Focused ethnographic Study on Acute Respiratory Infection (ARI) among children.
Executive Summary: 1. Introduction Acute Respiratory Infection (ARI) in Nepal continues to be one of the major causes of childhood morbidity and mortality. A child may have as many as five episodes in a year, most of which are simple cough and cold. Without proper home care, however, cough and cold...
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| Format: | Book |
| Language: | English |
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c2005.
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| Summary: | Executive Summary: 1. Introduction Acute Respiratory Infection (ARI) in Nepal continues to be one of the major causes of childhood morbidity and mortality. A child may have as many as five episodes in a year, most of which are simple cough and cold. Without proper home care, however, cough and cold may develop into pneumonia which, unless treated early and appropriately, can be fatal in young children. The majority of deaths in children less than 5 years suffering from ARI are caused by pneumonia. A focused ethnographic study was conducted to explore recognition and interpretation of ARI signs and symptoms by mothers and management of ARI at household and community levels. The study also focused on sequence of care seeking practices in these communities. Additionally, the study also dealt with the perception of the mothers towards various health care facilities. 2. Methodology The study was carried out in four districts: Morang, Sunsari, Makwanpur and Chitwan to cover five different caste/ethnic groups. In Morang and Sunsari districts, three study sites (VDCs) were selected. In these districts, Tharu, Musahar and Muslims were selected as study population. Similarly, in Chitwan and Makwanpur, two study sites (VDCs) were selected to carry out research with Brahmin/Chhteri and Tamang. The study sites (VDCs) were selected based on concentration of study groups and safe accessibility. Study sample comprised of 198 mothers with children below 5 years of age; 70 mothers having children with past ARI episodes; 30 mothers with sick babies 6 months old and below; and 43 health care providers. Methodology included a series of Focus Group Discussions (FGD) and Indepth interviews followed by presentation of hypothetical case scenarios. A variety of service providers consulted by respondent mothers including FCHVs, private practitioners, care providers at government health facilities and traditional healers were interviewed using a set of structured interview checklists. 3. Major Findings The findings summarized below, show that the response patterns with some exceptions is generally similar across all the caste/ethnic groups. • A revealing change noted from that of 1994 study is that most of respondent mothers were familiar with symptoms of pneumonia and its severity. • All mothers recognized the various types and stages of ARI related illness i.e. cold, cough and pneumonia and signs and symptoms of each type, for which each caste and ethnic group had its own terms and expressions. • Mothers were aware that cold and cough can develop into pneumonia if proper care was not taken. Almost all the mothers in all communities also believed that most ARI illnesses are seasonal and "purbiya" (easterly wind) also causes ARI problems. • Mothers were able to describe the symptoms of pneumonia and severity of illness. Difficult or fast breathing is perceived as one of the symptoms of early stage of pneumonia but warranted medical attention only if accompanied by one or more other symptoms such as high fever, convulsions, restlessness, lethargy, excessive sleepiness and chest in drawing, loss of appetite and cold body. • Common ARI illness such as cough and cold including mild fever were not considered as serious and were treated with traditional home medications , such as o keeping the child warm, chest in particular, o specially prepared hot drink, o Massage on scalp and chest with specially seasoned mustard oil. • Only if the problem persisted for more than 3-4 days other kind of help were sought. But in case of infants, most mothers sought for immediate medical care. • All the mothers believed that evil spirits, angry deities and clan god (kul devta) may also be the reasons which caused illness to children includingARI. Almost all the mothers performed special rituals annually, to appease the spirits and the deities as a preventive measure. Should the children fall sick-ARI or other reasons - a practice to call traditional healers to ward off evils was prevalent before seeking other help. This practice was more prevalent among Tharus, Tamangs, Muslims and Musahar mothers. • Dietary and fluid restriction was observed by most breast feeding mothers when their child suffered from ARI. This practice was also found common for other illnesses. Likewise, children suffering from ARI were not given chilly hot, oily and spicy food. • Mothers belonging to Brahmin/Chhetri and Tharu community were relatively quick in approaching the health care providers as compared to mothers from other communities. Mothers belonging to Musahar community reported to wait for 4-5 days while treating the child with home remedies before visiting medical practitioners. • In case of ARI illnesses considered not severe, the practice of self medication was found very common among the mothers. If simple medication did not help they often administered antibiotics (available in all drug stores) on their own. It was seen that such practice was more common with Tharu, Musahar and Muslim mothers. • Traditional healers have very important place in these communities. The mothers did not rely entirely on traditional healers, nevertheless they sought their help prior to and/or simultaneously other health care providers. • It was found that most of the mothers did not really understand antibiotics though they had given it to their child. For them it is a medicine that is effective in improving the conditions of their child. Mothers reported to have bought it repeatedly when similar problem occurred. It was also found that most mothers stopped the medicine as soon as the health of the child improved and saved remaining medicine for future use. • Female Community Health Volunteers (FCHVs) were generally found to be effective in advising mothers on essential care practices as well as management of simple ARI problems. All the same, in some communities mothers were not aware of FCHVs. While young and educated mothers (Brahimin/Chhteri and Tharu) had low opinion about FCHVs. • Mothers' perception regarding the severity of illness determined the type of care sought. However, in order of priority, after home remedy, consultation with traditional healers and self-medication was preferred by the mothers. It was also seen that the mothers preferred the drug stores and the private clinics compared to the health posts. Mothers reported a visit to hospital only as the last resort. • The health seeking behavior of mothers for their sick child varied from one caste/ethnic group to another. Moreover, it was also found that the economic status of the family, educational status of the mothers, accessibility of the health facilities greatly influenced type and when to seek help. This study clearly shows degree of variation on care seeking practices among different caste/ethnic groups. It was also found that the care seeking practices differed within the same caste/ethnic groups. There are certain factors that facilitated or hindered seeking care from medical practitioners and health care providers; • Awareness and knowledge level of mothers on danger signs impact the lag time between child developing and illness and seeking health care from health practitioners. Lesser the knowledge, longer was the time lag. • Education status of the mothers was an important factor in determining how prompt the mothers seek health care from the health care providers. Though not universally true, more educated mothers (combined with awareness on danger signs) were seen to be more prompt on consulting and visiting health care providers, than illiterate one. • Economic condition of the family also was found to be a major factor that affected the care seeking behavior. Financial constraints normally prevented families (mothers) from seeking immediate care from health care providers. Usual practice was to wait for home therapy to cure the illness. • Distance and accessibility to health care providers was an important factor in determining timing of seeking care and the choice of health care providers. Health providers in near vicinity usually meant the consultation was much more immediate, however it was also seen that the limited working hours of public health facilities worked as disincentive for mothers to seek care from them. • The belief and trust on traditional healers and practices (including home therapies) also was found to be a crucial factor in care seeking behaviors of the mothers. The more "perceived" knowledge and trust on traditional home therapies (not always helpful) meant greater time lag in seeking care from health care providers. • It was also observed that one of the most important factors was the age of the sick child. It was observed that lesser the age of the child more sensitive were the mothers in consulting and visiting health care providers. |
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| Item Description: | Research Report. |
| Physical Description: | iv,56p. |