We applied a quantitative, quasi-experimental study design to evaluate nurses' knowledge concerning children with moderate-to-severe dehydration under five years at two pediatric hospitals. The study was conducted in two main pediatric hospitals, the Duhok and Zakho Cities of the Iraqi Kurdistan Region. The nurses were recruited from two main pediatric hospitals, Heevi Pediatric Teaching Hospital and Bedar General Hospital, from the 3rd of February 2022 till the 12^th of June 2022.

The nurses were divided into two experimental and control groups as follows. The experimental group was recruited from nurses who work in the Bedar General Hospital in Zakho City. The control group was recruited from the Pediatric Teaching Hospital in Duhok City. The nurses were followed up before and after the nursing education. The nurses in the experimental group (n=24) received a nursing education about the knowledge of dehydration in children under five years old. The nurses in the control group (n=24) did not receive nursing education.

A purposive probability participant of 48 nurses who were employed in pediatric hospitals and met the sample criteria was included in this study. The samples were separated into two groups; the first group comprised 24 nurses in the experimental group who were exposed to the educational program. But the second group of 24 nurses in the control group were not exposed to the involvement of the educational program. Every set had nearby similar features as probable. The groups were recruited from two independent hospitals to avoid allocation bias.

The level of knowledge about dehydration among children under five years was assessed before and after the completion of education. In order to assess the effectiveness of the health education program earlier and after the running of the instructive program, knowledge instruments were structured to assess the nurse's knowledge. It consists of 2 parts: - Part One: demographic characteristics: This linked to the sample demographical characteristics, which included age, gender, educational level, marital status, years of experience, unit of work, participation in a training course regarding dehydration, and residential area. Related to nurses' knowledge about dehydration management which included 20 items of multiple choice questions, each item had two alternatives. Each item in the knowledge questionnaire was scored as an incorrect or correct answer. Each nurse received one score for each correct answer and zero for an incorrect answer. The total scores given to each nurse were added together, and obtained the knowledge score.

The general characteristics of nurses were presented as numbers and percentages. The comparisons of demographic characteristics between control and experimental nurse groups were examined using Pearson chi-square tests. Moreover, the comparisons of knowledge frequencies between control and experimental nurse groups at baseline were examined using Pearson chi-square tests. The comparisons of knowledge scores between control and experimental nurse groups at different times were examined using an independent t-test. The comparisons of knowledge scores between study steps in control and experimental nurse groups at different times were examined using Bonferroni correction. The associations of knowledge scores with demographic characteristics in the experimental groups at the second follow-up were examined using an independent t-test or ANOVA one-way. The pairwise comparisons were examined using a Tukey test. The significant level of difference was determined at a p-value <0.05. The statistical calculations were performed by JMP Pro 14.3.0 (https://www.jmp.com/en_us/home.html).

The average knowledge score of the nurses was 26.75 (pre-test), 26.58 (post-test 1), and 27.63 (post-test 2) among the control group, with no significant differences. In a study [12], the majority of nurses' knowledge was discovered to be inadequate in test one (84.9%) and test two (79.2%) in the control group. Another study [13] found 88% of nurses had limited knowledge of intravenous fluid therapy for dehydrated infants under five years. Similar to what Mahmoud [14] discovered in their study—that approximately 40% of nurses had inadequate knowledge. However, Qamar, Afzal [15] disagreed with Alrubaiee, Baharom [16] and found in their study conducted in Pakistan that 87% of nurses in public hospitals had a good awareness of IV cannula protocols. There are no programs for ongoing education, and most nurses graduated from an institute.

The nurses in the experimental group had higher knowledge scores than the control group (37.13 and 36.54 in the post-tests 1 and 2, respectively). This showed that nurses' knowledge of how to treat dehydration in young infants was significantly improved. This study's findings are supported by Imazu, Faria [17], who discovered that there was an improvement in knowledge about the disease in the interventional group. Similarly, Maria, Kaur [18] compared video-assisted teaching versus self-instructional modules for the care of ventilated patients on staff nurses'. They found that the mean of nurses' knowledge and practice in the pre-test were increased in the post-test. Similar effects were found by AlReshidi [19] as well.

The study showed that the experimental group in post-tests 1 and 2 had a higher mean score compared to the control group. Also, there were very significant differences in the experimental group's nurses' knowledge compared to pre, post-test1, and post-test2. These analyses supported the findings of studies by Aslam, Afzal [20], and Abd Elalem and Fouad [21], which found that nurses lacked sufficient knowledge about administering fluids and electrolytes, which had an impact on patient care. These studies suggested that special education programs would raise nurses' recognition and knowledge regarding body fluid balance assessment. Asfour [22] reported that more than a third of nurses lacked information about measuring fluid input and output. Furthermore, the current finding was supported by Sanders [23], who revealed that the majority of nurses knew that children with severe dehydration (Plan C) are resuscitated using intravenous fluids, which generally necessitates the kid to be transported to an inpatient ward. Our findings were also consistent with a study done by Abd El-SalamSheta and Mahmoud [24], who discovered that the overall nurse's knowledge and practice score regarding body fluid balance assessment increased from 6% to 86.7% after the teaching program. Similar to how this study's findings strongly concur with those of Al-Mussawi, Sajjad S. Issa [25], who examined how an educational program affected students at a nursing college's knowledge of intravenous therapy in Basra, Iraq. Their study discovered that students' knowledge had improved and that there was a highly significant correlation between nurses' knowledge on the pre-test and post-test.

This study showed that nurses with fewer than five years of experience scored higher on knowledge tests than nurses with five to ten years of experience. Similar results were reported by Orrisa as well [26]. They discovered that nurses with less than one year of professional experience (38.6%) had enough knowledge about intravenous therapy than those with more than two years of experience (29.4%). However, the findings indicated no correlation between working units and nurses' knowledge in the experimental group. The findings of a recent study [27] in Kenya did not support the findings of this study. They found that respondents in surgical wards had higher average knowledge scores on IV fluid therapy than their medical ward peers. Likewise, the majority of the participants did not attend any training courses, and the results showed no differences between the knowledge of nurses and the training course for either group. This finding disagreed with a study [24] that examined the effect of a structured educational program on nurses' knowledge and expertise concerning the assessment of body fluid balance for critically ill patients in the intensive care unit in Egypt. Additionally, a study [28] contradicted this conclusion by reporting that less than a quarter of nurses did not attend a training session. Nurses can stay up to date on current procedures and take advantage of possibilities for improvement by taking part in training programs and courses that are offered as part of continuing nursing education.