Kauchali Shuaib, Rollins Nigel, Van den Broeck Jan
Africa Centre for Health and Population Studies, Mtubatuba, KwaZulu/Natal, South Africa.
J Trop Pediatr. 2004 Apr;50(2):82-9. doi: 10.1093/tropej/50.2.82.
The aim of this study was to describe perceptions and beliefs about childhood diarrhoea in a rural South African area. A further aim was to describe mismatches with medical concepts that may influence quality of diarrhoea care and validity of population-based diarrhoea research. This was a descriptive study carried out in a rural district of KwaZulu/Natal, South Africa. Using a validated ethnographic method information was compiled from semi-structured interviews, card sorting exercises, case histories, and focus group discussions with 29 caregivers in total. Description of locally perceived diarrhoea types, signs, symptoms, causes and actions taken were recorded. Eleven 'local types of diarrhoea' were identified, which were classified into three categories: (A) natural causation, (B) supernatural causation, and (C) caused by 'germs' or change in diet. Conceptual mismatches included: (1) not all conditions with frequent or watery stools were perceived as diarrhoea; (2) hygiene was considered irrelevant in the causation of A and B; (3) signs of dehydration were not always attributed to loss of fluid; (4) medical care and oral rehydration therapy were considered useless in B; (5) potentially harmful treatments, such as herbal enemas, are always preferred in B, sometimes in A. These mismatches carry the potential to hamper health promotion, predispose to delayed and poor care and may lead to selection bias, under- and misreporting and poor compliance in research. This study highlights the discrepancies in concepts between medically trained and local people regarding the nature of childhood diarrhoea, the rationale behind care-seeking behaviour, and what can be expected from proposed interventions. Taking these discrepancies into account is not only essential to programmatic success and continued support but also for epidemiological surveys.
本研究的目的是描述南非一个农村地区对儿童腹泻的认知和看法。另一个目的是描述与医学概念的不匹配之处，这些不匹配可能会影响腹泻护理的质量以及基于人群的腹泻研究的有效性。这是一项在南非夸祖鲁/纳塔尔省一个农村地区开展的描述性研究。采用经过验证的人种学方法，通过与29名照料者进行半结构化访谈、卡片分类练习、病例史记录和焦点小组讨论来收集信息。记录了当地对腹泻类型、体征、症状、病因及采取措施的描述。确定了11种“当地腹泻类型”，并分为三类：(A)自然病因，(B)超自然病因，(C)由“病菌”或饮食变化引起。概念上的不匹配包括：(1)并非所有大便频繁或呈水样的情况都被视为腹泻；(2)卫生被认为与A类和B类病因无关；(3)脱水体征并不总是归因于体液流失；(4)在B类病因中，医疗护理和口服补液疗法被认为无用；(5)在B类病因中，有时在A类病因中，人们总是更倾向于使用潜在有害的治疗方法，如草药灌肠。这些不匹配有可能阻碍健康促进，导致护理延迟和质量不佳，并可能导致选择偏倚、报告不足和错误报告以及研究中的依从性差。本研究强调了受过医学培训的人员与当地人在儿童腹泻的本质、就医行为背后的理由以及对拟议干预措施的期望方面存在的概念差异。考虑到这些差异不仅对项目成功和持续支持至关重要，而且对流行病学调查也至关重要。
