The role of selected duty-bearers in realising the right to water of children (0-24 months) in Colesberg, Northern Cape, during the nutritional management of diarrhoea in primary health care institutions

Snyman, Susanna (2016-03)

Thesis (MNutr)--Stellenbosch University, 2016.

Thesis

ENGLISH SUMMARY : Introduction: Diarrhoea and malnutrition are some of the main causes of death in children under the age of five years. They are especially prevalent in children from 0 to 24 months that are most vulnerable, since their immune systems are not yet fully developed. It is therefore crucial for their health to have access to adequate and safe water. There are various human rights instruments (both national and international) protecting children’s human rights to water and health. Since children are not able to realise their own right to water, it is the role of duty-bearers to realise their right to water for them. Objectives: The main aim of this study was to investigate whether selected duty-bearers were fulfilling their responsibilities towards the realisation of the right to water of children (0–24 months) residing in Colesberg, Northern Cape, during the nutritional management of diarrhoea in primary health care institutions. The two broad objectives were to investigate if the child’s right to safe and adequate water is being realised and to investigate the prevalence and management of diarrhoea in this study population. Methods: In a cross-sectional observational survey with an analytical component, caregivers of children aged 0–24 months (n=123) from the three feeder clinics of the hospital in Colesberg completed an interviewer-administered questionnaire. Eight nursing practitioners participated in semi-structured interviews. Concepts related to the perceptions, knowledge, attitudes and practices of caregivers and nursing practitioners with regard to the right to water of young children and the management of diarrhoea were investigated. Qualitative data was analysed inductively by identifying, coding and grouping emerging themes to enrich quantitative data obtained from the questionnaires. Results: The children that had not experienced diarrhoea previously were significantly (p<0.05) younger than those that had had diarrhoea (mean age 7 and 12 months respectively). It was highly significant (p<0.05) that those caregivers that knew what oral rehydration treatment (ORT) was, were also able to explain how to mix ORT correctly. Statistical significant (p<0.05) differences were found between the prevalence of diarrhoea in children (mean age 4.8 months) that were eating complementary foods and younger infants who were not yet receiving complementary foods. Caregivers perceived the lack of a constant water supply as a barrier in realising the right to water of their children. Nursing practitioners perceived the intermittent water supply, the poor quality of the water and the caregivers’ actions as barriers to realising the right to water of children. Nursing practitioners were knowledgeable about the management of diarrhoea as well as the treatment and prevention of dehydration. Conclusion: It was found that caregivers and nursing practitioners were fulfilling their role as duty-bearers to the best of their ability in realising the right to water of children but faced several challenges. On behalf of Government as the primary duty-bearer, the municipal government should do more in realising the right to water of children. Recommendations included more education for caregivers with regard to what they can do to realise the right to water of their children 0–24 months with limited resources.

AFRIKAANSE OPSOMMING : Inleiding: Diarree en wanvoeding van kinders tussen 0 en 24 maande is twee van die hoofoorsake van sterftes. Dit is dus noodsaaklik vir hul gesondheid dat kinders toegang sal hê tot voldoende en veilige water. Daar is verskeie menseregte instrumente (beide nasionaal en internasionaal) wat kinders se mensereg tot water en gesondheid beskerm. Dit is die rol van pligtedraers om die reg tot water van kinders namens hulle te realiseer. Doelwitte: Die hoof doelwit van hierdie studie was om ondersoek in te stel of geselekteerde pligtedraers hulle verpligtinge met betrekking tot kinders (0 – 24 maande) wat in Colesberg, Noordkaap woon, nakom. Dit is veral nodig om hulle reg tot water te verwesentlik tydens die voedingsbehandeling van diarree in primêre gesondheidsorg instellings. Die twee breë doelwitte was om vas te stel of die kind se reg tot veilige en voldoende water verwesentlik word en om vas te stel wat die voorkoms en behandling van diarree in hierdie studie populasie is. Metode: ‘n Deursnit waarnemende opname met ‘n analitiese komponent is uitgevoer by die drie voederklinieke van die hospitaal in Colesberg. Versorgers met kinders 0 – 24 maande oud (n=123) het vraelyste wat deur die navorser geadministreer was, voltooi. Agt verpleegkundiges het aan semi-gestruktureerde onderhoude deelgeneem. Konsepte wat gehandel het oor die persepsies, kennis, houding en praktyke van versorgers en verpleegkundiges met betrekking tot die reg tot water van jong kinders en die behandeling van diarree was ondersoek. Data analise van kwalitatiewe data is uitgevoer deur ontwikkelende temas te identifiseer, kodeer en groepeer op ‘n induktiewe wyse om die kwantitiatiewe data wat uit die vraelyste verkry is, te verryk. Resultate: Die kinders wat nooit vantevore diarree gehad het nie was beduidend (p<0.05) jonger as diegene wat vantevore diarree gehad het (gemiddelde ouderdom 7 en 12 maande respektiewelik). Dit was hoogs beduidend (p<0.05) dat die versorgers wat geweet het wat die “orale rehidrasie oplossing (ORO)” was, ook in staat was om te verduidelik hoe om ORO korrek aan te maak. Statisties beduidende (p<0.05) verskille was gevind tussen die voorkoms van diarree in kinders (gemiddelde ouderdom 4.8 maande) wat alreeds komplementêre voedsel eet en jonger babas wat nog nie komplementêre voedsel ontvang het nie. Versorgers was van mening dat die gebrek aan ‘n konstante watervoorsiening ‘n hindernis is in die verwesentllking van hul kinders se reg tot water. Verpleegkundiges het die wisselvallige watervoorsiening, die water se swak kwaliteit en die versorgers se aksies as hindernisse vir die verwesentllking van die reg tot water van kinders beskou. Verpleegkundiges was kundig oor die behandeling van diarree asook oor die behandeling en voorkoming van dehidrasie. Gevolgtrekking: Daar was gevind dat versorgers en verpleegkundiges as pligtedraers hulle rol in die verwesentliking van kinders se reg tot water na die beste van hulle vermoë vervul het. As verteenwoordiger van die Staat as primêre pligtedraer behoort die munisipale regering meer te doen om die reg tot water van kinders te verwesentlik. Dit word aanbeveel dat meer opleiding aan versorgers gegee word met betrekking tot hul rol om die reg tot water van hulle kinders (0-24 maande oud) te verwesenlik wanneer hulpbronne beperk is.

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