Caregivers’ knowledge, attitudes and practices on causes, treatment and prevention of diarrhoea in under-five children in western Kenya

Objectives: Diarrhoea remains a leading cause of morbidity and mortality among under-five children, particularly in low-resource settings where access to clean water, sanitation and health education is limited. Despite national initiatives to strengthen community-based management and promote caregiver education, critical gaps in knowledge, attitudes and practices (KAP) remain. This study examined caregivers’ KAP on causes, treatment and prevention of diarrhoea in under-five children in western Kenya.

Methods: A sample of 207 caregivers was selected and data were collected through structured questionnaires and observation checklists. A recall period of two weeks was applied to determine the proportion of under-five children with diarrhoea. Item response theory models were developed to determine knowledge and practice levels. Multi-level logistic regression models were used to identify explanatory variables associated with good or bad levels of KAP.

Results: The reported frequency of diarrhoea in the previous two weeks was 42.5% (95% CI: 35.9 – 49.4%). Caregivers understood the importance of safe food in preventing diarrhoea but were less familiar with the role of germs in causing diarrhoea, the importance of breastfeeding for prevention, and the need to administer more fluids to treat diarrhoeal cases. Females were less likely to have good knowledge and practice levels. Yet female, older caregivers and those with higher income had a more positive attitude regarding their ability to prevent the occurrence of diarrhoea in their children. Caregivers with a higher education were more likely to adopt certain good practices. Spatial clustering was observed in the caregivers’ knowledge levels, suggesting the presence of shared explanatory variables at the village level.

Conclusions: This study identified gaps in caregivers’ knowledge and practices towards diarrhoea. The high frequency of diarrhoea reported in this study underlines the need for integrated strategies combining strengthened caregiver health literacy and improved sanitation to reduce diarrhoea in under-five children.

研究背景与目的：腹泻仍是5岁以下儿童发病与死亡的首要诱因，在清洁水获取、卫生设施与健康教育资源匮乏的低资源地区尤为突出。尽管各国已推出多项举措强化社区腹泻管理与照护者健康教育，但在知识、态度与行为（Knowledge, Attitudes and Practices，以下简称KAP）层面仍存在显著缺口。本研究针对肯尼亚西部5岁以下儿童腹泻的病因、治疗与预防，调研了照护者的KAP现状。

研究方法：本研究选取207名照护者作为研究样本，通过结构化问卷与观察清单收集研究数据。设置2周回顾周期，以统计5岁以下儿童的腹泻患病比例。构建项目反应理论（Item Response Theory）模型以评估照护者的知识与行为水平，运用多水平逻辑回归（Logistic Regression）模型筛选与KAP优劣程度相关的解释变量。

研究结果：既往2周内报告的儿童腹泻发生率为42.5%（95%置信区间（Confidence Interval，CI）：35.9–49.4%）。照护者知晓安全饮食在腹泻预防中的重要性，但对病菌在腹泻发病中的作用、母乳喂养的预防价值，以及腹泻患儿需补充更多液体的治疗要点较为陌生。女性照护者具备良好知识与行为水平的概率更低。然而，女性、年长及收入水平较高的照护者，在预防儿童腹泻的自我效能感方面态度更为积极。受教育程度更高的照护者更易践行良好的腹泻防控行为。研究还观察到照护者的知识水平存在空间聚集性，提示村级层面存在共享的影响因素。

研究结论：本研究明确了照护者在儿童腹泻防控相关知识与行为层面存在的缺口。本次研究报告的高腹泻患病率，凸显了需整合强化照护者健康素养与改善卫生设施的综合策略，以降低5岁以下儿童的腹泻发病风险。