Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7-24 Months in Rural Uganda.

The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.

Zinc and Vitamin Supplementation in an Under-5 Indigenous Population of Guatemala: Influence of Lay Health Promoters in Decreasing Incidence of Diarrhea.

BACKGROUND: Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters. METHOD: The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits. RESULTS: Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (χ(2) = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (χ(2) = 5.850, p ≤ .05), with both of these improved in the health promoter group. DISCUSSION: This study suggests that the training and implementation of para-health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries. IMPLICATIONS: Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

OBJECTIVE: To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. DESIGN: We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. SETTING: Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. SUBJECTS: The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. RESULTS: In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. CONCLUSIONS: This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

A community perspective on changes in health related to diarrhea in northeastern Brazil.

BACKGROUND: Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. OBJECTIVE: To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. METHODS: This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. RESULTS: Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. CONCLUSIONS: Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.

The role of clinical vignettes in rapid ethnographic research: a folk taxonomy of diarrhoea in Thailand.

This paper presents the findings of a rapid ethnographic research methodology used to investigate the beliefs and practices of rural mothers and grandmothers concerning diarrhoeal diseases in children under five years of age in Khon Kaen Province, Northeast Thailand. The multi-phase study used a combination of focus groups and clinical vignettes, semi-formal questionnaires and open-ended interviews. The efficiency of the combination of focus groups and clinical vignettes in obtaining an understanding of the important areas of belief in a short period of time is discussed, as well as the importance of quantifying and validating this information using other methodologies. A folk taxonomy of diarrhoea and its management is presented, and the implications of this for health planners is discussed. Most diarrhoea in children under one year is perceived to be su, a normal developmental stage which requires no treatment. As su is not considered to be diarrhoea, health messages concerning diarrhoea are not considered by care-givers. The labelling of a child with diarrhoea as having su results in a delay in help-seeking, a risk factor for dehydration. Thus su needs to be taken into consideration in health education campaigns. The informants demonstrated little understanding of the role of infection in diarrhoea, nor of the role of personal and domestic hygiene for its prevention, nor of the place and function of ORS, highlighting important areas where education is still necessary.

[Childhood diarrhea in rural Nicaragua: beliefs and traditional health practices]. / Diarrea infantil en la Nicaragua rural: creencias y prácticas de salud tradicionales.

In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.

Transcultural nursing: providing culturally congruent care to the Hausa of Northwest Africa.

Research around the world is now beginning to validate the theory of Cultural Care as an important means to provide culturally congruent care to clients, families, and groups of diverse cultures. Knowledge of Leininger's Theory of Cultural Care Diversity and Universality can provide meaningful care to clients who have different traditional and current beliefs and values. The Leininger Sunrise Model can serve as a valuable guide to discover care meanings and practices related to the theory, and to provide practical and meaningful culture specific care decisions and actions by nurses. The three major modes of action, namely, cultural care maintenance or preservation, accommodation or negotiation, and repatterning or restructuring, are important differential means to provide culturally congruent care to clients within their own cultural setting. This article considers the application of such care for the Hausa of Northwest Africa.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aspects of the popular attitude about diarrhea among Tswana-speaking urbanites]. / Aspekte van populêre opvattinge oor diareesiektes onder Tswanasprekende stedelinge.

This article contains a general overview of cultural perceptions of diarrhoeal disease amongst infants as expressed by Tswana-speaking urbanites. Attention is mainly given to the perception of gastro-enteritis. The research on which this article is based was concluded during 1984. The article indicates that a majority of respondents maintains the view that aetiologically it is possible to distinguish between three categories of illness, viz. illness of sorcery, illness of the shades or ancestors and "natural" illness or illness that "just happens". Within this general aetiological frame, serious diarrhoeal disease of infants is usually seen as sorcery related. Contact of infants with people regarded as ritually polluted is seen as a major causal agency. It is conceptualised as infants being "stepped upon" by "tracks". It causes an illness known as "phogwane", which can be interpreted as "sunken fontanelle". The concept "kokwana", which can be interpreted as "intestinal snake", is however also used to indicate serious diarrhoeal illness. In the case of "kokwana" it is said that the snake, "sent" to the child through witchcraft, "eats" the child's food and the child itself. Although many of the respondents were in doubt, the majority were of the opinion that Western doctors do not really understand the treatment of these dangerous illnesses. The author believes that nursing practitioners who are involved in health education services should take note of these popular conceptions of gastroenteritis. Knowledge of these views should be used during education session in a meaningful way, to tactfully dissipate "misconceptions".

[Breast feeding in the etiology of diarrhea]. / La lactancia materna en la etiología de la diarrea.

Information derived from different anthropological studies carried out in Guatemala as part of the activities of the maternal and child health and nutrition project reveal that, according to popular beliefs, maternal milk plays a definite role in the etiology of diarrheal diseases in the lactating child. This paper presents information on popular classification of diarrheal diseases that differ from biomedical definitions of same. Different factors that may alter the quality of mothers' breast milk and that may cause gastrointestinal diseases in the lactating child are given in detail. The possibilities and limitations of the popular concept frame of "hot-cold", so common in the popular medical beliefs in Latin American populations, are also pointed out as an explanatory model. Lastly, implications of findings in this study are suggested for public health programs, especially for the communication and education programs on breast feeding, and for the application of the high-risk focus.

PIP: Selected results are presented of studies of diarrhea and its treatment carried out in Guatemala in 1985-1987 and of qualitative studies of child feeding especially during and after diarrhea conducted in 1988-89 by the Nutrition Institute of Central America and Panama (INCAP). This work focuses on ethnoclassification and the role of breast feeding in diarrheal disease, the possibilities and limitations of the common Latin American system of classification into hot or cold properties as an explanatory model for diarrhea, and implications of the findings for public health programs. In the diarrhea studies, 15-20 randomly selected mothers of children under 5 were interviewed in 4 communities of about 1000 inhabitants in both indigenous and Ladino communities. Interviews were also conducted with curanderos, midwives, and other traditional health care providers. The dietary information on children with diarrhea came from focus groups with mothers in 3 marginal urban communities, 3 rural indigenous communities, and 4 rural Ladino communities. Biomedical practice and popular beliefs both consider alterations in the frequency or consistency of stools and stomach pain to be part of the definition of diarrhea. But the mothers viewed diarrhea as either an illness in itself, or 1 symptom of another illness defined by traditional practice such as "empacho" (indigestion) or evil eye, or as a normal accompaniment of changes in child growth and development such as loss of teeth or the 1st steps or words. Diarrhea caused by the mother's mild is believed to be a distinct type that occurs when the milk becomes very cold or hot in the folk classification, or when it is disturbed. Illnesses are viewed as violations of the equilibrium between hot and cold in the diet, activities, emotions, or general state of the nursing mother. Women are considered in a state of cold for about 40 days after birth and should follow specific recommendations for diet, activity, and personal care. Lactation is considered a hot state, and women should continue to consume hot foods to overcome the cold of the postpartum. Lactating women should avoid foods considered very hot, such as coffee, chile, and spicy foods. Strong maternal emotions such as anger or fright are also believed to affect the milk. Treatment may follow various forms depending on the suspected cause, and may include dietary change, consumption of a home or commercial remedy, or complete weaning. Public health programs should take local health systems into account, encouraging favorable prescribed practices such as postpartum rest and attention to the maternal diet. Specific advice to the mother may vary, but health education should maintain the integrated focus on the women that is part of the traditional system.

La lactancia materna en la etiología de la diarrea / Breast feeding in the etiology of diarrhea

La información proveniente de distintos estudios antropológicos llevados a cabo en Guatemala dentro de un proyecto del INCAP en apoyo de los programas y actividades de salud y nutrición maternoinfantil, revela que, de acuerdo a la perspectiva popular, la leche materna juega un papel definido en la etiología de las enfermedades diarreicas, en el niño lactante. Este artículo presenta información acerca de las clasificaciones populares de las enfermedades diarreicas que difieren de las definiciones biomédicas de las mismas. Se detallan los distintos tipos de factores que pueden alterar la calidad de la leche materna que, a su vez, puede producir enfermedades gastrointestinales en el niño lactante. Se señalan, asimismo, las posibilidades y limitaciones del marco conceptual popular "caliente-rfrio" tan común en los sistemas de creencias médicas populares de América Latina, como modelo explicativo. Finalmente, se sugieren implicaciones de los hallazgos de estos estudios para los programas de salud pública, especialmente en el área de comunicación y educación en lactancia materna y en la aplicación del enfoque de alto riesgo

Congenital chloridorrhea in Korean infants.

The present paper describes two Korean male infants, 1. 16 year old and newly born neonate from two families who were diagnosed and managed for one of very rare inborn errors of metabolism, congenital chloridorrhea (Darrow-Gamble syndrome). The diagnosis was suggested by one of the authors (HRM) from the unusual combination of metabolic alkalosis with severe gastrointestinal disorder presenting with chronic, profuse watery diarrhea in the newborn period in the first patient; and the maternal polyhydramnios, the appearance of dilated fetal bowel loops on prenatal ultrasonography and profuse watery diarrhea beginning at birth without passage of meconium in the second patient. The diagnosis was confirmed in both patients by examination of the stool chloride concentration which revealed extremely high exceeding the sum of sodium and potassium concentrations. Serum electrolytes and arterial blood gas analyses revealed hyponatremia, hypokalemia and hypochloremia with elevated bicarbonate. With replacement of fluid and electrolyte deficit and adequate dietary supplements of potassium and chloride, both patients remained well although the character of the stools waxed and waned. This is the first reported case of congenital chloridorrhea in korean population.