Introduction
Globally, diarrhoeal diseases account for approximately 1.7 billion cases annually, making them the second leading cause of death and one of the top 10 contributors to Disability-Adjusted Life Years (DALYs) among children under five years of age [1]. Diarrhoeal diseases are estimated to account for approximately 9% of global mortality among children under five years of age, despite the availability of simple, affordable, and effective interventions such as oral rehydration therapy and zinc supplementation [2]. In India NFHS 6 shows slight increase in prevalence in diarrhea among under 5 children with prevalence being 7.3in NFHS 5 and 7.9 in NFHS 6 but there has been reduction in prevalence of severe diarrhea from 0.7 to 0.5 percent in NFHS 5 and 6 respectively. The rota virus vaccination cover also increased more than double as per NFHS 6 [3]. According to the World Health Organization (WHO), diarrhoea is characterized by the passage of three or more loose or watery stools in a day, or stools occurring more frequently than normal for a child [6]. Most diarrhoeal episodes are self-limiting; however, severe dehydration remains the principal cause of diarrhoea-related deaths. Prevention and management of diarrhoea can be addressed at both primary and secondary levels. Primary prevention involves measures such as immunization, improved sanitation, ensuring safe drinking water, and exclusive breastfeeding. Secondary prevention focuses on the early identification of dehydration and timely initiation of oral rehydration using ORS or appropriate home-prepared fluids, continued breastfeeding and zinc supplementation [4]. However, evidence on caregivers’ knowledge and practices regarding the home management of diarrhoea remains scarce in geographically isolated island settings such as South Andaman, where limited accessibility to healthcare services may contribute to delays in seeking appropriate care.
Methods
Aim
To evaluate the impact of health education intervention on the knowledge and home management practices of primary caregivers of under-five children regarding childhood diarrhoea in South Andaman.
Objective
To assess the knowledge and practices of primary caregivers regarding childhood diarrhoea including its causes, symptoms, prevention and home-based management practices
Methodology
Study Design: Community-based quasi-experimental study
Study Population: Primary caregivers of children aged less than 5 years (0–59 months) residing in field practice area of UHTC Haddo, ANIIMS, South Andaman.
Inclusion Criteria
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Primary caregivers of children aged less than 5 years.
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Primary caregiver willing to provide written informed consent
Exclusion Criteria
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Caregivers of under 5 children who are health care workers.
Sample size calculation:
Sample size was calculated using the following formula for interventional studies:
Where, n is the minimum sample size required for the study;
P0 is the initial proportion of people with a good level of knowledge of home management of Diarrhoea (8.6%) as given in study by Njideka Mesiobi-Anene et al. in Nigeria in 2023. [5]
P1 is the new proportion as a result of the intervention bringing the new expected proportion (P1) to 18.6% (0.186) after the intervention.
Z(α) is the statistic that defines the level of confidence desired in the study (1.96 for significance of 95% CI)
Z(β) is the statistic that defines the power of the study (0.84 for a power of 80%).
The minimum sample size was 77 participants per group. Considering 20% attrition, the minimum sample size was calculated to be 92 participants. However, a total of 108 participants were enrolled in our study.
Sampling technique
A line listing of all Anganwadi Centres in the field practice areas was prepared. Subsequently, a line listing of all primary caregivers of under-five children registered at these Anganwadi Centres was obtained from the Anganwadi registers which identified a total of 680 eligible primary caregivers. The required sampling interval (k) was calculated by dividing the total number of eligible caregivers (680) by the required sample size for each study arm (108), yielding a sampling interval of approximately 6. After selecting the first participant randomly from among the first six eligible caregivers, every 6th eligible caregiver was selected using the systematic random sampling technique until the required sample size of 108 participants was achieved.
Data collection methods
Data were collected thrice during the study period, before intervention, one immediately post intervention and one after a washout period of 1 month, using a pre-tested, structured, interviewer-administered questionnaire.
Data collection was carried out by the trained interns at the selected Anganwadi Centres during the scheduled Anganwadi sessions. Eligible primary caregivers accompanying under-five children were approached consecutively, and the purpose of the study was explained. Written informed consent was obtained before enrolment. Face-to-face interviews were conducted in a private area of the Anganwadi Centre using a pre-tested, structured interviewer-administered questionnaire. Baseline data were collected prior to the health education intervention, followed by an immediate post-intervention assessment and a follow-up assessment one month later using the same interview guide.
The interview guide consisted of three sections:
Part I: Socio-demographic Characteristics
This section collected information on the socio-demographic profile of the primary caregivers and their under-five children.
Part II: Knowledge Assessment
This section assessed caregivers' knowledge regarding diarrhoea, including its definition, causes, causative organisms, signs and symptoms, danger signs, preparation and administration of ORS, zinc supplementation, and preventive measures.
Part III: Home Management Practices
This section evaluated caregivers' practices related to the home management of diarrhoea, including:
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Type and amount of fluids offered during diarrhoeal episodes
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Continued breastfeeding
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Feeding practices during diarrhoea
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Handwashing practices
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Cleaning of feeding utensils
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Preparation and administration of ORS
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Duration of ORS use
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Exclusive breastfeeding practices
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Safe disposal of child faeces
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Other preventive measures against diarrhoea.
Study procedure: The study was conducted in three phases
Phase I: Baseline Assessment
A pre-validated, pre-tested, structured interviewer-administered questionnaire was used for data collection. The questionnaire was pilot-tested among primary caregivers from an Anganwadi Centre outside the study area, and necessary modifications were made based on the pilot findings to improve its clarity, relevance, and feasibility. Following written informed consent, baseline information was collected from all enrolled primary caregivers using the finalized questionnaire. The questionnaire assessed the caregivers' socio-demographic characteristics, knowledge regarding diarrhoea, and home management practices.
Phase II: Health Education Intervention
Primary caregivers in the intervention group received a structured face-to-face health education session lasting approximately 30 minutes. The educational intervention included information on the causes of diarrhoea, modes of transmission, preventive measures, danger signs, preparation and use of Oral Rehydration Solution (ORS), zinc supplementation, continued breastfeeding, appropriate feeding practices during diarrhoea, hand hygiene, safe drinking water, sanitation, and indications for seeking medical care. The sessions were delivered using booklets, pictorial aids, PowerPoint presentations, demonstrations, and interactive discussions. Following this post-test was taken.
Phase III: Post-Washout Assessment
One month after the health education intervention, a post-washout assessment was conducted among participants using the same interviewer-administered questionnaire. This assessment evaluated changes in caregivers' knowledge and home management practices regarding diarrhoea.
Scoring System
Knowledge and practice were assessed using a structured scoring system.
The knowledge score consisted of 15 items assessing caregivers' knowledge regarding diarrhoea. Each response was scored as:
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Correct response: 2
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Don't know: 1
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Incorrect response:0
The total knowledge score was calculated by summing the individual item scores. Caregivers who obtained 70% or more of the maximum possible score were categorized as having good knowledge, while those scoring less than 70% were categorized as having poor knowledge.
The practice score was similarly calculated based on caregivers' responses regarding home management of diarrhoea, ORS use, and preventive practices. Each item was scored as:
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Correct practice: 2
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Don't know/Unsure: 1
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Incorrect practice: 0
Participants achieving more than median of the total practice score were classified as having good practice, whereas those scoring below it, were classified as having poor practice.
Statistical Analysis
Data were entered into Microsoft Excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics were used to summarize the data. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation (SD).
The effectiveness of the health education intervention was assessed by comparing pre- and post-intervention mean knowledge and home management practice scores using the paired Student's t-test. Associations between selected sociodemographic characteristics and baseline knowledge and practice categories were analysed using Fisher's Exact test because of the small number of observations in some categories. All statistical tests were two-tailed, and a p-value of <0.05 was considered statistically significant. Ninety-five percent confidence intervals (95% CI) were reported where appropriate.
Results
Table 1 shows the baseline sociodemographic characteristics of primary caregivers in the intervention group (n=108). Among the 108 primary caregivers included in the study, 59.27% had higher education, while 37.96% had secondary education and 2.78% had primary education or below. The majority of caregivers were unskilled workers (87.96%), followed by skilled workers (10.19%) and professional/semi-professional workers (1.86%). Regarding socioeconomic status, 46.30% belonged to the lower-middle class, followed by the upper class (20.37%), upper-middle class (16.67%), middle class (15.74%), and lower class (0.93%).
Almost all caregivers (98.15%) had no additional child aged ≤5 years, while 1.85% had two children in this age group.
Among the children, 74.07% had a normal birth weight of 2.5–3.74 kg, while 12.96% were low birth weight (1.5–2.49 kg), 11.11% weighed ≥3.75 kg, and 1.85% were very low birth weight. Most children were first-born (62.96%), followed by second-born (32.41%) and third-born children (4.63%).
Regarding diarrhoeal morbidity during the preceding six months, 94.44% of children had experienced no diarrhoeal episode. One episode was reported in 3.70% of children, while 0.93% each experienced three and eight episodes. Among the reported episodes, 66.67% lasted ≤1 day, 32.41% lasted 2–4 days, and 0.93% lasted approximately one week.
| Variable | Frequency(n) | Percentage |
| Education of primary caregiver | ||
| Primary education and below | 3 | 2.78% |
| Secondary education | 41 | 37.96% |
| Higher Education | 64 | 59.27% |
| Occupation of caregiver | ||
| Professional/ Semi professional | 2 | 1.86% |
| Skilled worker | 11 | 10.19% |
| Unskilled worker | 95 | 87.96% |
| Socioeconomic class (Modified B.G. Prasad classification) | ||
| Lower middle | 50 | 46.30% |
| Middle | 17 | 15.74% |
| Upper | 22 | 20.37% |
| Upper middle | 18 | 16.67% |
| Lower | 1 | 0.93% |
| Total number of children ≤5 years | ||
| 0 | 106 | 98.15% |
| 2 | 2 | 1.85% |
| Demographic Characteristics of Children | ||
| Variable | Frequency | Percentage |
| Birth weight | ||
| 1–1.49 kg (VLBW) | 2 | 1.85% |
| 1.5–2.49 kg (LBW) | 14 | 12.96% |
| 2.5–3.74 kg (Normal) | 80 | 74.07% |
| ≥3.75 kg | 12 | 11.11% |
| Birth order | ||
| 1st | 68 | 62.96% |
| 2nd | 35 | 32.41% |
| 3rd | 5 | 4.63% |
| Diarrhoeal episodes in last 6 months | ||
| 0 | 102 | 94.44% |
| 1 | 4 | 3.7% |
| 3 | 1 | 0.93% |
| 8 | 1 | 0.93% |
| Duration of each episode | ||
| ≤1 day | 72 | 66.67% |
| 2-4 days | 35 | 32.41% |
| 1 week | 1 | 0.93% |
Table 2 shows a marked improvement in caregivers' knowledge following the educational intervention. Correct understanding of diarrhoea increased from 94.44% to 100%, while awareness of Rotavirus vaccination, exclusive breastfeeding, the importance of ORS, zinc supplementation, continued feeding during diarrhoea, and the correct use of freshly prepared ORS reached 100% in the post-test. Knowledge regarding the causes, modes of transmission, risk factors, signs of diarrhoea and dehydration, and complications requiring medical consultation also improved substantially, accompanied by a marked reduction in the proportion of caregivers reporting "no idea/don’t know" responses across all domains.
| QUESTIONS | RESPONSES | PRE-TEST Frequency (Percentage) | POST-TEST Frequency (Percentage) |
| What do you understand by Diarrhoea? | Frequent passing of watery stool (3 or more times) Others, please specify………….. | 102(94.44%) | 108 (100%) |
| No idea | 6 (5.56%) | - | |
| What do you think are the causes of Diarrhoea? | Infection Others; please specify………… | - | 40 (37.04%) |
| Food Poisoning | 33(30.56%) | 31(28.70%) | |
| Teething / Crawling | - | 1(0.93%) | |
| Worm Infestation | - | 1(0.93%) | |
| Contaminated water | 22 (20.37%) | 19 (17.59%) | |
| Poor digestion & absorption of food | 9 (8.33%) | 10 (9.26%) | |
| infection | - | 40(37.04%) | |
| No Idea | 13(12.04%) | 4 (3.70%) | |
| Modes of spread of infection | Contaminated water Others; please specify………… | 17 (15.74%) | 21(19.44%) |
| Spoiled or contaminated food | 38 (35.19%) | 50(46.30%) | |
| Flies | 2 (1.85%) | 2 (1.85%) | |
| Unclean fingers and hand | 25 (23.15%) | 33 (30.56%) | |
| No Idea | 26(24.07%) | 2 (1.85%) | |
| Predisposing Factors | Undernourished/underweight child | 6(5.56%) | 7 (6.48%) |
| Unhygienic practices | 78 (72.22%) | 93(86.11%) | |
| Partial immunization | 2 (1.85%) | 3 (2.78%) | |
| Don’t know | 22 (20.37%) | 5 (4.63%) | |
| What are some of the common signs associated with Diarrhoea? | Frequent passing of watery stools | 81(75.00%) | 88 (81.48%) |
| May have vomiting with diarrhoea | 16 (14.81%) | 20(18.52%) | |
| May have fever with diarrhoea | 1(0.93%) | - | |
| May have Blood/mucus in the stool | - | - | |
| No idea | 10(9.26%) | - | |
| What are the Signs of Dehydration? | Marked thirst for water | 19 (17.59%) | 23 (21.30%) |
| Eating or drinking poorly | 16 (14.81%) | 19 (17.59%) | |
| Sunken eyes | 10 (9.26%) | 18 (16.67%) | |
| Dry Lips and tongue | 7 (6.48%) | 11 (10.19%) | |
| Reduced urine output | 13 (12.04%) | 8 (7.41%) | |
| Reduced skin turgor | 3 (2.78%) | 4 (3.70%) | |
| Irritability | 2 (1.85%) | 4 (3.70%) | |
| Lethargic | 20(18.52%) | 12 (11.11%) | |
| Don’t know | 18 (16.67%) | 9 (8.33%) | |
| What are the complications of unmanaged diarrhoea (Needs doctor’s consultation)? | Severe dehydration Others, please specify …………… | 55 (50.93%) | 78 (72.22%) |
| Severe irritability | 10 (9.26%) | 16 (14.81%) | |
| Unable to move | 3(2.78%) | 2 (1.85%) | |
| Unconscious | 6(5.56%) | 3 (2.78%) | |
| Convulsions | 1(0.93%) | 2 (1.85%) | |
| Don’t know | 33(30.56%) | 7 (6.48%) | |
| Does the Rota virus vaccine effectively help preventing diarrheal disease in young children? | Yes | 44 (40.74%) | 108 (100%) |
| No | 37 (34.26%) | - | |
| No Idea | 27 (25.00%) | - | |
| Does exclusive breastfeeding for the first 6 months of life help protect a baby from getting Diarrhea? | Yes | 102 (94.44%) | 108 (100%) |
| No | 3 (2.78%) | - | |
| I Don’t know | 3 (2.78%) | - | |
| Is Diarrhea dangerous if not treated properly? | Yes | 99 (91.67%) | 108(100%) |
| No | 6(5.56%) | - | |
| I Don’t know | 3 (2.78%) | - | |
| Why do you give ORS to your child in diarrhoea? | To replace the lost fluids | 94 (87.04%) | 108 (100%) |
| Stop Diarrhea immediately | 1(0.93%) | - | |
| Provide nutrition | 6 (5.56%) | - | |
| Don’t know | 7 (6.48%) | - | |
| Is giving Zinc is helpful in Diarrhoea? | Yes | 59 (54.63%) | 108(100%) |
| No | 22 (20.37%) | - | |
| I Don’t know | 27 (25.00%) | - | |
| Should food be given during Diarrhea? | Yes | 96 (88.89%) | 108(100%) |
| No | 9 (8.33%) | - | |
| I Don’t know | 3 (2.78%) | - | |
| Do you know how long freshly prepared ORS can be used? | Yes | 78(72.22%) | 108(100%) |
| No | 19(17.59%) | - | |
| I Don’t know | 10 (9.26%) | - |
Table 3 demonstrates an overall improvement in caregivers' diarrhoea management practices following the educational intervention. Correct treatment practices, including the use of ORS, zinc, increased fluids, and continued feeding, improved from 70.37% to 91.67%. Post-test knowledge regarding the use of boiled and cooled water (100%), correct preparation of ORS (95.37%), 14-day zinc supplementation (100%) and handwashing with soap after defecation (100%) also showed marked improvement. Appropriate practices related to continued breastfeeding and feeding during diarrhoea, food hygiene, safe water storage, and drinking water source were maintained or improved, while incorrect responses and "no idea" responses decreased substantially following the intervention.
| QUESTIONS | RESPONSES | PRE-TEST Frequency (Percentage) | POST-TEST Frequency (Percentage) | |
| 1 | What treatments do you offer to a child in diarrhoea? | Must receive increased fluids, ORS, zinc, and regular feeding | 76(70.37%) | 99(91.67%) |
| Requires ORS, but should receive less food in order to reduce the diarrhoea | 17(15.74%) | 9(8.33%) | ||
| Should immediately receive antibiotics to stop the Diarrhoea | 2(1.85%) | - | ||
| No idea | 13 (12.04%) | - | ||
| 2 | What oral feeds can be given if child has diarrhoea? | Rice water | 36 (33.33%) | 38 (35.19%) |
| Sago | 3 (2.78%) | 3 (2.78%) | ||
| Rice kanji | 51(47.22%) | 52(48.15%) | ||
| Lemon drink | 3(2.78%) | 2(1.85%) | ||
| Coconut water | 11(10.19%) | 13(12.04%) | ||
| Fruits | 4(3.70%) | - | ||
| 3. | Does your child wash hands after defecation? | No | 2(1.85%) | - |
| Yes, with water only | 1(0.93%) | - | ||
| Yes with water and soap | 105(97.22%) | 108 (100%) | ||
| 4. | Do you wash your hands before preparing food? | No | - | - |
| Yes, with water only | 2(1.85%) | 1(0.93%) | ||
| Yes with water and soap | 106(98.15%) | 107(99.07%) | ||
| 5. | How do you prepare oral rehydration therapy at home? | Use homemade ORS (with salt and water) | 47(43.52%) | 54(50.00%) |
| Use sachet of ORS (powdered ORS) | 60(55.56%) | 53(49.07%) | ||
| Use Tetra pack of ORS | 1(0.93%) | - | ||
| 6. | What sort of water you use while preparing ORS | Tap water | 1(0.93%) | - |
| Filtered water | 57(52.78%) | - | ||
| Mineral water | 4 (3.70%) | - | ||
| Boiled and cooled water | 46(42.59%) | 108 (100%) | ||
| 7. | How you prepare marketed ORS at Home? | Small sachet - Mix ORS in 1 glass of water | - | 4(3.70%) |
| Big Sachet - Mix ORS in 1 liter of water | - | 103(95.37%) | ||
| Mix ORS in water without any measurement | - | - | ||
| Follow the instructions on sachet | - | 1(0.93%) | ||
| 8. | When do you give ORS to your child in diarrhoea? | To replace the lost fluids | 54(50.00%) | 54(50.00%) |
| After every watery stool | 25(23.15%) | 39(36.11%) | ||
| Once a day | 1(0.93%) | - | ||
| 2-3 Times a day | 4 (3.70%) | - | ||
| Wherever the child wants to drink | 17(15.74%) | 14(12.96%) | ||
| No idea | 7(6.48%) | 1(0.93%) | ||
| 9. | Did you take rota virus vaccine to prevent Diarrhea in your child? | Yes | 39(36.11%) | 42(38.89%) |
| No | 42(38.89%) | 33(30.56%) | ||
| Don’t know | 27 (25.00%) | 33(30.56%) | ||
| 10 | When do you give Zinc to your child in Diarrhoea? | Till diarrhoea stops Others please specify ………… | 19(17.59%) | - |
| 14 days even after diarrhoea stops | - | 108 (100%) | ||
| No idea | 89(82.41%) | - | ||
| 11 | What other treatments can be offered at home to a child in Diarrhoea? | If child is on breast feed Stop breast feeding(n=51) | - | - |
| Continue breast feeding | 14(12.96%) | 24(22.22%) | ||
| If child is eating Stop giving food | - | - | ||
| Continue giving food | 91(84.26%) | 83(76.85%) | ||
| Don’t know | 1(0.93%) | - | ||
| Stop giving food | 2(1.85%) | 1(0.93%) | ||
| No idea | 13(12.04%) | - | ||
| 16 | Do you give antibiotics to your child every time your child suffers from Diarrhea? | Yes | 32 (29.63%) | - |
| No | 76 (70.37%) | - | ||
| 17. | Do you wash fruits and vegetables before use? | Yes | 108 (100%) | 108 (100%) |
| No | - | - | ||
| 18. | What methods do you use for water purification at your home? | Boiling | 47(43.52%) | 43 (39.81%) |
| Filtration | 61(56.48%) | 65 (60.19%) | ||
| Chlorination | - | - | ||
| No treatment | - | - | ||
| 19. | Do you clean your water container? | Yes | 108 (100%) | 108(100%) |
| No | - | - | ||
| 20. | How do you usually store cooked food? | Refrigerated | 47 (43.52%) | 53 (49.07%) |
| Covered at room temperature | 43 (39.81%) | 43 (39.81%) | ||
| Uncovered | - | |||
| Eat immediately | 18 (16.67%) | 12 (11.11%) | ||
| 21. | Where does your household dispose of faecal waste? | Bury it/burn it | - | |
| Municipal waste disposal | 108 (100%) | 108 (100%) | ||
| Designated open area | - | |||
| 22. | What is your main source of drinking water? | Municipal water | 99 (91.67%) | 105 (97.22%) |
| Well water | - | - | ||
| Bottled water | 9 (8.33%) | 3 (2.78%) |
Table 4 shows the mean knowledge score increased from 24.09 at baseline to 26.76 at end line, showing a significant improvement (p = 0.001). Similarly, the mean practice score increased from 24.57 to 25.04, with a statistically significant difference (p = 0.001). Overall, the intervention resulted in significant improvement in both knowledge and practice scores.
| Baseline mean score | End line mean score | p value | |
| Knowledge score | 24.09 | 26.76 | 0.001 |
| Practice score | 24.57 | 25.04 | 0.00122 |
Table 5 shows the association between selected sociodemographic characteristics and pre-intervention knowledge scores among caregivers. A statistically significant association was observed between caregivers' age and pre-intervention knowledge scores (p = 0.010), with caregivers aged 26–35 years accounting for the highest proportion of good knowledge scores. However, birth order of the child (p = 0.717), educational status (p = 0.225), socioeconomic status (p = 0.099), occupation (p = 0.761), and number of children (p = 0.472) were not significantly associated with pre-intervention knowledge scores (p > 0.05).
| GOOD SCORE (>70%) (n) | POOR SCORE (<70%) (n) | p-value | |
| Age | |||
| >25 | 4(4.3%) | 2(12.5%) | 0.0103 |
| 26-35 | 73(79.3%) | 7 (43.8%) | |
| >35 | 15(16.3%) | 7(43.8%) | |
| Birth order of child | |||
| 1st | 57 (83.8%) | 11 (16.2%) | 0.717 |
| 2nd | 31 (88.6%) | 4 (11.4%) | |
| 3rd | 4 (80%) | 1 (20%) | |
| Education status | |||
| Primary education or below | 9 (69.2%) | 4 (30.8%) | 0.225 |
| Secondary education | 43 (87.7%) | 6 (12.2%) | |
| Higher education | 40 (87%) | 6 (13%) | |
| Socioeconomic status (Modified B.G.Prasad classification) | |||
| Upper | 18 (81.8%) | 4 (18.2%) | 0.099 |
| Upper middle | 14 (77.8%) | 4 (22.2%) | |
| Middle | 14 (82.4%) | 3 (17.6%) | |
| Lower middle | 46 (92%) | 4 (8%) | |
| Lower | 0 (0%) | 1 (100%) | |
| Occupation | |||
| Professional/ Semi- professional | 2(100%) | 0(0%) | 0.761 |
| Skilled | 9 (81.8%) | 2 (18.2%) | |
| Unskilled | 81 (85.3%) | 14 (14.7%) | |
| No. of children other than under 5 child enrolled in this study | |||
| 0 | 55 (88.7%) | 7 (11.3%) | 0.472 |
| 1 | 35 (79.5%) | 9 (20.5%) | |
| 2 | 2 (100%) | 0 (0%) |
Table 6 presents the association between selected socio demographic characteristics and pre-intervention practice scores using Fisher's exact test. A statistically significant association was observed between caregivers' occupation and pre-intervention practice scores (p = 0.018), with caregivers engaged in professional/semi-professional occupations showing the highest proportion of good practice scores. However, birth order of the child (p = 0.802), educational status (p = 0.343), socioeconomic status (p = 0.975), age (p = 0.670), and number of children (p = 0.474) were not significantly associated with pre-intervention practice scores (all p > 0.05).
| GOOD SCORE (n) | POOR SCORE(n) | p-value | |
| Age | |||
| >25 | 2 (33.3%) | 4 (66.7%) | 0.67 |
| 25-35 | 20 (25%) | 60 (75%) | |
| >35 | 7 (31.8%) | 15 (68.2%) | |
| Birth order of child | |||
| 1st | 17 (25%) | 51 (75%) | 0.802 |
| 2nd | 11 (31.4%) | 24 (68.6%) | |
| 3rd | 1 (20%) | 4 (80%) | |
| Education status | |||
| Primary education or below | 5 (38.5%) | 8 (61.5%) | 0.343 |
| Secondary education | 10 (20.4%) | 39 (79.6%) | |
| Higher education | 14 (30.4%) | 32 (69.6%) | |
| Socioeconomic status | |||
| Upper | 5 (22.7%) | 17 (77.3%) | 0.975 |
| Upper middle | 5 (27.8%) | 13 (72.2%) | |
| Middle | 5 (29.4%) | 12 (70.6%) | |
| Lower middle | 14 (28%) | 36 (72%) | |
| Lower | 0 (0%) | 1 (100%) | |
| Occupation | |||
| Professional/Semi-professional | 2 (100%) | 0 (0%) | 0.0175 |
| Skilled | 5 (45.5%) | 6 (54.5%) | |
| Unskilled | 22 (23.2%) | 73 (76.8%) | |
| No. of children under 5 years other than the one enrolled in this study | |||
| 0 | 15 (24.2%) | 47 (75.8%) | 0.474 |
| 1 | 13 (29.5%) | 31 (70.5%) | |
| 2 | 1 (50%) | 1 (50%) |
Discussion
The present study demonstrated that a structured health education intervention significantly improved caregivers' knowledge and home management practices regarding childhood diarrhoea. Significant improvement was observed in overall knowledge scores with mean pre-test score of 24.57 ± 1.54, which increased to 25.04 ± 0.81(p=0.001) in the post-test. Practices related to ORS preparation, zinc supplementation, continued feeding and breastfeeding following the intervention also improved with pre-test mean being from 24.09 ± 3.94 in the pre-test which improved to 26.76 ± 0.61(p<0.001) in the post-test. These findings suggest that community-based educational interventions are effective in strengthening caregivers' ability to manage diarrhoeal illness at home.
Our findings are consistent with those reported by Rachna et al. in their study conducted in rural setting in Chandandih village of Raipur in 2021 demonstrated that community-based structured teaching programme was effective significantly in improving mothers’ knowledge regarding oral rehydration therapy[6]. Similarly, S Mangala et al. in a study carried out in Bangalore, Karnataka in 2001, who observed that improved maternal knowledge was associated with better caregiver education on diarrhoea management practices [7].
In the present study, caregiver age showed a significant association with pre-intervention knowledge, while occupation was associated with practice scores. This in contrast to findings of study done by Rachna et al. in rural setting in Chandandih village of Raipur in 2021, which showed no relationship between pre-test level of knowledge about ORS therapy among mothers of under 5-year children with their demographic variables such as age, education, occupation and no. of children [6].However, educational status and socioeconomic class were not significantly associated with knowledge or practice, suggesting that structured health education can effectively improve caregiver competencies irrespective of baseline socio demographic characteristics.
Strengths
The strengths of this study include the use of a pre-validated, pilot-tested structured questionnaire and standardized health education sessions enhanced the reliability and consistency of the findings. Furthermore, the community-based setting and adequate sample size improved the applicability of the results to similar populations.
Limitation
The study relied on self-reported responses to assess caregivers' practices, which may have been influenced by recall and social desirability bias. In addition, the study was conducted in a single district of the Andaman and Nicobar Islands which may limit the generalizability of the findings to other settings.
Recommendations
Regular caregiver education on diarrhoea prevention and home management should be incorporated into routine Anganwadi and primary healthcare activities. Periodic reinforcement through frontline health workers, supported by practical demonstrations on ORS preparation, zinc supplementation, and appropriate feeding practices, may help sustain behavioural change. Further multicentric studies with larger sample sizes and longer follow-up are recommended to evaluate the long-term impact of such interventions on diarrhoeal morbidity and mortality.
In conclusion, the present study concludes that a structured health education intervention significantly improved the knowledge and home management behaviour of primary caregivers regarding diarrhoea among under-five children. Caregivers demonstrated substantial improvement in awareness regarding ORS preparation and administration, zinc supplementation, continued feeding, breastfeeding, dehydration recognition, hygiene practices, and preventive measures. The findings support integrating regular caregiver education through Anganwadi centres and primary healthcare services as a cost-effective strategy for reducing diarrhoeal morbidity and improving child survival in resource-limited settings.
Abbreviations
ORS: Oral Rehydration Solution
SPSS: Statistical Package for the Social Sciences
Declarations
Ethical Approval and Consent to participate
The study was conducted in accordance with ethical principles for biomedical research involving human participants. Ethical approval was obtained from the Institutional Ethics Committee of Andaman and Nicobar Islands Institute of Medical Sciences. Written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity of participants were strictly maintained.
Consent for publication
Not applicable. The manuscript does not contain any individual person’s data in any form (including images or videos)
Availability of supporting data
The datasets used and/or analysed during the current study are not publicly available due to confidentiality considerations but are available from the corresponding author on reasonable request
Competing interests
The authors declare that they have no competing interests.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
Aanchal Anand: Conceptualization, data collection, analysis, manuscript drafting
Mitul Saha: Conceptualization, data collection, analysis, manuscript drafting
Samar Hossain: Conceptualization, data collection, analysis, manuscript review
Ajay Raj: Supervision, critical revision of manuscript