Mothers’ knowledge, attitude and practice towards management and prevention of diarrhoea among children under five: A descriptive study at the Lower Manya Krobo Municipal Assembly of Ghana
Dr.
BensonOwusu1✉Phone+233(0)247586344Email
KateGbile1,2
GideonAntwi1
MagdalineYaa1
AmoakoaAnsah3
Accra-Ghana.1
1School of Nursing and MidwiferyCentral UniversityAccraGhana
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Faculty of Medicine, Health and Social CareCanterbury Christ Church UniversityUnited Kingdom
3Department of Child HealthKorle-Bu Teaching HospitalGhana
Benson Owusu1 Kate Gbile1,2, Gideon Antwi1, Magdaline Yaa Amoakoa Ansah3
1 School of Nursing and Midwifery, Central University, Ghana
2 Canterbury Christ Church University, Faculty of Medicine, Health and Social Care, United Kingdom
3 Department of Child Health, Korle-Bu Teaching Hospital, Ghana
Dr. Benson Owusu, Accra- Ghana.
School of Nursing and Midwifery, Central University, Accra-Ghana
Tel: +233(0)247586344
Email: bowusu@central.edu.gh
Corresponding Author
ORCID: https://orcid.org/0000-0002-4061-490X
Abstract
Diarrhoea continues to be one of the leading causes of death among children under five in Ghana preceded by malaria and pneumonia. We aimed to assess mothers' knowledge, attitudes, and practices (KAP) regarding the prevention and management of diarrhoea in children under five years of age in the Lower Manya Krobo Municipality, Ghana. A descriptive cross-sectional design was employed, utilizing a convenience sampling technique to select 116 mothers attending health facilities in the municipality. Data were collected using a structured questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 23. The study found that majority of the mothers were aged 24–29 years (41%). Over 52% of them demonstrated good knowledge of diarrhoea. Approximately 45% identified contaminated food and water as the main cause of diarrhoea, with 26% recognizing dehydration as a major complication. Regarding practices, 94% restricted food intake during diarrhoea episodes, with 50% discontinuing breastfeeding. Additionally, 57% self-medicated with antibiotics for non-bloody diarrhoea. While mothers exhibited good knowledge of diarrhoea, negative attitudes and suboptimal practices were prevalent, particularly concerning breastfeeding and appropriate treatment. Health promotion programs should focus on enhancing attitudes and practices, emphasizing the importance of continued breastfeeding and appropriate medical treatment during diarrhoea episodes.
Keywords:
Diarrhoea
Knowledge
Attitudes
Practices
Child Health
Ghana
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Introduction
Diarrhoea remains one of the leading causes of morbidity and mortality among children under five years in Ghana (Kombat et al., 2024; (Ghana Statistical Service, 2018).). Defined as the passage of three or more loose or liquid stools per day, diarrhoea is often symptomatic of infections caused by various pathogens, including bacteria, viruses, and parasites. Despite global efforts to reduce its impact, diarrhoea continues to pose significant public health challenges, especially in sub-Saharan Africa (World Health Organization [WHO], 2023).
The Ghana Multiple Indicator Cluster Survey reported a prevalence of 17% among children under five years (Ghana Statistical Service, 2018). Factors influencing diarrhoea incidence include maternal education, household wealth, and access to clean water and sanitation. For instance, children whose mothers had secondary or higher education had significantly lower odds of experiencing diarrhoea compared to those whose mothers had no formal education (Ghana Statistical Service, 2018).
Beyond Ghana, several African studies have highlighted the critical role of maternal knowledge, attitudes, and practices (KAP) in diarrhoea prevention and management. In Ethiopia, a study found that although mothers possessed good knowledge about diarrhoea, their practices were suboptimal due to negative attitudes and misconceptions (Bekele, 2017). Similarly, in Nigeria, a study indicated that despite awareness of diarrhoea prevention methods, improper practices and delayed healthcare seeking were prevalent among caregivers (Workie et al., 2018).
The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend the use of oral rehydration salts (ORS) and zinc supplementation as effective treatments for diarrhoea.
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However, adherence to these guidelines varies. In some regions, the use of ORS is widespread, while zinc supplementation remains underutilized due to factors such as cost, availability, and lack of awareness (UNICEF & WHO, 2004).
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Attitudes towards diarrhoea management also significantly impact health outcomes. A study in Botswana found that only 43% of mothers had favorable attitudes towards diarrhoea and its management (Mosweu, 2019). This highlights the need for targeted interventions to address misconceptions and promote positive health behaviors.
In Ghana's Lower Manya Krobo Municipality, limited data exist regarding maternal KAP on diarrhoea prevention and management. Understanding these factors is crucial for designing effective health interventions tailored to the community's needs. Therefore, this study aims to assess the knowledge, attitudes, and practices of mothers concerning the prevention and management of diarrhoea in children under five years in the Lower Manya Krobo Municipality.
Methods
Study Design
A cross-sectional design was employed to assess the knowledge, perception and practice towards management and prevention of diarrhoea among children under five.
Study Setting and Population
The study was conducted at the Atua Government Hospital, located in the Lower Manya Krobo Municipality. According to the Head of Public Health at Atua Government Hospital (personal communication, May 2024), the community continues to struggle with access to clean and safe water. The target population included mothers of children under five years of age who reported to the hospital with cases of diarrhoea between June to September 2025.
Sampling and Sample Size
The sample size was determined using Cochran (1977) formula at a 95% confidence interval and a 5% margin of error, resulting in a sample size of 116 respondents. A simple random sampling technique was employed to select participants from the target population.
Inclusion Criteria
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Mothers were eligible to participate if they met the following criteria:
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Primary caregivers of children under give years
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Had a child under the age of five diagnosed with diarrhoea at the Atua Government Hospital during the study period (June–September, 2025), and
3.
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Provided informed consent to participate in the study.
Exclusion Criteria
Mothers were excluded from the study if they:
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Were not the primary caregivers of the child; or
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Had children diagnosed with other conditions aside from diarrhoea during the study period.
3.
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Declined to provide informed consent
Data Collection Instrument
Data were collected using a structured questionnaire, which included both open-ended and closed-ended questions. The questionnaire was selected due to its effectiveness in collecting large volumes of data in a cost- and time-efficient manner. Its flexibility also allowed for the capture of both qualitative and quantitative information relevant to the study objectives.
Data Analysis
The coded data were entered and analyzed using the Statistical Package for the Social Sciences (SPSS), version 23. Results were summarized using descriptive statistics and presented in the form of frequency tables, bar charts, and pie charts.
Result
The findings of the present study indicated that 24 (21%) of the respondents were between 18 and 23 years of age, 48 (41%) were between 24 and 29 years, 34 (29%) were between 30 and 34 years, and 10 (9%) were 35 years or older.
With respect to religious affiliation, 95 (82%) of the respondents identified as Christians, 18 (16%) as Muslims, and 3 (2%) belonged to other faiths.
Regarding educational attainment, 45 (39%) of the respondents had completed secondary education, 20 (17%) had primary education, 16 (14%) had tertiary education, and 35 (30%) reported having no formal education.
Concerning the number of children, 40 (34%) of the respondents had four children, 38 (33%) had three children, 18 (16%) had two children, 10 (9%) had one child, and 10 (9%) had no children.
In terms of occupation, 30 (26%) of the respondents were traders, 22 (19%) were farmers, 20 (17%) were civil employees, 17 (15%) were fishmongers, and 27 (23%) were unemployed. This is illustrated in Table 1.
Table 1
Sociodemographic Characteristics of Respondents (N = 116)
Variable
Category
Frequency (n)
Percentage (%)
Age (years)
18–23
24
21
 
24–29
48
41
 
30–34
34
29
 
35 and above
10
9
Religion
Christian
95
82
 
Muslim
18
16
 
Other faiths
3
2
Educational level
No formal education
35
30
 
Primary
20
17
 
Secondary
45
39
 
Tertiary
16
14
Number of children
None
10
9
 
One
10
9
 
Two
18
16
 
Three
38
33
 
Four
40
34
Occupation
Trader
30
26
 
Farmer
22
19
 
Civil employee
20
17
 
Fishmonger
17
15
 
Unemployed
27
23
Knowledge about causes of diarrhoeal disease
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Nearly half of the respondents, 52 (45%), indicated that diarrhoeal disease is caused by eating contaminated food, while 30 (26%) attributed it to drinking contaminated water. 14 (12%) of the respondents believed that diarrhoea is transmitted through shaking hands with infected individuals, whereas 8 (7%) identified viral infection as the cause. The remaining 12 (10%) respondents provided other or unspecified causes (Fig. 1).
Fig. 2
Knowledge of mothers on the signs of diarrhoea among children under five years
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Knowledge of mothers on the signs and symptoms of diarrhoea
The study revealed that respondents demonstrated varying levels of knowledge regarding the symptoms of diarrhoeal disease. A total of 45 (39%) of the respondents indicated that dehydration is a symptom of diarrhoeal disease, whereas 56 (48%) reported that watery or bloody stool characterizes episodes of diarrhoea. Additionally, 15 (13%) of the respondents identified abdominal pain and discomfort as symptoms associated with diarrhoeal disease (Fig. 2).
Figure 2: Knowledge of mothers on the signs of diarrhoea among children under five years
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Attitude of mothers towards diarrhoea management and prevention
Managing diarrhoea disease
A total of 77 (66%) of the respondents indicated that diarrhoeal disease was managed at home by using oral rehydration solution (ORS). Additionally, 25 (22%) stated that taking zinc tablet as supplements was a common home management approach, while 14 (12%) reported that avoiding the intake of snacks was a means of managing diarrhoea at home (Fig. 3).
Fig. 3
Home management of mothers on diarrhoea among children under five years
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Practices of Mothers on diarrhoea prevention
Respondents were assessed on their practices regarding the prevention of diarrhoeal disease at home. Findings revealed that 32 (28%) of the respondents identified eating well-cooked food as an effective preventive measure against diarrhoeal disease. Additionally, 26 (22%) indicated that boiling water before drinking helps to prevent the condition, while 24 (21%) reported that regular handwashing serves as an important preventive practice. Furthermore, 22 (19%) of the respondents acknowledged exclusive breastfeeding, whiles 12 (10%) mentioned keeping a clean environment as a means of preventing diarrhoeal disease at home (Fig. 4).
Fig. 4
Mothers practices on the signs of diarrhoea among children under five years
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Discussion
This study assessed mothers' knowledge, attitudes, and practices (KAP) toward the prevention and management of diarrhoea among children under five in the Lower Manya Krobo Municipality, Ghana. The findings reveal moderately good knowledge and practice, but less favourable attitudes among many mothers. These results have implications for health promotion, clinical care, and policy in similar settings.
Knowledge
Over half (45%) of mothers in this study demonstrated good knowledge of diarrhoeal disease, including defining it correctly as the passage of frequent watery stool more than three times a day. This is somewhat lower than findings from Eastern Ethiopia, where about 65.2% of mothers had good knowledge of prevention and home-based management of diarrhoea in children under five (Workie, Sharifabdilahi, & Muchie, 2018) but higher than in studies from some parts of South Sudan, which reported many mothers had low knowledge (South Sudan Medical Journal, 2017; Mothers’ Knowledge, Attitude and Practice on Preventing Diarrhoea in Juba, South Sudan) (Mothers’ Knowledge, Attitude and Practice …, 2017). The discrepancy suggests that community, educational, and outreach program strength may differ across locations.
Higher knowledge is critical: understanding what diarrhoea is and recognising its signs allow for earlier and more appropriate home management and timely health-seeking behaviour, which are known to reduce morbidity and mortality (Workie et al., 2018; WHO & UNICEF, 2004). Yet, knowledge alone does not guarantee action.
Practice of Management and Prevention
Concerning management at home, 66% of respondents reported using Oral Rehydration Salts (ORS), and 22% reported using zinc supplementation during diarrhoeal episodes. The use of ORS is high relative to many settings, but zinc use remains low in comparison.
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WHO and UNICEF guidelines recommend both ORS and zinc as standard of care for management of childhood diarrhoea, noting that the combination improves outcomes more than ORS alone (WHO, 2023). The lower uptake of zinc may be due to factors such as limited awareness of its importance, access issues, cost, or unavailability.
In terms of preventive practices, mothers in this study endorsed eating well-cooked food (28%), boiling water (22%), and hand washing (21%) as means of preventing diarrhoea. These hygiene and food safety behaviours are consistent with practices identified in several sub-Saharan contexts. For example, in Vhembe District, South Africa, caregivers identified good personal hygiene (82.1%) and fresh food (73.6%) as preventive strategies (Moloko & Tshivhase, 2021). The lower percentages in this study might reflect differences in awareness, infrastructure, water supply or cultural practices.
Overall, the data indicate that mothers in Lower Manya Krobo display relatively strong practice in many areas despite knowledge gaps, especially in terms of zinc usage and some hygiene behaviours. This suggests that interventions may be having an effect, but that full adherence to recommended practices is incomplete.
Attitudes
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A key finding is that, although knowledge and practices are relatively strong, attitudes were less favourable: many mothers held negative attitudes toward prevention and management of childhood diarrhoea. This aligns with findings in Diredawa, Ethiopia, where more than half of mothers (54.9%) exhibited negative attitudes despite good knowledge (Workie et al., 2018). Negative attitudes may include beliefs that diarrhoea is inevitable, or that healthcare is only necessary when diarrhoea becomes severe, among others. Attitude is often a mediator between knowledge and practice: even when mothers know what to do, a negative attitude can lead to delay in seeking care, underutilization of health services or overreliance on home remedies of questionable efficacy.
Comparison with Literature
When comparing with findings of Jagadeesh et al. (2024), in a rural area of India, about 47% of mothers had good knowledge of the definition of diarrhoea, which is similar to the 52% observed in this study (Jagadeesh et al., 2024). However, practice levels and use of zinc supplementation in India appear variable but often lower than ORS usage, as in the present study.
In Maseru, Lesotho, Adeleke & Mhlaba (2019) reported that maternal KAP levels were lower in rural settings, with particular deficits in knowledge and preventive practices. This contrast suggests that urban proximity, exposure to health communication campaigns, and healthcare access may influence KAP positively, and that similar influences may be acting in the Lower Manya Krobo area.
Implications for Nursing and Public Health
Given the gap in attitudes and suboptimal use of zinc, educational programs should not only provide information but also address beliefs, myths, and perceived barriers. Nurse-led community education, mother support groups, or clinic-based counselling could help in reshaping attitudes.
Healthcare systems must ensure that both ORS and zinc are readily available, affordable, and known to caregivers. Training of healthcare workers to emphasize zinc in management of diarrhoea is essential.
Hygiene, safe water, proper food handling, and sanitation should be integrated into maternal and child health programs. Because mothers seem more aware of ORS than some preventive hygiene measures, reinforcing prevention through mass media, community health workers, and schools may improve behaviour.
Negative attitudes may lead to delays in seeking facility care. Empowering mothers to recognize danger signs (severe dehydration, blood in stool, persistent vomiting) is crucial. Nurses and midwives can play a central role in counselling during routine child health visits.
Strengths and Limitations
This study employed structured data collection tools and targeted a clearly defined population of mothers attending Atua Government Hospital, enhancing the relevance of the findings for facility-based health service planning. The inclusion of knowledge, attitudes, and practices provides a comprehensive understanding of the behavioral determinants influencing diarrhoeal disease management. However, the cross-sectional design limits the ability to establish causality; it remains unclear whether higher knowledge leads to better practices or whether mothers with better practices seek more knowledge. The sample was restricted to a single government hospital over a three-month period, excluding mothers who use private, traditional, or community-based care, which may limit generalizability. Additionally, reliance on self-reported data could introduce social desirability bias, with participants potentially overstating favorable practices. Finally, the attitude measures may not have fully captured the complexity of maternal attitudes, including cultural beliefs and traditional practices, suggesting that qualitative exploration could provide deeper insights.
Conclusions
In the Lower Manya Krobo Municipality, most mothers exhibit good knowledge and practice regarding childhood diarrhoea management, especially with respect to ORS usage and some preventive behaviours. However, attitudes toward prevention and management of childhood diarrhoea are less positive, and zinc supplementation remains underused. Bridging these gaps is vital to reducing diarrhoeal morbidity among under-five children.
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We recommend the development and implementation culturally sensitive health promotion programs focused on changing attitudes, addressing misconceptions, and reinforcing prevention and management in line with WHO/UNICEF guidelines.
Ethical Consideration
Ethical approval
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for this study was obtained from the Ghana Health Service Ethics Committee
(Central/IRB/02/25). Participation in the study was voluntary, and informed consent was
obtained from all participants prior to data collection.
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Consent for Publication
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All participants provided written informed consent for publication.
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Availability of Data and Materials
The data supporting the findings of this study are available from the corresponding author upon
reasonable request.
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Competing Interests
The authors declare that they have no competing interests.
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Funding
The authors received no specific funding for this work.
Acknowledgement
We acknowledge the support of Manyo Krobo Municipal Assembly during the research.
References
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