none of these helped, go to allopathic
doctor.
A total of 140 group discussions were conducted
amongst mothers of small children (aged less than 5 yrs).
A total of 420 depth interviews were conducted amongst
mothers, medical practitioners and chemists/pharmacists.
These samples were taken from 70 villages (selected on
the basis of several criteria such as size, distance from
large town etc) which in turn represented 35 socio-cultural
regions.
However, while qualitative research reveals a range of
prevailing attitudes, beliefs and practices, it does
not indicate the extent to which a particular belief or
practice holds true.
Thus, out of a range of ten to twelve
beliefs that may be revealed through qualitative research,
each appearing to be equally important, it may happen
that in fact only one or
two of those are widely prevalent
while the others were beliefs held by only a few persons
in the total universe.
It was therefore necessary to quantify the findings that
had emerged from the first stage of research so that communication could be designed around the knowledge, attitudes
and practices that were most widely prevalent.
Findings
from the qualitative study were incorporated into a
questionnaire that was used to interview women from
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villages across the country.
on the basis of a
These villages were selected
stratified random sampling method such
that each village in the regions under study had an equal
chance of being selected.
A total of 5310 women with at least one child under the
age of 5 were interviewed.
Each of these children being
referred to had had an episode of diarrhoea either in
the past two months or in the past two weeks or were currently
having diarrhoea.
These mothers were selected from 408 villages which
represented 34 socio-cultural regions.
All interviews were conducted in the respondent's mother
tongue.
The term diarrhoea and loose motion, while used
interchangeably in this report, were referred to by the
term that was most commonly used for the condition, in
that language.
Data expressed in this report refers to the country as
a whole; major differences have been highlighted.
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Indian Market Research Bureau
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MAJOR FINDINGS
ONE :
THE RURAL MOTHER DOES NOT RECOGNIZE A SERIOUS DIARRHOEAL
PROBLEM AS SOON AS SHE SHOULD
1.1
Frequency
On an average, a rural mother acknowledged that
the child had a diarrhoeal problem after the child
had passed 4-5 motions.
This means that she
would have done nothing till such time, indicating
that the child had already been put at a disadvan
tage at the very onset of diarrhoea.
If we look
at this finding in conjunction with the findings
of qualitative research which revealed that after
recognizing diarrhoea, a mother’s practice is to
wait and watch for a while, the implications appear
to be grim.
Behaviour differed by regions. In the East zone
and in the states of Gujarat and Kerala, the
majority of mothers (67%) said that they looked
upon 2-4 motions in a day as a sign of a
diarrhoeal problem.
On the other hand, in Uttar Pradesh and Madhya
Pradesh an average of 5 - 7 motions in a day were
considered to be a sign of a problem.
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Qualitative research had revealed that a mother
believed that her child was weak when he looked
tired, stopped playing, sat quietly or became cranky
and irritable,?Iay down and became inactive.
In some regions, other symptoms of a serious problem
were mentioned by a majority of mothers.
These
were as follows :
In Tamil Nadu, mothers said that the child would
look dull, feel giddy (76%) and that his limbs
would become loose (51%).
In Gujarat, more than physical signs, mother depended
on several loose and watery motions to indicate
a serious problem.
In West Bengal, mothers mentioned lethargy and
silence as signs of a serious problem.
1.4
Awareness of death as a result of diarrhoea
Respondents had been asked in the course of the
interview about the consequence of repeated attacks
of diarrhoea and whether diarrhoea could lead to
death.
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Responses revealed that 67?o of the mothers recognized
that diarrhoea could sometimes or often lead to
death.
By assigning a score of 1 to those mothers who
said that diarrhoea could not lead to death, 2
to those mothers who said that it could rarely
lead to death, 3 to those who said that it could
sometimes lead to death, 4 to those who said that
it could often lead to death and 5 to those who
had spontaneously spoken of death as a conseguence
of diarrhoea,it was possible to arrive at mean
scores on this subject for each state. These are
given in the table below
:
Mean scores
Haryana
2.8
HP/JK
2.6
Rajasthan
3.2
UP
3.2
Bihar
3.7
Orissa
3.7
West Bengal
3.7
Assam
4.0
Gujarat
2.4
Madhya Pradesh
3.3
Maharashtra
2.4
Andhra Pradesh
3.6
Karnataka
3.2
Kerala
3.7
Indian Market Research Bureau
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This table indicates higher awareness of death as
a result of diarrhoea in the East zone, particularly
in Assam/and in Kerala in the South zone.
Lowest
awareness of death was revealed in Gujarat and Maharashtra
in the West zone and in HP/JK in the North zone.
Indian Market Research Bureau
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TWO :
THE RURAL MOTHER DOES NOT WITHOLD FLUIDS DURING
DIARRHOEA
2.1
Fluids during diarrhoea
Research indicates that mothers continue to give as much
fluids during diarrhoea as during normal times and
more.
All mothers who had been breastfeeding their children
continued to do so (99%).
76% of all mothers had given water to the child
when he had diarrhoea.
42% of all mothers had given the child some fluid,
other than water and breastmilk, when he had diarrhoea.
2.1.1
Water
As we have just seen, 3 out of 4 mothers gave
water to the child when he had diarrhoea. Of
these,
48% gave as much water as usual
36% gave more water than usual
16% gave less water than usual
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Indian Market Research Bureau
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Of the remaining one-fourth who had not been giving water
during diarrhoes, 87% were breastfeeding the child.
It
is likely that they considered the child to be too small
for water since we found through both qualitative and
quantitative research that infants aged less than 6
months, who
were almost wholly breastfed, were consi
dered too small to be given water.
In Kerala, most mothers (76%) gave larger quantities of
water than normal.
In the East zone and in Rajasthan, 25% of the mothers gave
smaller quantities.
This was higher than the national
average of 16% who gave less quantity water than normal.
The main reasons for giving less water were as follows :
The child rejected water - 35?o
This response came mainly from the East zone,
specifically Orissa and West Bengal.
Water could have a cooling effect - 21%
This belief led to fears that if the child
was
given water he could catch a cough or cold or fever
or combinations of the same.
It must be remembered
that this study was conducted in the months of
February and March which was the end of winter.
Mothers specifically avoided giving water during
winter months, particularly in the North zone.
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Water could aggravate diarrhoea - 17%
This belief was expressed mainly in Assam, West
Bengal, Tamil Nadu and Kerala.
Child too small
2.1.2
13%
Attitude to breast feeding during diarrhoea
A study of the actual practice during the last episode
of diarrhoea revealed that 99% of those who had been
breastfeeding the child, continued to do so even
when he had diarrhoea.
All respondent^ whether currently breastfeeding or
not, were questioned on their belief on the subject.
70%
of all respondents believed that breastfeeding
should be continued even when a child had diarrhoea
22%
felt that it should be stopped (2% of these
continued inspite of their belief to the contrary)
4%
felt that the total quantum of breastmilk given
to the child should be reduced.
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Indian Market Research Bureau
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The states where mothers were strongly in favour
of breastfeeding during diarrhoea were
:
9W
Tamilnadu
Karnataka,Himachal
89?o
Pradesh
Rajasthan
86%
Maharashtra
80%
The states where mothers (more than the national
average) spoke in favour of stopping or reducing
breastfeeding were Kerala, West Bengal and Assam.
2.1.3
Fluids during diarrhoea
In 42% of the cases studied, some fluid other than
water and breastmilk had been given to the child
during diarrhoea.
The highest proportion of mothers
who gave additional fluids came from Kerala (92%)
and Tamilnadu (71%).
The main fluids were milk and tea.
Milk was given
by mothers in all four zones whereas tea was reported
from the North, West and South zones but not from
the East zone.
In the South zone, a wide range of fluids had been
given, of which buttermilk, rice water, coconut
water and glucose water were the most common.
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In West Bengal, barley water had been given by 17%
of the mothers.
Oral rehydration salts (ORS) and sugar salt solution
(SSS) were mentioned by only 2.5% and 0.8% of the
respondents respectively.
2.1.4
Total fluids given
A study of the respondents fluid giving behaviour reveals
that each respondent had given some fluid to her child
when he had diarrhoea.
This could have been breastmilk,
water or some other fluid.
(See figure 1)
100% |
Non-breastfed
Z--->
1718 (33%) 100%/
2477
69%
1563
91?6
42%
1220
34%
1031
60%
18%
107
3%
876
51%
Breastfed
Total
2.1.5
5308
100%
3590
Water
4040
76?o
Fluids
2251
Both
983
(67%)
Perceived role of fluids during diarrhoea
The main perceived role of fluids and the reason for
giving fluids was to quench thirst.
This was expressed
by 26% of all respondents but more frequently by respon
dents in Assam and Andhra Pradesh.
The second expectation was that fluids would give strength
and reduce weakness (19%). This was mentioned in Himachal
Maa
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Pradesh, Jammu & Kashmir, Haryana, Madhya Pradesh
and Gujarat.
The third expectation was that fluids would stop
stools(l8?o) once again expressed by mothers in Himachal
Pradesh/Jammu & Kashmir, Gujarat, Madhya Pradesh &
Haryana.
The fourth expectation was that fluids would
combat dryness and water loss (15?o).
help
Water loss was
mentioned in Kerala, in Himachal Pradesh and Jammu &
Kashmir & in Haryana.
Those mothers who were literate spoke of the strength
giving and water-replenishing
roles of fluid signi
ficantly more often than illiterate mothers.
2.2
Inadequacies in terms of rehydration
The preceding section on practices with regard to
fluids indicates that mothers in rural India are not,
in principle, opposed to the concept of fluids during
diarrhoea.
However, their practices have shortcomings
that prevent effective rehydration and could partially
account for the high diarrhoea-related mortality in
India.
The first of these shortcomings is that fluids are
not given in sufficient quantity or frequency.
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60% of all mothers who gave some fluids other than
water and breastmilk gave less than 100 ml* at a
time.
More than half of all mothers who gave the fluid,
gave it 2-3 times a day; 11?o gave it once a day while
the rest gave it more than 3 times a day.
Secondly, since fluids were not given in a conscious
attempt to maintain fluid balance in the body,
their consumption was not related to loose motions
fi equency.
Thus, a child could pass several loose
motions and lose a lot of water but get only 100
ml of fluid or less, 2-3 times a day.
However,
fluid intake was sometimes related to thirst and
to this extent a child was likely to get more fluids
on demand.
This would, by definition, benefit
an older child more than it would a younger child.
Thirdly, the fluids that were given (barrihg breastmilk)
were mainly, water, milk and tea.
These fluids
all share one shortcoming, namely, lack of salt,
Thus
they were inadequate for the task of rep
lenishing lost
body salts which would be important
for proper rehydration.
* The quantity was determined in this study by means
of a standard 200 ml plastic beaker marked at £th,
3/4 levels that was given to each interviewer.
i
2
and
The respon
dent was asked to indicate the level to which the fluid
quantity given by her, at a time, would fill that beaker.
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Fourthlyeffective rehydrants such as ORS and SSS
were not used.
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THREE :
FOOD IS NOT WITHHELD; HOWEVER, FOOD ITEMS
AND QUANTITIES ARE REDUCED
3.1
Food items
All food items were dropped to some extent during
diarrhoea.
This was reported from all four zones
in the country.
Rice was dropped by some respondents (32%) in
every zone except in the West zone.
Roti (or chapatis, the traditional whole wheat
flour bread) was dropped across all zones (36%)
where it was traditionally consumed in a normal
diet.
Vegetables were dropped by 40% of all respon
dents from all four zones and by over half the
respondents in the East and South zones.
Pulses were dropped by 36% of the respondents,
particularly in the East and South zones.
3.2
Food quantities and consistency
47% of all respondents gave as much food as
normal and with the same frequency as normal.
36% gave less food, less often in the day.
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4?o gave more quantity of food more frequently whereas
3.5% gave less quantity of food at a time but made
no changes in the frequency.
Most mothers made no changes in the method of cooking
food; only one mother in eight deliberately changed
cooking methods to make food more liquid, softer and
sometimes, more bland. Changes in cooking method were
mentioned mainly in the East and South zones.
3.3
Attitudes with regard to food
74?o of all respondents believed that feeding should
be continued when a child had diarrhoea.
23% believed that feeding should be stopped, primarily
because they felt that food .could worsen the diarrhoeal
attack.
There were no special practices with regard to food
after the diarrhoea had stopped.
Mothers allowed
the child's appetite to dicate the quantity of food
consumed.
If the child was more hungry, they did
not hesitate to give more food; if, on the other hand
the child had a poor appetite, they did not coax him
to eat more either.
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19
FOUR:
THERE WAS A HIGH PROPENSITY TO SEEK TREATMENT
DURING DIARRHOEA.
THE MAIN DEPENDENCE WAS
ON PRIVATE PRACTITIONERS, USUALLY OF THE ALLOPATHIC
SCHOOL.
4.1
Preventing the worsening of diarrhoea at home
In order to understand the reason for the high
tendency to seek medical treatment, it would be
useful to look at the mother’s confidence in
her own abilities to handle the problem.
Respon
dents were asked to talk of the measures that
they could adopt at home to prevent the worsening
of diarrhoea.
56% of the respondents said that nothing could
be done at home; another 14% ventured the suggestion
that they could seek treatment for the child.
Thus, in effect, 70% of the respondents believed
that there was nothing that they could do,
at home, to prevent the worsening of diarrhoea.
25%
spoke of home remedies that they could
try in an effort to prevent the diarrhoeal attack
from worsening.
Qualitative research had revealed
a wide range of home remedies based on herbs,
spices and leaves, etc.
Home remedies were
mentioned by over 25% of the respondents in
the states of Kerala, Tamilnadu, Gujarat and
Orissa.
0}
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Indian Market Research Bureau
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4.2
Treatment sought
65% of all respondents had sought treatment during
the last episode of diarrhoea being studied.
An
additional 10% had sought informal advice (mostly
from the husband or the mother-in-law).
Only 25%
had managed the last episode of their own, without
advice or treatment.
The 35% who had not sought formal treatment were
asked to name the person whom they would have consulted
had they felt the need to seek treatment for their
child when he had recently had diarrhoea.
The following table reveals the pattern of reference
that had been followed by respondents who had actually
sought treatment (actual) and who had not sought
treatment but spoke of the person they would have
referred to if required (hypothetical).
Actual(65%)
0/
/O
1.
Private practi
tioner
83.3
Hypothetical(35%)
Total(100%)
%
0/
/□
75.0
80.4
Allopathic
70.2
57.3
65.7
Type not known
13.1
17.7
14.7
Health centre/
worker
7.5
12.9
9.4
2.
Homeopathic
5.1
3.3
4.5
4.
5.
6.
Ayurvedic
Faith healer
Vaid/Herbal
Chemist
4.1
1.4
1.8
1.2
2.8
2.9
1.2
3.7
1.9
1.6
2.
7.
0.8
wm
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Indian Market Research Bureau
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It is interesting to note that fewer respondents
actually went to the health centre or health worker
than had thought they would in a hypothetical
situation.
On the other hand, a higher proportion went to
private practitioners (allopathic, homeopathic
and ayurvedic) than had thought would do so in a
hypothetical situation.
The role of the chemist in diarrhoea treatment was
negligible.
There were variations in actual treatment seeking
practice by regions and by literacy levels.
95% of all respondents in Kferala had sought treat
ment during the episode of diarrhoea being referred
to.
Over 70% of the respondents in Himachal Pradesh/
Jammu & Kashmir, West Bengal, Andhra Pradesh and
Karnataka had sought treatment.
A larger proportion of literate women sought
treatment than illiterate women.
w0}
Indian Market Research Bureau
0/^93
22
4.3
Treatment received
TreatTnent provided by the doctors consisted of :
%
Tablets
70.7
Syrups/mixtures
53.6
Injection
39.7
Powdered medicine
17.5
ORS had only been given by 6.2% of the doctors on
the whole.
The states in which a larger proportion
of doctors had prescribed ORS were
17% of the doctors in West Bengal
14% of the doctors in Kerala
11% of the doctors in Maharashtra
4.4
Cost of treatment
The treatment had cost an average respondent
Rs 38/- in all.
The median value was at Rs 21 - 30 which
indicates that half the respondents had spent
less than 21 — 30 Rs while half the respondents
had spent more than that sum.
Cost of treatment (and other related expenses)
varied by zones.
In the South zone, the average
cost of treatment had amounted to Rs 48/- while
in the East, the cost was lowest, at Rs 29/-.
K
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Indian Market Research Bureau
FIVE
THE ENVIRONMENT IS RECEPTIVE TO THE PROMOTION
OF HOME-BASED FLUIDS.
AWARENESS AND USAGE
OF ORAL REHYDRATION SALTS(ORS) AND SUGAR
SALT SOLUTION (SSS) is LOW
5.1
Home based fluids
A number of fluids were read out to each
respondent; for each fluid she was asked
if she would be willing to give that fluid
to her child when he had diarrhoea.
The list of fluids and the percentage of
respondents who were willing to give that
fluid are listed below.
Water and glucose
water emerged as being the two fluids that
most mothers would be willing to give.
Mothers were also asked if they would be
willing
to add sugar or
jaggery (for
the first five fluids in the list) and salt,
(for all the fluids) if adviced to do so.
The percentages of those who would be willing
to add
sugar and salt are also given below.
.. Jian Market Research Bureau
Base : Willing to.give - 100%
Willing
to add
sugar
Willing
to add
salt
%
%
?0
Water
82
46
39
Tea
47
85
26
Coffee
25
91
15
Buttermilk
43
48
72
Dal water
39
20
82
Coconut water
44
23
Rice water
45
85
Potato soap
15
79
Glucose water
68
21
Willing
to give
Glucose water with salt would
have been
,
: an acceptable rehydrant.
However, most respondents were unwilling to add salt.
Rice water, acceptable to 45% and acceptable with salt
to most of these respondents, could spearhead the promotional
effort for the use of home-based fluids during diarrhoea,
since rice is an ingredient that is also easily available
in most households in the country, as is illustrated
below.
Availability of ingredients
In order to enable realistic decision making on the
subject of home-based fluids to be promoted, this study
had covered the purchase and storage patterns of several
relevant ingredients.
The pattern is illustrated below for the nation as
a whole.
Indian Market Research Bureau
n . AVAIL-frSlL-iaV Or l^bK^J21&£±JL^
25
All India
re
50
15
IOG Z
i
[
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Rack salt
_____ ,
Powder F’dt
Ric^;
CM
-- -
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Bar.arv-1
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________ :
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Always
Sam^times
Never
as needed _
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26
Rice emerged as the one ingredient that would always
be available in 3 out of 4 houses in rural India
and bought as necessary in almost all the remaining
households.
Rice water could thus play an important
role in home-fluid usage promotion.
Data had also been collected with regard to the
availability, at that point in time, of each of
the ingredients given above.
This data was cross
tabulated to determine the extent of overlap in
terms of substitutable ingredients and the extent
of households covered by both ingredients.
The cross-tabulated data is illustrated below :
Indian Market Research Bureau
AVAILABILITY
OP
^ssent/al
/
(“in
INSKEdiG-MTS
ths
House ToDAyJ)
sfb
r
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s
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28
Either sugar or gur would be available in 73%
of all households at any given point of time.
However, 2.7% of the households would be without
either of these items.
Salt would be available, at any time, in 95%
of the houses.
The extent of overlap between
coarse salt and powder salt was low, indicating
that one or the other is usually stocked in the
house, but usually not both.
The overlap between sugar, gur and rice was studied,
assuming mutual substitutability.
This revealed
that 92% of the households at that time, had one
of the three
ingredients that they could use
to make home-based rehydration fluids.
Kitchen fire lighting frequencies
It had been felt that one obstacle to making fluids
in the home would be that kitchen fires in
rural
areas would not be lit more than once in a day.
The kitchen fire lighting practices were examined
in this study.
It was found that kitchen fires are lit 2-3
times a day in over 80% of rural households.
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Indian Market Research Bureau
29
Barring Tamilnadu, where 18% of the respondents spoke
of lighting kitchen fires only once in a day, no other
state revealed this practice in any sizeable proportions.
In small villages, fires were lit twice a day. In larger
villages, fires were lit as and when required in one out
of four houses.
The main fuels used were wood (89%) and cowdung cakes
(52%). The use of easy-to-light fuels such as kerosne,
gas and coal was negligible (kerosene : 6%; gas : 1%;
coal 5%).
5.2
Oral rehydration salts
Awareness and usage
Respondents were shown
packets of branded ORS
(including the brand leader, Electral) and packets of
the government distributed oral rehydration mixture and
asked if they had ever seen and used any of those.
37% of all respondents had heard of oral rehydration
salts.
Highest awareness
existed in
West Bengal
(67%) and Kerala (59%).
Of those who were aware of and had seen ORS, 72% had
used it.
Thus, 26% of all respondents had ever used
ORS. It is disheartening to note that inspite of the
fact that as many as 26% had ever used ORS, only
Indian Market Research Bureau
Awarenass of ORS
Haryana
tx/.
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hp/tsk
Rajasthan
^o>’/
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yp
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Bihar
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Orissa
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Assam
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-------- !---- 4 a /.
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10
20
4ff/
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30
40
50
%
60
70
90
90
100
30
2.5% had used it in the last episode.
This reveals
low salience of the product in the mind of the target
audience.
Usage as a proportion of awareness had been high in
Uttar Pradesh, Kerala, Karnataka and Maharashtra.
ORS had been used mainly for children (84%); 6%
had
used it only for adults and the balance 10% had used
it for both adults and children.
Expectations from ORS
The main expectation from ORS had been that it would
stop loose motions (53%).
(Base - all users - 1398
respondents) .
The other expectations were that ORS would help prevent
or quench thirst (25%), that it would prevent weakness
(20%), cool the body (11%) and keep the child active
(11%).
Of those who had expected that
:
ORS would stop loose motions, 79% were satisfied
that it had indeed stopped loose motions
ORS would prevent weakness and cool the body, 45%
in each case had been satisfied
ORS would keep the child active, 100% had been
satisfied that it had indeed kept the child active.
Indian Market Research Bureau
31
It would appear from this analysis that ORS lived
up to the expectation that it would stop diarrhoea.
Since correctly managed diarrhoea would come to a
halt in due course of time, it would be harmless
to allow the mother to believe that ORS did play
a curative role.
In fact, it would be beneficial
for her to believe so (without cure being a direct
product promise) since that would give her a
reason for use that she could easily understand.
Method of use
50% of the respondents had used a spoon to measure
the powder; 37?o had used the scoop provided with
some branded ORS packs; 10% had used the powder by
emptying out the whole pack or parts of it.
Data an the amount of powder used with a scoop and
the water used in the same case was analysed. This
revealed that the mixture was more dilute than
had been recommended.
Fig. 4.
This is illustrated in
The dotted line indicates the recommended
water-powder ratio while the unbroken line shows
the actual water-powder ratio in use.
Water
proportions were higher than recommended for a
given guantity of powder.
Indian Market Research Bureau
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5.3
Sugar-salt solution
Awareness and usage :
Sugar-salt-solution had been used in the last
diarrhoea episode by less than 1% of all respon
dents and had been spontaneously mentioned as a
means of preventing the worsening of diarrhoea
by less than 2% of all respondents.
Upon being
asked (Have you heard of a solution made with
sugar or gur and salt which is to be given to a
child having diarrhoea ?), 16.7% expressed aware-
ness.
Awareness was highest in the following states :
Of
terala
47%
Tamilnadu
40%
Maharashtra
32%
Andhra Pradesh
22%
West Bengal
20%
all those who had heard of SSS, only 46% had
ever used it.
The states where usage
as foltows
had been the highest were
:
b)
Indian Market Research Bureau
33
Users as %
bf those
aware
Aware and
used of all
respondents
%
%
Tamilnadu
64.6
26
Gujarat
64.4
10
Karnataka
60.9
5
Orissa
57.1
6
Reasons for non-use
Over half (56%) of those who had not used SSS inspite
of being aware of the same, had no reason for not
having used it.
The lack of reason indicates lack
of conviction or faith in the efficacy of SSS.
Of those who did give some reason for non-use, 29%
said that they did not know the method of preparation.
Another 12% expressed doubts about the usefulness
of such a solution.
Only 3.5% of the respondents said that sugar was
bad for diarrhoea, thereby putting to rest the fear
that SSS might be rejected on grounds of the belief
that sugar could be harmful during diarrhoea.
Indian Market Research Bureau
34
CONCLUSIONS
A
:
DEHYDRATION IS NOT UNDERSTOOD AS LOSS OE VITAL BODY FLUIDS
This conclusion has been derived on the basis of the quali
tative research segment where respondents expressed their
understanding of water loss in diarrhoea.
Their perception appears to be one of a direct flow of water
through the body such that water taken in by the child flows
out without being absorbed by the body, causing dryness and
thirst. However, they do not perceive the water as being
body fluids that flow out.
In Uttar Pradesh and in Madhya Pradesh some mothers had spoken
of "body loss in diarrhoea" and explained that, in diarrhoea, blood
turned into water and was lost.
This may be the closest
that the average mother came to understanding "loss of body
fluids".
It would be necessary for mothers to understand that the fluid
lost in diarrhoea is fluid that is drained out of the blood
system.
If water loss is understood as a loss that directly
affects the blood system and dehydration perceived not just
as "dryness" but as a vision
of a sluggish blood stieam that
cannot flow because of the deficiency of fluids, it could
trigger off the concern that would be necessary if a mother
had to constantly and carefully keep a child, particularly
an infant, rehydrated.
Indian Market Research Bureau
35
B
HOME-MADE FLUIDS SHOULD BE PROMOTED AMONGST
MOTHERS SINCE THEY ARE LIKELY TO BE RECEPTIVE TO
THE CONCEPT
The fluids that find acceptance per se are water
and glucose water.
Water by itself would not be
sufficient to effectively rehydrate a child
suffering from diarrhoea; the sugar salt solution
could run into problems of measures and propor
tions as well as credibility.
Glucose water with salt could be an effective
rehydrating fluid. The fact that glucose powder
is a branded, purchased item could add to the
overall faith in the effectiveness of the fluid.
The difficulty would be in terms of convincing
mothers to add salt to glucose powder.
Rice water would be another potential home-fluid
which has three factors in its favour namely
reasonable acceptability, the availability of
rice in most households and the willingness to
add salt to rice water.
However, since it is
an item that would need to be specially prepared,
there might be a high drop-out factor between
theoretical acceptance and actual usage.
Indian Market Research Bureau
36
c
:
PRIVATE PRACTITIONERS ARE IMPORTANT INFLUENCERS
IN THE RURAL ENVIRONMENT
As this study reveals, tvo out of three mothers
sought treatment and the large majority of these
went to private practitioners.
It would be important to ensure that these
private practitioners impart knowledge to the
mother on correct diarrhoea management practices.
There are two aspects to this :
Firstly, private practitioners should themselves
have correct knowledge with regard to diarrhoea
management in terms of continued feeding and
prevention of dehydration.
Since the medical
qualifications of private practitioners in
rural areas may not always be as per desired
norms, they might need education and information
on the subject.
Secondly, qualitative research had revealed
that often doctors in a village were aware of
dehydration and ORS or SSS but mothers belonging
to the same village would be unaware of the
of the same.
Therefore.it is essential that
private practitioners be willing and sincere
about imparting knowledge to mothers.
One
communication task would be to convince doctors
of the need to impart knowledge and educate
mothers.
Indian Market Research Bureau
37
D
ORAL REHYDRATION SALTS. IF WIDELY KNOWN AND
AVAILABLE, WOULD BE LIKELY TO FIND TRIAL AND
ACCEPTANCE
This conclusion is based on the collective
experience gained from this study.
ORS is a branded, packaged item which is more
likely to find favour with the rural people as
being something reliable and modern.
Branded
ORS would need to be paid for which is something
that a parent needs to do if he has to believe
that he is doing the best for an ailing child.
ORS is easy to use and has an acceptably
pleasant taste.
This study shows a higher trial
rate for ORS than for SSS which is testimony
to its acceptability and ease of use.
ORS was found to be perfectly satisfactory
in its expected role of keeping the child
active.
Since weakness is an important signal
that causes concern and weakness is judged
by several factors such as fatigue, crankiness,
inactivity etc., a fluid that could promise and
deliver continued alertness and activity in the
child would find acceptance.
Finally. ORS was expected to and mostly perceived
as having successfully stopped loose motions.
If
Indian Market Research Bureau
JL
38
ORS gets perceived as a fluid that would prevent
weakness in the child and contribute towards
stopping loose motions,it would certainly strike
a responsive chord in the mother.
Indian Market Research Bureau
40
An additional question pertaining to the mother’s
faith in each person if he/she were to advise her
on the subject of diarrhoea management had been
asked and graded on a three point scale where a
score of 1 implied no confidence, 2 implied an
unsure answer and 3 implied confidence.
All
roles were given a rating ranging from 2.5 - 2.7;
the school teacher got a 2.5 score.
Thus, a school teacher would appear to be the
best personal medium for spreading information
and education on the subject of diarrhoea manage
ment .
Indian Market Research Bureau
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