Knowledge of mothers on diaper dermatitis management and associated factors in Ethiopia  – Nature.com 03:02

Scientific Reports volume 15, Article number: 4322 (2025) Cite this article

Abstract

Diaper dermatitis is an inflammatory reactions of the skin under a diaper due to prolonged skin contact with irritants (urine and faeces), seborrhoea, allergic reaction, fungal (candida), and bacterial infections. It is more common in children aged 1–24 months, with the majority of instances occurring in newborns younger than one year. Over half of newborns suffer from the case at least once throughout their diaper-wearing phase. In low- and middle-income countries like Ethiopia, there is a lack of published data regarding the degree of parental knowledge of diaper dermatitis, its management, and the risk factors associated with the disease. Moreover, the topic receives little to no attention. Therefore, this study aims to assess the mothers’ knowledge of diaper dermatitis and the risk factors linked with the disease. Data was collected from 396 mothers who came for immunization services from August 01 to September 01, 2024, consecutively. The data was cleaned, checked for completeness manually, and entered into SPSS version 26 for analysis. A binary multivariable logistic regression was used to analyze the association between the independent and the outcome variables. Variables with a p-value < 0.05 were considered statistically significant, and an adjusted odds ratio with a 95% confidence interval was reported. The study findings revealed that 84.6% of mothers had self-reported good knowledge of DD and its management, and their main source of information is family members and relatives (35.4%). Nearly two-thirds (65.4%) of children experienced DD, and only 23.6% sought healthcare. Over one-third (37.1%) of mothers used Vaseline to treat DD at home, followed by baby powder (35.1%). The majority (83.6%) of mothers uses disposable diapers only, and 84.8% change 0–2 times per day. The output of logistic regression shows that being a 7–12 month-old child (aOR = 4.03; 95% Cl (1.41–11.50)), being a male child (aOR = 2.16; 95% Cl (1.14–4.06)), and being firstborn (aOR = 5.95; 95% Cl (1.39, 25.53)) variables had a significant association with knowledge of mothers. The study found that although the majority of mothers have self-reported good knowledge, a significant number of them have no awareness of the diapering practice, how to treat DD, when to seek medical attention, and how to take care of their skin after a bowel movement. Therefore, we suggest a structured teaching program to increase mothers’ understanding of DD, including its prevention and management.

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Introduction

Diaper dermatitis, or diaper rash, is an inflammatory reaction of the skin under a diaper due to primarily prolonged skin contact with irritants (urine and faeces), seborrhoea, allergic reaction, fungal (candida), and bacterial infections1. DD is primarily a form of contact dermatitis that results in an erythematous rash, erosions, scaling, and papules around the thighs, suprapubic region, scrotum, and buttocks2,3. Diaper dermatitis is a common dermatological disorder in children aged 1–24 months, with the majority of instances occurring in newborns younger than one year4. Over half of newborns are affected by diaper dermatitis at least once throughout their diaper-wearing period5. The frequency of diaper dermatitis varies substantially between studies and countries. Globally, it is estimated that about 67% of infants and young children suffer from diaper dermatitis at some point, and up to 25% of children seek healthcare due to this case6,7,8.

Despite its complicated etiology, irritating contact diaper dermatitis develops in diaper-covered areas as a result of prolonged skin contact with faeces and urine9,10. Irritant diaper dermatitis is thought to be caused by the proteolytic enzymes found in faeces and the urea in urine, which is converted into ammonia by faecal bacteria with urease activity9. Approximately 10% of diaper dermatitis cases are severe, while the majority of patients have mild symptoms11. Children with impaired immune systems may have discomfort or bacterial or candidal superinfections as a complication of diaper dermatitis12.

Management of diaper dermatitis includes facilitating skin recovery and avoiding recurring rashes. Irritating skin is in response to prolonged contact with urine and liquid stool, decreasing exposure to urine and liquid stool by changing their diaper frequently. The use of diapers with absorbent gel material (AGM) and the application of barrier creams can reduce the moisture and contact of urine and faeces with the skin. Rashes and inflammations can be treated with topical antifungal and steroid medications. Most of the time, diaper dermatitis is a mild, self-limiting illness that requires little intervention, such as changing diapers frequently, using superabsorbent diapers, and taking good care of the skin around the diaper, including its pH, the local microbiome, the potential for irritation and allergy from contactants, and applying topical agents when needed13,14,15,16,17,18.

According to recent studies, mothers have low awareness regarding diaper dermatitis and its management19,20,21. Literature from Africa and Asia indicated that diaper dermatitis has a substantial association with parental characteristics4,22. The major risk factors for diaper dermatitis include parents with low educational levels, unemployment, and low socioeconomic status22,23. A previous study found that mothers have an insufficient understanding of diaper dermatitis prevention and management in infants20,24,25. In low- and middle-income countries like Ethiopia, there is a lack of published data regarding the degree of parental knowledge of diaper dermatitis, its management, and the risk factors associated with the disease. Moreover, the topic receives little to no attention26. Therefore, by determining the level of knowledge of mothers and identifying associated factors, this study will contribute to the prevention and management strategies of diaper dermatitis.

Materials and methods

Study design and period

A cross-sectional study was carried out at the Adama Hospital Medical College (AHMC) between August 01 and September 01, 2024.

Study site

The study was carried out at Adama Hospital Medical College on 396 mothers. AHMC was established in 1946 and serves a catchment population of approximately ten million people. The Expanded Programme on Immunization (EPI) clinic is one of the most loaded outpatient departments in the hospital.

Study population

The study comprised children less than 24 months of age who visited Adama Hospital Medical College’s EPI clinic during the study period. Children older than 24 months or children who came for treatment of any case were excluded from the study.

Sample size determination and sampling procedure

The single population proportion formula was used to calculate the sample size. Assuming a 95% confidence interval (Z = 1.96) and a margin of error of 0.05, we employed proportions of 62.5% from a previously conducted study in Adama town22. Hence, the number of children who visited the EPI clinic was greater than 10,000 in the previous year; the sample size correction formula was not applied. Lastly, the total sample size was 396 after accounting for a 10% non-response rate. The data was gathered over the study period using a convenience sampling technique. All children who visited the EPI clinic and met the inclusion criteria were consecutively recruited until the required sample size was attained.

Instruments, data collectors, and procedure

A structured interview-based questionnaire that was adopted from previous studies20,27,28 was used to collect the data. The questionnaire has 35 questions and is grouped into three categories: socio-demographic factors (12 questions), knowledge (13 questions), and experience of baby diaper and DD management-related factors (10 questions). The socio-demographic characteristics of mothers and children, such as age, gender of the child, educational level, employment status, birth order, health status of the baby, and the number of children currently in diapers. A closed-ended questionnaire consisting of 12 items was used to measure respondents’ knowledge of diaper dermatitis (DD). For every knowledge question, respondents had to select the “True,” “False,” or “I don’t know” option. A 10-item closed-ended questionnaire was also used in the study to evaluate the diaper dermatitis management practice of the participants.

Experienced and trained two BSc holder nurses who can speak and understand the local language conducted the data collection. The principal investigators supervised and checked whether the questionnaires were correctly filled out during the data collection period and collected the completed questionnaire on the day of data collection. The principal investigators reviewed each completed questionnaire to ensure that all the information was accurate before analyzing it.

Data processing and analysis

The data was cleaned, checked for completeness manually, and entered into SPSS version 26 for analysis. After categorizing and defining variables, descriptive analysis was carried out for each independent variable, and frequencies and percentages were calculated. Results were presented using tables and figures. In binary logistic regression, variables having a p-value of <0.25 were identified as candidates for the multivariable logistic regression model. An adjusted odds ratio with a 95% confidence interval was declared to have a significant relationship with the outcome variable. The Hosmer-Lemeshow goodness of fit test was used to assess the model’s fitness. To check for multicollinearity, the variance inflation factor (VIF) was used. We determined the respondents’ knowledge score by giving one1 point for a correct response and zero (0) for a wrong or “I don’t know” response. Those who answered more than six of the twelve questions were categorized as having good knowledge, while those who answered below six questions were categorized as having poor knowledge.

Data quality management

The collection of data was checked by the principal investigators on a daily basis for any incompleteness and/or inconsistency. Data collectors received one-day training on the study’s objectives, inclusion and exclusion criteria, and questionnaire contents in order to ensure the quality of the data. Every day, the investigators reviewed the data collection process to look for any incompleteness or inconsistencies. A pre-test was done to assess the understanding level of the data collectors and the integrity of the questionnaire among 5% of the sample size at Adama General Hospital Medical College (AGHMC).

Ethical consideration

The methodology of the study was reviewed and approved by the Institutional Review Board of Adama General Hospital and Medical College with Reference Number. AGHMC/2006/01/24. A letter of support was obtained from the biomedical sciences department and given to the AHMC. A written letter of permission for data collection was obtained from the hospital manager. After being informed about the study, all participating mothers provided their informed consent to participate by signing the questionnaire. Personal identifier data were not collected from the respondents, and each questionnaire was identified by the identification code given for it. The study was conducted following the Declaration of Helsinki.

Results

Demographic data of mother and child

Of all respondents, about one-third (62.4%) of the mothers are less than 30 years of age, and 357 (90.2%) are married. More than half (61.9%) of mothers attended college and above, followed by secondary school9,10,11 69 (17.4%). One-third, 131 (33.1%), of mothers are merchants, followed by unemployed 127 (32.1%), and the majority, 34(86.1%), resides urban areas. Of all children who participated, more than half (52.5%) were aged less than 6 months, and 213 (53.8%) were females. Three hundred seventy-six (94.9%) were term births, and 323 (81.6%) of the family had one child in diapers (Table 1).Table 1 Socio-demographic data of mothers and children.

Full size table

The diapering practice of mothers

As presented in Table 2, three hundred forty-one (86.1%) of mothers do not use plastic underpants for their children and 280 (70.7%) of them attach the diaper firmly in order to prevent faeces leakage. Over one-third (36.9%) of mothers use water and soap for cleaning their child after bowel movement, followed by wet tissue 95 (24.0%). Three hundred thirty-one (83.6%) of mothers use natural air to dry their children after cleaning. More than four-fifths (83.6%) of mothers use disposable diapers only, and 336 (84.8%) change 0–2 times per day.Table 2 Practice of mothers regarding child diapering.

Full size table

Knowledge of mothers on diaper dermatitis management

This study revealed that 84.6% (95% CI: (82.8 − 86.4%)) of respondents had good knowledge towards diaper dermatitis and its management, and the mean (± SD) of the overall knowledge score was 8.38 ±1.86. Three-fourths (75.5%) of mothers knew that DD is a common skin condition in children, and 77.5% identified not changing babies’ diapers frequently as the main cause of DD. The majority of mothers (62.9% and 62.1%) knew that some baby wipes containing alcohol and zinc oxide ointment, respectively, are used to prevent DD. Only 126 (31.8%) knew that a sprinkle of talcum powder on a diaper would soak up moisture and help prevent DD was a false statement. One hundred ten (27.8%) of mothers had the wrong belief that disposable diapers cause DD more than cloth diapers (Table 3). As shown in the below figure, the main respondents’ sources of information are family members and relatives (35.4%), followed by TV advertisements (33.5%) (Fig. 1).Table 3 Knowledge of mothers on diaper dermatitis and its management.

Full size table

figure 1
Fig. 1

Diaper dermatitis and its management

Nearly two-thirds (65.4%) of children experienced diaper dermatitis (rash) in the last 6 months, and 16.6% of them experienced more than one episode. Of the children who experienced diaper dermatitis, only sixty-one (23.6%) experienced visiting a hospital due to DD. Ninety-six (37.1%) of mothers used Vaseline to treat DD at home, followed by baby powder (35.1%) (Table 4).Table 4 Diaper dermatitis and its management among mothers of children with diaper dermatitis.

Full size table

Factors associated with knowledge of diaper dermatitis

Variables included in multivariable analysis were the age of both mothers and children, the gender of the child, the educational level of mothers, the employment status of mothers, residence, birth order, the health status of the baby, type of diapers used, and experience of DD in the last 6 months. The output of logistic regression shows that the age of the child, the gender of the child, and the birth order (first) variables had significant associations with knowledge of diaper management. Mothers with 7–12 month-old children were 4 times more likely to have good knowledge in diaper dermatitis management compared with mothers who have > 13 month-old children (aOR = 4.03; 95% Cl (1.41–11.50)). Mothers with male children were 2 times more likely to have good knowledge of diaper dermatitis management compared with mothers who have female children (aOR = 2.16; 95% Cl (1.14–4.06)). Mothers who gave birth to their first child were six times more likely to have good knowledge in diaper dermatitis management compared with mothers who gave birth to more than four (aOR = 5.95; 95% Cl (1.39, 25.53)) (Table 5).Table 5 Bivariable and multivariable analysis of factors associated with knowledge of mothers on diaper dermatitis and its management.

Full size table

Discussion

The study aimed to determine the level of knowledge of mothers of children aged less than 24 months regarding diaper dermatitis and its management in Ethiopia. We included 396 mothers who came for immunization services at Adama Hospital Medical College in the study. The study revealed that 84.6% (95% CI: (82.8 − 86.4%)) of respondents had good knowledge of diaper dermatitis and its management. The findings of the current study are higher compared to the study carried out in Iraq, 43.3%28, 45.33% in Ethiopia21, 58.2% in Lithuania30, and 59.7% in Korea27. However, our finding was lower compared with a study conducted in Saudi Arabia, 94.0%31. This variation may be attributed to the difference in study period and setting. The majority (86.1%) of our study population were urban residents who were prone to information. The respondents’ main sources of information are family members and relatives (35.4%), followed by TV advertisements (33.5%). Similarly, studies conducted in Bangladesh, Iraq, and Saudi Arabia show the majority of mothers received information from their family members, relatives, and health professionals19,28,31.

In the current study, nearly two-thirds (65.4%) of children experienced diaper dermatitis in the last 6 months. Similarly, some evidence from Asia and Africa reported the case as 67.3% in India7 and 62.5% in Ethiopia21. However, this finding was higher compared with studies carried out in Thailand, 36.1%4, Bangladesh, 33.6%19, and Kenya, 27.3%24. Out of those who experienced diaper dermatitis, only 23.6% experienced visiting health facilities due to the case. However, a study conducted in Lithuania reported that 59.5% of parents seek health care30. The possible justification for the variation may be attributed to differences in health service coverage, health service-seeking behavior, and differences in the socio-economic status of the population. Over one-third (37.1%) of mothers used Vaseline to treat diaper dermatitis at home, followed by baby powder (35.1%). This finding is related to a report by Bante et al.21, where 47.14% and 18.83% of mothers applied Vaseline and baby powder, respectively, to treat and prevent diaper dermatitis. The application of topical emollients reduces skin contact, avoids irritation, and prevents overhydration by acting as a barrier to shield the skin from urine and faeces12,13,14,18.

Over 83.6% of mothers use disposable diapers only, and 84.8% change their babies´ diapers at most twice per day. The findings of the current study are similar to those of a study conducted in Ghana, in which 70% of the mothers use disposable diapers, and more than half of mothers change their children’s diapers 0–2 times per day20. The stratum corneum of the diaper region (the outer layer of skin that acts as a barrier) is damaged by moisture and friction. Urine causes the skin to become overhydrated, which increases its vulnerability to potential irritants. In the presence of faecal urease, urine also breaks down urea, raising the pH of the region. Additionally, bile salts, faecal lipases, and proteases produce erythema and damage to the epidermal barrier12,14.

A higher proportion of mothers (86.1%) do not use plastic underpants for their children, and 70.7% of them attach the diaper firmly in order to prevent feces leakage. Over one-third (36.9%) of mothers use water and soap for cleaning their children after bowel movements, followed by baby wipes (24.0%). Over four-fifths (83.6%) of mothers dry their children after cleaning them using natural air. According to Collins G. et al., 88.4% of mothers do not use plastic underwear, 51.1% of mothers attach the diaper firmly to prevent feces leakage, 31.6% of mothers wash their babies with water after a bowel movement, and over half, (58.6%) of mothers use natural air drying after cleaning their children20. Bante A. et al.21 also reported the majority of mothers use water only, water and soap, and baby wipes for cleaning their child after bowel movement.

The findings of the present study found that the age of the child, gender of the child, and birth order variables had a significant association with knowledge of diaper dermatitis and its management. Mothers with 7–12-month-old children were four times more likely to have good knowledge of diaper dermatitis management compared with mothers who have > 13-month-old children. Mothers with male children were 2 times more likely to have good knowledge of diaper dermatitis management compared with mothers who have female children. Mothers who gave their first birth were six times more likely to have good knowledge in diaper dermatitis management compared with mothers who gave more than four births. Similarly, the age of the child was one of the significantly associated variables with the knowledge of mothers in a study conducted in Bangladesh19. In contrast to the above findings, a study carried out in India reveals there is no significant association between the knowledge of mothers and the birth order of the child, the gender of the child, and the age of the child32. The findings from this study indicate that further effort is required, for the study site was the second-largest city next to the capital, and we believe that the current study population has comparatively greater access to healthcare and better hygiene practices. Furthermore, current study’s findings may encourage researchers to give more emphasis to conducting further studies on the topic by using this study as baseline evidence.

Strengths and limitations of the study

We believe that this study addressed a national gap by providing knowledge to mothers regarding diaper dermatitis and its management. Additionally, the study identified factors associated with the knowledge of mothers regarding diaper dermatitis that will assist all responsible agencies in acting on the subject. There may be a difference in the proportion of knowledge of diaper dermatitis in the general population and health institutions (clinics). As a result, care should be taken when generalizing these results. The study neither evaluates diaper dermatitis treatment options nor compares the topical applications. Lastly, causal effects are not established due to the nature of cross-sectional studies.

Conclusion and recommendations

The study found that although the majority of mothers have self-reported good knowledge, a significant number of them have no awareness of the diapering practice, how to treat diaper dermatitis when to seek medical attention, and how to take care of their skin after a bowel movement. Additionally, the study revealed that the age of the child, gender of the child, and birth order (first) variables are among the significantly associated factors with knowledge of diaper dermatitis management. The treatment of diaper dermatitis involves maintaining skin integrity through good hygiene, frequent diaper changes, and superabsorbent diapers. Topical emollients improve skin barrier function, providing a barrier between the skin and diaper, urine, and feces. In cases of candida diaper dermatitis, topical antifungals, and antibiotics may be necessary.

The study, therefore, recommends that the Ministry of Health, Ethiopia, and all interested agencies give more emphasis to the subject and design strategies for an organized educational campaign to increase mothers’ understanding of diaper dermatitis, including how to manage and prevent it. We also recommend future studies on the complications of diaper dermatitis and evaluations of products used in treatments of diaper dermatitis.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author (AN) upon reasonable request.

Abbreviations

AHMC:

Adama Hospital Medical CollegeaOR:

adjusted Odds RatioCI:

Confidence IntervalDD:

Diaper DermatitisEPI:

Expanded Programme on ImmunizationSD:

Standard DeviationVIF:

Variance Inflation Factor

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Acknowledgements

Our gratitude goes to the study participants for their willingness and for giving necessary information during data collection. We also appreciate Adama Hospital Medical College’s administrative bodies for their cooperation and support.

Funding

There is no funding for this study.

Author information

Authors and Affiliations

  1. Department of Nursing, College of Health Sciences, Mattu University, Mattu, Oromia, EthiopiaAtoma Negera
  2. Department of Biomedical Sciences, Adama Hospital Medical College, Adama, Oromia, EthiopiaMidekso Sento
  3. Department of Biomedical Sciences, College of Health Sciences, Ambo University, Ambo, Oromia, EthiopiaGemechu Tola

Contributions

AN conceptualized the study, developed the tool, conducted the research, carried out the statistical analysis, and wrote the manuscript. MS and GT participated in the design of the study and tool development, performed statistical analysis, and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atoma Negera.

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Competing interests

The authors declare no competing interests.

Ethical approval

The methodology of the study was reviewed and approved by the Institutional Review Board of Adama General Hospital and Medical College with Reference Number AGHMC/2006/01/24.

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Negera, A., Sento, M. & Tola, G. Knowledge of mothers on diaper dermatitis management and associated factors in Ethiopia. Sci Rep 15, 4322 (2025). https://doi.org/10.1038/s41598-025-88742-6

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