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Effect of Oral Rehydration Therapy Availability on Diarrhoea Treatment among Children Under Five in Nigeria

Abstract

Diarrhoeal disease remains an important public health problem among children under five years in Nigeria and is associated with dehydration, malnutrition, impaired growth, and preventable childhood morbidity and mortality. Prompt and appropriate treatment is essential to prevent complications, particularly in settings where children may experience repeated diarrhoeal episodes and access to healthcare services may be limited. Oral rehydration therapy, particularly the timely use of oral rehydration solution (ORS), is a simple and effective intervention for preventing and treating dehydration associated with diarrhoea. However, inadequate availability of ORS at healthcare facilities and in communities, stock-outs, limited caregiver awareness, financial barriers, inappropriate preparation, and delayed healthcare-seeking may affect the extent to which children receive appropriate diarrhoea treatment. Ensuring consistent availability of ORS may therefore improve access to timely treatment and support appropriate management of childhood diarrhoea. Against this background, this study investigates the effect of oral rehydration therapy availability on diarrhoea treatment among children under five years in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Donabedian Model of Healthcare Quality. The Health Belief Model explains how caregivers' perceptions of diarrhoeal disease severity, perceived benefits of ORS, perceived barriers, knowledge, and cues to action may influence their use of oral rehydration therapy. The Social Ecological Model emphasizes the interaction between child, caregiver, household, community, healthcare facility, and broader health-system factors in determining access to and utilization of diarrhoea treatment. The Donabedian Model explains healthcare quality through structure, process, and outcome, with ORS availability representing an important structural component and appropriate diarrhoea treatment serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how oral rehydration therapy availability may influence diarrhoea treatment among children under five years in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise children under five years who experience diarrhoeal illness and their mothers or primary caregivers, as well as selected healthcare facilities providing childhood diarrhoea treatment services in Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, households, and eligible children and caregivers. Oral rehydration therapy availability will be assessed using indicators such as availability of ORS at healthcare facilities, frequency and duration of ORS stock-outs, quantity of ORS available, availability of ORS at community level, accessibility and affordability of ORS, availability of zinc supplementation, adequacy of ORS storage, frequency of resupply, healthcare worker knowledge of ORS, and availability of appropriate treatment guidelines. Diarrhoea treatment will be assessed using indicators such as receipt of ORS during diarrhoeal episodes, appropriate preparation and administration of ORS, use of zinc supplementation where recommended, continued breastfeeding and feeding, appropriate fluid intake, timely healthcare-seeking, treatment adherence, referral for severe illness, recognition of dehydration and danger signs, and avoidance of inappropriate medicines. Data will be collected using structured questionnaires, caregiver interviews, healthcare facility records, pharmacy and medicine registers, stock records, child health records, treatment registers, and facility assessment checklists. Descriptive statistics will be used to summarize caregiver and child characteristics, ORS availability, diarrhoeal episodes, and treatment practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of ORS availability on diarrhoea treatment. Where a quasi-experimental design is adopted, diarrhoea treatment outcomes before and after interventions aimed at improving ORS availability may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that adequate and consistent oral rehydration therapy availability has a significant positive effect on diarrhoea treatment among children under five years in Nigeria. Children whose caregivers have timely access to ORS are expected to have a higher likelihood of receiving appropriate rehydration during diarrhoeal episodes than children in settings where ORS availability is limited. Consistent availability at healthcare facilities and community-level outlets may reduce delays in treatment and encourage caregivers to initiate appropriate rehydration early. The availability of zinc alongside ORS may further support recommended diarrhoea management practices. However, stock-outs, inadequate supply-chain management, limited caregiver knowledge, incorrect ORS preparation, financial constraints, poor healthcare access, cultural beliefs, and inappropriate use of antibiotics or other medicines may reduce the effectiveness of ORS availability. The study therefore expects reliable and continuous availability of oral rehydration therapy, combined with caregiver education and appropriate healthcare guidance, to contribute significantly to improved diarrhoea treatment among children under five years in Nigeria. The study is expected to contribute to the literature on oral rehydration therapy, childhood diarrhoea treatment, ORS availability, child health, primary healthcare, essential medicines, community-based healthcare, treatment-seeking behaviour, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare facilities, pharmaceutical and supply-chain managers, community health workers, child health programme managers, development partners, and policymakers regarding strategies for improving childhood diarrhoea management. The study will also provide evidence-based recommendations for maintaining uninterrupted ORS supplies, strengthening essential medicine supply chains, improving stock monitoring and forecasting, expanding community-level ORS availability, educating caregivers on correct ORS preparation and administration, integrating ORS and zinc into routine childhood illness services, and strengthening monitoring of diarrhoea treatment practices across Nigeria.

Keywords: Oral rehydration therapy, oral rehydration solution, childhood diarrhoea, diarrhoea treatment, children under five, ORS availability, zinc supplementation, essential medicines, primary healthcare, Nigeria, public health.