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Davey Smith G, Phillips AN. Correlation without a cause: an epidemiological odyssey. Int J Epidemiol 2020; 49:4-14. [DOI: 10.1093/ije/dyaa016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background
In the 1980s debate intensified over whether there was a protective effect of high-density lipoprotein cholesterol (HDL-C) or an adverse effect of triglycerides on coronary heart disease (CHD) risk. In a 1991 paper reprinted in the IJE we suggested that the high degree of correlation between the two, together with plausible levels of measurement error, made it unlikely that conventional epidemiological approaches could contribute to causal understanding. The consensus that HDL-C was protective, popularly reified in the notion of ‘good cholesterol’, strengthened over subsequent years. Reviewing the biostatistical and epidemiological literature from before and after 1991 we suggest that within the observational epidemiology pantheon only Mendelian randomization studies—that began to appear at the same time as the initial negative randomized controlled trials—made a meaningful contribution. It is sobering to realize that many issues that appear suitable targets for epidemiological investigation are simply refractory to conventional approaches. The discipline should surely revisit this and other high-profile cases of consequential epidemiological failure—such as that with respect to vitamin E supplementation and CHD risk—rather than pass them over in silence.
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Affiliation(s)
- George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Mekonnen GK, Mengistie B, Sahilu G, Mulat W, Kloos H. Caregivers' knowledge and attitudes about childhood diarrhea among refugee and host communities in Gambella Region, Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:24. [PMID: 30466488 PMCID: PMC6249824 DOI: 10.1186/s41043-018-0156-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities. OBJECTIVE This study aims at assessing the caregivers' knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia. METHODOLOGY This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p < 0.05). RESULT The study indicates that 633 (28.0%) of the caregivers had poor knowledge, while 393 (23.6%) of them had unfavorable attitudes towards childhood diarrhea. Knowledge of the caregivers was significantly associated with formal education (AOR, 1.3; 95% CI, 1.03-1.5) and health information obtained from a health care institution (AOR, 1.8; 95% CI, 1.28-2.3). Caregivers' knowledge is a single predictor of their attitude (p < 0.001), and Pearson's correlation coefficient revealed that there was a significant positive correlation (r = 0.2, p < 0.001) between knowledge and attitude scores. CONCLUSION The study indicates that significant numbers of caregivers had inadequate knowledge and unfavorable attitudes about diarrhea in under-five children. Designing and implementing an inclusive health education intervention focusing on uneducated child caregivers may be beneficial for improving knowledge and attitudes towards reducing the incidence of acute childhood diarrhea in the region.
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Affiliation(s)
- Getachew Kabew Mekonnen
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O. BOX. 150461, Addis Ababa, Ethiopia
- College of Health and Medical Sciences, Haramaya University, P.O. Box 1570, Harar, Ethiopia
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, P.O. Box 1570, Harar, Ethiopia
| | - Geremew Sahilu
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O. BOX. 150461, Addis Ababa, Ethiopia
| | - Worku Mulat
- Department of Civil and Environmental Engineering, University of Connecticut, Storrs, CT USA
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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Colombara DV, Hernández B, McNellan CR, Desai SS, Gagnier MC, Haakenstad A, Johanns C, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica. Am J Trop Med Hyg 2016; 94:544-52. [PMID: 26787152 DOI: 10.4269/ajtmh.15-0750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022] Open
Abstract
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ(2) tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.
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Affiliation(s)
- Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Diego Ríos-Zertuche
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Paola Zúñiga-Brenes
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Nicholas Zyznieuski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Emma Iriarte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
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Carter E, Bryce J, Perin J, Newby H. Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health 2015; 15:788. [PMID: 26282400 PMCID: PMC4538749 DOI: 10.1186/s12889-015-2127-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Harmful practices in the management of childhood diarrhea are associated with negative health outcomes, and conflict with WHO treatment guidelines. These practices include restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. We conducted a systematic review of English-language literature published since 1990 to assess the documented prevalence of these four harmful practices, and beliefs, motivations, and contextual factors associated with harmful practices in low- and middle-income countries. METHODS We electronically searched PubMed, Embase, Ovid Global Health, and the WHO Global Health Library. Publications reporting the prevalence or substantive findings on beliefs, motivations, or context related to at least one of the four harmful practices were included, regardless of study design or representativeness of the sample population. RESULTS Of the 114 articles included in the review, 79 reported the prevalence of at least one harmful practice and 35 studies reported on beliefs, motivations, or context for harmful practices. Most studies relied on sub-national population samples and many were limited to small sample sizes. Study design, study population, and definition of harmful practices varied across studies. Reported prevalence of harmful practices varied greatly across study populations, and we were unable to identify clearly defined patterns across regions, countries, or time periods. Caregivers reported that diarrhea management practices were based on the advice of others (health workers, relatives, community members), as well as their own observations or understanding of the efficacy of certain treatments for diarrhea. Others reported following traditionally held beliefs on the causes and cures for specific diarrheal diseases. CONCLUSIONS Available evidence suggests that harmful practices in diarrhea treatment are common in some countries with a high burden of diarrhea-related mortality. These practices can reduce correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality.
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Affiliation(s)
- Emily Carter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Holly Newby
- Division of Policy and Strategy, Data and Analytics Section UNICEF, UNICEF, 3 UN Plaza, New York, NY, 10017, USA.
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Tanner S, Chuquimia-Choque ME, Huanca T, McDade TW, Leonard WR, Reyes-García V. The effects of local medicinal knowledge and hygiene on helminth infections in an Amazonian society. Soc Sci Med 2011; 72:701-9. [PMID: 21306810 DOI: 10.1016/j.socscimed.2010.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 11/30/2022]
Abstract
Social science has long recognized the importance of understanding how interactions between culture and behavior shape disease patterns, especially in resource-poor areas where individuals draw on multiple medical treatments to maintain health. While global health programs aimed at controlling high infection rates of soil-transmitted helminthes among indigenous groups often acknowledge the value of local culture, little research has been able to examine this value. This study investigates the association between parental ethnomedical knowledge, parental biomedical knowledge, and household sanitation behavior and childhood soil-transmitted helminth infections among a group of foragers-farmers in the Bolivian Amazon (Tsimane'). During 2007, a parasitological survey was completed for 329 children (≤ 16 years of age) from 109 households in combination with a comprehensive survey of both of the child's parents to assess biomedical and ethnomedical knowledge and household sanitary environment. Soil-transmitted helminthes were found to be common with 67% of sample positive for hookworm species. Indices that capture a household's relative state of risky and preventive hygienic behavior were significantly associated with risk of hookworm infection. Mother's but not father's ethnomedical knowledge was also negatively associated with a child's probability of being positive for hookworm infection. The effect was stronger for young children and boys. Like many rural populations, Tsimane' actively draw upon multiple medical systems to respond to health challenges. Integration into markets and national societies is likely to affect local medical systems by increasing the use of biomedicine as formal education prioritizes biomedical over ethnomedical systems. This study underscores the value of considering both ethnomedical knowledge systems and household hygiene in public health campaigns to treat and control soil-transmitted helminths. There is no question that providing medication is critical, but this study demonstrates that poverty is not synonymous with either poor hygiene or the lack of valuable ethnomedicinal knowledge.
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Affiliation(s)
- Susan Tanner
- Department of Anthropology, University of Georgia, Athens, GA 30602, USA
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Ellis AA, Winch P, Daou Z, Gilroy KE, Swedberg E. Home management of childhood diarrhoea in southern Mali--implications for the introduction of zinc treatment. Soc Sci Med 2006; 64:701-12. [PMID: 17097788 DOI: 10.1016/j.socscimed.2006.10.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Indexed: 11/18/2022]
Abstract
Diarrhoea remains one of the leading killers of young children. A recent meta-analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children (Bhutta et al., 2000. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. American Journal of Clinical Nutrition, 72(6), 1516-1522). Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies. As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea, the concept of joint therapy of zinc and ORS should be well accepted in the community. Mothers-in-law and fathers, who play a significant role in decisions to seek treatment for sick children, as well as traditional healers, should also be considered when designing new programs to promote zinc. Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed.
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Affiliation(s)
- Amy A Ellis
- Johns Hopkins School of Public Health Baltimore, MD, USA.
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Vázquez ML, Mosquera M, Kroeger A. People's concepts on diarrhea and dehydration in Nicaragua: the difficulty of the intercultural dialogue. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2002. [DOI: 10.1590/s1519-38292002000300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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.
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Affiliation(s)
| | | | - Axel Kroeger
- Liverpool School of Tropical Medicine, United Kingdom
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Bérard C, Pilliard D, Robert E. [First consultation with specialists for a child presenting with forelimb unilateral agenesis. Group for the Study and Research of Limb Agenesis (GERAM)]. Arch Pediatr 1998; 5:190-3. [PMID: 10223143 DOI: 10.1016/s0929-693x(97)86836-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
After the birth of a child with a forelimb unilateral agenesis, the first consultation is of cardinal importance for the family. It should take place as soon as possible. The major point to be emphasized is that the child, although different, must not be considered as handicapped. If the aesthetic prejudice is evident, the functional incapacity is limited to some specific situations. In practice, the child with or without a prosthesis will have the same autonomy as children of the same age. A first prosthesis is usually proposed at 6 or 7 months of age. The child will wear the prosthesis more or less easily depending mainly upon the family attitude. It is recommended that the family have access to a medical team including a psychologist and an occupational therapist.
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Affiliation(s)
- C Bérard
- L'Escale, rééducation pédiatrique, centre hospitalier Lyon-Sud, Pierre-Bénite, France
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Kehrt R, Becker M, Brösicke H, Krüger N, Helge H. Prevalence of Helicobacter pylori infection in Nicaraguan children with persistent diarrhea, diagnosed by the 13C-urea breath test. J Pediatr Gastroenterol Nutr 1997; 25:84-8. [PMID: 9226533 DOI: 10.1097/00005176-199707000-00014] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The impairment of gastric acid barrier caused by Helicobacter pylori (H. pylori) at the onset of infection may predispose to small bowel bacterial overgrowth, which could contribute to persistent diarrhea. METHODS Using the 13C-urea breath test, we determined the prevalence of H. pylori infection in 123 Nicaraguan children from Tipitapa, aged 1 to 65 months, from a low socioeconomic background. RESULTS The overall prevalence of H. pylori infection was 77.2% (95/123). The prevalence varied with age and was significantly (p < 0.001) higher in infants < or = 12 months than in children aged 13-65 months, 91% (57/63) as against 63% (38/60). H. pylori infection was present in 44 of 59 (75%) children suffering from persistent diarrhea compared with 51 of 64 (80%) age-matched asymptomatic controls. In the diarrheal group, 20 of 59 (34%) children presented with malnutrition, and 16 (80%) of them showed H. pylori infection. In the control group, 20 of 64 (31%) were malnourished, and 14 (70%) of them showed H. pylori infection. CONCLUSIONS In Nicaragua, H. pylori is acquired in early infancy. The high prevalence among children in the first 12 months of life and the lower infection rate between 1 and 5 years of age suggest a loss or clearance of infection, also an occasional finding in adults. H. pylori infection appears to be not a risk factor for persistent diarrhea or malnutrition in Nicaraguan children.
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Affiliation(s)
- R Kehrt
- Department of Pediatrics, Virchow-Klinikum, Humboldt University, Berlin, Germany
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Affiliation(s)
- James A. Trostle
- Five College Medical Anthropology Program, Mount Holyoke College, South Hadley, Massachusetts 01075
- Institute of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Johannes Sommerfeld
- Five College Medical Anthropology Program, Mount Holyoke College, South Hadley, Massachusetts 01075
- Institute of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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Shawyer RJ, bin Gani AS, Punufimana AN, Seuseu NK. The role of clinical vignettes in rapid ethnographic research: a folk taxonomy of diarrhoea in Thailand. Soc Sci Med 1996; 42:111-23. [PMID: 8745112 DOI: 10.1016/0277-9536(95)00075-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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MESH Headings
- Adult
- Aged
- Anthropology, Cultural/methods
- Child, Preschool
- Diarrhea, Infantile/ethnology
- Diarrhea, Infantile/etiology
- Diarrhea, Infantile/prevention & control
- Diarrhea, Infantile/therapy
- Female
- Focus Groups/methods
- Health Education
- Health Knowledge, Attitudes, Practice
- Humans
- Infant
- Infant, Newborn
- Interviews as Topic/methods
- Medicine, Traditional
- Middle Aged
- Rural Health
- Surveys and Questionnaires
- Thailand
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