SUMMARY

ORAL REHYDRATION THERAPY IN UGANDA:

A COMMUNITY-BASED SURVEY ON THE KNOWLEDGE, ATTITUDES AND PRACTICES OF ORAL REHYDRATION THERAPY IN MASINDI

DISTRICT, UGANDA.

C. KISAMBA-MUGERWA

and

GIMONO WAMAI

CDD Programme, Child Health and

Ministry of Health. Development Centre

UNICEF Makerere University

APRIL, 1992

ABSTRACT

In Uganda ORT was first introduced in 1984 as a major component of the CDD programme. Evaluation of the programme in 1987 and 1989 and other studies conducted in Uganda show that although a majority of respondents could recognize the ORS sachet, fewer respondents used them during diarrhoea and even fewer used the ORS correctly, i.e., there existed a knowledge-usage gap. It was the main objective of this survey to identify factors responsible for this gap.

A community-based descriptive cross-sectional survey was conducted in Masindi district to identify household and community factors that constrain appropriate use of ORS. Five focus group discussions were conducted with rural women, health workers and traditional healers. In addition, information was obtained from 240 households about 462 children aged five years and below.

Awareness of ORS was high (214/240, 90%). The concept of oral rehydration was not, however, well recognized by most respondents (152/214, 71%). ORS is more often referred to as a "medicine" than as a rehydrating agent. This misconception affects the way ORS is used and also influences the users' expectations. The rehydrating effect of ORS is not appreciated by the caretakers.

A good proportion of the respondents 190/240 (79%) had ever used the ORS sachet. Of these, 110/190 (58%) mentioned the correct amount of water to be used in mixing a sachet of ORS. When it came to demonstrating, however, fewer people were able to measure the water correctly. Among those who carried out the demonstration, only 26/52 (50% of the demonstrators), (26/240, 11% of the total) were able to measure the correct amount of water. So, although awareness figures may be high, awareness is not equivalent to adequate knowledge and/or skills to practice proper use of ORS.

Diarrhoea was the third commonest (77/463,17%) illness reported for under-fives after respiratory tract infection and fever in a two week recall period. Action taken when a child suffered from diarrhoea ranged from doing nothing, to using home remedies like ORS, herbs, tablets, porridge and fruits juices to seeking treatment away from home. Whatever the form of treatment, the mothers' therapeutic goal was to stop diarrhoea, i.e., to decrease the frequency of stooling. Even when mothers used ORS in diarrhoea they expected it to stop diarrhoea.

Constraints to the use of ORS identified were: a) The misconception of ORS as a `medicine' used in treatment of diarrhoea; b) Non-availability of ORS sachets at health units and lack of readily available utensils for mixing; c) Lack of readily available water with which to clean the utensils and prepare the ORS solution. In view of the above findings a number of conclusions and recommendations have been made.

KEYWORDS[ diarrhoea, ORT