Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term "hidden curriculum," move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.

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Aim: To compare the knowledge, attitudes and practices of mothers in the prevention and management of child diarrhoea, in rural and urban settings of Maseru. Methodology: This cross-sectional study was carried out in the Domiciliary (Urban) and Tlali (Rural) Health centres in Maseru, within the period of February to May, 2017. Data was collected from 458 mothers/caregivers, with 299 (65%) and 159 (35%) from urban and rural settings respectively. Scores were assigned for the level of knowledge, attitudes, and practices. STATA 14.1 was applied to determine the strengths of associations between categories of the maternal characteristics and the outcome variables. Results: Aggregation of participants’ knowledge, attitudes, and practices response reveal a statistical significant association with residence. The maternal age range of 30-39 years, P = .03, and mothers with three (3) children, P = .02 were significantly associated with the knowledge of prevention and management of diarrhoea in the rural area. In the urban area, mothers with tertiary education, P = .04, employed, P = .001, unemployed, P = .004, and all categories of monthly income were significantly associated with the knowledge of prevention and management of diarrhoea. For the urban setting, an association between mothers’ attitudes and monthly income between M500 – M1399, P = .05 was observed. The practices of mothers/caregivers in the prevention and management of diarrhoea showed no significant differences in the light of the socio-demographic variables in both settings. Conclusion: The study revealed low level of maternal knowledge, attitudes and practices in prevention and management of child diarrhea in the rural and urban settings, hence the need to strengthen the existing health education messages on both settings.

IntroductionIn response to revisions in global and national policy in 2011, six-month isoniazid preventive therapy (IPT) became freely available as a preventive measure for people living with HIV in the uMgungundlovu District of KwaZulu-Natal province, South Africa. Given a difference in uptake and completion by sex, we sought to explore the reasons why Zulu women were more likely to accept and complete IPT compared to men in an effort to inform future implementation.MethodsUtilising a community-based participatory research approach and ethnographic methods, we undertook 17 individual and group interviews, and met regularly with grassroots community advisory teams in three Zulu communities located in uMgungundlovu District between March 2012–December 2016.Findings & discussionThree categories described women’s willingness to initiate IPT: women are caregivers, women are obedient, and appearance is important. The findings suggest that the success of IPT implementation amongst clinic-utilising women of uMgungundlovu is related to the cultural gender norms of uMakoti, isiZulu for “the bride” or “the wife.” We invoke the cultural concept of inhlonipho, meaning “to show respect,” to discuss how the cultural values of uMakoti may conflict with biomedical expectations of adherence. Such conflict can result in misinterpretations by healthcare providers or patients, and lead some patients to fear the repercussions of asking questions or contemplating discontinuation with the provider, preferring instead to appear obedient. We propose a shift in emphasis from adherence-focussed strategies, characteristic of the current biomedical approach, to practices that promote patient agency in an effort to offer IPT more appropriately.ImplicationsBuilding on existing tools, namely the harm reduction model and the use of mini-ethnography, we provide guidance on how to support women to participate as agents in the decision to initiate or continue IPT, decisions which may also impact the health and choices of the family.