Knowledge, Attitudes and Practices addressing young child diarrhoea in Moramanga, Madagascar: The MOSAIQUE cross cultural qualitative study

Problem Statement/ Objective: Severe dehydration due to diarrhoea leads to 19.8% of deaths among children under 5 years of age in Madagascar (1). The Ministry of Health identified infant diarrhoea as a public health priority. Several studies show that there is an association between infant and young child feeding practices and diarrhoea morbidity (2,3). A conceptual framework allowed a description of child undernutrition as immediately linked to poverty with diarrhoea as a short-term consequence(4). A cultural contruction of diarrhoeal illness one was proposed by Weiss with the KAP model (5). Thus, there is a need to understand how young child diarrhoea is managed with regard to knowledge, attitudes, feeding and treatment practices in the households of Moramanga (Madagascar). Material and Methods: This study is a qualitative study and the following methods were used: 1) 5 focus groups discussions (FGDs) were conducted with mothers, grandmothers and fathers in an area close to the Maternal and Child Health Centre (CSMI); 2) 5 semi-structured interviews (SSIs) with health professionals (doctors, midwife and community health workers) were made in Moramanga to supplement the information and explore the reality of caregivers during child diarrhoea episodes with regards to the education. The information analyzed was triangulated between the data provided by FGDs and SSIs. Reliability was improved by leading FGDs only in the local language and translating from Malagasy to French with two independent local translators and then comparing the translations with two independent doctors. Findings: Health and diarrhoea treatment are not a priority requirement for people in Moramanga. Their opportunity to pay for the health care is limited and the financial charge in relation with the illness leads them to a bigger poverty. Even the cost of ORS is expensive for the population who prefere using traditional medicine. Health workers confirmed sub-optimal treatment practices and varied acknowledgement of the socio-economic burden of diarrhoea was seen. Discussion and conclusion: Considering all these results, most of the children could be treated at home with zinc and ORS or a family preparation with salt and sugar. Population has to learn how to rehydrate properly the child. Health workers must now implement a preventive programme involving people targeting the financial constraint of the population. This programme will be differenciated for each group in the population and will not only implement a global programme. Understanding the priorities of the population can assist in improving the diarrhoea programme in this region