Diarrhoeal diseases: perceptions and practices in Nepal.

A study undertaken in Nepal collected information on believed causes of diarrhoea and traditional treatments. Natural causes for diarrhoea were more frequently reported than supernatural causes, the most important being teething (75% of respondents reporting it to be a cause) followed by food considered to be 'cold' in the Hindu ayurvedic classification (57.5%), stale food (52.5%), hot food (41%) and dirty water (38%). The terminology reported for dehydration however, indicates strong links with supernatural causes. For prevention of diarrhoea the recognition of the importance of stale food and dirty water is encouraging for health education programmes. Its association with teething may be an obstacle. In the promotion of correct diarrhoea management, the high proportion (83%) of mothers reportedly continuing to breast-feed is a good sign, but 75% of respondents reported that fluids are always or sometimes withheld, and 58% that foods are withheld. The literature does suggest that administration of certain foods and fluids is the commonest form of treatment of diarrhoea, but the choice of these is based upon the hot-cold principle. Both diarrhoea and dysentery were reported to be caused by both 'hot' and 'cold' influences in this study. In addition, 'hot' and 'cold' foods and fluids were reported to be both useful and harmful in their treatment. Thus, while treatment by giving foods or fluids is suitable, neither 'hot' nor 'cold' types will be universally acceptable. The promotion of oral rehydration solution consequently needs to be flexibly manipulated in terms of the hot-cold principle. The current recommendation of its preparation using cold water may be unacceptable in a proportion of cases. A wide variety of nutritious foods and fluids were reported to be considered beneficial and it is concluded that these traditionally accepted feeding practices should be reinforced, especially at the onset of diarrhoea in infants and children.