American International Journal of Business Management (AIJBM)

ISSN- 2379-106X, www.aijbm.com Volume 3, Issue 8 (August 2020), PP 168-177

Knowledge, Attitude and Practices of Caregivers towards

Disabled Children under- Five Years and It’s
Influence on Clinical Outcome
1
FRANK OWUSU SEKYERE, 2CHARLES KWAME R. GYAMFI, 3GODWIN
NTIAMOAH POKU
1
(Dept.of interdisciplinary studies UEW)
2
(Dept. of special education UEW)
3
(Dept. of child health- kath)
*Corresponding Author: 1Frank Owusu Sekyere

ABSTRACT:- Delays in seeking appropriate medical care is one of the major factors contributing to severe
disease among children presenting to hospitals with severe forms of malaria, pneumonia and diarrhoea (UNDP,
2015). This study therefore explored the knowledge, attitude and practice of caregivers towards sick disable
children under- five years in a local indigenous setting of Bawku. A cross-sectional descriptive study design
which was quantitative in nature was used and a convenient sampling technique was used to sample 200
caregivers seeking health care for their sick-disabled children at health facilities at the Bawku township of
which they responded to questionnaires which were analyzed using the Statistical Package for Social Sciences
(SPSS) version 21. A Pearson’s correlation test was done to test variables with a significance of p value of ≤0.05
being considered statistically significant. There is a significant relationship between age (p=0.03), educational
status (p=0.001), marital status (p=0.05) as well as religious affiliation (p=0.003) and the three variables.
Findings of the study also showed that all respondents were aware that their children were sick and they have
been sick for some days but thought their children’s illness to be mild/moderate due to the combined symptoms
that was exhibited (78%) and hence 80% did not stop their daily routine to take care of their children and sought
treatment after the father made the decision. Economic factors such as low income levels, lack of transport
during illness, high cost of medical care and high cost of transport whilst socio-cultural factors such as low level
of education, lack of adequate health information, lack of support from partner and cultural barriers/beliefs all
influenced caregivers’ choice of care and practices for their sick children under five years. The study
recommends that there is the need to have an effective and functioning referral system in the health care
delivery system to ensure children are attended to promptly in health facilities at the onset of any illness.

Key Words: disability, children, caregivers

I. INTRODUCTION
Despite the significant progress that has been made in reducing mortality in children under-five years
of age, about 6.9 million children of under-five years died in 2011 worldwide (World Health Organisation
[WHO], 2012). Children in Sub-Saharan Africa (SSA) are about 16.5 times more likely to die before the age of
five years than children in developed region (WHO, 2011). About half of under-five deaths occurs only in
China, Democratic Republic of the Congo, India, Nigeria and Pakistan. More than a third of all under-five
deaths accounted by India (21%) and Nigeria (13%) (WHO, 2013).
The practice of appropriate health care seeking has a great potential to reduce the occurrence of severe
and life-threatening childhood illnesses. However, varieties of factors have been identified as the leading causes
of poor utilization of primary health care services by caregivers. Poor socio-economic status, lack of physical
accessibility, attitude to modern treatment, low literacy level of the caregivers, large family size, number of
symptoms, previous experience of child death, and perceived severity of illness have been the predictors of care
seeking behaviour as well as lack of health insurance coverage especially among the low-economic status
families (Abdulraheem, 2009; Assefa et al., 20008).
Acheampong (2013) noted that in Ghana, most caregivers are not well informed about the risk factors
and prevention of childhood illnesses, its home management, good feeding practices and seeking of early
medical attention. Acheampong noted that most cases that are presented for treatment at the hospitals are poorly
managed at home. Hence she concluded that generally, there was a perception that most of the caregivers who
lack knowledge in the causes and the associated danger signs of childhood illness as well as their management
practices have low level of education.

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...
This study therefore intends to assess the knowledge, attitude and practice of caregivers towards sick-
disabled children under- five years and how these factors can be addressed to reduce childhood illness which
results in disabilities, morbidity and mortality among children under five.

THE DISABILTY CONCEPT

The UNICEF in 2007 estimated that, overall, between 500 and 650 million people worldwide live with
a significant impairment. They further quoted that with respect to the World Health Organization (WHO),
around 10% of the world’s children and young people, some 200 million, have sensory, intellectual or mental
health impairment. Around 80 per cent of them live in developing countries (UNICEF, 2007). Statistics such as
these demonstrate that to be born with or acquire impairment is far from unusual or abnormal. The reported
incidence and prevalence of impairment in the population vary significantly from one country to another.
Specialists, however, agree on a working approximation giving a minimum benchmark of 2.5% of children aged
0-14 with self-evident moderate to severe levels of sensory, physical and intellectual impairments. An additional
8 can be expected to have learning or behavioural difficulties, or both. These estimates were found to be useful
in the detailed analysis of statistics on incidence and prevalence of childhood disability in the UNICEF study on
Children and Disability in Transition in CEE/CIS and Baltic States (UNICEF, 2005). They are based on
research and data gathered over years in countries with the highest human development rankings.

ATTITUDES TOWARDS SICK -DISABLED CHILDREN

It is important to note that culture plays an important role on how children and adults with disabilities
are identified and served in a country.
For instance in Tanzania, they believe that the basis of life lies on the values and norms of the society,
where every person regardless of the differences has dignity, equal opportunity to education and respect. A
study done in Tanzania by Polat (2011) stresses that, inclusive education aims to build a society that promotes
equal opportunities for all citizens to take part in and play their role in development of the nation. Based on
principles of indigenous customary education and traditional African socialism, everybody was included and
was assigned roles according to their abilities. Those principles and values have been emphasized in Tanzania’s
“Development Vision 2025 (1-3)” where the goal is to build a society that promotes the same chance for all
residents to participate in and contribute to the improvement of the nation. Special attention is directed to
women, children, the youth and disabled persons (Polat, 2011).
Durand (2010) also reported that in Tanzania, children with disabilities were thrown away, killed or
being locked inside the house cages because of being associated with bad luck in the family. Most of the
children with disabilities in Tanzania and in developing countries like Ghana are still out of school because of
social and cultural reasons attached to them. Such cultural beliefs have largely affected disabled children’s
rights to education, social living and justice. But it was not until the transitional period when new understanding
and knowledge raised concerns about persons with disabilities in the communities where humanity resulted into
the attempt to serve these children (Skojorten, 2001)

PRACTICES OF CAREGIVERS
In responding to their children’s illness, caregivers institute presumptive treatment which may occur at
all levels of the healthcare system, but is most common within the informal sector, which includes self-treatment
at home or at a local drug shop (Chibwana et al., 2009). At home, caretakers typically diagnose their children
based on the presence of fever, and self-treat with medicines stored in the house (Assefa et al., 2008). In local
drug shops, caretakers purchase any available drug of their choice without a prescription (WHO, 2010).
Presumptive treatment may also occur at local health facilities when diagnostic capabilities are not available, but
there is a professional health worker present to make a more informed diagnosis (WHO, 2010).

PERCEPTION OF CAREGIVERS TOWARDS CHILDHOOD ILLNESS

Cultural beliefs and attitudes especially affect how a family perceives a child’s illness as well the
healthcare and treatments options available to them (Ogunrinde et al., 2012). It also affects what they decide
about, where and when to seek help. Many societies have their own beliefs and classification for illnesses.
Diarrhoea for example, may not always be described as a single disease. Different types of diarrhoea can have
local names and there may be local beliefs about symptoms, causes and treatment. Families may seek treatment
for some types of childhood diarrhoea depending on how they think the illness is. When a child becomes ill, a
family may seek advice from several sources and try a variety of treatments. The first is usually home
medication based on local beliefs about the illness and the advice from family, friends and neighbours. Only
later will they visit a traditional healer, a pharmacist or a physician (Hoan et al., 2009).

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...
METHODS
This study was a quantitative research design which was descriptive in nature. This study utilised the
convenient sampling technique. As such, in this study, the caregivers who were met first were sampled till the
target sampling size of 200 was met and this took from August to September of 2019.
A set of questionnaire was used to collect data. The questions on the questionnaire consisted of both
closed and open-ended questions.
Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) software version 21.
Descriptive analysis was performed and the results expressed as means and percentages. The Pearson’s test was
used to test the difference between two independent groups.

RESULTS PRESENTATION AND DISCUSSIONS

Table 4.1 shows the demographic characteristics of the respondents, 57% were females. This supports
the Ghana Statistical Report in 2014 which revealed that the within the Bawku Municipality females are more
than males. Also, 8% had primary level education, 15% had middle school education whilst 12% had no formal
education As a native area with indigenes, the Statistical Report indicated that the populates are less educated
and this is in line with this study. Also, 49% been Muslims. Likewise, the Ghana Housing and Population
Census in 2010 revealed a Muslim dominant society but with less to no education rates.

Table 4.1: Socio-Demographic characteristics of the respondents

Socio-Demographics Freq (N=200) Percent (%)
Level of Education
Primary 16 8.0
JHS 30 15.0
Secondary 62 31.0
Tertiary 68 34.0
None 24 12.0
Gender
Male 86 43
Female 114 57
Religion
Christian 82 41.0
Muslim 98 49.0
Traditional 20 10.0
Source: Field Survey, (2019)

Recognizing and responding to childhood illness should be evaluated and treated by a trained health
care provider is very important to averting death (WHO, 2013). Likewise in this study, all respondents were
aware that their children were sick and they have been sick for some days. Caregivers according to the World
Health Organisation should recognize when children displays signs of severe disease. Similarly, the first sign
they noticed was fever (32%) whilst 65% noticed other signs such as not feeding well (92.3%), weakness
(92.3%), shivering (92.3%) cough

Table 4.2 Respondents Knowledge on Childhood Illness

Variable Freq (N=200) Percent (%)
Duration
Days 200 100.0
First sign notice
Cough 30 15.0
Not feeding 32 16.0
Weakness 12 11.0
Difficulty in breathing 18 9.0
Fever 64 32.0

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...

Vomiting 18 9.0
Diarrhoea 8 4.0
Shivering 4 2.0
Convulsing 4 2.0
Any other sign
Yes 130 65.0
No 70 35.0
What other signs
Cough 60 46.2
Not feeding 120 92.3
Weakness 120 92.3
Difficulty in breathing 60 46.2
Fever 14 10.8
Vomiting 100 76.9
Diarrhoea 100 76.9
Shivering 120 92.3
Convulsing 110 84.6

Cause of the illness

Germ/microorganism 121 60.5
Spiritual 4 2.0
Wrong medication 28 14.0
Poor feeding 10 5.0
Dirty water 37 18.5

Severity of illness
Severe 55 27.5
Moderate 78 39.0
Mild 67 33.5
Identify severity of illness
Combined symptoms 156 78.0
Illness continues for long 44 22.0
time

Source: field Survey, (2019)

and difficulty breathing (46.2%), vomiting and diarrhoea (76.9%). Likewise, 72.5% of respondents thought their
children’s illness to be mild/moderate due to the combined symptoms that was exhibited (78%). This is in line
with a WHO sponsored survey in which they reported that most mothers saw the child’s behaviour which
interfered with household activities such as crying or restlessness. Only a few that took notice about signs
associated with eyes and changes in the appearance of stools as some of the vital signs to serious ailment.
Webair & Bin-Gouth (2013) and Assefa et al. (2014) revealed similar findings.

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...

Source: field Survey, (2019)

Figure 1: Stratification of Respondents Age against Knowledge about Child Illness.

Figure 1 gives a stratification of respondents’ age against knowledge about child’s illness. All age groups knew
their child was sick.
Studies by Mwenesi et al. (2005), Nyamongo (2002) and Thind & Cruz (2003) as well as Beegle et al. (2011)
found results which corroborates with this study. They found that understanding the signs and symptoms of the
child results in prompt medical treatment.
Table 4.3 Respondents’ Perception on Causes of Illness
Variable Frequency Percent
(N=200) (%)
Child’s illness is due to
Witchcraft 8 4.0
Sorcery 16 8.0
Curse 12 6.0
Cultural practices 18 9.0
Orthodox medication 22 11.0
Herbal medication 114 57.0
Incurable disease 8 4.0
Partner conflict 27 13.5
Complimentary feeding 24 12.0
Poor maternal hygiene 30 15.0
Source: field Survey, (2019)

Cultural beliefs and attitudes especially affect how a family perceives a child’s illness as well the
healthcare and treatments options available to them (Ogunrinde et al., 2012). This assertion supports this study
in that from table 4.3, respondents perceived that their children’s illness was due to herbal medications (57%),
complimentary feeding (11.0%), partner conflict (13.5%), orthodox medication bought from vendor (12%),
cultural practices (9%) and sorcery (8%).
In responding to their children’s illness, caregivers institute presumptive treatment which may occur at
all levels of the healthcare system, but is most common within the informal sector, which includes self-treatment
at home or at a local drug shop (Chibwana et al., 2009). This is in line with this study since 75% sent their ward
to a health facility after three days of illness (70%) when presumptive treatments have failed.

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...
Respondents (30%) sometimes and usually seek treatment at traditional homes when child is ill and hence 84%
usually use herbal remedies as home management for their wards whilst 11.5% have ever been to the traditional
healer to seek treatment for their child. This is in line with the World Health Organisation affirmation that in
most rural African areas and elsewhere in developing countries, people rely on traditional medicines. Caregivers
continue relying on traditional medicine because they live in remote areas where modern medicine is not
accessible hence they have the habit of seeking traditional medicine. Furthermore, people prefer traditional
medicine to modern medicine because they believe that they are effective and have few side effects (Gyasi et al.,
2011).
During childhood ailment, the father makes decision on the choice of treatment (94.5%) to be
instituted. This corroborates with the conclusion of Mbagya 2005 and Howard et al. (2010).
Economic factors influencing respondents’ (Table 4.5) choice of care and practices for their sick children under
five years were their low income levels (81.5%), lack of transport during illness (61%), high cost of medical
care (51.5%) and high cost of transport (43.5%). The study findings are in line with those of Ajibade et al.
(2013), Taffa & Chepngeno (2005), Ouathara et al (2011) and Littrell et al. (2011).

Table 4.4 Respondents’ Practices during Child Illness

Variable Freq Percent (%)
(N=200)
First response to child illness
Health facility 150 75.0
Traditional treatment 18 9.0
Self-treatment at home 10 5.0
Buy from pharmacy without 16 8.0
prescription
Treat with holy water 4 2.0
Did nothing 2 1.0
Duration before seeking medical
care
Same day
After a day 30 15.0
After two days 30 15.0
After three or more days 140 70.0
Seek treatment at traditional
homes
Yes 32 16.0
No 140 70.0
Sometimes 28 14.0
Treat child using herbs
Yes 168 84.0
No 32 16.0
Decision for child’s treatment
Father of child only 189 94.5
Both parents 11 5.5
Ever consulted a traditional
healer
Yes 23 11.5
No 177 88.5
Source: field Survey, (2019)

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...
Table 4.5 Respondents’ Economic Factors Influencing Choice of Care
Variable Freq (N=200) Percent (%)
Lack of transport during illness 55 61.0
Low income levels 115 81.5
High cost of medical care 103 51.5
High cost of transport 61 43.5
Lack of insurance 57 16.5
Employer not permitting 54 7.6
caregivers
Busy nature of job of care giver 26 13.0
High cost of orthodox medicines 40 20.0
Source: field Survey, (2019)

Socio-cultural factors influencing respondents’ choice of care and practices for their sick children
under five years were their low level of education (37.5%), lack of adequate health information (42%), lack of
support from partner (34%) and cultural barriers/beliefs (18%). The findings support those of Kaatano et al.
(2010), Davy et al. (2010) and Getahun et al (2010).

Table 4.6 Respondents’ Socio-Cultural Factors Influencing Choice of Care

Variable Freq (200) Percent (%)
Socio-cultural factors
Low level of education of caregiver 75 37.5
Lack of adequate health information 84 42.0
Marital conflict 22 11.0
Polygamous marriage 26 13.0
Conflict with other family members 7 3.5
Large family size 47 23.5
Lack of support from partner 68 34.0
Lack of support from relatives 46 23.0
Cultural beliefs/barriers 36 18.0
Religious beliefs/barriers 30 15.0
Single parenthood 28 14.0
Infidelity 9 4.5
Source: field Survey, (2019)

IV. CONCLUSION
This research study aimed at assessing the knowledge, attitude and practice of caregivers towards sick
children under- five years in a local indigenous setting of Bawku and concludes that there is a significant
relationship between age, educational status, marital status as well as religious affiliation and the three variables.
Caregivers are usually aware of their children’s illness through the signs they exhibit but they usually term it as
a mild illness.
Caregivers do not seek prompt treatment unless after the child exhibit the symptoms for more than
three days and this decision is solely that of the child’s father.
Caregivers are reluctant to stop their daily routine to take care of their child since they see the symptoms to be
minor symptoms for ailment.
Economic factors such as low-income levels, lack of transport during illness, high cost of medical care
and high cost of transport influence caregivers choice of care and practices for their sick children under-five
years.
Socio-cultural factors such as low level of education, lack of adequate health information, lack of
support from partner and cultural barriers/beliefs influence caregivers’ choice of care and practices for their
disabled sick children under five years.

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 Knowledge, Attitude and Practices of Caregivers towards Disabled Children under- Five Years...
5.3 RECOMMENDATIONS
Based on the findings of this study, the following are recommended;
1. There is need to have an effective and functioning referral system in the health care delivery system to
ensure children are attended promptly in health facilities at the onset of any illness.
2. Mass communication and vigorous campaign for the population on seeking treatment early in
recognized health care institutions.
3. Socio-economic development of the rural community through income generating can reduce poverty
levels hence improve healthcare seeking behaviour during the childhood illness.
4. Further studies should be carried out to address access and utilization of health care, water sanitation,
hygiene, use of herbal remedies and their implications.
5. Scope for further longitudinal study design to address specific management of childhood illness.

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1
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