Factors that predict the maternal use of oral rehydration solution during diarrhea home treatment for children under 5 in India

Abstract

Background: Worldwide, diarrhea is the second major cause of mortality among children less than 5 years of age and in 2016, diarrheal deaths accounted for 8% of all deaths among under 5 children. In India, around 300,000 children under 5 die due to diarrhea each year. According to 2016 data, case fatality rate of diarrhea among children aged under 5 was 9% in India. Aim: The purpose of this study was to find the determinants of maternal use of ORS during diarrheal episode in children less than 5 years of age in India to contribute to developing effective strategies to increase the ORS usage. Methods: The study used the National Family Health Survey-4 (2015 – 2016) data. Descriptive analysis evaluated any significant differences in the distribution of categorical variables and continuous variables across the ORS users vs. non-users (outcome variable). For the predictive model, all the variables that were different between the groups at the level of significance P<0.25 in descriptive analysis were included into logistic regression analysis, first, one by one (univariate), then together (multivariable) – adding the variables to the model manually and removing insignificant ones by using the level of significance P<0.05. For the association model, confounders of the association between dependent variable (ORS usage) and independent variable (type of diarrhea) were identified. Then, the association between ORS usage and type of diarrhea (bloody or non-bloody) was measured in a multivariable model controlling for all the identified confounders. Results: The significant predictors of ORS usage included child’s higher age group (OR=0.39 for 0-59 month olds and OR=0.86 for 6-23.9 months olds compared to 24-59 month olds), mothers’ secondary or higher education (OR=1.10) compared to mothers with lower education, urban residence of the household (OR=0.86 for rural residence), high wealth index (OR=1.20), other than Hindu or Muslim religion (OR=0.67 for Hindus/Muslims), non-backward caste of the household (OR=0.88 for backward classes), lower sequential number of the child in the family (OR=0.95), bloody type of diarrhea (OR=1.28), exposure to mass media (OR=1.31), seeking care from public (OR=4.37) or private (OR=2.24) healthcare facilities as compared to other careseeking behaviors, amount of food given to the child during diarrhea (OR=0.89 for not decreasing the amount of food), and use of zinc (OR=2.68). In the multivariable logistic regression model, type of diarrhea (bloody and non-bloody) was statistically significantly associated with ORS usage (OR=1.27 for bloody diarrhea) after adjusting for all the identified confounders. Conclusion: The study findings will help the public health practitioners to develop effective strategies to increase the maternal use of ORS during diarrhea home treatment. Modifiable factors such as exposure to mass media, seeking care from health facility, amount of food given to the child during diarrhea, and use of zinc could be the focus of interventions targeting ORS use. Public health interventions on importance of ORS usage for preventing dehydration should specifically target rural residents, population groups with lower wealth index, lower education, Hindu and Muslim religion, and Scheduled caste/Scheduled tribe/other backward classes. Health education program should focus on the importance in the usage of ORS to fight against dehydration during diarrheal episode.