Knowledge of Early Childhood's Mothers Regarding Toilet Training at Primary Health Care Centers in Alrusafa District in Baghdad City
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4552 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2
Knowledge of Early Childhood‘s Mothers Regarding Toilet
Training at Primary Health Care Centers in Alrusafa District
in Baghdad City
Ahmed Abd-Alkadeem Mohammed1, Eqbal Ghanim Ali2
1
BSN, Ministry of Health/ Enviroment, Directorate of TechnicalAffairs, Department of Nursing Affairs, Iraq,
2Professor PhD, University of Baghdad, College of Nursing, Pediatric Nursing Department, Iraq
Abstract
Toilet training refers to the acquisition of skills necessary for controlling of both the bowel and bladder for
the right use of toilet by child at appropriate age and time. A descriptive study (cross-sectional design)was
used; To aseess the Knowledge of early childhood‘s mothers Regarding Toilet Training and to find out the
relationship between between the knowledge of early childhood‘s mothers’ demographic variables such as
(age, educational level, occupational status et al ….) and their child’s demographic variables (age, gender,
number of children et al….).
Non probability (convenience sample) of (225) early childhood’s mothers (have children’s age between 1-5
years).
The study concludes that the early childhood’s mothers with moderate border to low level of knowledge
regarding toilet training. No significant association among parent’s socio-demographical characteristics
andchild’ssocio-demographical characteristics with the knowledge, except between “Starting toilet training
or not” and knowledge, also significantassociation found between mother’s source of information with
the knowledge. The study recommends that extensive health educational programme should be applied to
increase the early childhood’s mother knowledge regarding toilet training.
Keywords: Early Childhood‘s Mothers, Knowledge,Toilet training.
Introduction was described as the age at which the child was fully
trained in terms of urine and stool [4[, [5], [6].
Toilet training is a training process of the child to
control defecation and urination properly and regularly. There are different types of toilet training methods
Its one of the most difficult facets of early childhood. available, such as the child’s oriented method of Brazelton
So, failure to train can result in serious physical and and the Azrin and Foxx method, other methods include
psychological effects, such as loss of child’s autonomy. variations of operant conditioning, assisted infant toilet
It is not advised that plans concerning toilet training training, and the Spock method [7].
begin when the family experiences major life stressful
events [1], [2], [3]. The number of toddlers who were difficult to control
urination at preschool age reached 75 million children,
There are many signs of readiness which indicate this phenomenon is triggered by many things, one of
that the child is ready for toilet training such as physical, them is the inadequate mother’s knowledge about how to
psychological, and intellectual.Toilet training in general train children to go to the toilet. So,lack of understanding
should be carried out in a child who has started to reach about toilet training among mothers must be determine
the stages of independence, usually between the ages of [8] , [9]
.
18 and 24 months. Completion’s age of toilet trainingIndian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 4553
Fathers and mothers are the primary care givers educational level, family type, crowding index, house
of the children, because they have an important role in ownership, house size, house expenses and possession
toileting process, but it has been revealing that they have of a car),and also include the child’s demographic
only a little knowledge about the toilet training aspects characteristic which include (age, gender, number of
of their children [10]. children, child‘s birth order, starting toilet training
or not, age of starting, and information source about
Toilet training should be an optimistic, non-
the toilet training). The second part is comprised of
threatening and normal process, using reinforcement
structured questions to assess the knowledge of the early
after progress or rewards.Its beneficial in many ways,
childhood’s mothers regarding toilet training. It includes
it reduces necessary care time for the parents, reduces
(20) questions, all were multiple choices question (MCQ)
costs, providing children with a sense of independence,
that having four options with one appropriate option,
and leads to an increase in sanitation [11] &[12].
and it was categorized under the following sub domain
later age of training was more associated with (General information, Influencing factors, Initiation of
showing disruptive behavior. And if it is conducted to toilet training andImportant consideration).
children older than 3 years, the child may experience
To make the instrument more valid, it was presented
developmental decline. Incorrect toilet training may lead
to a panel of (15) expertswhich have more than (10)
to chronic urinary tract infections, enuresis, constipation,
years’ experience in their field. Those experts were
and encopresis [1], [6], [13].
asked to review the instruments of the study. Acceptable
reliability of structured questionnaire format depending
Method of the Study
on the value of the Cronbach’s Alpha which was
A descriptive (cross-sectional design) study was (0.7333).
conducted from the period of 19th September 2020
to the 15th March 2021. The study was carried out in Rating and Scoring:
the primary health care centers (PHCCs) in Alrusafa
Multiple choices question (MCQ) scored for
district in Baghdad city to assess the knowledge of early
the “Knowledge item’s”, using the nominal binary
childhood‘s mothers regarding toilet training.
dichotomous categories responding (True, and False)
Non probability (convenience sample) of (225) early which are scored by (1, 0) scales respectively. Evaluation
childhood’s mothers who attend the (PHCCs), where intervals of relative sufficiency: [L: Low (0.00 – 33.3)];
selected as (10%) from the average of a (3) previous [M: Moderate (33.3 – 66.7)]; [H: High (66.7 – 100)]
monthly visits of mothers to the immunization units. The after transforming both scored to (true, and false) by the
study including two primary health care sectors (PHCSs) values of (1, and 0) respectively.
which was selected as (20%) from all (PHCSs), which
The Statistical Data Analysis
account (10) sectors in Alrusafa district. A total of (6
PHCCs) was selected as (20%) from each sectors “Al- The following statistical data analysis approaches
Sadr Sector” (Third, Al-Shahid Kadeem Abdalnabi, were used in order to analyze and assess the results
Al-Shahid Ibrahim Al-Ashiqi, and Al-Shahid Jamal Al- of the study under application of the statistical
Mousawi) PHCCs, and “Al-Baldiat second Sector” (Al- package (SPSS) ver. (22.0). Descriptive data analysis
Jawadeen, and Al_Imam Mohammed Al-jawad)PHCCs (Frequencies, Percentages, Mean, Standard deviation,
and randomly for the purpose of the study. Relative Sufficiency (RS %), Percentile Grand Mean of
Score, Percentile Global Mean of Score (PGMS), Pooled
The Study instrument
Standard Deviation (PSD %), Reliability Coefficient ans
The tool for the study, including two parts, first Alpha Cronbach). and the Inferential data analysis (One
concerned with the demographic characteristic of early sample Chi-Square test, Binomial test and Contingency
childhood’s mothers such as (age, marital status et Coefficients (C.C.) test).
al…), and the socioeconomic status scale which have
items related to the child’s Parent (occupational status,4554 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2
Results and Discussions
Table (1): Distribution of the parent’s socio-demographical characteristics variables (SDCv.), and the Socio-
Economic Status.
Parent’s (SDCv.) Groups No. %
< 20 29 12.9
20 _29 109 48.4
Age of mother in years 30 _39 75 33.3
40 _ above 12 5.3
Mean ± SD 27.43 ± 6.79
Married 216 96
Divorce 3 1.3
Marital status
Separate 5 2.2
widow 1 0.4
Extended 107 47.6
Type of family
Nuclear 118 52.4
Illiterate 29 12.9
Read & write 37 16.4
Primary graduate 72 32
Educational level of (child’ Father)
Secondary graduate 47 20.9
College graduate 32 14.2
High Education 8 3.6
Illiterate 31 13.8
Read & write 36 16
Educational level of (Mother) Primary graduate 68 30.2
Secondary graduate 65 28.9
College graduate 25 11.1
Employed 105 46.7
Retired 5 2.2
Occupational status (child’ Father)
Free jobs 113 50.2
Unemployed\ House wife 2 0.9
Employed 23 10.2
Occupational status (Mother) Without Work 3 1.3
Unemployed\ House wife 199 88.4
(80 - 100) High 4 1.8
Socio-Economic Status (50 - 79) Middle 135 60.0
(0 - 49) Low 86 38.2Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 4555
No.=Number, % = percentages The present study reveals thatmajority of child’s
parent “Father and mother” 72(32%), 68(30.2%)
The table (1) Reveal that the vast majority of
respectively were primary graduates. This finding agree
mothers were at the second and third age groups (20 –
with a study conducted with “Kalika Municipality” in
29), (30 – 39) yrs., respectively. Most of the mothers
which the level of education for the husbands (father)
in these two age groups are usually healthy young’s,
81(56.6%) focused on the primary and secondary
newlyweds and aware of the process of visiting PHCCs
graduate,also agree with the study conducted in Erbil
for the vaccination of their children . The study findings
reported that 102(34%) of mothers have completed
agree with a study counducted at “Jaipur, Rajasthan”
primary school [16] & [17].
reveals that 50(100%) of samples were in the age group
of (21-35) years [9]. The present study shows more than half of child’s
fathers 113 (50.2%) were free jobs, and most 199(88.4%)
In related to “Marital Status” most mothers
of mothers were house wife. The study findings agrees
216(96%) were married, this is due to the cultural nature
with a study conducted in “Egypt” which reported that
of the sample area that encourages early marriage. This
(72%)fathers were free jobs, and consistent with a study
findings agree a study conducted in sudia Arabia in
counducted at “Jaipur, Rajasthan” reported that 45(90%)
which (91%) of the mothers were married [14].
of mothers were housewife [18] & [9].
The child’s family “Nuclear Family” type has
The present study indicate that majority of the
recorded vast majority 118 (52.4%). This finding agree
studied sample at middle level “Socio-Economic Status”
with a study conducted in Bangalore in which most of
135 (60%).This finding agree with a study conducted in
mothers 32(53.33%) belong to nuclear family [15].
“Kalika Municipality” in which in “Not enough for a
year class” account 76(49%) of the respondent family
[16].
Table (2): Distribution of child’s socio-demographical characteristics variables (SDCv.) and the Source of
Information about toilet training.
Child’s SDCv. Groups No. %
1 42 18.7
2 39 17.3
3 53 23.6
Age of the child in years
4 51 22.7
5 40 17.8
Mean ± SD 3.04 ± 1.37
Male 143 63.6
Gender of child
Female 82 36.4
None 32 14.2
1 _ 2 101 44.9
Number of children (brothers and
3 _ 4 65 28.9
sisters)
5 _ 6 21 9.3
≥ 7 6 2.74556 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2
Cont... Table (2): Distribution of child’s socio-demographical characteristics variables (SDCv.) and the
Source of Information about toilet training.
The First 77 34.2
The Second 58 25.8
Child’s birth order The Third 40 17.8
The Fourth 23 10.2
The Fifth and above 27 12.0
No 87 38.7
Starting toilet training or not
Yes 138 61.3
None 87 38.7
After age of one year 13 9.42
Age of starting toilet training After age of two years 87 63.04
After age of three years 30 21.74
After age of four years and above 8.0 5.80
Social media (TV, Net, Magazine) 47 20.9
Household and relatives 113 50.2
Source of Information
Primary health care centers 9 4.0
Previous experience 56 24.9
No.=Number, % = percentages
Table (2) Reveal that highest percentages refer 28 (92.9%) [19].
to three years old of child’s age 53(23.6%). The
The results show that the first and the second child’s
convergence of age groups may be attributed to the
birth order were vast majority 77(34.2%), 58(25.8%)
closeness of the periods of pregnancy and childbearing
respectively. This findings agree with a study conducted
in Iraqi women. The present study findings agree with
in “Kalika Municipality” reveals that first and second
the study conducted in “Erbil” in which most 180(60%)
child were vast majority 108(69.7%) [16].
age group were (2 and 3) years old [17].
The results show that most of children 138(61.3%)
The present results reveal that male child’s account
start toilet training and 87(63.4%) of them started training
143(63.6%). The present study finding agrees with
after the age of two years.This findings agree with a
Saudi study reported that (54%) of the toddler is males
[14] study conducted in “Bangalore” in which 55(91.67%) of
. The present study results focused at (one to two)
children started toilet training. Also agrees with a study
number of children 101(44.9%). This is due to the trend
in Erbil in which 165(55%) of children starting their
twoards preparing and creating a promising generation,
toilet training at equal or more than twenty four months
educating and rearing them well. The study findings
old. [15] & [17]
agree with astudy to “Assess the Knowledge Regarding
Toilet Training among Mothers of Toddlers” in which The results reveal that “Household and relatives”
the number of children ranging between (1 to 2) child group has formed the most 113(50.2%) sources ofIndian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 4557
information for mothers. The present study findings agree with a study conducted in “manamadurai”, shows that
(64%) of the mothers were got information on toilet training from elders, relatives of the family and friends [20].
Table (3): Distribution of sub and main domains of knowledge concerning early childhood‘s mothers
regarding toilet training
Sub and Main Domains No. Min. Max. PGMS PSD Ev.
General Information 225 0.00 100 47.11 33.11 M
Influencing Factor 225 0.00 100 36.44 33.82 M
Initiation 225 0.00 100 46.07 30.47 M
Important Consideration 225 0.00 90.91 43.03 18.32 M
Main Domain: Knowledge 225 2.27 97.73 43.17 18.00 M
Ev. : Evaluated (0.00 – 33.33) Low (L) ; (33.34 – 66.66) Moderate (M) ; (66.67– 100) High (H).
Table (3) shows that the responses of mothers accounted a moderate level border to low for knowledge sub and
main domain. Most of mother get information from “elders & relatives” so it normally that they have moderate level
of knowledge.
The present study result agree withstudy conducted in “mysuru” reported that majority of mothers 34(56.6%)
are having average knowledge regarding toilet training. And agree with study conducted in “moradabad district”
reported reported that majority of mothers (57%) were having moderate knowledge [10] ,[21].
Table (4): Relationships among mothers responding regarding studied sub and main domains of knowledge
with parent’s and child’s Socio-Demographical Characteristics variables (SDCv.).
Mothers’ Knowledge Mothers’ Knowledge
Parent’s (SDCv.) Child’s (SDCv.)
C.C. Sig. C.S. (*) C.C. Sig. C.S. (*)
Age of mother in years 0.076 0.724 NS Age of the child in years 0.122 0.495 NS
Marital status 0.055 0.875 NS Gender of child 0.112 0.091 NS
Number of children
Type of family 0.056 0.403 NS 0.179 0.113 NS
(brothers and sisters)
Educational level of
0.200 0.094 NS Child’s birth order 0.166 0.173 NS
parent (Father)
Educational level of Starting toilet training or
0.064 0.922 NS 0.137 0.039 S
parent (Mother) not
Occupational status Age of starting toilet
0.121 0.344 NS 0.164 0.285 NS
(Father) training
Occupational status
0.038 0.847 NS
(Mother)
Sources of Information 0.217 0.011 S
Socio-Economic Status 0.145 0.088 NS4558 Indian Journal of Forensic Medicine & Toxicology, April-June 2021, Vol. 15, No. 2 S : Sig. at P0.05 among parent’s (SDCv.) and child’s 29;6(1):44-9. (SDCv.) with knowledge, except between “Starting 5. Mugianti S, Aslama ZR, Donsu JD. Efforts of toilet training or not” and mothers knowledge, at P
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