An inflammatory response to the skin in the perineal and perianal areas is known as diaper dermatitis. It is the most typical skin condition that affects young infants. Although skin irritation is the most frequent cause, other conditions including atopic dermatitis and seborrheic dermatitis can also manifest as diaper rash. Candida albicans infection, which can be primary or secondary, is another frequent cause. The majority of the time, diaper dermatitis is a mild, self-limiting condition that only needs mild treatment. Skincare, good hygiene, and avoiding anything irritating are some of the management strategies [1].

Contact with an irritant such as urine, feces, soaps, detergents, ointments, friction for an extended period of time or repeatedly is what causes diaper dermatitis. Although feces and urine are the most common irritant, irritation is caused by a variety of reasons. Long-term skin contact with diaper wetness causes more friction, more abrasion damage, increased trans epidermal permeability, and increased microbial counts. Potential irritants have a harder time irritating healthy skin. Although ammonia was once believed to be the culprit behind diaper rash due to the link between dermatitis and the pungent smell of diapers, ammonia is not enough to induce diaper rash. Because of the decomposition of urea in the presence of fecal urease, urine's irritating character is associated with an increase in pH. Increased pH encourages the activity of fecal enzymes, primarily the irritating proteases and lipases [2].

Mothers are mostly responsible for child care. As a result, the mother's knowledge of child care affects the type and standard of care provided for the kid. Numerous studies have shown that the mother's education degree influences her understanding of and approach to child health care concerns in a good way [3]. The majority (70\%) of mothers said they learned about diaper dermatitis through websites, despite the fact that many children under the age of two suffer from the condition. This suggests that there is a lack of awareness of the condition and a felt need for education on the issue, particularly in our health facilities. Inadequate research on the topic may be to blame for the predicament [4].

The prevalence is highest in children under 24 months, with the peak occurring between 9 and 12 months of age. This is probably because children in this age group need diapering more frequently than children in other age groups. Diaper dermatitis has been linked to a variety of risk factors. These variables included gastrointestinal illness, the kind of diaper worn, and how frequently diapers were changed[5].

Design and Setting

In primary health centers, a descriptive research was under taken on mothers with children under 2 years old. The study began on January 1 and ran until May 15 of 2023 to determine the level of mothers' awareness regarding diaper dermatitis.90 mothers were chosen from Bab Al-Moadem Health Center and New Iraq Health Center as a non-probability purposive sample.

Study Participants and Sampling

The criteria used to pick mothers included those who were between the ages of 18 and 45, could read and write, had children under the age of two, and agreed to take part in the study. Cronbach's Alpha was computed on 10 mothers randomly chosen from primary health centers in Baghdad city to assess the instrument's internal consistency. The questionnaire showed a sufficient level of internal consistency and equivalent measurability based on the reliability result (r = 0.78), which was statistically satisfactory.

Data Collection and Instruments Tools

The researchers created the questionnaire for the current study after reviewing the pertinent literature. To serve the research objectives, the questionnaire is divided into two parts. The The first part is related to mothers' sociodemographic data and information about diaper dermatitis also, related to information about the current child such as (age in months, gender, ordinal in the family, if the current child suffering from diaper dermatitis and others. There are sixteen items total for part two's questions. A three-point Likert scale was used to grade the questionnaire: agree = 2, not sure = 1, disagree = 0. Constant validity for the questionnaire was established with the help of a panel of experts relating to the subject of the current study. There were ten specialists in all who were chosen. In response to the advice, recommendations, and insightful comments of those specialists, a few items underwent minor alterations. The information gathered between the 2nd of February and the 2nd of March 2023 using a built-in questionnaire and a direct interview method.

Data Analysis

The social science statistics package (IBM SPSS Statistics) version 22.0 was used to perform the statistical analysis. Inferential statistics (Chi-square test, Standard deviations, degree of significance) and Descriptive statistics (Frequencies, Percentages, and Means of Score) were used in the application approaches for data analysis.

Ethical Considerations

Data collection were done by the researchers, who kept the confidentiality and anonymity of the data. The form of data collection is applied without mentioning the name of the mothers, their address, or any other information. All participated in the study have signed consent form for human subjects' right.

The study shows that more than half of the mothers with age group of 25-31 years are 51.1%. All of the mothers' resident in urban. According to level of education; the highest percentage of the mothers refers that 30% of them are diploma/bachelor's graduated. Regarding to the occupation of mothers; the highest percentage refers that 73.3 of them are unemployed. Around 47.8% of the family monthly income is 300,000-600,000. In addition, 76.7% of mothers were have information about diaper dermatitis and their source of information about 40.6% from relatives, see Table 1.

The study shows that the majority of the children are 67.8% male with age group 9-16 months 51.1%. Regarding child ordinal in the family, 35.6% of children are ranked third. About 74.4% of children were suffering from previous diaper rashes. The children use of diapers was 95.6% a single use diaper (commercial) and changing times about 76.7% of them is 3-4 times per day. According to mothers' use of material, the highest percentage 33.3% use powder, see Table 2.

Table 3 offers that the samples of (90) mothers, 56.7 % of them are at poor level in the overall awareness about diaper dermatitis, whereas 43.3% of them are at good level in overall awareness.

The current study shows that there is significant relationship between levels of mothers' awareness and sociodemographic characteristics such as level of education, occupation, family income and source of information at p. value < 0.05, except age of mothers' there is no significant relationship with levels of mothers' information about diaper dermatitis (Table 4).

Table 1 in the current study indicates that all of the sample were urban residents. This finding is consistent with study that discovered the majority of respondents resided in urban areas [6]

From the researcher perspective, this data shows that the majority of visits to health care facilities are made by people who live in the neighbor hood, which is within the context of the work of the health centers. The dominating age group of the study sample, as measured by the age groups, falls most squarely within the range of (25-31) years old. This result is consistent with a study which found that 37.5% of the sample was between the ages of 26 and 30 [7]. Additionally, this outcome is consistent with study which indicated that 41.3% of the sample belonged to the 24- to 30-year-old age range [8].

The current study's findings indicate that the majority of the sample had graduated with a diploma or a bachelor's degree in terms of education. These results go opposite that found the majority of the sample sample had completed high school [9]. However, this study supports a study which found that the majority of the samples were bachelors [10]. More than half of mothers are unemployed, according to the current study's findings about their employment status. This is also consistent with a study which found that 50.3% of samples were unemployed [7]. This finding, however, is in contrast to the study that found 73% of mothers were employed [11]. In terms of family income, the majority of participants had monthly incomes between 300,000 and 600,000 ID, which is regarded to be at a moderate level; this result contrasts with study, which found that 56.6% of samples had high incomes [12].

According to the mothers' sources of information in this study, the most of samples get their information from relatives. This result is consistent with the study that found 44% of mothers obtain their information from family members [13]. However, this result is in contrast to a study that found that 33.3% of the sources were medical practitioners [9]. More over half of the children in the age range of 9 to 16 months are shown in Table 2 distribution of the children's ages. This conclusion conflicts with one study, which found that 45% of children were under four months old [13]. However, this study also supports with a study that found 38.1% of children were between the ages of 9 and 16 [9]. According to the current study's analysis of children gender, boys make up the majority of the study group. This finding conflicts with the study's finding that 50.8% of children are female [6]. However, this result was in line with the study revealed that 56.6% of children were male [7]. The majority of children are ranked third in a family in terms of child ordinal. A study by Mohammed and Hatab [14] revealed that children rated 30.0% first, 56.7% second, and 10.0% third, was in conflict with the current findings.

The current study's findings regarding the percentage of children who had diaper dermatitis in the previous indicate that 74.4% of children have had rashes in the past. This result conflicts with the study which found that the majority of children had never had diaper rash [3] Additionally, this study's findings conflict with those of a study which found that 78.6% of the samples had no diaper rash[9].

The majority of mothers' use single-use commercial diapers for their children. This result is consistent with a research that found all children use disposable diapers [7]. This result is consistent with a research which found that the majority of kids use disposable diapers [3]. According to the current study, 76.7% of mothers change their children's diapers three to four times daily. This result is in contrast to a study that indicated a 46.5% change once every day [7]. However, this finding is consistent with a research which found that the majority of children changed diapers 3-4 times each day [13]. 33.3% of mothers' use powder for their children when changing diapers, according to the type of material used in the study. This result conflicts with a study that found more mothers use palm kernel oil for their children [13]. Additionally, this result conflicts with a study, which revealed that 37.2 of the participants used nothing [7]. According to table 3, mothers generally have a low level of awareness regarding diaper dermatitis. This result is consistent with study which found that 76.5 % of respondents had poor understanding of diaper dermatitis and only 23.5% of respondents had high knowledge [3]. The researcher argues that a number of factors, including the fact that most mothers get their information from unreliable sources, the lack of mother-specific awareness campaigns about the disease and how to handle it, or the lack of mother-specific education about child health care, contributed to the mothers' inadequate or poor level of awareness. According to table 4, the current study demonstrates a significant correlation between mothers' awareness levels and demographic variables like education level, occupation, family income, and information source. However, except for mothers' age, there is no correlation with mothers' awareness levels about diaper dermatitis. This finding conflicts with the fact that explained that the majority of women give birth in this age range and that most do not have experience with newborn cleanliness [6]. In the current study, the level of education and the level of mothers' awareness are significantly correlated. This finding is consistent with study, which found that mothers' levels of education were an important variable in lowering diaper rash in children [13].

The occupation of the current study reveals a substantial relationship with level of mothers' awareness. This finding concurs with study which found a strong correlation between mothers' knowledge and working status [15]. Family income in the present study reveals a strong link with level of mothers' knowledge. This conclusion concurs with finding that family income is a factor in providing proper care for children [9]. The current study's finding that the source of information has a significant relationship with mothers' awareness levels is consistent with study, which found that mothers who got information from health-care workers found it to be more useful than information from other sources [13].

This study is the first report on the prevalence of diaper rash in Iraq for children under 2 years. There was significant association between following demographic variables (level of education, occupation, family income and source of information variables) and level of mothers 'awareness. Most mothers get their information about diaper rash from their relatives. The vast majority of the were suffered from previous diaper rash and the vast majority of the mothers' use disposable diaper for their children and changing it in adequate times. We recommended when mothers visit medical facilities, health care professionals including doctors, nurses, and medical assistants should assume responsibility for educating them about child care, including how to care for the diaper area. They should also run educational programs on how to apply practical strategies to reduce or prevent diaper dermatitis. Educate mothers about the correct practices when the child has any rash, especially in the diaper area, and leave the wrong practices resulting from customs and traditions because they can result in complications.

We express gratitude to the mothers having children under Two Year who took part in the study.

This research paper received no external funding.

The authors declare no conflicts of interest.

All authors contributed equally to this paper. They have all read and approved the final version.

Informed consent was obtained from all participates in the study as needed.

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