Despite considerable advances in the understanding and management of diarrheal disorders in childhood, globally these still account for a large proportion (20%) of childhood deaths, with an estimated 2.2 million deaths.In a global estimate of the burden of diarrheal disorders in 1980 the World Health Organization calculated that there were over 700 million episodes of diarrhea annually in children under 5 years of age in developing countries (excluding China), with approximately 4.6 million deaths. More recent reviews of studies published in the last 10 years indicate that although global mortality may have been reduced, the overall incidence remains unchanged at about 3.2 episodes per child year . Diarrheal diseases is the leading cause of infant and child mortality in Pakistan, where it accounts for an estimated 300,000 deaths per year.Appropriately, it is currently the focus of massive nationwide Oral Rehydration Therapy(ORT) campaign. The gravity of childhood diarrhea in urban slums was documented in 1984-85 by the Department of Community Health Sciences at Aga Khan University (AKU) in Karachi, the largest city in Pakistan. Health surveys conducted by the department indicated that more then 1 child in 5 fails to survive to the age of 5 in Karachi Shantytowns, and that 30% to 40% of these deaths are due to diarrhea. The infant (first year) mortality rate in one typical Shantytown, Orangi was found to be 110/1000 live births . In order to learn about knowledge, attitude and practices of mothers and families of new born babies suffering from diarrhoea, I and my team from Health Services Academy, Islamabad visited Social Security Hospital in District Rawalpindi and interviewed the mothers, mother-in – laws and sister -in -laws.
nderstanding, perceptions of diarrhea It is watery stool (Putla Dast) that is continuous and takes place more than 7-8 times a day. Normal Dast? Is called Qabz. It’s normal two times a day. Moreover, yeh dastoon ki bemaari hai.
It is due to teething and diarrhea is usually present during teething. Teething causes Garmi ( Heat) in the mouth. Garmi say gost galta hai or pechish lagti hai.(Heat causes decay of flesh of mouth cavity that leads to diarrhea.teething causes kharish(itching) in the gums which get swollen and the garmi (heat effects) then goes to the stomach. “sadi apni ghaltain nayy jii” (by our own mistakes). Our child due to mistake sometimes eats things which are not clean enough. Sometimes children play with pica so due to that they get diarrhea. Sometimes due to mosquito bites our children get diarrhea. And sometimes by playing or moving out of house in evening children get “SAYAA” I think it occurs mainly due to teeth eruption. In teeth eruption usually fleshes of gums gets bad and due to that disease occur “goshat gall janda aay”. Sometimes “SAYAA” plays main role in diarrhea. Mothers and children are careless and eat dirty things and sometimes diarrhea occurs due to“NAZARR” I mean that when woman comes to our house and says that your child is very beautiful then my child usually get ill. No I think my child usually get diarrhea due to “JARASEEM” (micro-organisms). But sometimes it may occur due to “NAZZAR”
Effects of diarrhea It is dangerous; water from the body is lost. It can cause death. The child becomes week and it is not dangerous when it lasts only for one day. Rather it is beneficial for child’s health because. iss se aantain saaf ho jaati hain aur zehreela maada bahir nikal jaata hai”.(it cleans intestines and all poisonous matter released)
Health Seeking Behavior
We use Gharailoo Totka (Home remedy). We give sauf ka pani,Anday ki Sufaidi( egg white) and Cheeni ( sugar) mixed in boiled water. We were told to do this by Amman ji of our pind ( an elderly woman in our village who is an expert in giving advise to mothers whose children are suffering from diarrhea. My father performs Dum for Nazar (Evil eye) Qurani Ayyat parh ke pani per phoonka jata hai( Quranic Verses are recited on a glass of water) then water is given to the ailing child. I use to give boil water, onion water “PIAZ DAA PANNI” (we use to press onion and then get its water one to two table spoon), “CHAWAL DI PITCH” rice water Sometimes I use to give “SAUNF AUR AJWAIN DAA PANI” and also use to give “nimkol”, sometimes only boiled water. I give “KEHWA” (green tea), “KITCHRII” boiled rice and “UBLA HUA PANII” boiled water. I give nimkol and immediately took my child to hospital Initially we try the local medicine "Daisi totka” and almost always kids get totally relieved and if they doesn’t then we plan to go to doctor/ hospital First we try our Daisi totka but if it does not work. We go to see a doctor/ hospital We wait for 01 day and give treatment at home but if the kid does not gets well we take him to hospital. We don’t wait .We take the child to hospital immediately For this child I waited for 15 days but she didn’t get well so I had to take her to hospital I waited for 1 week then I took my son to hospital We don’t wait more than 2 days. We took the child to hospital after couple of days of diarrhea We don’t wait; we took the child straight away to hospital/ doctor. Yes, A doctor in Gujjar Khan who treated the child. The child did not improve so he referred us to this hospital. They seek medical advice as “kia pata kis kay hathoon shiffa mill jay”
Analysis of Causes of Diarrhea
In “SAYAA/NAZAR” children usually cry more and cry at evening and use to stick to mother and they do not sleep at night. First they get fever followed by diarrhea when it does not appear like that then we think this is a disease I think child tends to keep quite more and cry less. Due to “NAZAR” child become very less reactive and don’t take any food. Then one can also differentiate by rays coming out the ears of child (Sufaid Roshni). In “SAYAA” children use to cry more with shivering and also it use to occur at “MAGHRIB” when sun is near to set. In “SAYAA” children use to get blue while crying and diarrhea use to occur after that cry but to simple disease straight away diarrheal episodes occurs.
Treatment according to perceptions
Nazar, Sayya or any other cause other then disease
My father performs Dum for Nazar (Evil eye). Qurani Ayyat parh ke pani per phoonka jata hai( Quranic Verses are recited on a glass of water) then water is given to the ailing child. We burn out the peppers “MIRCHAIN JALATAIN HAIN” and if there is no smell then it confirms the presence of “SAYYA or NAZAR”…………… “SANU YAQEEN HU JANDA AYY KEH AYY SAYYA AYE YAH NAZAR AYE” and if there is smell then it is not “SAYYA” it is the disease. If there is no smell we keep on doing this for seven days and by this “NAZAR” removes. But if smell doesn’t comes even after 7 days then we go to “BABA JEE” for “DAMM” and “TAWEEZ” She is right we do some of these things but on majority of occasions we put sugar in fire to remove “NAZAR-E-BUD” (bad eye) and hope that it will remove “NAZAR”. We also show the face of diseased child to early rising sun and put drops of water in form of shower on face of child as “Daisi totka” but even then if child does not get well we took child to shrine near our village Taxilla where “PIR SAHIB” advised me to offer 10 “rakat Namaz Nafal” (prayer). In addition to all above ways we boil egg and put it in the “MATKA” (clay pot) and keep it in that for 24 hours and then give it to child for next 24 hours while all other foods are stopped. But if this method fails then we use to consult a lady in our neighbor for “SALAH MASHWARA”. She is very intelligent “POONHCHI HUE AYA”. She guide us what to do depending on situation. But many times she tells us to recite different SURH from The Holy Quran and by this my child use to get better. Though I do not believe in this but when my kids don’t get healthy after long treatment (15 days) even in hospital then I go to shrine “BARRI IMAM SAHIB” and get “TAWEEZ”. In addition they use to promise mannat of Jhanda (flag) on the holy shrine in suburbs of Rawalpindi ( jhanday wali ziarat). They also perform Sadqa which diverts forth coming dangers.
Food during Diarrhea
It is necessary to give food. We were told to do so by the doctor. The doctor has a hospital in Gujar khan and many patients come to see him. Boiled rice, Banana, Cow milk and Yoghurt. More food should be given because child needs Taaqat (Strength). Mostly solid foods should be given because they don’t cause diarrhea. It is the liquid foods which result in watery stools and cause diarrhea. It is better to give solids during diarrhea as it doesn’t cause diarrhea, where as liquids cause more diarrhea.
The above mentioned perceptions were of the people who are not Health Care Providers. Their continuous practised therapy can put the baby's life in danger.
The role of LHWs is very important in educating mothers and trying to change their belief with respect to superstition. Instead, the mothers should be educated to look for danger signs of Diarrhoea like sunken eyes and irritable behavior. ORS Therapy should be initiated and immedediate treatment should be sought from a Registered Medical Practitioner.
