Severity signs of childhood diarrhoea in north eastern Nigeria.

Oral Rehydration Therapy (ORT) use in Nigeria is currently far short of the national Control of Diarrhoeal Diseases (CDD) programme goals. Towards designing health education strategies to improve this, maternal lay health concerns during diarrhoea in under-fives were examined among two large ethnic groups, the Kanuris and Buras, in northeastern Nigeria. Over half of the respondents judged the severity of diarrhoea by more than one sign and expected ORT to stop diarrhoea. Severity signs frequently described (averaging from a quarter to a half of respondents) included weakness and refusal of food; frequent stooling and fever were more frequently used by the Kanuris (p < 0.001) compared to Buras and weight loss and dehydration by the Buras (p < 0.01) compared to Kanuris. Generally, rural residents were less concerned with dehydration and weight loss (p < 0.0001 and 0.003 respectively, compared to urban residents) and more concerned with restlessness, including excessive crying (p < 0.07 to 0.0001). Stool characteristics and vomiting were rarely used as severity signs although the Kanuris in focus group discussions related severity to diarrhoea typology. Concerns with persistent diarrhoea, and diarrhoea associated with measles, were rarely expressed by participants, irrespective of ethnic group and domicile, suggesting that health education aimed at increasing awareness in relation to these two serious illnesses is urgently needed in Nigeria. Several of the lay health concerns expressed by participants in the study could form a useful basis for promoting ORT use in Nigeria and elsewhere.