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Developing a focused ethnographic study for the WHO acute respiratory infection (ARI) control programme.
In: RAP: Rapid Assessment Procedures. Qualitative methodologies for planning and evaluation of health related programmes, edited by Nevin S. Scrimshaw and Gary R. Gleason. Boston, Massachusetts, International Nutrition Foundation for Developing Countries, 1992. 215-25.The development process used to construct and test a protocol for conducting community-based, focused ethnographic studies of acute respiratory infections (ARI) in children is described. The development of the Focused Ethnographic Study (FES) protocol is a component of the behavioral research activities of the ARI Program of the World Health Organization, which attempt to generate ethnographic data on beliefs and practices related to pneumonia and other respiratory conditions. The goal of this Program is to reduce mortality from ARI in children in developing countries. Some of the requirements of FES research are the distinction between lower vs. upper respiratory infections and research has to be completed in a relatively short period of time. The protocol on how to collect, analyze, and present data is the primary means of attaining the project objectives. The protocol consists of the overview of the project, guidelines on research management, specific research procedures, preparing the report, using the information from the study, and adapting the ARI household morbidity and mortality treatment survey. The program manager's questions are concerned with: 1) caretaker and household recognition and interpretation of ARI symptoms; 2) ARI household management practices; 3) patterns of care seeking; 4) maternal expectations concerning ARI treatment; 5) perspectives of practitioner on maternal care-seeking; and 6) recommendations concerning communication with mothers. Specific data-gathering techniques included: key informant interviews, free listing of illnesses and symptoms, narratives, hypothetical scenarios, and inventory of home medications. The first field study was carried out in July-August 1989 in Mindoro Oriente Province in the Philippines; the next round of studies took place in Turkey, Ghana, Honduras, Haiti, and Egypt. Common findings from ARI FES studies indicated: 1) peoples' explanatory models of ARI were complex, with differentiation of symptoms, but diagnoses varied; 2) milder conditions were perceived as likely to worsen if not treated; and 3) home remedies were universal.