Garcia et al. Int J Gastroenterol Hepatol Transpl Nutr 2016;1(iv): 27-35

ISSN 2455–9393

27

Original Article

Acute gastroenteritis and its impact on the quality of life of parents and

children

Jacqueline V. Garcia, Portia Menelia D. Monreal, Mylah L. Tuazon

ABSTRACT

Aim: To assess the impact of acute gastroenteritis on the quality of life of both parents

and children ages 3mos-5years old.

Methods: A prospective study with Ninety-five respondents recruited based on

inclusion/exclusion criteria for a duration of six months (April 2016-September 2106)

at a local government hospital in the Philippines. A Self-administered standardized

questionnaire was given to parents.

Results: Acute gastroenteritis moderately affected the children’s sleep. They were

noted to become more clingy, irritable and sad. Parents themselves became severely

worried. Their sleep, daily activities inside the home, level of energy, and social

interactions were moderately affected. In addition, Acute Gastroenteritis also brought

moderate stress to the parents. They became mildly upset, frustrated, guilty,

embarrassed and helpless. Moreover, there was no significant association

demonstrated between the demographic status of the parents and the negative impact

on their physical, emotional and social interaction because of the children’s

gastroenteritis. Furthermore, there was a statistically significant association between

the symptom severity of gastroenteritis with the child’s functional and emotional

symptoms. Conversely, Acute gastroenteritis did not show statistical significant

association with the physical and emotional status of the parents. It significantly

affected their social interaction with other family members, friends and extended

family.

Conclusion: Acute gastroenteritis affects the quality of life of both parents and

children and poses a significant negative impact on their daily lives. Relevant

measures such as proper counseling on sanitation and hygiene, nutrition and

vaccination by healthcare practitioners are therefore imperative to prevent the disease

occurrence.

INTRODUCTION

Acute diarrhea in children usually presents as a change in

normal bowel habits, defined as a substantial increase in stool

frequency and/or a decrease in stool consistency. Its severity can

be related to the child’s age, nutritional status, and the

underlying cause of diarrhea. Acute diarrhea is frequently

caused by a gastrointestinal infection, which is often

accompanied by vomiting, fever, and dehydration.7

According to the Department of Health (DOH) in the

Philippines’ statistics in 2010, acute gastroenteritis is one of the

top 10 leading cause of mortality in children 1-4years old.19

Often, rotavirus is the leading cause of acute gastroenteritis

(AGE) and the most frequent cause of severe diarrhea in

children aged less than 5 years. It is estimated that rotavirus

acute gastroenteritis (RVGE) is the cause of 611,000 deaths

annually in children aged less than 5 years, of which

approximately 230 occur in the European Union. Diarrhea

International Journal of Gastroenterology, Hepatology,

Transplant & Nutrition

Pasig City General Hospital, F. Legaspi Street, Maybunga, Pasig City, Philippines

Address for Correspondence:

Jacqueline V. Garcia

E-mail: jacky_vergara@yahoo.com

Access this article online

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Website:

www.journal.pghtn.com

Key words: dif Acute gastroenteritis, Quality of life, HRQL, Pediatric

Garcia et al. Int J Gastroenterol Hepatol Transpl Nutr 2016;1(iv): 27-35

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28

remains a common cause of physician visits and hospital

admissions in children aged less than 5 years.3 While the clinical

aspects have been well described in different studies, little

information is available regarding the emotional, social, and

physical impact of acute gastroenteritis on the family of a sick

child.6 In a research by Mast et al, an observational study was

done on families to show the impact of rotavirus gastroenteritis

which was based on focus groups and individual interviews with

parents. It also presents information regarding the clinical

severity of illness associated with rotavirus-positive and

negative gastroenteritis, and results from a questionnaire asking

parents to rank the importance of various factors associated with

their child's illness. Results showed that most parents felt that

gastroenteritis was worse than other common childhood disease.

Many parents missed several days of work, and several stated

that caring for their sick child had substantially disrupted their

sleep, meal preparation, and the timely completion of other tasks

such laundry and housecleaning. Episodes of rotavirus

gastroenteritis were sometimes disruptive with respect to social

events.6

Johnston et al7 came up with a conceptual framework for

Health-related Quality of Life (HRQL) assessment in Acute

Gastroenteritis, wherein they were able to counsel and interview

25 parents to formulate a self-administered standardized self-

assessment for both parents and children. The HRQL for

children is based on signs and symptoms as well as changes in

behavior as reported by parents, which included 2 domains

(physical and emotional health). For parents, the HRQL

includes 3 domains (physical, emotional and social). The

development of quality life instruments for acute gastroenteritis

is a relatively new area of research.

As pediatricians, we should have a holistic approach in dealing

with a sick child, thus we also need to learn more about the

child and parents’ emotional, psychological, physical and the

social impact of the illness. Therefore, this study will present the

survey findings of the impact of acute gastroenteritis on the

parent’s quality of life in a local government hospital in Metro

Manila.

SIGNIFICANCE OF THE STUDY

This study will help assess the impact of acute gastroenteritis in

both the child and parents’ quality of life. On the other hand, it

will help parents become more compliant in the prevention of

acute gastroenteritis. A better understanding of

how gastroenteritis impacts the family can help healthcare

providers ease parental fears and advise them on the

characteristics of this illness, practices to prevent infection, and

the optimal care of an affected child.

OBJECTIVES

General Objective:

To assess the impact of acute gastroenteritis on the quality of

life of both parents and children ages 3mos-5years old.

Specific Objectives:

1. To describe the demographics as to age, sex, educational

attainment, occupation, marital status, number of children,

monthly income, healthcare/day care training of

respondents and the rotavirus vaccine status of their child.

2. To determine the physical and emotional health status of

children ages 3mos-5 years old with acute gastroenteritis

using the Child Acute Gastroenteritis Questionnaire Self-

Administered Standardized Format (CAG-SAS) answered

by the parents. (APPENDIX E)

3. To determine the physical, emotional and social health

status of parents with children who have acute

gastroenteritis ages 3mos-5 years old using the Parent

Acute Gastroenteritis Questionnaire Self-Administered

Standardized Format (PAG-SAS). (APPENDIX F)

4. To determine the association of socio-demographic factors

of the parent with their physical symptom, emotional health

and social interaction as a result of their child’s

gastroenteritis.

5. To determine the association of the child’s acute

gastroenteritis symptom to the functional symptom and

emotional health of the child and the physical, emotional

and social function of the parent.

Definition of Terms:

Acute Gastroenteritis- according to the definition used by

European Society of Pediatric Gastroenterology,

Hepatology and Nutrition and the European Society for

Pediatric Infectious Disease as a decrease in consistency of

stools ((loose or liquid) and/or an increase in frequency of

evacuations (typically ≥ 3in 24 hours) with or without fever

or vomiting. 7

Quality of life- pertains to the physical and emotional

status of children with acute gastroenteritis and their

parents’ physical, emotional and social status.

Chronic/ Persistent diarrhea- diarrhea of more than or equal

to 14 days.

Child Acute Gastroenteritis Questionnaire Self-

Administered Standardized Format (CAG-SAS)- a 7 point

interval scale self-administered questionnaire answered by a

parent composing of the following elements: Physical

symptoms (diarrhea, vomiting, retching, lethargy, pain,

nausea), Functional symptoms ( eat, sleep, other daily

activities), and Emotional aspect (clingy, irritable,

embarrassed, frightened, sad, others).

Parent Acute Gastroenteritis Questionnaire Self-

Administered Standardized Format (PAG-SAS)- a 7 point

interval scale self-administered questionnaire answered by a

parent composing of the following elements: Physical

function (sleep, daily activities in the home: such as

preparing meals, house cleaning, showering, Daily

activities-outside the home such as shopping, errands, work

attendance), level of energy and others, Emotional function

(worry, upset, frustration, stress, guilt, embarrassment,

helplessness, others), Social function such as interaction

with immediate family and interaction with friends and

extended family.

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INCLUSION CRITERIA

1. Children ages 3mos -5years of age

2. Accompanied by either the mother or father

3. Seen at the emergency, outpatient department and ward

4. Given a diagnosis of acute gastroenteritis

5. With ongoing diarrhea or

6. Had diarrhea within two weeks of resolution

7. Parents who were able to sign a consent form to answer a

validated self-standardized self-assessment survey

questionnaire in tagalong with English subtitle.

EXCLUSION CRITERIA

1. Children admitted to the hospital because of severe acute

gastroenteritis requiring extended clinical observation.

2. Children with diarrhea for ≥14 days (suggestive of chronic

or persistent diarrhea)

3. Children with serious chronic disease (e.g. sepsis, global

developmental delay, immune, cardiac, non-intestinal

infections, pneumonia, malnutrition).

ETHICAL CONSIDERATIONS

The study protocol and informed consent was approved by the

Research and Ethics Committee of our hospital. Informed

consent was obtained from each participant.

PARTICIPANT RECRUITMENT

This study was conducted at a Local Government hospital in

Metro Manila from April to September 2016. Parents were

asked to sign a written consent form prior to participation (see

Appendix C). The parents who were selected have children with

ongoing acute gastroenteritis or parents whose children had

diarrhea within 2 weeks of resolution. All the children were seen

at the emergency room (ED), out-patient department (OPD) or

ward.

METHODOLOGY

A Letter was emailed to Dr. Bradley Johnston (see appendix A)

to ask permission for the usage of the 7-point standardized self-

administered rating scale. The questionnaires (CAG-SAS and

PAG-SAS) were adapted from Dr. Johnston’s conceptual

framework for health-related quality of life assessment

published in Canada7. The respondents were asked to rate the

statements from 1 to 7 depending on how they observe the

physical, emotional and functional symptoms of the child as

well as how parents has severely affected their physical,

emotional and social interactions.

Questionnaire validation

After permission was granted by the author (APPENDIX B), the

CAG-SAS and PAG-SAS were translated in tagalog. The

tagalog format with english subtitles were tested for reliability

in local settings, a test and re-test were done to thirty parents of

admitted patients asking them to take the test on day 1 and to

recall the condition of the patient on admission for the retest

done on day 3. A written informed consent (see Appendix B)

was secured before participation. The pearson-r coefficient of

reliability test was employed to the test and re-test of the CAG-

SAS and PAG-SAS tagalog with english subtitle questionnaires.

Both questionnaires showed a high positive correlation. CAG-

SAS obtained a coefficient of 0.86 and PAG-SAS a coefficient

of 0.90. This means that the respondents were consistent in their

responses. The questionnaires are reliable and can be used in the

present study at local settings (see Appendix H).

After reliability testing, the tagalog CAG-SAS and PAG-SAS

with English subtitle were administered to parents of children

(3mos-5y/o) with acute gastroenteritis on the first day of

admission at the Out-patient, ward and emergency department.

Data were collected and interpreted. At the end of the study, the

participants were gathered and a lecture was given regarding

acute gastroenteritis its prevention and the impact to the

participants.

STATISTICAL ANALYSIS

The data gathered were analyzed using descriptive statistics.

The weighted mean was used as a measure to determine the

consensus among the responses.

Chi square test with a p value of <0.05 was used to determine

the significance of association between:

a. Demographics and the symptom severity of child’s

gastroenteritis;

b. Symptom severity of the child’s gastroenteritis and the

physical, functional and social interaction of both the parent

and the child.

RESULTS

Table 1: Demographic characteristics of respondents

Respondents (n=95)

n %

AGE

19-25 37 39.0 %

26-32 27 28.4%

33-39 25 26.3%

40-46 6 6.3 %

Total 95 100%

GENDER

Male 6 6.3%

Female 89 93.7%

RELATIONSHIP TO PATIENT

Father 6 6.3%

Mother 89 93.7%

MARITAL STATUS

Not Married 35 36.8%

Married 51 53.7%

Separated 9 9.5%

TOTAL NUMBER OF CHILDREN

1-2 59 62.1%

3-4 25 26.3%

5 & above 11 11.6%

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EDUCATIONAL ATTAINMENT

H.S. Level 39 41.1%

H.S. Graduate 22 23.2%

College Level 21 22.1%

College Graduate 13 13.7%

OCCUPATION

Employed 32 33.7%

Not Employed 59 62.1%

Self-Employed 4 4.2%

MONTHLY INCOME

< 1000 php 26 27.4%

1000-4999 34 35.8%

5000-9999 15 15.8%

10000 &above 20 21.0%

HEALTHCARE/DAYCARE TRAINING

YES 11 11.6%

NO 84 88.4%

ROTAVIRUS VACCINE OF PATIENT

YES 11 11.6%

NO 84 88.4%

Table 1 presents the profile of the respondents in the study. The

respondents were the parents of the children brought to the

emergency department, outpatient unit or admitted at the ward.

Out of the ninety-five (95) parents, 39% (n=37) were in the age

group 19-25 years old. Majority were mothers of the patients at

93.7% (n=89), 53.7% (n=51) of whom were married. 62.1%

(n=59) of them have an average of 1-2 children.

With regards to educational attainment, 41.1% (n=39)) were

high school undergraduate. Occupational status showed that

62.1% (n=59) were unemployed and this was more than half of

the surveyed participants. According to family size, the present

study showed that majority of the families belong to the low

socio economic status with Php1,000-4,999 monthly income.

Table 2: Demographic characteristics of children

Patients

Frequency %

AGE

< 1 y/o 43 45.3%

1-2 y/o 35 36.8%

3-5y/o 17 17.9%

Total 95

GENDER

Male 54 56.8%

Female 41 43.2%

Table 2 shows that majority of children enrolled in the study

were less than 1 year old and predominantly male at 56.8%

(n=54).

Table 3: Summary of responses of the respondents in the Child Acute Gastroenteritis Questionnaire Self-Administered

Standardized Test (CAG-SAS)

Level of Severity n (%)

None Very Mild Mild Moderate Severe Very Severe Extremely Severe

A. Physical Symptoms

1. Diarrhea 8

(8.4%)

3

(3.2%)

12

(12.6%)

37

(38.9%)

27

(28.4%)

3

(3.2%)

5

(5.3%)

2. Vomiting 21

(22.1%)

5

(5.3%)

12

(12.6%)

31

(32.6%)

19

(20.0%)

4

(4.2%)

3

(3.2%)

3. Retching 39

(41.0%)

13

(13.7%)

10

(10.5%)

16

(16.8%)

12

(12.6%)

2

(2.1%)

3

(3.2%)

4. Lethargy 10

(10.5%)

10

(10.5%)

11

(11.6%)

39

(41.1%)

18

(18.9%)

4

(4.2%)

3

(3.2%)

5. Pain 30

(31.6%)

9

(9.5%)

12

(12.6%)

24

(25.3%)

14

(14.7)

3

(3.2%)

3

(3.2%)

6. Nausea 26

(27.4%)

12

(12.6%)

11

(11.6%)

27

(28.4%)

15

(15.8%)

2

(2.1%)

2

(2.1%)

B. Functional Symptoms

1. Eating 10

(10.5%)

22

(23.2%)

24

(25.3%)

28

(29.5%)

9

(9.5%)

0

(0.0%)

2

(2.1%)

2. Sleeping 8

(8.4%)

6

(6.3%)

19

(20.0%)

45

(47.4%)

12

(12.6%)

3

(3.2%)

2

(2.1%)

3. Other Daily Activities

(playing)

21

(22.1%)

13

(13.7%)

17

(17.9%)

32

(33.7%)

7

(7.4%)

2

(2.1%)

2

(2.1%)

C. Emotional Function

1. Clingy 13

(13.7%)

7

(7.4%)

11

(11.6%)

34

(35.8%)

17

(19.9%)

5

(5.3%)

8

(8.4%)

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Level of Severity n (%)

None Very Mild Mild Moderate Severe Very Severe Extremely Severe

2. Irritable 12

(12.6%)

10

(10.5%)

12

(12.6%)

29

(30.5%)

22

(23.2%)

3

((3.2%)

7

(7.4%)

3.Embarrassed 46

(48.4%)

10

(10.5%)

17

(17.9%)

16

(16.8%)

5

(5.3%)

1

(1.1%)

0

(0.0%)

4. Frightened 30

(31.6%)

10

(10.5%)

19

(20.0%)

21

(22.1%0

6

(6.3%)

3

(3.2%)

6

(6.3%)

5. Sad 12

(12.6%)

11

(11.6%)

21

(22.1%)

28

(29.5%)

13

(13.7%)

3

(13.2%)

7

(7.4%)

Table 3 shows the summary of the 3 domains of CAG-SAS.

Each parent answered the questionnaire and the results

demonstrate how each parent perceives his/her child as regards

the latter’s clinical and emotional status during the time of

hospitalization.

For the physical symptoms, 38.9% of parents reported the

diarrhea of their child as moderate in degree while 32.6%

graded vomiting as moderate. There were 28.4% children who

experienced moderate nausea. On the other hand, 41%

respondents reported that their child did not experience retching.

There were 8 (8.4%) parents who answered “none” to the

question on the severity of the diarrhea. This may mean that

they did not perceive the diarrhea of their child as severe or they

probably have not fully understood the survey questions.

For the functional symptoms, Acute Gastroenteritis moderately

affected the children’s eating (29.5%), sleep (47.4%) and their

daily activities such as playing (33.7%).

For the emotional discomfort/distress of the children, 35.5%

became moderately clingy to their parents, 30.5% became

moderately irritable. 48.6% did not become embarrass and 30%

were not frightened., 29.5% of these children were observed to

be moderately sad during the illness. Overall, most of the

children have moderate diarrhea, nausea, vomiting and lethargy

which affected their eating sleeping and other daily activities

moderately. These children moderately became clingy, irritable

and sad.

Table 4: Summary of responses of the respondents in the Parent Acute Gastroenteritis Questionnaire Self-Administered

Standardized Test (PAG-SAS)

Level of Severity n(%)

None Very Mild Mild Moderate Severe Very Severe Extremely

Severe

A. Physical Health

1. Sleeping 16

(16.8%)

11

(11.6%0

21

(22.1%)

19

(20.0%)

18

(18.9%)

6

(6.3%

4

(4.2%)

2. Daily activities inside home 18

(18.9%)

11

(11.6%)

17

(17.9%)

25

(26.3%)

9

(9.5%0

11

(11.6%)

4

(4.2%)

3. Daily activities outside home 25

(26.3%)

10

(10.5%)

14

(14.7%)

23

(24.2%)

10

(10.5%)

6

(6.3%)

7

(7.4%)

4. Level of energy 18

(18.9%)

10

(10.5%)

17

(17.9%)

25

(26.3%)

13

(13.7%)

6

(6.3%)

6

(6.3%)

B. Emotional function

1. Worry 7

(7.4%0

8

(8.4%)

11

(11.6%)

24

(25.3%)

20

(21.1%)

10

(10.5%)

15

(15.8%)

2. Upset 23

(24.2%)

12

(12.6%0

11

(11.6%)

24

(25.3%)

12

(12.6%)

6

(6.3%)

7

(7.4%)

3. Frustration 30

(31.6%)

12

(12.6%)

8

(8.4%)

19

(20.0%)

14

(14.7%)

8

(8.4%)

4

(4.2%)

4. Stress 9

(9.5%)

10

(10.5%)

10

(10.5%)

28

(29.5%)

13

(13.7%)

11

(11.6%)

14

(14.7%)

5. Guilt 22

(23.2%)

7

(7.4%)

20

(21.1%)

21

(22.1%)

11

(11.6%)

8

(8.4%)

6

(6.3%)

6.Embarrassment 27

(28.4%)

15

(15.8%)

15

(15.8%)

20

(21.1%)

9

(9.5%)

9

(9.5%)

0

(0.0%)

7. Helplessness 29

(30.5%)

12

(12.6%)

15

(15.8%)

18

(18.9%)

11

(11.6%)

7

(7.4%)

3

(3.2%)

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C. Social interaction

1. Interaction with immediate

family

11

(11.6%)

10

(10.5%)

18

(18.9%)

40

(42.1%)

3

(3.2%)

5

(5.3%)

8

(8.4%)

2. Interaction with friends and

extended family

10

(10.5%)

17

(17.9%)

17

(17.9%)

33

(34.7%)

7

(7.4%)

5

(5.3%)

6

(6.%)

Table 4 shows the summary of responses of the parents. This

shows the effect of the child’s illness to their physical health,

emotional symptoms and social interaction.

In the daily activities of the parent, 22.1% said that their sleep

was mildly affected. Most of the parent’s daily activities outside

the home were not affected (26.3%). But their level of energy

was moderately affected (26.3%).

With regards to the level of anxiety, most of the parents were

moderately worried, upset and stressed, while some did not

experience frustration, guilt, embarrassment and helplessness.

Social interactions with immediate and extended family were

moderately affected.

Table 5: Mean responses of the extent of severity of the signs

and symptoms and the impact of childhood acute

gastroenteritis on children as perceived by parents

Mean Response Interpretation

A. Physical symptoms

1. Diarrhea 4.1 Moderate

2. Vomiting 3.5 Moderate

3. Retching 2.7 Mild

4. Lethargy 3.7 Moderate

5. Pain 3.0 Mild

6. Nausea 3.1 Mild

B. Functional Symptoms

1. Eating 3.1 Mild

2. Sleeping 3.7 Moderate

3. Other Daily Activities 3.0 Mild

C. Emotional Function

1. Clingy 3.9 Moderate

2. Irritable 3.8 Moderate

3. Embarrassed 2.2 Very Mild

4. Frightened 3.0 Mild

5. Sad 3.6 Moderate

Table 5 shows that diarrhea, vomiting and lethargy appeared to

be moderate. Retching, pain and nausea were mildly seen in the

patients. The children’s sleep was moderately affected while

their eating and daily activities were mildly affected. They

became moderately clingy, irritable and sad but mildly

embarrassed and frightened.

Table 6: Mean responses and interpretation of the extent of

impact of childhood acute gastroenteritis on the quality of

life of parents

Mean Response Interpretation

A. Physical Functions

1. Sleeping 3.5 Moderate

2. Daily activities inside

home

3.5 Moderate

3. Daily activities outside

home

3.3 Mild

4. Level of energy 3.5 Moderate

B. Emotional Functions

1. Worry 4.4 Severe

2. Upset 3.4 Mild

3. Frustration 3.2 Mild

4. Stress 4.2 Moderate

5. Guilt 3.4 Mild

6. Embarrassment 3.0 Mild

7. Helplessness 3.0 Mild

C. Social Interaction

1. Interaction with

immediate family

3.6 Moderate

2. Interaction with friends

and extended family

3.5 Moderate

Table 6 shows that among the normal activities of parents,

sleeping, daily activities inside the home and level of energy

were noted to be moderately affected while daily activities

outside the home were mildly affected. The emotional status or

the level of anxiety of the parent show that they became

severely worried while the level of stress is moderate. The rest

of the emotions such as being upset, frustrated, feeling guilty,

embarrassed and helplessness were noted to be mildly affected.

The interaction with the immediate family, friends and extended

family were moderately affected.

Table 7: The association of the demographic characteristics

of the parents to their physical, emotional and social

interactions as a result of child’s gastroenteritis

Physical

Functions of

Parent

Emotional

Functions of

Parent

Social

Interactions

of parent

A. Age of

Parent

p=0.99999

Not

Significant

p=0.99996

Not

Significant

p=0.99999

Not

Significant

B.

Educational

Attainment

p=0.99999

Not

Significant

p=0.99999

Not

Significant

p=0.99999

Not

Significant

C. Monthly

Income of

Parent

p=0.99999

Not

Significant

p=0.988946

Not

Significant

p=0.996154

Not

Significant

D. Number of

Children

p=0.442552

Not

Significant

p=0.939519

Not

Significant

p=0.999799

Not

Significant

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Table 7 shows that there is no significant association between

the demographic characteristics of parents and the effect of the

child’s gastroenteritis on their physical, emotional and social

interaction.

Table 8: Significance of the impact of gastroenteritis to the

quality of life of the child and parent

p - value of chi -

squareata = 0.05

Interpretation

A. Level of Signs and

Symptoms child’s

gastroenteritis and the

functional symptoms of

the child

𝑝 = 0.000024

Significant

B. Level of Signs and

Symptoms child’s

gastroenteritis and the

emotional functions of

the child

𝑝 < 0.00001

Significant

C. Level of Signs and

Symptoms child’s

gastroenteritis and the

physical functions of the

parent

𝑝 = 0.9999

Not

Significant

D. Level of Signs and

Symptoms child’s

gastroenteritis and the

emotional functions of

the parent

𝑝 = 0.467359

Not

Significant

E. Level of Signs and

Symptoms child’s

gastroenteritis and the

social interaction of the

parent

𝑝 = 0.000291

Significant

The severity of the signs and symptoms of gastroenteritis has a

significant impact on the functional health and emotional status

of the child as shown in the p-value of chi-square at 0.05 level

of significance. For the parent, the signs and symptoms of

gastroenteritis of their child has a significant impact on their

social interaction having a p-value of 0.000291.

DISCUSSION

Quality of life (QOL) is an individual’s understanding of his/her

life situation with respect to his/her values and cultural context

as well as in relation to his/her goals, expectations and concerns.

QOL has many dimensions such as material well-being, close

relationships, health, emotional well-being, and productivity.

QOL differs from individual to individual and is dependent on

different factors. This study focuses on the health-related quality

of life of the child as well as the parent. This paper presents

results from a questionnaire designed to be completed by

parents to assess the impact of acute gastroenteritis on affected

children and the parents’ quality of life measurement. The

questionnaire was validated and used as an observational

prospective study of children 3mos-5years of age admitted at the

emergency department, OPD and ward. Ninety-five (95)

respondents were enrolled in this study.

Our findings revealed that children with acute gastroenteritis

moderately affected their sleep, they became more clingy and

lethargic. This was consistent with the findings of Mast el. in his

research wherein children lost their appetite, cuddled a lot with

little energy and became sleepy all the time. In another study by

Versteeg et al (2008)6, children lost their appetite, became weak

and cried a lot. Similarly, in this study, the children also became

sleepy, lethargic, irritable and sad but their daily activities were

just mildly affected. This finding can be explained by their age

since majority was less than one year old.

There were significant findings in the association of disease

severity and the physical function of the child such as diarrhea,

vomiting, retching, lethargy and pain. The more severe the

diarrhea, the more physical symptoms are evident. In this study,

it was shown that the symptoms were predominantly moderate

and it also demonstrated the association of diarrhea with the

emotional function of the child. Similarly, the study done by

Domingo et al. showed that the severity of the diarrhea is

associated with greater changes in the child’s behavior.8

Impact on the parent’s physical symptoms such as sleep, daily

activities inside the home and level of energy were moderately

affected. However, daily activities outside the home such as

shopping, work attendance and errands were mildly affected in

this study since majority of the mothers were unemployed and it

was explained in a similar study by Domingo et al, that mothers

of children under 6months compared to older age groups require

a great deal of parental attention regardless of their health status

and therefore the change in response to illness may be

correspondingly less than in older age groups. This means that

they have freely given their time to be with their children and

have taken cared of them that is why other activities outside the

home were mildly affected. The Impact on parent’s emotional

symptoms revealed that worrying as well as stress were

predominant symptoms and were also seen in other

studies.13,6,29 In the study by Domingo et al, there was no

significance between symptom severity and parental worry.

They found out that the impact on parental worry and disruption

of daily activities vary in different countries. However, in the

study by Mast et al in the USA, findings showed that children

with acute gastroenteritis managed in the ER or hospital settings

have higher stress, anxiety, low sleep and disrupted normal

family life 6 which is comparable to our present study. However,

when chi square was computed, diarrhea did not have any

significant association with the parent’s physical and emotional

symptoms. Since our respondents belongs to a low

socioeconomic status, this might explain that their current

emotional and physical symptoms prior to the child’s diarrhea

such as the level of worry , stress, sleep and activities inside the

home are at the same scale since there are other factors that

could trigger the stress. It can also be explained by the coping

strategies of people in Low socioeconomic group mentioned by

atal et al he states that people in Low socio economic group tend

to be more flexible when deploying different strategies to handle

Garcia et al. Int J Gastroenterol Hepatol Transpl Nutr 2016;1(iv): 27-35

ISSN 2455–9393

34

stressors.” This may explain the non-association of the

emotional and physical symptoms of the parents. The

demographic characteristics of the respondents were similar to a

study by Mast et al6 which were composed mostly of female

mothers (93.7%) and majority are married. The respondents’

age, sex, educational attainment, total number of children,

employment status, and low socioeconomic income were not

significantly associated with the physical, emotional and social

interaction of the parent. In a study entitled, "socioeconomic

health disparities revisited: coping flexibility enhances health-

related quality of life (HRQoL) for individuals low in

socioeconomic status (SES)", people in Low SES tend to be

more flexible and vary their use of coping strategies according

to perceived controllability of stressful situations and this can be

explained by the fact that people from the low SES place value

on acceptance and adjustment and thus may tend to be more

flexible when deploying different strategies to handle stressors.

Coping refers to the thoughts and/or behavior used to manage

the demands of a stressful event.37 An individual with an

increasing in coping flexibility may have a better health related

quality of life.31 This may explain why there is no association

between low economic status and the health-related quality of

life of the parent. The coping flexibility of parents in this study

may also explain why the severity of the child’s diarrhea

symptoms did not significantly affect the parent’s emotional and

physical symptom. However, we were not able to measure the

coping flexibility per se on this study.

The number of children did not significantly associate with the

HRQoL of parents because majority has only 1-2 children per

family in this study. In this study, it was found out that the

severity of gastroenteritis significantly affected the parent’s

interaction with immediate and extended family members. This

maybe because In the Philippines, most of the mothers who are

unemployed and in low socio economic status, interacting with

other family members and neighbours are their primary means

of relaxation. They felt the difference in their daily interactions

when their child had the illness. They have to go to the hospital

and take care of their child. Similarly, in a study by Van der

Wielen, social interactions were affected and parents were not

able to take care of other family members.13 In another study by

O’brien et al, the illness disrupted daily routines of everybody

in the nuclear family. During the illness, parents had to postpone

or cancel their daily tasks to focus on and take care of the sick

baby. Since majority of the parents were young (19-25 years

old) and did not finish high school, there was a limitation of

their knowledge. Most of the parents have no knowledge about

diarrhea and its prevention. Most of the parents have no idea

that there are available vaccines for diarrhea which are often

caused by rotavirus. This explains why there is no significant

association with the parent’s age and educational attainment.

One limitation of the study is that we were unable to monitor

patients who have previous consultations as well as on follow

up consult at the time they are given the survey questionnaires.

Another limitation of this study is that rotavirus isolation was

not done. It focused on acute gastroenteritis in general.

However, in a study by Paje Villar et al in 1992 entitled

“Diarrhea among Filipino Infants and children: clinical and

laboratory correlation,” findings showed that 65.7% of diarrhea

seen in the hospital was due to rotavirus and the subjects were

predominantly male.24 Similarly, children in this study were

56.8% male and majority were less than one year old. In both

diarrhea and control group, higher rotavirus isolates were seen

in the younger age group. Rotavirus was the single most

important cause of acute diarrhea in less than 2 years old. Thus,

among Filipino children, rotavirus vaccination is highly

recommended. Hence, this study may help out in realizing the

need for free rotavirus vaccines at the local health center. It is

also important that healthcare providers educate parents how to

recognize signs of illness or treatment failure that necessitate

medical intervention.

CONCLUSION

Childhood gastroenteritis affects the quality of life of both

parents and children and poses a significant negative impact on

their daily lives. Knowledge and realization of

how gastroenteritis can burden the family brings the healthcare

providers’ focus on the importance of the preventive aspects of

the disease which includes proper hand washing, hygiene and

sanitation and vaccination.

RECOMMENDATIONS

Healthcare education program for parents

Health care provider’s counseling to parents on the burden

of gastroenteritis to stress the importance of prevention

Rotavirus vaccination in the local health centers

Future studies using a larger group/population

Future studies conducted in a private hospital setting or in a

community

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