People's concepts on diarrhea and dehydration in Nicaragua: the difficulty of the intercultural dialogue

摘要

OBJECTIVES: to analyse people's concepts and health seeking behavior relating to diarrhea and dehydration and its implications to improve health services practice. METHODS: individual and group interviews were conducted in two municipalities in the North of Nicaragua, with mothers, other community members, traditional healers and basic health personnel. A household interview survey in a random sample of 1.924 families with under-fives was carried out in three departments. RESULTS: people can easily identify diarrhea, as a disease in itself or as a symptom of several folk diseases. The popular construction of the causes of diarrhea is complex, with a mixture of folk concepts and modern medical concepts which influence preventive and health seeking behavior. Health personnel often believe in these popular concepts. Dehydration is a new term and concept introduced by the health education campaigns and often mistaken for the term malnutrition. Oral rehydration solution (ORS) is seen as an ineffective drug against diarrhea. The inadequate use of pharmaceuticals is widespread and in most cases they have been prescribed by doctors. CONCLUSIONS: these results show the co-existence of popular and medical concepts, the latter with different interpretations. There is a need for a change in the communication between health services and population, based on an alternative analysis of people's knowledge and behavior.