Stewart M K, Parker B, Chakraborty J, Begum H
Johns Hopkins University, School of Hygiene and Public Health, Department of International Health, Baltimore, MD 21205.
Med Anthropol. 1994 May;15(4):377-94. doi: 10.1080/01459740.1994.9966100.
Acute Respiratory Infections (ARI) are a major cause of death in children under five in rural Bangladesh. A popular strategy for lowering ARI mortality in such settings includes detecting and managing pneumonia in children at the community level. The success of programs using this approach requires a well-trained community-based cadre of health workers and the appropriate utilization of services provided. Determinants of health care seeking behavior are clearly of interest in this regard. A qualitative study was conducted in Matlab, Bangladesh to describe community perceptions of signs and symptoms of ARI, case management behavior, and constraints to service utilization. Mothers recognized pneumonia and thought it to be caused by "exposure to cold." They were able to identify labored breathing, chest retractions, lethargy, and inability to feed as signs of severe disease needing treatment outside the home. Nevertheless, similar illnesses were sometimes believed to be due to attack by evil influences. In these cases, spiritual healers were sought and allopathic treatment was avoided or delayed. The mothers' observance of purdah and "proper" behavior were reported to play a role in prevention of child death from disease. Implications of this belief and its impact on service utilization are discussed. Suggestions for program managers are made in addition to recommendations for further research.
急性呼吸道感染（ARI）是孟加拉国农村地区五岁以下儿童死亡的主要原因。在这种情况下，降低ARI死亡率的一种常用策略包括在社区层面检测和管理儿童肺炎。采用这种方法的项目取得成功需要一支训练有素的社区卫生工作者队伍，并合理利用所提供的服务。在这方面，寻求医疗行为的决定因素显然是值得关注的。在孟加拉国的马特莱进行了一项定性研究，以描述社区对ARI体征和症状的认知、病例管理行为以及服务利用的制约因素。母亲们认识肺炎，并认为其是由“着凉”引起的。她们能够识别呼吸急促、胸部凹陷、嗜睡和无法进食等作为需要在家外治疗的严重疾病的体征。然而，类似的疾病有时被认为是受到邪恶影响的攻击。在这些情况下，人们会寻求精神治疗师的帮助，而避免或推迟使用对抗疗法。据报道，母亲们遵守深闺制度和“适当”行为在预防儿童因病死亡方面发挥了作用。讨论了这种观念的影响及其对服务利用的作用。除了对进一步研究的建议外，还为项目管理人员提出了建议。
