Granich R, Cantwell M F, Long K, Maldonado Y, Parsonnet J
Department of Internal Medicine, California Pacific Medical Center, San Francisco 94120, USA.
Soc Sci Med. 1999 Feb;48(4):489-95. doi: 10.1016/s0277-9536(98)00356-6.
In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be influenced by local beliefs and cultural practices. Few studies have attempted to quantitatively evaluate health seeking behavior (HSB) for diarrheal diseases in indigenous communities, while controlling for potential confounding factors such as parental education or socioeconomic status. A rapid ethnographic survey was conducted in Nabenchauc, Chiapas, to determine hypothetical HSB patterns for each of four major types of childhood diarrhea. Additionally, we examined the actual HSB for the last episode of childhood diarrheal illness within the household. One hundred households participated in the survey; 94 households with children < 5 years old reported a mean of 1.9 diarrheal episodes during the preceding month. Households reported using a mean of 1.3 types of in-home remedies. Oral rehydration therapy (ORT) was used in <2% of the 368 HSB patterns elicited for the four types of diarrhea. HSB patterns utilized an eclectic combination of traditional, allopathic, local and distant health care options. A mean of 2.5 outside-the-home health care options were reported for each diarrheal type; the local grocery store was reported in 245 (67%) of the hypothetical HSB patterns and as a first option in 199 (54%). Maternal and/or paternal education had little impact on hypothetical HSB. Households with lower SES were more likely to report using local grocery stores as a first option and were less likely to use options outside the village. The rapid ethnographic survey approach allows for assessment of changes in the approach to health care option utilization in cultures incorporating new health care paradigms. Public health interventions targeting local stores may lead to increased use of ORT, thereby potentially reducing early morbidity and mortality due to childhood diarrhea.
在墨西哥恰帕斯州，腹泻病导致了五岁以下儿童的大多数死亡。儿童腹泻的治疗可能会受到当地信仰和文化习俗的影响。很少有研究试图在控制诸如父母教育程度或社会经济地位等潜在混杂因素的同时，对土著社区腹泻病的就医行为进行定量评估。在恰帕斯州的纳本乔克进行了一项快速人种志调查，以确定四种主要类型儿童腹泻的每种类型的假设就医行为模式。此外，我们还研究了家庭中儿童上一次腹泻疾病发作的实际就医行为。一百户家庭参与了调查；94户有五岁以下儿童的家庭报告称，前一个月平均有1.9次腹泻发作。家庭报告平均使用了1.3种家庭疗法。在为四种腹泻类型引发的368种就医行为模式中，口服补液疗法（ORT）的使用率不到2%。就医行为模式采用了传统、对抗疗法、当地和远程医疗保健选择的折衷组合。每种腹泻类型报告的平均外出医疗保健选择为2.5种；在245种（67%）假设就医行为模式中提到了当地杂货店，其中199种（54%）将其作为首选。母亲和/或父亲的教育程度对假设就医行为影响不大。社会经济地位较低的家庭更有可能报告将当地杂货店作为首选，而使用村外医疗保健选择的可能性较小。快速人种志调查方法有助于评估在引入新医疗保健模式的文化中，医疗保健选择利用方式的变化。针对当地商店的公共卫生干预措施可能会导致口服补液疗法的使用增加，从而有可能降低儿童腹泻导致的早期发病率和死亡率。
