Diarrhoea, Diarrhea, Dehydration and Oral Rehydration - Rehydration Project home
Diarrhoea Kills a Child Every 26 Seconds
 

Home > Oral Rehydration Salts > Oral Rehydration Therapy > Knowledge and Use for Childhood Diarrhoea in India

Oral Rehydration Salts
Low-osmolarity ORS
Oral Rehydration Therapy
Made at Home
Treat Your Child's Diarrhoea at Home
Frequently Asked Questions
Rice-Based ORS
ORS WHO UNICEF Update
The Salts of Life
Rehydration Saves More Children

Low-osmolarity Oral Rehydration Salts
New Formula of Oral Rehydration Salts
Expert Consultation
WHO UNICEF Statement
New Formula will save millions
New Formula Studies
Low-osmolarity ORS Questions & Answers
Frequently Asked Technical Questions
Production of Low-osmolarity Oral Rehydration Salts

Oral Rehydration Therapy
Oral Rehydration Therapy (ORT) History
ORT: Celebration and Challenge
How Oral Rehydration Works
Management of Diarrhoea and use of ORT
Achievements and Challenges
25 Years of Saving Lives
Knowledge and Use of ORT
Communication and Social Mobilization
The Solution is in Your Hands
A Solution for Survival
Brochure: A Pocket Reference for Scouts
ORT: Elixir of life
ORT: Saved My Daughter's Life
ORT: Success Stories

Knowledge and Use of Oral Rehydration Therapy for Childhood Diarrhoea in India:
Effects of Exposure to Mass Media

National Family Health Survey Subject Reports
Number 10 - November 1998

http://www.nfhsindia.org/research.html
http://www2.eastwestcenter.org/pop/pop53002.htm

K. V. Rao, Vinod K. Mishra, and Robert D. Retherford
International Institute for Population Sciences - Mumbai, India
East-West Center Program on Population - Honolulu, Hawaii, USA
November 1998

Download this document in Knowledge and Use of Oral Rehydration Therapy for Childhood Diarrhoea in India: Effects of Exposure to Mass Mediapdf 55 pages 160 kb

NFHS Subject Reports

The NFHS Subject Reports are based on secondary analysis of data from the 1992-93 and 1998-99 National Family Health Surveys (NFHS) in India. The series is copublished by the International Institute for Population Sciences (IIPS) in Mumbai and the East-West Center.

The NFHS surveys collected information from nearly 90,000 Indian women on a range of demographic and health topics. Conducted under the auspices of the Indian Ministry of Health and Family Welfare, they provide national and state-level estimates of fertility, infant and child mortality, family planning practice, maternal and child health, and the utilization of services available to mothers and children. IIPS conducted the surveys in cooperation with consulting organizations and population research centres in India. The East-West Center and ORC Macro provided technical assistance, and the United States Agency for International Development (USAID) provided financial support.

Despite the Indian Government's vigorous Oral Rehydration Therapy (ORT) Programme, conducted for more than a decade, very few children who fall ill with diarrhoea are treated with ORT or increased fluids. Many of the children who receive treatment from a health facility or provider are given unnecessary, and sometimes harmful, antibiotics and other antidiarrhoeal drugs, but not ORT. These findings indicate a lack of awareness of proper treatment of diarrhoea not only among mothers but also among health-care providers. The analysis shows clearly, however, that mother's exposure to radio, television, and cinema increases awareness and use of ORT.

Results from these two studies indicate that, despite a vigorous Oral Rehydration Therapy Programme in India for more than a decade, knowledge and use of ORT to treat childhood diarrhoea remain quite limited. Very small percentages of children who fall sick with diarrhoea are treated with oral rehydration salt (ORS) packets, recommended home solution (RHS), or increased fluids, despite the fact that 61 percent of these children receive treatment from a health facility or provider. In the NFHS, among children born 1-47 months before the survey who had diarrhoea in the last two weeks, 18 percent were given ORS and 19 percent were given RHS. Considered together, only 31 percent were given ORS or RHS.

Among those who receive treatment from a health facility or provider, a very large proportion (94 percent) are treated with antibiotics or other antidiarrhoeal drugs, contrary to WHO recommendations that drugs not be used to treat diarrhoea in young children. The use of drugs is common among both public- and private-sector providers but is more common in the private sector.

The analysis indicates that the electronic mass media are effective in increasing awareness and use of ORT. Women regularly exposed to the media are much more likely than unexposed women to know about ORS packets and to use ORS or RHS. This result is valid even after controlling for the effects of a number of potentially confounding variables by holding them constant. Results also indicate some discrimination against girls in the use of ORS.

These findings suggest that both mothers and health-care providers are not well informed about the proper treatment of childhood diarrhoea. There is clearly a need to strengthen education programmes for mothers and to provide supplemental training to health-care providers, emphasizing the importance of increased fluid intake and discouraging the use of unnecessary and often harmful drugs. The Oral Rehydration Therapy Programme also needs to address the problem of gender discrimination in the treatment of diarrhoea. In all these efforts, the mass media can help.


This paper is a subject study using data from the 1992-93 National Family Health Survey (NFHS-1), carried out by the Indian Ministry of Health and Family Welfare. It uses the data to gauge knowledge and behaviour relating to the use of Oral Rehydration Therapy (ORT) for the treatment of diarrhoea, a major cause of juvenile illness and death in India. The study focuses on women who gave birth during the 4 years before the NFHS-1 survey. The study also attempts to link ORT practices and knowledge to media exposure. While the Indian government has been actively promoting ORT use through an extensive media campaign, this study does not attempt to create direct linkages to that effort but, rather, evaluates the impact of media exposure in the broader sense. Nevertheless, the authors believe that the study reflects on the overall impact and effectiveness of the government's ORT campaign.

The NFHS covered 25 states representing 99% of India’s population. Data were collected from a nationally representative sample of 89,777 ever-married women age 13-49 residing in 88,562 households. This report is based on data for the 38,161 women covered by the NFHS who gave birth during the 4 years before the survey and on data for the 4,558 children born in the period 1-47 months before the NFHS who were ill with diarrhoea during the 2 weeks before the survey. A lengthy explanation details the rational for weighting procedures and the inclusion of all control variables.

The study begins with an assessment of the potential scope of media exposure. Researchers found that 39% of women access radio at least once a week, 27% watch television once a week, and 14% go to the cinema hall or theatre at least once a month. 48% are regularly exposed to at least one form of electronic mass media. 52% are not exposed on a regular basis. Women aged 20-29 are less likely to be unexposed to any media (49%) than those aged 13-19 (52%) or those aged 30-49 (62%). The rural-urban divide is even more pronounced, with 61% or rural women not being exposed to any coverage, as opposed to only 23% of urban women. There were also significant regional differences.

According to the report, 43% of women giving birth 4 years before the survey knew about ORS packages, ranging from 20% knowledge to greater than 70%. The unadjusted figures show that women who are exposed to electronic mass media are significantly more likely to know about ORS packets than those who are not; for example, 56% of exposed women knew about ORS compared to only 32% of unexposed women. The difference of ORS knowledge among rural residents who had been exposed was slightly greater (12% diff.) than among urban residents (9% diff.).

Overall, 30% (adj.) of exposed women had ever used ORS packets, compared to only 23% among those not exposed. This difference was even more evident when the analyses included ORS and recommended homemade solution (RHS) therapies. Of those mothers with children who were ill 2 weeks before the survey, 36% of those with exposed administered either ORS or RHS, compared with only 27% who were not exposed. The difference between exposed and unexposed mothers who ever used of ORS packets within urban areas is relatively limited (33% exposed to 31% unexposed) but in rural areas the variance was more pronounced (29% of those exposed versus 22% of those unexposed).

One noteworthy finding was that media exposure had a far more significant impact on the administration of ORS/RHS to boys than it did to girls. The difference exposed/unexposed when it came to girls was only a 4% increase, while for boys it amounted to a 13% increase. The authors suggest the need for further inquiry and strategies to combat this significant bias. Among children receiving treatment for diarrhoea, public health facilities or providers were more likely to recommend ORS or RHS (45% of the time) than those from private-sector (37% of the time).

In conclusion, the authors suggest that despite the governmental campaign, ORT knowledge and use remains comparatively limited. Only 43% of women who gave birth in the previous 4 years knew about ORS, and a full 69% of children who were ill in the 2 weeks preceding the survey were given neither ORS nor RHS therapy. These findings indicate an overall lack of knowledge amongst both mothers and many health care providers. Nevertheless the analysis, demonstrates that electronic mass media are effective in increasing awareness and usage of ORT. Based on the Abstract of the full report, researchers would agree: "These findings indicate a lack of awareness of proper treatment of diarrhoea not only among mothers but also among health-care providers. There is clearly a need to strengthen education programmes for mothers and to provide supplemental training to health-care providers, emphasizing the importance of increased fluid intake and continued feeding and discouraging the use of drugs. The Oral Rehydration Therapy Programme also needs to address the problem of discrimination against girls in the use of ORS packets. The results of this study indicate that the mass media can help in these efforts."



Description
This study examines the use of electronic mass media to educate women in India about oral rehydration therapy (ORT). This type of therapy can support child survival by preventing diarrhoea, which organisers say accounts for "a significant portion of childhood mortality in India". The study is based on data from India's 1992-93 National Family Health Survey (NFHS). The NFHS covered 25 states (including Delhi), representing 99% of India's population.

This government programme aims at educating mothers and other community members about the causes, symptoms, and treatment of diarrhoea. It instructs them to increase fluids, continue feeding, and recognise danger signs. Dissemination of these messages has been accomplished through radio and television messages on home treatment of diarrhoea using Oral Rehydration Salt (ORS) and Recommended Home Solution (RHS); longer documentaries are shown in cinema halls. A number of community-level activities, such as films, drama and song performances, exhibitions, group meetings, and training camps, are intended to educate rural people about major public health issues, including ORT.

Rationale
Excerpts from the study follow:
"Results indicate that, despite a vigorous Oral Rehydration Therapy Programme for more than a decade, knowledge and use of oral rehydration therapy remain quite limited. Very small percentages of children who fall ill with diarrhoea are treated with ORS, RHS, or increased fluids, despite the fact that many of these children receive treatment from a health facility or provider. Many of the children who are treated by a health facility or provider are given unnecessary, and sometimes harmful, antibiotics and other antidiarrhoeal drugs but not ORS or RHS. The proportion receiving inappropriate treatment is slightly higher among children who are treated in the private sector."

"The analysis indicates that mother's exposure to electronic mass media increases awareness and use of oral rehydration therapy. Women who are regularly exposed to radio, television, or cinema are much more likely than are unexposed women to know about ORS packets and to use ORS or RHS to treat childhood diarrhoea. In rural areas, community-level mass media and group educational activities also have positive effects on knowledge and use of ORS and RHS, independent of mother’s exposure to electronic mass media and other demographic and socioeconomic variables."

"The results show some discrimination against girls in the use of ORS. These findings indicate a lack of awareness of proper treatment of diarrhoea not only among mothers but also among health-care providers. There is clearly a need to strengthen education programmes for mothers and to provide supplemental training to health-care providers, emphasizing the importance of increased fluid intake and continued feeding and discouraging the use of drugs. The Oral Rehydration Therapy Programme also needs to address the problem of discrimination against girls in the use of ORS packets. The results of this study indicate that the mass media can help in these efforts."


Contact Information

International Institute for Population Sciences
Govandi Station Road
Deonar, Mumbai - 400 088, India

Tel.: 91+22+2556 3254/55/56
Fax: 91-22-556-3257
[email protected]
[email protected]

OR

East-West Center
Program on Population/Publications
1601 East-West Road
Honolulu, Hawaii 96848-1601, USA

Fax: 1-808-944-7490
[email protected]

updated: 21 April, 2014

Feedback Form