CHAPTER ONE
INTRODUCTION

1.1 Background to the Study
Diarrhea is a disease of the gastrointestinal tract, characterized by abdominal fluidity and frequently of fecal evacuation, three or more or at least one bloody stool in a 24 hours period. It is not unusual to also find mucus in the stool (Ifeoma, Achadu, Kpurkpur, Drenkat, 2017).
According to the World Health Organization (WHO) and UNICEF, there are about 2 billion cases of diarrhea diseases worldwide every year, and 1.9 billion children younger than 5 years of age perish form diarrhea each year, mostly in developing countries. This amounts to 18% of all the deaths of children below the age of 5 and meand that >5000 children are dying every day as a result of diarrhea, 78% occur in the African and Southeast Asian regions. Each child below 5 years of age experiences an average of 3 annual episodes of acute3 diarrhea Globally in this age group, acute diarrhea is the second leading cause of death (after pneumonia), and both the incidence and the risk of mortality from diarrhea diseases are greatest among children in this age group, particularly during infancy, thereafter, rates decline incrementally. Other direct consequences of diarrhea in children include growth faltering malnutrition and impaired cognitive development in resources limited countries. During the past 3 decades, changes in water supply, sanitation, and personal hygiene are believed to have contributed to a decline in the mortality rate development countries (Farthing, Salam, Lindberg, Dite, Khalif, Salazar-Lindo, Ramakrishna, Goh, Thomson, Khan, Krabshuis, Lemair, 2013).
In developing countries like Nigeria, majority of diarrhea infection is caused by viruses, few by bacteria and other parasites and diarrhea is often inadequately managed at homes, which may result to poor outcomes. Timely medical attention for diarrhea is important for reducing deaths from diarrhea. Understanding the disease risk and identifying determinants of seeking care from a professional healthcare provider may provide a basis upon which governments can estimate the burden of the disease and detect barriers to seeking appropriate health care (Fahima, Iqbal, Sweta, Firdausi, Mohammad, 2015). It was in this vain that the effective use of Oral Rehydration Therapy (ORT) was recommended by WHO in the treatment of diarrhea.

Oral Rehydration Therapy (ORT) is the administration of appropriate solutions by mouth to prevent or correct diarrhea dehydration. ORT is a cost-effective method of managing acute gastroenteritis and it reduces hospitalization requirements in both developed and under-developed countries. ORT consists of: Rehydration – water and electrolytes administered to replace losses, maintenance fluid therapy to take care of ongoing losses once rehydration is achieved along with appropriate nutrition (Farthing, Salam, Linberg, Dite, et al, 2013).

1.2 Statement of Problem
Globally diarrhea disease is the second leading cause of death in children under five and responsible for the deaths of about 760,000 children every year. The disease is particularly dangerous for young children, who are more susceptible to those living in low and middle income countries (Fahima, Iqbal, Swela, Firdpos, et al) loss of intestinal fluid caused by gastroenteritis may lead to severe hypovolemia, shock and death particularly in children younger than 5 years of age. Although the total number of death resulting from diarrhea globally remains high, the overall mortality rates has steadily decline over the last few years. The decline especially in developing countries is largely due to the use of early and effective use of Oral Rehydration Therapy (ORT) as well as improved nutrition and water sanitation measures.
In Nigeria, Diarrhea disease is one of the leading causes of infant and child mortality where in accounts for an estimated 250,000 deaths per annum. Although, the federal government has contributed appreciable resources towards the reduction of the disease in Nigeria, these efforts have not yielded significant results. Report of the United Nations children, education and scientific fund indicates that more than one child in every five fails to survive to the age of five in Nigeria, and that as high as 40% of these deaths are due to diarrhea (Alex, 2010).
The early use of Oral Rehydration Therapy (ORT) at home in children with diarrhea will decrease the number of our patients visits and hospitalization and overall medical cost (Billy, 2009).
In Amassoma community, the researcher has observed that malnutrition, poor hygiene condition of mothers and lack of proper health education reduces the change of preventing the outbreak of diarrhea in children between 0-5 years. Despite the benefits of Oral Rehydration Therapy, the cases of children with diarrhea are still being brought to the health facilities on a daily basis which should not be so after the discovery of Oral Rehydration Therapy.

Against the backdrop the researcher wishes to determine the knowledge and acceptance of Oral Rehydration Therapy of mothers in the management of Diarrhea in children 0-5years in Amassoma.

1.3 Purpose of the Study
The main purpose of the study is to assess the knowledge and acceptance of Oral Rehydration Therapy of mothers in the management of Diarrhea in children 0-5 years in Amassoma community Bayelsa State.

1.4 Significance of the Study
When the study will be completed, the result will provide materials and necessary fact to the midwife-education as a means of information and a guide to the students. To the Midwife Researcher, it will serve as a source of information. Also to the Midwife-Clinician it will create awareness on the importance and effectiveness of Oral Rehydration Therapy to mothers.

1.5 Objectives of the Study
To determine the level of knowledge on Oral Rehydration Therapy among mothers in Amassoma community, Bayelsa State
To assess the rate of acceptance on Oral Rehydration Therapy among in Amassoma community, Bayelsa State.
To determine factors influencing the acceptance of Oral Rehydration Therapy among mothers in Amassoma community, Bayelsa State.

1.6 Research Questions
What is the level of knowledge on Oral Rehydration Therapy among mothers in Amassoma community, Bayelsa State?
What is the rate of acceptance on Oral Rehydration Therapy among mothers in Amassoma Community, Bayelsa State?
What are the factors influencing the acceptance of Oral Rehydration Therapy among mothers in Amassoma community, Bayelsa State.

1.7 Scope of Study
This study covers 100 mothers ranging from 16-45 years.

1.8 Operational Definition of Term
Mother: A female parent of a child or children
Child: A young human from 0-5 years.
ORT: An Abbreviation for Oral Rehydration Therapy
Knowledge: Understanding or information about a subject which has been experience or study. This includes the mother having the basic knowledge of ORT in the management of diarrhea.
Diarrhea: The passage of frequent watery stool 3 or more times within 24 hours.
Dehydration: The process of losing body fluid and electrolyte through vomiting, passing out of watery stool, excessive sweating and urinating.
Management: The process of controlling.
Acceptance: This is where mothers have had the adequate knowledge of ORT and start using it in their homes when necessary.