This is a cross-sectional study conducted to determine the educational needs of mothers about using Oral Rehydration Salt (ORS) at home during acute diarrhea in children under 5 years of age covered by Urmia Population Research Centers. The study was conducted two months after the approval of the Research Council of Urmia University of Medical Sciences. From Urmia city health centers, 3 population research centers were selected as field of research. A health worker was selected from each of the selected centers in order to complete the questionnaires. The selected health workers were trained about questionnaires and items completed in the presence of the researcher as a test. Health workers with a list of mothers with children under 5 years old were extracted and interviewed and completed a health questionnaire. Clients who didn t want to cooperate were excluded from the list and other mothers after obtaining written consent, a semi-structured questionnaire " Educational needs for use ORS at home during acute diarrhea in children under 5 years was determined by interviewing health professionals. In this study the total number of samples was 460. The questionnaire included questions on demographic characteristics such as age, literacy and maternal occupation, place of residence, access to health services at home. Mothers were asked about how to prepare ORS. The variables studied were: health centers, maternal age, maternal literacy, residence, age of the father, adult child literacy. The collected data were entered into the computer using SPSS software. Descriptive-analytic statistics were used for data analysis. Demographic data and level of knowledge and attitude about ORS were analyzed using SPSS software. P <0.05 was considered statistically significant.

There was a significant relationship between mothers' educational needs in the cognitive domain of using ORS and three health centers (P <0.001).  There was no significant relationship between mothers' educational needs in the cognitive domain regarding the use of ORS and maternal age (P = 0.730). There was no significant relationship between mothers 'educational needs in the cognitive domain of using ORS and mothers' literacy (P = 0.198).  There was a significant relationship between mothers' educational needs in cognitive domain regarding the use of ORS and place of residence (P <0.001). There was no significant relationship between the educational needs of mothers in the cognitive domain regarding the use of ORS and the literacy of adult children in the family (P = 0.983).  There was no significant relationship between mothers' educational needs in cognitive domain regarding the use of ORS and the number of children (P = 0.487). There was a significant relationship between mothers' educational needs in cognitive domain about using ORS and the age of the father (P = 0.038).

 There was a relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and the health center (P <0.01). There was no significant relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and the age of the father (P = 0.117). There was no significant relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and maternal literacy (P = 0.093). There is a significant relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and the place of residence (p=0.02). There was no significant relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and the literacy of adult children (P = 0.388). There was no significant relationship between the educational needs of mothers in the attitude domain regarding the use of ORS and the number of children (P = 0. 213). Table 1, Table 2.

In this study, health workers collected information about the knowledge and attitudes of the mothers and this will promote the quality of health services. Several studies have been conducted to evaluate the knowledge about the use of ORS in diarrhea patients, which has shown that maternal literacy has a significant impact on the performance of ORS use in diarrhea 8910. Which is not consistent with our study findings (P = 0.198). Also in a study by Thammanna et al. lastly, there was a significant relationship between maternal literacy and knowledge about the use of ORS (p = 0.0027), which is not consistent with our study findings (p = 0.198) 6. The results of studies by Salmalian showed that mothers had more knowledge (84%) about moderate diarrhea and poor performance (50%). Mothers' knowledge and practice with a variable occupation, literacy level, place of residence, number of children, birth order, child's age, child care information at the time of diarrhea, the most important source of information was significant (P <0.05). The residence was consistent with this study and was not consistent with literacy, number of children, and age of father 4. Studies by Shams et al. found that there was a significant difference between mothers' knowledge and their literacy, which was not consistent with the findings of our study 11. The results of the Omokhodion FO et al. study suggest that environmental health may be the major determinant of diarrhea among children, which is consistent with the findings of the present study(p=0.02) 12. Mothers with one or two children had higher the level of knowledge than mothers with four children or more (p <0/0001) and this is not consistent with the results of the present study (P = 0.487). Mothers with low age than 35-year-olds were more aware (p <0.04) than mothers of 35-year-olds and above (P = 0.730) 13. Literate mothers compared to illiterate mothers (38.7% vs. 22.6%). Significantly (p=0.002 ) used ORS and this was not consistent with the study findings (p = 0.198) 14 .In the study by Kalahi et al. It was shown that mothers' knowledge and practice about diarrhea is not appropriate 15. Health care workers are the best educational channels, so ORS information is generally better transmitted by health care providers 16. Better results can be achieved by engaging health care providers in determining the mothers' educational needs and by training health workers. The situation of ORS using in patients with diarrhea below 5 is not satisfied, therefore, health education, information dissemination, and community dialogue should create and develop a positive attitude and practice towards better prevention and management of less than 5 diarrheal diseases 1718. The results of the study by Onwukwe et al. show that mothers' knowledge and attitude about ORT is related to the ability to initiate ORT at home (p = 0.000) 19. Educating mothers on the use of ORS in the treatment of diarrhea may be a powerful tool for identifying acute diarrhea and dehydration in the children and treating them orally at home with ORS by mothers 20. A structured curriculum aimed at health care providers and mothers focused primarily on the management and prevention of diarrhea can improve clinical outcomes in children under 5 years old 21.