Ecological and cultural barriers to treatment of childhood diarrhea in riverine areas of Ondo State, Nigeria

In Nigeria diarrhea still poses the greatest health problem to the survival of the under-fives in spite of the fact that the majority of mothers are reportedly to have been reached by health education on oral rehydration therapy (ORT) regardless of their ecological and socioeconomic situations. This study assesses the effect of different ecological and sociocultural conditions on use of ORT in riverine areas of Ondo State for the identification of the most effective means of dissemination of information on ORT in similar geographically disadvantaged localities in Nigeria and elsewhere. It is a formative study, but its results are expected to lead to identification of potentially effective intervention modalities to improve diarrhea treatment in remote areas. Of great concern in this study are communities whose awareness and acceptance of ORT may be more dictated by environmental conditions. This study combines two different research methodologies; namely, semistructured questionnaires and in-depth interviews to gain 'focused' insight into the communities. The study was carried out in Ilaje-Ese-Odo local government area (LGA) in southwestern Nigeria. It covered 308 mothers from 2 subethnic groups (Ilaje and Apoi) from a set of randomly chosen villages situated in 3 ecological strata and the in-depth interviews with 42 key informants. The majority of the mothers described some dangerous signs of last diarrhea suffered by their children under the age of five. Preliminary results indicate that awareness of actual causation was lowest in the remotest saltwater areas compared with other mothers in the study communities. Sixty-eight percent of the mothers in Ilaje mainland, 57% in fresh water Apoi and 44% in saltwater Ilaje stated that they have ever heard of salt, sugar solution (SSS). Furthermore, only 43% of them said they could prepare SSS while 42% ever made it. None of those mothers in saltwater Ilaje who confirmed awareness of and how to administer and prepare SSS could in reality do it correctly. When shown a typical sachet of ORS, only 8% of mothers living in salt-water swamps said they have seen one before. Thus, promotive health services to reduce high mortality rates of children under five have passed the study mothers whose area reported the highest incidence of diarrhea in the state.