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    Behavioral aspects of child survival: oral rehydration therapy.

    Sukkary-Stolba S

    [Unpublished] [1988]. [3], 89 p.

    The use of oral rehydration therapy is often affected by local beliefs and behaviors in relation to the causes and cures of diseases. Folk beliefs may include diarrhea with diseases of the land, not amenable to modern medicine. They may consider it as due to an imbalance of hot and cold elements, breathing of the wrong air, exposure of the fetus to lightning, agitation of benign intestinal worms, the evil eye, fright, fallen fontanelle or various supernatural causes. In many places diarrhea is so common that it is considered a normal part of growing up. Beliefs about cures are as varied as beliefs about causes. Purgatives and herbal teas are commonly administered, and breast milk as well as other food is commonly withheld. When oral rehydration therapy is administered, it is often discontinued because it does not immediately stop the diarrhea. The lack of sanitation itself is often supported by folk beliefs, such as the idea that using latrines is like defecating in a house or that latrines give witches a chance to collect urine or feces of their enemies. Often adults use latrines, but children may defecate anywhere. Human wastes are sometimes used for fertilizer; kitchens are often located near latrines; and farm animals may share the family living quarters. Water is often polluted or contaminated at the source, or in storage, or when poured into unclean vessels; so that even if the mother understands how to mix the oral rehydration solution, both the water and the container may be contaminated. Oral rehydration salts may be rejected as therapy because they do not stop the diarrhea or because they conflict with a traditional remedy, or they are regarded as inferior medicines because they are not expensive enough. They may be rejected on the basis of taste or the color of the package. Standard measures are rarely available among the rural poor, so oral rehydration salts are more likely to be used successfully if they come in premeasured packets and/or with standard measures. Such items may add to the cost, but the additional cost is offset by the reusability of the containers. Graphics and logos on the packets will increase correct use of oral rehydration salts among illiterate people by showing in pictures what they are for and how to mix them. If mothers are too poor to buy the premixed packets, they can be taught to use the pinch and scoop method for measuring salt and sugar as long as some commonly used container of a standard size is available. Oral rehydration solutions may be distributed by physicians or pharmacists, but these people are usually too busy to explain correct use to mothers, so, unless trained community health volunteers are available, traditional healers should be thoroughly trained in mixing the solutions, especially since the traditional healers are usually trusted and accepted by the community. Since mothers are the group that has most need to know about oral rehydration therapy, an integrated media approach that reaches the mothers directly is recommended. The messages must be clear, simple, given in the local language, and carefully worded so as to overcome, but not conflict with, cultural barriers and beliefs. As illustrative examples of the promotion of oral rehydration therapy, successful experiences in Ecuador, Honduras, and the Gambia are recounted.
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