Workie et al.

BMC Pediatrics (2018) 18:358

https://doi.org/10.1186/s12887-018-1321-6

RESEARCH ARTICLE Open Access

Mothers’ knowledge, attitude and practice

towards the prevention and home-based
management of diarrheal disease among
under-five children in Diredawa, Eastern
Ethiopia, 2016: a cross-sectional study
Hailemariam Mekonnen Workie* , Abdilahi Sharifnur Sharifabdilahi and Esubalew Muchie Addis

Abstract
Background: Diarrhea remains the 2nd leading cause of death among children under 5 globally. It kills more
young children than AIDS. It would have been prevented by simple home management using oral rehydration
therapy. Mothers play a central role in its management and prevention. So, the main objective of this study was
to assess mothers’ knowledge, attitude & practice in prevention & home-based management of diarrheal disease
among under-five children in Dire Dawa, Eastern Ethiopia.
Methods: Institutional based cross-sectional study was conducted from March 15–April 14, 2016, in Diredawa
among 295 Mothers who had under-five child with diarrhea in the last 2 weeks using simple random sampling
method. Mothers were interviewed face to face by using pretested, standard and structured questionnaire. The data
quality was assured by translation, retranslation and pretesting the questionnaire. Data were checked for completeness,
consistency and then entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was
used to compute frequency, percentages, and mean of the findings of this study. The results were presented using
tables, charts, and graphs.
Results: In this study, 295 participants were included with 100% response rate. From total 295 mothers, around
two-thirds (65.2%) of them had good knowledge, but more than half of mothers (54.9%) had a negative attitude
towards home-based management and prevention of diarrhea among under-five children. Regarding the attitude
of the mothers, 58% had poor practice towards home-based management and prevention of diarrhea among
under-five children.
Conclusion: The finding of this study showed that the attitude and practice of mothers were unsatisfactory
about the prevention and home-based management of under-five diarrheal diseases. Therefore, Health education,
dissemination of information, and community conversation should plan and implement to create a positive
attitude and practice towards the better prevention and management of under 5 diarrheal diseases.
Keywords: Knowledge, Attitude, Practice, Mothers, Prevention, Home-based management, Diarrhea, Under-five children

* Correspondence: [email protected]
School of Nursing and Midwifery, College of Health and Medical Science,
Haramaya University, P.O. Box 235, Harar, Ethiopia

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Workie et al. BMC Pediatrics (2018) 18:358 Page 2 of 9

Introduction washing with soap & the safe disposal of excreta can re-
According to WHO, Passage of 3 or more than 3 loose duce the incidence of diarrhea by 35% [1, 22].
of stool or watery stools per day or considers as abnormal Diarrhea is not lethal itself, the improper knowledge,
by the mothers or stools more frequent than normal for a poor practice and negative attitudes of mothers and their
child is considered as diarrhea [1, 2]. Diarrheal disease re- misdirected approach towards its management and pre-
mains the second leading cause of death among under 5 vention leads to high degree of severe dehydration and
children globally [3–6]. Nearly one in five deaths of a lastly death [23, 24]. Therefore, the main objective of
child – about 1.5 million each year – is due to the dis- this study was to assess the mothers’ knowledge, atti-
ease of diarrhea [4, 7]. It kills more young children than tude, and practice in the prevention and home-based
malaria HIV/AIDS, and measles together [1, 4]. management of diarrhea towards their under-five chil-
Diarrheal disease is one of the commonest illnesses dren in Diredawa, East Ethiopia.
that has the greatest negative impact on the growth and
development of infants and young children [8]. World- Method
wide, children whose age is less than 5 years’ experience, Study area and period
on average, 3.2 episodes of diarrhea every year and con- The study was conducted from March 15 –April 14,
sequently 1.87 million children will die from dehydration 2016, in Diredawa city. Diredawa city is one of the two
associated with diarrheal disease, particularly in the administrative cities in Ethiopia. It situated and located
countries of Asia, Africa and Latin America [3]. in the eastern part of Ethiopia with 515 km from Addis
According to Ethiopian demographic health survey Ababa (capital city of Ethiopia) and 313 from Djibouti.
(EDHS) of 2000, 2005, 2011 and 2016 the 2 weeks preva- According to the 2011 Ethiopian Demographic health
lence of diarrheal disease among under-five children was survey (EDHS), the total population of the administra-
24, 18, 13, 12% respectively [9–12]. Even though there was tion was 341,834 of which 174,461 were men and
a double reduction of the prevalence of under 5 diarrheal 170,461 women [11]. About 233,224 (68.23%) of the
diseases in the last 16 years in Ethiopia, but, still it is one population were urban inhabitants, while 31.77% were
of the most important public issue and major health prob- rural inhabitants. In Dire-Dawa administration there
lems of the country [9, 12]. was 2 governmental and 4 private hospitals. From
Rotavirus is among the commonest diarrheal pathogen these, the 3 hospitals were selected for this study.
in children worldwide that causes about one-third of
diarrhea-associated hospitalizations and 800,000 deaths Study design and participants
per year [13–15]. Children in the poorest countries like A cross-sectional study design was conducted in selected
Ethiopia account for 82% of rotavirus deaths of under-five Diredawa hospitals to assess mothers’ knowledge, atti-
children [16]. Rotavirus can cause intestinal losses of fluid, tude & practice towards the prevention & home-based
electrolyte and nutritional deficiency which relatively pro- management of diarrheal disease among under-five chil-
gresses rapidly to cause dehydration and death [17, 18]. dren. Mothers who had a child less than 5 years of age
Contaminated weaning food, inappropriate feeding with diarrhea in the last 2 weeks were included in an
practice, lack of clean water, poor hand washing, lim- interview using each hospital monthly patient flow re-
ited sanitary disposal of waste, poor housing condi- port as a sampling frame. Those mothers with a physical
tions, and lack of access to adequate and affordable impairment (unable to hear and speak) and mentally ill
health care are aggravated factors of the under 5 diar- were excluded from the study.
rheal disease [6, 8, 19, 20].
Diarrheal diseases among under 5-year children can Sample size determination and technique
be tackled in at both primary and secondary preven- The sample size (n) required for this study was deter-
tion levels. The former about the improvement of mined using a single population proportion formula
sanitation and water quality but the latter is about (n = (Zα/2)2 p(1-p)/d2)); whereas n = the required sam-
early recognition of dehydration due to diarrhea and ple size for this study, Zα/2(1.96): significance level at
prompt oral rehydration using ORS (oral rehydration α =0.05 with 95% confidence interval, p: proportion of
solution) or appropriate home available fluids. Oral re- prevalence of diarrhea in eastern region which was
hydration solution has been proven to be effective in 22.5% [25], d: margin of error (5%) and 10% non-re-
preventing diarrhea mortality in the community while sponse rate. The final required sample size was 295.
varying degree of evidence favors the use of home Lottery method was used to select the 3 hospitals and
available fluid [21]. the sample was collected proportionally from each
Optimal infant & young child feeding practices could hospital using simple random sampling method. Each
prevent more than 10% of deaths from diarrhea. On the hospital monthly patient flow report was used as a
other hand, better hygiene practices, particularly hand sampling frame.
Workie et al. BMC Pediatrics (2018) 18:358 Page 3 of 9

Operational definitions Data processing and analysis

Immediately after the data collection was completed,
Dehydration: It is a condition when the child loses too each questionnaire was thoroughly reviewed for com-
much water and salt from the body [2, 26] pleteness and consistency by the data collectors, super-
Rehydration: The correction of dehydration with oral visor and investigators. Then the data were entered into
rehydration salts (ORS) or home prepared solution [2]. Epi Info version 3.1 and analyzed using SPSS for window
Oral Rehydration Therapy (ORT): The administration version 20. The descriptive statistical analysis was used
of fluid by mouth to prevent or correct the dehydration to compute frequency, percentages, and mean of the
that is a consequence of diarrhea. It is a mixture of findings of this study. The results were presented using
clean water, salt and sugar [2]. tables, graphs, and result statements.
Good knowledge: Those mothers who answered above
the mean of the knowledge questions [27]. Results
Poor knowledge: Those mothers who answered below A total of 295 mothers have participated in the study
the mean of the knowledge questions [27]. with a response rate of 100%. So, 295 respondents’ data
Positive Attitude: Mothers who answered above the were included in the analysis process.
mean questions of the attitude were assigned as having
“positive attitude” [28] Socio-demographic characteristics of the mothers
Negative Attitude: those who answered below the In this study, more than half of the mothers (51.5%)
attitude questions were assigned as having a “negative were in the age of 25–34 years with the mean age of 27.
attitude” [28] Based on religion, Muslims (67.5%) and Orthodox (22%)
Good practice: Mothers who able to answer above the were dominant. Regarding ethnicity, 137 (46.4%) mothers
mean of the practice questions were measured as good were Oromo, 121 (41.0%) Somali, 31 (10.5%) Amhara and
practice [29]. 6 (2.1%) were from other ethnicities.
Poor Practice: Those mothers who answer below the From the total participants, 275 (93.2%) were married,
mean of the practice questions were measured as poor 113 (38.3%) were housewives and 132 (44.8%) were un-
practice [29]. able to read and write. The mean monthly family income
of the respondents was 1551 Ethiopian Birr. About half
Measurement and data collection procedure of the children [146 (49.5%)] were in the age group of
Face to face interview was employed by using a standard 6–24 months (Table 1).
and structured questionnaire that contained sociodemo-
graphic status, knowledge, attitude, practice, and health- Mothers knowledge about diarrhea prevention and
seeking behavior questions of the mothers regarding under management among under 5 children
5 children diarrheal diseases. There were four trained BSc Most of the mothers (92.5%), defined diarrhea as the pass-
nurse data collectors and 1 M.Sc. nurse as a supervisor. ing of loose stool 3 or more times per day, while, only 8
(2.7%) mothers identified blood in the stool. Two hundred
Data quality control fifty-two (85.5%) respondents thought that diarrhea is
The data quality was assured by using different methods. caused by drinking contaminated water. Around half
The standard and structured questionnaire was used (51.2%) of the participants identified that weakness or leth-
(Additional file 1). The questionnaire was prepared in argy is the danger sign of under-five diarrheal disease. To
English and translated into the local language (Amharic, the contrary, only 2 (0.7%) of them knew that marked thirst
oromic, and somalic) for data collection and then re for water is the danger sign of diarrheal disease (Table 2).
translated back into English for analysis. Two days of Regarding homemade solution, only less than half of
training was given to the data collectors and supervisors the participants [125 (42.4%)] were used homemade so-
on the data collection tool and procedures. Then the lution during diarrheal disease of their child. From them,
questionnaire was pretested on 5% of the sample size to [117 (93.6%)] prepared the solution using 1/2 teaspoon
ensure its validity. Findings from the pretesting were uti- of salt, and 6 teaspoons of sugar in 1 liter of water.
lized for modifying and adjustment of the instrument Around two-thirds [184 (62.4%)] of the mothers knew
and interviewing technique. Data collectors were super- about the recommended volume of water for mixing a
vised closely by the supervisors and the principal investi- sachet of ORS (i.e., 1000 ml. of water to 1 sachet of
gators. Completeness of each questionnaire was checked ORS). One hundred three (34.9%) of the respondents be-
by the principal investigator and the supervisors on day- lieved that ORS should be given after the passing of
lily basis. Double data entry was done by two data clerks every loose stool of the child, while 90 (30.4%) said that
and the consistency of the entered data was cross-checked should be administered whatever child needs to drink
by comparing the two separately entered data. (Table 3).
Workie et al. BMC Pediatrics (2018) 18:358 Page 4 of 9

Table 1 Sociodemographic characteristics of respondents, Table 2 Maternal knowledge about under 5 diarrheal diseases
Diredawa, East Ethiopia, 2016 in Dire Dawa, Eastern Ethiopia, 2016
Characteristic Category Frequency Percentages Characteristic Frequency %
Age of the mother 15–24 109 36.9% Definition of diarrhea
25–34 152 51.5% Frequent passing of watery stool 273 92.5%
(3 or more times)
35–44 32 10.9%
Frequent passing of normal stool 12 4.1%
> 45 2 0.7%
Blood in stools 8 2.7%
Age of the child 0–5 months 60 20.3%
Greenish stools 2 0.7%
6–24 months 146 49.5%
Diarrheal causes
24–59 months 89 30.2%
Teething 15 5.1%
Marital status of the Married 275 93.2%
mother Evil eye 24 8.1%
Single 2 0.7%
Contaminated water 252 85.5%
Widowed 6 2.0%
No idea 4 1.3%
Divorced/separated 12 4.1%
Diarrheal danger signs
Occupation of the Housewife 235 79.7%
mother Becoming weak or lethargic 151 51.2%
Gov’t/NGO employed 52 17.6%
Repeated vomiting/vomiting everything 103 34.9%
Self-employed 8 2.7%
Fever and blood in the stool 37 12.5%
Monthly income of the <=1000 106 35.9%
mother (Binned) Marked thirst for water 2 0.7%
1001–3000 148 50.2%
Others 2 0.7%
3001 & above 41 13.9%
Mother’s educational Unable to read and 132 44.8%
status write breastfed less than usual during the diarrheal episodes.
Primary 113 38.3% Likewise, only 83 (28.1%) offered a drink more than
Secondary 29 9.8% usual during diarrheal episodes but most of the mothers
Diploma and above 21 7.1% 181 (61.4%) offered a drink for their child less than usual
The religion of the Islam 199 67.5%
during the diarrheal episodes. Concerning feeding, 99
mother (33.6%) of mothers offered food more than usual to eat
Orthodox 65 22.0%
during the diarrheal episodes and 185 (62.7%) of the
Protestant 29 9.8% mother offered less than usual. Most of the mothers
Others 2 0.7% (67.8, 84.7% & 100%) responded that they usually wash
The ethnicity of the Oromo 137 46.4% their hands before preparing food, after preparing food,
mother and after defecation respectively (Table 4).
Somali 121 41.0%
Amhara 31 10.5%
Mothers care-seeking behavior and places during their
Others 6 2.1%
children diarrheal episode
Almost all of the mothers [289 (98.0%)] sought medical
Mother’s attitudes toward prevention and home-based treatment for their children during the time of diarrheal
management of under-five diarrhea diseases. From those who sought care for their child’s
From the total respondents, the majority of them [162 diarrhea, the majority [179 (60.7%)] visited hospitals for
(55%)] disagreed towards the provision of oral rehydration the treatment of diarrhea, and 9 (3.1%) went to the trad-
solution at home for the treatment of under-five diarrheal itional practitioner (Table 5).
diseases. Similarly, most of the participants [181 (61.4%)]
disagreed with the statement “mothers can treat their chil- The overall level of knowledge, attitude, and practice of
dren’s diarrheal disease at home”. Around half of the mothers in prevention and home-based management of
mothers, 152 (51.5%) believed that their child dislikes the diarrhea among under-five children
taste of oral rehydration solution (Figs. 1, 2, and 3). Knowledge was assessed by asking, whether the mothers
know about ORS and what the benefits of ORS, and so
Practices of mothers towards the prevention and home on. Mothers who respond above the mean of the ques-
management of diarrhea among under-five children tions correctly were assigned as having “good know-
Only one-quarter of the mothers [77 (26.1%)] breastfed ledge” while mothers who answered below the mean
their child more than usual while majority 178 (60.3%) were regarded as having “poor knowledge”:
Workie et al. BMC Pediatrics (2018) 18:358 Page 5 of 9

Table 3 Respondents’ knowledge about the correct use of ORS, Diredawa, East Ethiopia, 2016
Variable Categories Freq. %
How is ORS prepared? 1 sachet of ORS- 300 ml (1 coke bottle) of water 25 8.5%
1 sachet of ORS- 500 ml (1 small size of mineral bottle) of water 56 18.9%
1 sachet of ORS- 600 ml (1 beer bottle) of water 25 8.5%
1 sachet of ORS- 1000 ml (1 l) of water 184 62.4%
1 sachet of ORS- 1500 ml (1.5 l or large size of mineral bottle) 5 1.7%
of water
How often should ORS be given? Once a day 50 17.0%
2–3 times a day 52 17.6%
Whatever child wants to drink 90 30.5%
After the passing of very loose stool 103 34.9%
How long should the mixed ORS last? 24 h. (1 day) 255 86.4%
48 h. (2 days) 33 11.2%
72 h. (3 days) 4 1.4%
96 h. (4 days) 3 1.0%

Also, the attitude was assessed whether they agree or about the prevention and home-based management of
disagree towards the taste of ORS to their child, or under 5 diarrheal diseases. Regarding the attitude, more
whether they agree or disagree that ORS is the first choice than half of the mothers (54.9%) had a negative attitude
in the management of diarrhea and so on. Mothers who and only 133 (45.1%) had a positive attitude towards the
answered above the mean questions were assigned as hav- prevention and home-based management of under 5 diar-
ing “positive attitude” and those who answer below the rheas. From the total of mothers participated in this study,
mean were assigned as having “negative attitude”. only 124 (42%) of them had a good practice and the
Like others, the overall practice of mothers was mea- remaining 171 (58%) had poor practice towards prevention
sured by asking how is ORS prepared, how often is it and home-based management of under 5 diarrheas.
given and how long should a mixed ORS last and so on.
Mothers who answered above the mean questions were Discussion
assigned as having “good practices” whereas those who This study has assessed mothers’ knowledge, attitude, and
did not be assigned as having “poor practice”. practices towards the prevention and home-based man-
Based on these criteria, 192 (65.2%) of the mothers agement of under 5 diarrheal diseases in Diredawa city,
had good knowledge and 103 (34.9%) had poor knowledge Eastern Ethiopia. Based on the findings, the majority of

Fig. 1 Mothers attitude toward giving oral rehydration therapy at home in Diredawa, Eastern Ethiopia, 2016
Workie et al. BMC Pediatrics (2018) 18:358 Page 6 of 9

Fig. 2 Mothers attitude towards the statement of “Mothers can treat diarrhea at home” in Dire Dawa, Eastern Ethiopia, 2016

the respondents (65.2, 54.9, and 58%) had good know- Ethiopia (65.9%) [29]. On the contrary, this finding is
ledge, negative attitude and poor practice about the pre- higher than studies done in Kashan, Iran (28.8%), Fagita
vention and home-based management of under 5 Lekoma, Ethiopia (56.2%), and Assosa, Ethiopia (37.5%)
diarrheal diseases respectively. [27, 28, 30]. This is mainly due to the fact that Dire
The finding of this study showed that 65.2% of Dawa city is a bigger and more urbanized city with many
mothers had a good knowledge about prevention and mass media.
home-based management of diarrhea among under-five Most of the mothers (92.2%) defined diarrhea correctly
children. A similar finding was observed in Fenoteselam, (as the passing of loose stool 3 or more times per day);

Fig. 3 Mothers attitude about the taste of oral rehydration fluid by their children, Diredawa, Eastern Ethiopia, 2016
Workie et al. BMC Pediatrics (2018) 18:358 Page 7 of 9

Table 4 Maternal feeding practices during child’s diarrheal episode and hand washing behaviors in Dire Dawa, 2016
Characteristic Category n %
When (Name) had diarrhea, did you breastfeed him/her Less 178 60.3%
less than usual, about the same amount, or more than usual?
Same 35 11.9%
More 77 26.1%
Child not breastfed 4 1.4%
Don’t know 1 0.3%
When (Name) had diarrhea, was he/she offered less than Less 181 61.4%
usual to drink, about the same amount, or more than
usual to drink? Same 31 10.5%
More 83 28.1%
Nothing to drink 0 0.0%
Don’t know 0 0.0%
Was (name) offered less than usual to eat, about the same Less 185 62.7%
amount, or more than usual to eat?
Same 11 3.7%
More 99 33.6%
Nothing to eat 0 0.0%
Don’t know 0 0.0%
When do you wash hands with soap Before food preparation 200 67.8%
Before feeding children 250 84.7%
After defecation 295 100.0%
Never 0 0.0%
Other 0 0.0%

which is much higher than other studies done in Fagita Less than half of the participants (42.4%) were used
Lekoma, Ethiopia (65.4%), Karachi, Pakistan (52.5%) homemade solution during diarrheal disease of their
[24, 27]. Similarly, in this study, two hundred fifty-two child. The result different from the Heidedal community
(85.5%) respondents thought that diarrhea is caused by (90%), Taung district (83.6%), Swaziland community
drinking contaminated water; that is significantly higher (97%) of South Africa [33]. This might be due to the fact
than studies conducted in Pakistan, India, Mali, and that most of the mothers in the city sought medical
Western Ethiopia [24, 28, 31, 32]. The probable explan- treatment for their children during the time of diarrheal
ation of the discrepancy might be due to the presence diseases.
of many mass media and health facilities in the city, Around two-thirds [184 (62.4%)] of the mothers knew
which may disseminate information to the population about the recommended volume of water for mixing a
and create good knowledge towards under-five diar- sachet of ORS. This is much less than other studies done
rheal diseases. in Ethiopia (85.4%), Pakistan (75.5%), Nepal (70%), and
India (76.7%) [24, 27, 31, 34]. This could be justified by
the fact that these mothers might not be familiar with
Table 5 Mothers’ care-seeking behavior and place sought for ORS mixing due to lack of education.
care in Dire Dawa, Eastern Ethiopia, 2016 Also, the majority of the mothers agreed that ORT can
Characteristic Category n % replace lost fluid but they disagreed ORT is the first-
Did you seek advice or treatment Yes 289 98.0% choice management of diarrhea. Similarly, a study done in
from someone outside of the Mali showed that majority of mothers knew ORT can re-
home for (Name’s) diarrhea? No 6 2.0%
place lost fluid but its inability to stop diarrhea caused
Where did you first go for advice Hospital 179 60.7% them to seek additional treatments such as antibiotics and
or treatment?
Health center 91 30.8% traditional medicines to treat diarrhea [32].
Health post 0 0.0% This study indicated that 42% of mothers had good
PVO center 0 0.0% practice in prevention and home-based management of
Clinic 16 5.4%
diarrhea. This is compiled with the finding of Northwest,
Ethiopia (44.9%), but the opposite was observed in stud-
Traditional practitioner 9 3.1%
ies conducted in Assossa District (62.9%) and Awi zone
Workie et al. BMC Pediatrics (2018) 18:358 Page 8 of 9

(37.6%), [27–29]. The difference may be due to the dif- exposure and outcome variable as this study design
ference of the study area, period and sample size. was a cross-sectional study. Additionally, determinant
In this study, 61.4 and 62.7% of the mother offered factors for the negative attitude and poor practice of
fluid and feeding less than usual to their child during the mothers were not included due to the limitation
the diarrheal episodes respectively. In the same way, of time and resource. So, another study is needed to
more than 70% of mothers in Kenya and 19.6% of determine these associated factors.
mothers in India decrease fluid intake and feeding dur-
ing the diarrheal episodes [31, 35]. To the contrary,
Additional file
other studies in Bangladesh and Pakistan showed that
more than 50 and 71% of mothers were in favor of giv- Additional file 1: English language copy of the questionnaire. (DOCX 30
ing food and fluids during the diarrheal illness of the kb)
child [24, 36]. Majority of the mothers in this study area
were uneducated and this might be the major reason for Abbreviations
the discrepancy as uneducated mothers could not have the EDHS: Ethiopian Demographic and Health Survey; EPI: Expanded Program on
opportunity to get information from books, newspaper, Immunization; FMOH: Federal Ministry of Health; HIV: Human Immunodeficiency
Virus; IMNCI: Integrated Management of Neonatal and Childhood Illnesses;
and other reading sources. The other possible reason for IV: Intra-venous; Kg: Kilograms; MDG: Millennium Development Goal; Ml: Milliliters;
the decrement of fluid intake and feeding during diarrheal ORS: Oral rehydration salt; ORT: Oral Rehydration Therapy; RHFs: Recommended
illness by the mothers might be due to the fear of more Home Fluids; SPSS: Statistical Package for Social Science; SSS: Sugar Salt Solution;
SSW: Sugar-Salt- Water; UNICEF: United Nations International Children Emergency
vomiting and lose of watery stool. Fund; WHO: World Health Organization
Most of the mothers (67.8% & 100%) usually wash
their hands before preparing food, and after defecation Acknowledgments
respectively. But in Assossa, Ethiopia only 11.7, and We would like to thank Dilchora, Yemariam Work and Bilal hospital for giving
16%, of the mothers was wash their hands before pre- us the permission to conduct this research in their hospital. Our sincere
gratitude and appreciation forward data collectors and participants without
paring food, and after defecation respectively [28]. To whom it would not be realized.
contrary, in Bangladesh, 60.0 and 3.1% don’t wash
their hands before food preparation and after de- Funding
fecation respectively [36]. This variation might be due This research didn’t receive grants from any funding agency in the public,
to differences in culture, sociodemographic and infor- commercial or not-for-profit sectors.

mation access.
Availability of data and materials
Almost all of the mothers [289 (98.0%)] in the present Data will be available upon consortium approval.
study sought medical treatment for their children during
the time of diarrhea diseases which much different from Authors’ contributions
Fagita Lekoma, Ethiopia (71.6%), Karachi, Pakistan (52.5%) All the authors had a substantial contribution from conception to the
and Assossa, Ethiopia (62.4%) [24, 27, 28]. As Diredawa is acquisition of data. HM & AS had a great contribution to study design,
analysis, and interpretation of the findings. HM drafted the manuscript. All
a highly urbanized city, mothers have more opportunity to authors revised the paper carefully for important intellectual contents. All
access health facilities within the near distance. authors read and approved the final manuscript.

Conclusions Ethics approval and consent to participate

The finding of this study showed that the attitude and Ethical clearance and approval was obtained from the Research and Ethical
Review committee (RERC) of school of Nursing and Midwifery, college of
practice of mothers were unsatisfactory about the preven- health and medical science, Haramaya University. Permission was taken from
tion and home-based management of under-five diarrheal each hospital to collect data. Informed verbal consent, which was approved by
diseases. Therefore, Health education, dissemination of in- ethics committee, was obtained from each study subject prior to the interview
after the purpose of the study was explained to them. If the participant was
formation, and community conversation should plan and under 16, consent was obtained from her husband (if above 18) or from her
implement to create a positive attitude and practice to- parents. Confidentiality of the information was assured and privacy of the
wards the better prevention and management of under 5 respondent was maintained.

diarrheal diseases.
Consent for publication
Not applicable
Strength and limitation of the study
As there was no the same study in the study area, it can Competing interests
use as a baseline for other studies. Similarly, it can also The authors declare that they have no competing interests.
be a blueprint to conduct an interventional study in the
particular area.
Publisher’s Note
The limitation of this study is that it was not pos- Springer Nature remains neutral with regard to jurisdictional claims in
sible to establish a temporal relationship between the published maps and institutional affiliations.
Workie et al. BMC Pediatrics (2018) 18:358 Page 9 of 9

Received: 1 December 2017 Accepted: 24 October 2018 25. Mengistie B, Berhane Y, Worku A. Prevalence of diarrhea and associated risk
factors among children under-five years of age in eastern Ethiopia: a cross-
sectional study. Open J Prev Med. 2013;3(07):446.
26. Gosling P. Dorland’s illustrated medical dictionary: 30th Edition. Australasian
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