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  • Title: Perceptions of severity of diarrhoea and treatment choice: a comparative study of HealthCom sites.
    Author: Yoder PS, Hornik RC.
    Journal: J Trop Med Hyg; 1994 Feb; 97(1):1-12. PubMed ID: 8107166.
    Abstract:
    This paper examines the association of treatments given for childhood diarrhoea with the severity of the illness as perceived by mothers and caretakers. Drawing on 11 large sample surveys in seven research sites of the HealthCom project, the study shows that in all sites, the children judged as very sick were more likely to receive treatment than those not very sick, and that the more severe cases were more likely to be taken to a health facility. The results also show that in half of the surveys, the more severe cases were more likely to be given SSS or ORS. No overall pattern of relations was found between severity and giving herbal medicine or pharmaceutical drugs at home. The study found that most carers of children with diarrhoea give some form of treatment at home in all research sites and that treatment choice is influenced by the severity of the episode. The results suggest that the perception of mothers and carers of the severity of episodes of diarrhoea is an important factor in their choice of treatment, and thus could be used in messages promoting improved treatment of diarrhoeal disorders. Staff of the Communication for Child Survival (HealthCom) project oversaw and reviewed 11 surveys from 7 HealthCom sites in 5 developing countries to determine the effect mother's perception of severity of illness has on diarrhea treatment choices. Mothers who perceived their children to be very sick were more likely to seek or give treatment than those who did not perceive their children to be very sick. They also were more likely to take the children perceived to be very ill to a health facility (e.g., in Zaire, 55% vs. 29% for somewhat sick and 24% for not sick; p .0001). In 5 surveys, mothers who perceived their children to be very sick were more likely to administer oral rehydration therapy (ORT) at home (e.g., in the Philippines, 52% vs. 30% for somewhat sick and 20% for not sick). On the other hand, severity was not associated with administering herbal treatment or pharmaceutical drugs at home, indicating that mothers applied cues other than severity for using herbal medicines and pharmaceuticals. At all sites, most mothers (range, 52% in 1 site in Lesotho to 76% in the Philippines) treated diarrhea at home. These findings showed that mothers were not only willing to treat their children with diarrhea at home, they were especially motivated to treat them when the children appeared seriously ill. In fact, at least 88% of children considered to be very sick were treated in 8 of 11 surveys. The results suggested that staff of health communication programs on diarrhea should consider perception of severity of diarrheal illness as well as knowledge of ORT when designing ORT promotion campaigns.
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