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  • Title: Cultural study of diarrhoeal illnesses in central Thailand and its practical implications.
    Author: Choprapawon C, Chunsutiwat S, Kachondham Y, Weiss MG.
    Journal: J Diarrhoeal Dis Res; 1991 Sep; 9(3):204-12. PubMed ID: 1787275.
    Abstract:
    A cultural study of diarrhoeal illness was conducted using the Explanatory Model Interview for Cultural Assessment (EMIC) to compare two socioeconomically distinct subdistricts of central Thailand and to determine the practical implications of illness-related perceptions, beliefs and practices. Subjects specified 12 terms for diarrhoeal illnesses that were grouped into four locally meaningful groups, namely, tong-sia, a non-specific term for diarrhoea, bid, associated with colicky abdominal pain, ahiwa, referring to severe illness, often cholera; and taae-tua, diarrhoea associated with milestones of growth and development. To compare pre-existing beliefs and practices with the experience of caretakers when actually confronted with an episode of illness, we inquired about each of the terms and about index cases in subsequent interviews over the course of a six-month surveillance period. Patterns of distress, perceived causes, and preferences for help seeking and treatment elicited by the EMIC identified cultural features of the four groups of diarrhoeal illness. Perceived causes of diarrhoea associated with sanitation, hygiene and infection, which most respondents considered preventable, were prominent explanations for three of the four categories, and the fourth was viewed as a normal feature of growth and development, rather than medical illness. We discuss these and other findings with reference to use of ORS and other issues related to the prevention and control of diarrhoeal illness, concluding with recommendations for public health policy and research. Between October 1987 and March 1988, research assistants used the explanatory model interview for classification to interview households in 2 villages in Banna subdistrict and 3 villages in Sam-Tai subdistrict in Ayutthaya province, Thailand. Researchers analyzed the data to examine the respondents' diarrhea-related perceptions, beliefs, and practices. The people used 12 terms for diarrhea. The mean number of terms/person was 6. Everyone used the term tong-sia (generic diarrhea). The Ministry of Public Health used the term ahiwa (severe diarrhea such as cholera) in its health education campaigns but only 39.3% of the people knew this term. 99.1% attributed a transitional phase in normal growth and development to be the cause of taae-tua. Bad child's and mother's food was frequently perceived as the cause of ahiwa, tong-sia, and bid (colicky abdominal pain). Everyone, 93.1%, and 67.5% mentioned flies and germs (sanitation and hygienic practices) as the cause of ahiwa, tong-sia, and bid, respectively. The responses were different between theory and actual practice, however. For example, 91% believed bad food and poor sanitation and hygiene were responsible for tong-sia, but only 34.4% gave this response when referring to index cases. Few people attributed supernatural causes or sorcery to bring about diarrhea illness. Most villagers were impressed with modern drugs and injections but they did not understand their nature. They sought treatment from professional sources that should know appropriate diarrhea treatment but did not. Only 51% used oral rehydration solution (ORS) to treat diarrhea and just 3.5% of them believed ORS to be the most useful treatment. Health education efforts should include descriptions of cholera rather than using the work ahiwa, emphasis on the need to treat diarrhea regardless of its perceived cause, promotion of improved sanitation and hygiene, and communication of appropriate expectations of ORS and its ability to prevent and ameliorate dehydration and reduce mortality.
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