The challenge of achieving community participation as a component of health sector reform is especially great in low- and middle-income countries where there is limited experience of community participation in social policy making. This paper concentrates on the social representations of different actors at different levels of the health care system in Colombia that may hinder or enable effective implementation of the participatory policy. The study took place in Cali, Colombia and focused on two institutional mechanisms created by the state to channel citizen participation into the health sector, i.e. user associations and customer service offices. This is a case study with multiple sources of evidence using a combination of quantitative and qualitative social science methods. The analysis of respondents' representations revealed a range of practical concerns and considerable degree of scepticism among public and private sector institutions, consumer groups and individual citizens about user participation. Although participation in Colombia has been introduced on political, managerial and ethical grounds, this study has found that health care users do not yet have a meaningful seat around the table of decision-making bodies.
Understanding linkages between household behavior and Aedes aegypti (L.) larval ecology is essential for community-based dengue mitigation. Here we associate water storage behaviors with the rate of A. aegypti pupal production in three dengue-endemic Colombian cities with different mean temperatures. Qualitative, semi-structured interviews and pupal counts were conducted over a 7-15-day period in 235 households containing a water storage vessel infested with larvae. Emptying vessels more often than every 7 days strongly reduced pupal production in all three cities. Emptying every 7-15 days reduced production by a similar magnitude as emptying <7 days in Armenia (21.9 degrees C), has a threefold smaller reduction as compared to <7 days in Bucaramanga (23.9 degrees C), and did not reduce production in Barranquilla (29.0 degrees C). Lidding vessels reduced mosquito production and was most feasible in Barranquilla because of container structure. Vessel emptying strongly correlated with usage in Barranquilla, where many households stored water in case of interruptions in piped service rather than for regular use. In the cooler cities, >90% of households regularly used stored water for washing clothes, generating a weaker correlation between emptying and usage. Emptying was less frequent in the households surveyed in the dry season in all three cities. These results show that A. aegypti production and human behaviors are coupled in a temperature-dependent manner. In addition to biological effects on aquatic stages, climate change may impact A. aegypti production through human behavioral adaptations. Vector control programs should account for geographic variation in temperature and water usage behaviors in designing targeted interventions.
Magnitude and distribution of Diarrhoea and Acute Respiratory Infections (ARI) in children were studied within a larger broader research that focused on health education. Two household surveys were conducted in a sample of families with at least one child under five years of Recife and Olinda in April-May 1992 and 1994. The total number of children studied was 5,436. The estimated adjusted annual incidence rate (AAIR) of diarrhoea was 2.7 episodes per child. The two-week incidence rate of diarrhoea was 10.2% for both years. Risk factors associated with higher incidence of diarrhoea were age (under two years), lack of sanitation facilities, and absence of electrical appliances in the household. Estimated AAIR of ARI was 9. 5 episodes per child. The two-week incidence rate of ARI was 41.0% in 1992 and 32.6% in 1994. Majority of ARIs affected the upper respiratory tract (75.9%). The only factor consistently associated with a higher risk of ARI was age (under three years). Study results indicate that both pathologies are still an important health problem for children under five in Pernambuco. In particular, in the case of diarrhoea the need for improving the access to basic services, such as water supply and sewage system is urgently needed.
OBJECTIVES: to analyse people's concepts and health seeking behavior relating to diarrhea and dehydration and its implications to improve health services practice. METHODS: individual and group interviews were conducted in two municipalities in the North of Nicaragua, with mothers, other community members, traditional healers and basic health personnel. A household interview survey in a random sample of 1.924 families with under-fives was carried out in three departments. RESULTS: people can easily identify diarrhea, as a disease in itself or as a symptom of several folk diseases. The popular construction of the causes of diarrhea is complex, with a mixture of folk concepts and modern medical concepts which influence preventive and health seeking behavior. Health personnel often believe in these popular concepts. Dehydration is a new term and concept introduced by the health education campaigns and often mistaken for the term malnutrition. Oral rehydration solution (ORS) is seen as an ineffective drug against diarrhea. The inadequate use of pharmaceuticals is widespread and in most cases they have been prescribed by doctors. CONCLUSIONS: these results show the co-existence of popular and medical concepts, the latter with different interpretations. There is a need for a change in the communication between health services and population, based on an alternative analysis of people's knowledge and behavior.
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