RESUMO
PIP: From 1980 through 1984 the same communication and social marketing strategy was applied to teaching oral rehydration therapy (ORT) and related child survival practices in both the Gambia and Honduras. Within that strategy, each country developed campaigns that had their own character, peculiarities, and challenges. Data bridging 3 years and the 2 cultures show almost identical results, including sustained adoption of ORT and significant improvement in nutritional practices. This discussion reports on the most interesting similarities, differences, and data from the 2 countries, based on recently published longitudinal studies conducted by Stanford University and Applied Communication Technology. Highly specific objectives were pursued and multiple channels -- radio, print materials, and direct contact -- were coordinated to support these objectives in the campaigns of Honduras and Gambia to teach ORT and related practices. Although emphasis shifted among topics for limited periods of time during the interventions, the key communication methods and procedures for conducting the interventions would not end abruptly but become an ongoing part of the public health education process and the health care delivery system. The interventions in Honduras and Gambia adapted lessons learned from past experiences. The methodological sequence is outlined. Stratified, random panels of approximately 750-1000 households with posttest controls were surveyed in each country in repeated waves over a 3 year period. The overall evaluation plan examined a sequential model of changes, recognizing that changes in any individual do not necessarily follow the same pattern. 1 technique used with strong impact in Gambia was the "Happy Baby Lottery." This was a contest of skill rather than chance and proved successful in overcoming the difficulty many Gambian women expeience in interpreting 2-dimensional graphs. The "lottery" in Gambia marked the beginning of a 2-year effort to teach a water/sugar/salt (WSS) home-mix solution and related diarrheal control and infant feeding practices. The evaluation shows that the mothers learned about ORT and changed their behavior accordingly. An overview of the 2-year data set indicates sustained adoption of WSS solution to treat diarrhea. The campaign in Health Region I of Honduras emphasizing ORT and related diarrheal control and infant feeding practices lasted 2 years and then expanded to the national level and to other topics during the 3rd year -- immunizations, malaria control, and compliance with tuberculosis treatment. The same method of village investigation, behavioral analysis, pretesting, integrated use of multiple channels, and monitoring were applied in developing and implementing a sustained, phased, public health communications intervention. Honduran mothers also learned and changed their practices significantly. At the beginning of the campaign none of the Health Region I mothers had used Litrosol, a newly introduced product, but within 6 months 37% of all surveyed mothers had tried it. By the end of the campaign over 60% of mothers had used Litrosol.^ieng
Assuntos
Comunicação , Atenção à Saúde , Educação , Hidratação , Educação em Saúde , Administração de Serviços de Saúde , Serviços de Informação , Meios de Comunicação de Massa , Mães , Organização e Administração , Avaliação de Programas e Projetos de Saúde , Terapêutica , África , África Subsaariana , África Ocidental , América , América Central , Países Desenvolvidos , Países em Desenvolvimento , Características da Família , Relações Familiares , Gâmbia , Saúde , Planejamento em Saúde , Honduras , América Latina , América do Norte , PaisRESUMO
Diarrheal disease prevention and diarrheal disease control with oral rehydration therapy are major goals of the World Health Organization and the international health community. This paper promotes the use of ethnographic research in this endeavor. It illustrates the use of ethnography in a diarrheal disease prevention and control program in Honduras by illustrating how knowledge of local beliefs and practices partially shaped promotion efforts. It confirms the validity of the original ethnographic findings by reporting the results of a survey conducted two years after program onset.
Assuntos
Hidratação , Planejamento em Saúde , Medicina Tradicional , Antropologia Cultural , Pré-Escolar , Diarreia/etiologia , Diarreia/prevenção & controle , Assistência Domiciliar , Honduras , Humanos , Estudos LongitudinaisRESUMO
PIP: 5 nurses and 14 Honduran mothers made up oral rehydration solutions from available materials (nurses bought supplies in Baltimore stores and Hondurans were supplied sugar and water by a rural health center but were asked to bring their own measuring devices) to determine the accuracy of homemade solutions under optimal and field conditions. 3 methods of preparation were used: 1) pinch and scoop; 2) household teaspoon and glass (both nurses and Honduran mothers performed these) 2; and 3) special double-ended plastic spoons (nurses only). The solutions prepared by the 5 U. S. nurses familiar with the physiologic basis of oral therapy and skilled in its use represent optimal conditions. However, there were statistically significant (P .01) nurse-to-nurse sodium level variations using Methods 1 and 2, making these methods unsuitable for promotion in an oral therapy program without health worker supervision. The findings from the Honduran mothers corroborated these findings (and others) because their sodium levels were generally beyond acceptable levels. Therefore, the special double-edged spoon method should be evaluated for its adaptability to field conditions.^ieng