Gorter A C, Sánchez G, Pauw J, Pérez R M, Sandiford P, Smith G D
Fundación de Desarrollo Social y Económico del Area Rural (DESEAR), Managua, Nicaragua.
Bol Oficina Sanit Panam. 1995 Nov;119(5):377-90.
In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.
在尼加拉瓜，婴儿死亡的主要原因是腹泻，腹泻每年导致40%的婴儿死亡。这一统计数据反映了卫生服务和口服补液疗法（ORT）的低使用率。为了改善这种情况，在卡洛斯·丰塞卡镇开展了几项研究。本报告描述了其中两项研究，一项是人种志研究，另一项是流行病学研究（分别于1989年和1990年进行），以了解人们的观念和传统保健做法，以及它们对母亲应对孩子腹泻疾病方式的影响。人种志研究包括采访70位平均年龄为28岁、孩子年龄在2岁以下的母亲。这些孩子分为两组：一组腹泻风险高，另一组腹泻风险低。其目的是了解腹泻的传统名称、风险认知以及所采用的治疗方法。流行病学研究包括391位14岁以上、有一个或多个5岁以下孩子的母亲，其中215位在调查前两周内孩子患过腹泻。其目的是描述当地的观念和保健做法，并根据母亲做出的诊断确定腹泻的发病率。至少确定了12种腹泻类型，人们使用了诸如“积食”和“眼热”等术语。在大多数情况下，母亲们对自己或传统治疗师（curanderos）采用的民间疗法比对卫生中心提供的服务更有信心。这种态度限制了她们对卫生服务和口服补液疗法的使用，不过据观察，在某些情况下，传统疗法与西医治疗方法结合使用。母亲的受教育程度与她们前往卫生中心的频率之间存在直接但不显著的相关性。作者建议，应该研究按摩、草药浴和其他传统治疗方法的效果，以评估其有效性，并尽可能使其适应“现代”医学。卫生服务提供者应该熟悉传统的术语和观念，以便能够更好地与母亲沟通，并引导她们摒弃有害做法，从而在婴儿腹泻疾病预防项目中取得更好的效果。
