Ecological and cultural barriers to treatment of childhood diarrhea in riverine areas of Ondo State, Nigeria.

In Nigeria diarrhea still poses the greatest health problem to the survival of the under-fives in spite of the fact that the majority of mothers are reportedly to have been reached by health education on oral rehydration therapy (ORT) regardless of their ecological and socioeconomic situations. This study assesses the effect of different ecological and sociocultural conditions on use of ORT in riverine areas of Ondo State for the identification of the most effective means of dissemination of information on ORT in similar geographically disadvantaged localities in Nigeria and elsewhere. It is a formative study, but its results are expected to lead to identification of potentially effective intervention modalities to improve diarrhea treatment in remote areas. Of great concern in this study are communities whose awareness and acceptance of ORT may be more dictated by environmental conditions. This study combines two different research methodologies; namely, semistructured questionnaires and in-depth interviews to gain 'focused' insight into the communities. The study was carried out in Ilaje-Ese-Odo local government area (LGA) in southwestern Nigeria. It covered 308 mothers from 2 subethnic groups (Ilaje and Apoi) from a set of randomly chosen villages situated in 3 ecological strata and the in-depth interviews with 42 key informants. The majority of the mothers described some dangerous signs of last diarrhea suffered by their children under the age of five. Preliminary results indicate that awareness of actual causation was lowest in the remotest saltwater areas compared with other mothers in the study communities. Sixty-eight percent of the mothers in Ilaje mainland, 57% in fresh water Apoi and 44% in saltwater Ilaje stated that they have ever heard of salt, sugar solution (SSS). Furthermore, only 43% of them said they could prepare SSS while 42% ever made it. None of those mothers in saltwater Ilaje who confirmed awareness of and how to administer and prepare SSS could in reality do it correctly. When shown a typical sachet of ORS, only 8% of mothers living in salt water swamps said they have seen one before. Thus, promotive health services to reduce high mortality rates of children under five have passed the study mothers whose area reported the highest incidence of diarrhea in the state.

An ethnographic study of acute respiratory infections in four local government areas of Nigeria.

An ethnographic study was conducted in four local government areas of Nigeria. The techniques of informal unstructured interviews and participant observation were used. A total of 104 focus group discussions with 53 groups of mothers, 21 groups of grandmothers, and 30 groups of fathers were conducted. Perception of causes of ARI ranged from cold water, to heredity, poor hygiene, exposure to smoke and dust and the supernatural forces. Preventive measures described were related to the perceived causes. For those groups that discussed home remedies to the treatment of ARI, the remedies described for cough included herbal drinks (39% of groups); honey with lemon (19.5%); eating specific vegetables believed to relieve cough (8.4%); and preparations containing palm oil (21.7%). Remedies described for measles included herbal drinks (62%); local tropical creams (24%); and palm wine (13.7%). Those for ear infections included drops of herbal mixtures in the ear (29.4%); putting various type of oil in the ear (38%); plugging the ear with cotton wool previously dipped in honey, or alcohol (17%). The findings of this study have implications for the Health Education Component of the National ARI Control Programm which Nigeria recently embarked upon. There is also the need for research on the efficacy and any possible adverse effects of identified home remedies.

PIP: An ethnographic study was conducted in four local government areas of Nigeria. The techniques of informal unstructured interviews and participant observation were used. A total of 104 focus group discussions with 53 groups of mothers, 21 groups of grandmothers, and 30 groups of fathers were conducted. Perception of causes of ARI ranged from cold water, to heredity, poor hygiene, exposure to smoke and dust and the supernatural forces. Preventive measures described were related to the perceived causes. For those groups that discussed home remedies to the treatment of ARI, the remedies described for cough included herbal drinks (39% of groups); honey with lemon (19.5%); eating specific vegetables believed to relieve cough (8.4%); and preparations containing palm oil (21.7%). Remedies described for measles included herbal drinks (62%); local tropical creams (24%); and palm wine (13.7%). Those for ear infections included drops of herbal mixtures in the ear (38%); plugging the ear with cotton wool previously dipped in honey, or alcohol (17%). The findings of this study have implications for the Health Education Component of the National ARI Control program which Nigeria recently embarked upon. There is also the need for research on the efficacy and any possible adverse effects of identified home remedies. (author's)

Diarrhoeal disease morbidity, risk factors and treatments in a low socioeconomic area of Ilorin, Kwara State, Nigeria.

A 12-month diarrhoeal disease surveillance was carried out in a sample of 351 children under 3 years of age in a low-income traditional area of Ilorin, Nigeria to determine whether sociodemographic characteristics, including age of the child, sex, parity, mother's education, occupation, mother's age and household kitchen, were associated with the incidence of acute diarrhoea. Bivariate and multivariate analyses were used to determine association. Results indicated that only the age of the child and the type of kitchen used by the household had a significant association with diarrhoea. Diarrhoeal incidence decreases with the child's age while households with a private kitchen had a significantly lower incidence rate than those without a kitchen. This finding emphasises the importance of good hygiene in reducing the risk of having diarrhoea. Three common treatments applied by mothers are ORS (used in 14.8% of diarrhoea days), antibiotics (54.5%) and local herbs (27.7%). The younger a child is the more likely that ORS and antibiotics will be administered during diarrhoea. About 53% of the antibiotic use was by self medication while 40% were prescribed by the clinics. The need for educational campaigns to discourage the inappropriate use of antibiotics was emphasised.

Training field workers to observe hygiene-related behaviour.

A study is reported from Nigeria on the training of field workers in the making of structured observations on hygiene-related behaviour with a view to improving the control of diarrhoeal diseases. The programme led to a high degree of consistency in the perception and description of such behaviour by the participants.

PIP: The trainee recruitment and instruction in evaluating hygiene-related behavior for Nigerian field workers, particularly to control for diarrheal diseases, is described. 6 Yoruba-speaking women 21-38 years old were nominated by village leaders in the Oluyole local government area of Oyo State, Nigeria, to be trainee field workers. All had a secondary education, and 4 had had experience with community-based interviews and home visits. Village leader cooperation was helpful in securing support for the project and housing and security for the trainees and their supervisor, who was a sociology graduate of the University of Ibadan. Training involved lectures and discussion meetings in both English and Yoruba, exercises to test observational acuity and prioritization, role playing, field interaction within homes on a trial basis, and data collection techniques and trial experience. The first phase of training involved a statement of objectives, a definition of the role of health worker, definitions for different terms for types of diarrhea and symptoms, the stated desired qualities of an observer working in a village setting, and desired behavior and the ways of assessing it. Multiple learning aids were used in presenting information on diarrheal diseases. Practical training included requesting trainees to contemplate a given area for 5 minutes and relate what they had seen in order of importance. Observational strengths and weaknesses were identified and discussed, until there was a correlation of 55% between observed and actual hygiene-related behavior. The second phase was concerned with role playing in a village scenario while participants assessed such behavior as the greeting, showing respect, displaying friendliness, and explaining the purpose of the visit. In a poor urban community of Idikan, trainees worked in pairs for 2 weeks observing a mother and her 5-year-old child for 4 hours and recording behavior in food preparation, feeding, defecation, and self contamination. The exercise was repeated until there was 90% agreement between the pairs. The third phase focused on data collection from questionnaires administered in people's homes for 2-3 hours, and the experience was repeated until the pairs agreed 95%. A pretest and continued training were conducted in Lagun for 2.5 weeks. The supervisor spent additional time with those needing it. Mothers rated the relationship as very satisfactory. The supervisor checked forms at the end of each day so that corrections could be made.