People's concepts on diarrhea and dehydration in Nicaragua: the difficulty of the intercultural dialogue

Abstract

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.

Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review

“…Multiple studies reported drugs were widely available and affordable in the public and private sector, typically without prescription [ 35 , 38 , 40 , 44 , 49 , 52 , 64 , 69 ]. In many contexts, caregivers stocked drugs at home, purchasing them in advance or saving leftover medication from previous illnesses [ 33 , 37 , 38 , 52 , 70 ]. Caregivers perceived drugs to be cheaper and more accessible than ORS, particularly given the flexibility to purchase a few tablets for little money [ 64 , 65 , 71 ].…”

“…Use of antibiotics in the treatment of pediatric diarrhea has become routine for both health care providers and caregivers in some contexts [ 18 , 40 , 66 ]. Caregivers may have also influenced provider behavior as caregivers’ preference for drug therapies creates pressure on providers to give medications in addition or instead of ORS [ 28 , 33 , 65 , 72 ]. Drugs were given in sub-clinical doses in multiple studies [ 67 , 69 , 73 ].…”

“…Multiple studies suggested treatment with modern medicines may be related to the perceived cause or type of diarrhea [ 18 , 52 , 60 , 79 – 81 ]. Treatment seeking was often related to inappropriate use of medicine for diarrhea management [ 33 , 57 , 62 , 82 ].…”

A qualitative study on cultural determinants for breastfeeding cessation and their association with child diarrhoea in the rural Peruvian Andes

“…Ideas about the efficacy and effectiveness of medicines have marked cultural dimensions. In Southeast Asia and Central and South America, some people doubt the efficacy of oral re-hydration solution for treating diarrhoea because its appearance does not resemble medicine [12, 63, 64]. Studies highlight antibiotics are commonly used (with and without medical prescription) for treating non-antibiotic-associated child diarrhoea in Peru and other LMIC [65, 66].…”

“…Local concepts, perceptions on causes and treatment options and practices in dealing with child diarrhoea exist cross-culturally and are generally referred to as local explanatory models [9-10]. Many of these local types of child diarrhoea are not commonly linked to hygiene and the germ disease concept, as they originate from environmental or supernatural events [10-12]. In addition, they are typically present and most widely accepted in locations where education levels are low, healthcare systems are weak and traditional medicine or elder family/community members are respected sources of information [13-16].…”