Table 3 Beliefs, motivations, and context related to harmful practices by region and country
Author, Year [reference] | Country | Study design: methods (number conducted), study population | Source of information on diarrhea treatment | Expected effect of treatment | Restriction of specific food or fluid | Treatment specific to type or cause of diarrhea | Drug specific: strength/effectiveness | Drug specific: and source/availability | Other |
|---|---|---|---|---|---|---|---|---|---|
Americas | |||||||||
Hudelson et al., 1994 [44] | Bolivia | Qualitative study: Indepth interviews IDIs (65), hypothetical case scenarios (10), and observation (5) of mother and health workers, El Alto 1993, Mothers of children <5 years and health workers | Food: Mothers worry increasing food intake could worsen episode | General: Type of treatment sought is dependent on perceived cause of the illness | Feeding: Diet is already poor so doesn’t vary much during episode | ||||
Food: Some may offer less food to reduce stool output | Drugs: Drugs are used to treat “diarrea por infeccion” | Food: Reduction in intake due to loss of appetite. Caregivers unaccustomed to encouraging feeding. | |||||||
Larrea-Killinger et al., 2013 [113] | Brazil | Qualitative study: IDIs (29) and observations, Salvador 1997–2004, Mothers and grandmothers of children <5 years | Combination of ORS and antibiotics believed to reduce severity of episode | ||||||
McLennan et al., 2002 [49] | Brazil | Qualitative study: IDIs (29) and observations, Salvador 1997–2004, Mothers and grandmothers of children <5 years | Feeding: 1/3 mothers reported restricting some foods | Drugs: 73 % mothers believe child should be given antibiotic for episode | |||||
Feeding: 95 % believe at least one food item should be restricted | |||||||||
Food: 38 % believe all solid foods should be restricted | |||||||||
BF: Few (3 %) believe BF should be suspended | |||||||||
Granich et al., 1999 [114] | Dominican Republic | Quantitative study: Structured interviews (582), Periurban Santo Domingo 1996, Mothers of children <5 years | Drugs: 71 % of caregivers would give pill or injection for hypothetical episode of diarrhea | ||||||
Ecker et al., 2013 [115] | Peru | Quantitative study: Structured interviews (1200), Periurban Lima (year not specified), Caregivers of children <5 years | Drugs: 65 % of caregivers believe antibiotic is necessary to treat hypothetical case of non-dysenteric diarrhea | ||||||
Europe | |||||||||
Eastern Mediterranean | |||||||||
Ali et al., 2003 [50] | Pakistan | Quantitative study: Self-administered questionnaire (400), Karachi 2000, Adult females attending clinic | Food: Most caregivers reported receiving information on food restriction from mother or grandmother | Food: Heavy foods, bread, meat commonly restricted | |||||
Food: 2 % of women believe all food items should be restricted | |||||||||
Agha et al., 2007 [116] | Pakistan | Quantitative study: Structured interview (647), Gambat, Singh Province (year not specified), Caregivers of children 6–59 months | Fluid: 12 % of caregivers believe less fluid is required during episode | ||||||
Food: 44 % believe less food is required | |||||||||
Rasheed et al., 1993 [117] | Saudi Arabia | Quantitative study: Structured interview (240) and self-administered questionnaire (589), Eastern Province 1990, Mothers of children attending government health center and girls attending government high school | Feeding: Fewer mothers than female students believe fluid and foods should be restricted during episode | ||||||
Drugs: Compared to students, more mothers preferred drugs as treatment | |||||||||
Africa | |||||||||
Kaltenthaler et al., 1996 [30] | Botswana | Qualitative study: Focus group discussions FGDs (4) and IDIs (12), KIIs (7) and observations, North-east Botswana 1991–1992, Caregivers of young children, health providers and traditional healers | BF: Pogwana (severe diarrhea with sunken fontanel) is an “African illness” and should be treated with breast feeding cessation and should go to health facility or traditional healer | General: Mothers report using multiple sources of treatment if episode doesn’t improve | |||||
Nkwi et al., 1994 [34] | Cameroon | Mixed-method study: Structured interviews (256) and hospital observations, 3 provinces in Cameroon, Caregivers of children <5 years | BF: Some diarrhea thought to be caused by “bad breastmilk” - mothers are given herbs to improve quality of milk | ||||||
Almroth et al., 1997 [36] | Lesotho | Qualitative study: FGDs (19) and IDIs (43), 3 geographically different locations 1991–1992, Mothers and grandmothers of children and nurses | General: Mothers received conflicting advice from grandmothers and nurses | Food: Believe food should be given because it “strengthens the bowels” | Food: Believe you should adjust diet for individual child, if a specific food makes diarrhea worse | Food: Mothers coax children to eat during and after diarrhea | |||
Feeding: Caregivers report providers still advise caregivers to restrict feeding | General: Mothers report using any treatment that works, sometimes multiple treatments | ||||||||
Munthali et al., 2005 [35] | Malawi | Qualitative study: IDIs and KIIs (sample size not specified), Rumphi 2000–2002, Old and young men and women and health providers | BF: Perceived causes of diarrhea include contaminated breast milk requires weaning | Drugs perceived to useful in treatment of all illnesses | |||||
General: Diarrhea due to teething is perceived as requiring no treatment | |||||||||
Ellis et al., 2007 [78] | Mali | Mixed methods study: Structured interviews (352), illness narratives (14), and IDIs (42), Bougouni District 2003, Caregivers of children <5 years with illness in past 2 weeks or seeking care and health providers | General: Mothers-in-law play important role initiating traditional treatment | Combining several different medicines/therapies is viewed as most efficacious | Treatment of diarrhea typically begins in the home with traditional medicines and/or antibiotics from nearby vendors | ||||
Ikpatt et al., 1992 [19] | Nigeria | Quantitative study: Self-administered questionnaire (561), Cross River and Akwa Iborn State (year not specified), Household representative | BF: 19 % mothers believe BF should be discontinued | Drugs: 53 % of mothers reported antibiotic and 15 % reported antidiarrheal as treatment for diarrhea | |||||
Fluid: 15 % believe fluid should not be offered during episode | |||||||||
Food: 17 % believe solid foods should be withdrawn | |||||||||
Jinadu et al., 1996 [48] | Nigeria | Mixed method study: Structured interview (335) and FGD (4), Rural Yoruba communities of Osuo State (year not specified), Mothers of children <5 years | Fluid: More mothers believe fluids should not be given for watery diarrhea (65 %) compared to bloody diarrhea (55 %) | ||||||
Ogunbiyi et al., 2010 [29] | Nigeria | Mixed method study: Structured interviews (250) and FGDs (2), Ibadan 2003–2004, Mothers of child <1 year attending sick baby/immunization clinic of 2 health facilities | BF: “Cultural” reasons for BF restriction - passed from generations | Food: Foods withdrawn because thought to prolong the duration of diarrhea in the child (86 %) and induce vomiting/loss of appetite (14 %) | Food: Indigenous foods rich in protein withdrawn because believed to aggravate diarrhea | BF: Overconsumption of BM thought to cause some diarrhea – therefor reduce BF frequency during episode | |||
Feeding: 71 % believe some food, fluid, or breast milk should be withdrawn during episode | Food: Withdrawal of other foods also linked to mother’s perception of cause of diarrhea | ||||||||
Olakunle et al., 2012 [56] | Nigeria | Quantitative study: Structured interview (186), Ilorin West Local Government Area (year not specified), Mothers of children <5 years | Feeding: Majority said food restriction was based on personal view, but some said received information on food restriction from nurses | Feeding: 46 % of mothers believe “some food” should be restricted during episode | Drug: 17 % of mothers believe child should be treated with antibiotic during episode | ||||
Kauchali et al., 2004 [32] | South Africa | Qualitative study: IDIs (16), FGD (1), Case histories (13) and card sorting, Rural Kwazulu-Natal 2001, Caregivers of young children, grandmothers, CHWs | BF: Perceived causes of diarrhea include “dirty” breast milk requires temporary stop in breastfeeding | ||||||
Friend du Preeze et al., 2013 [72] | South Africa | Mixed method study: IDIs (17), FGDs (5) and structured interviews (206), Johannesburg and Soweto 2004, Caregivers of children <6 years in longitudinal study and health providers | Drugs: Health care workers reported that mothers commonly use non-prescribed antibiotics | ||||||
Drugs: Demand for modern medicines is high | |||||||||
Mwambete et al., 2010 [118] | Tanzania | Qualitative study: Semi-structured interviews (88), Dar es Salaam 2007, Mothers of children <5 years | 35 % of mothers reported metronidazole as most effective chemotherapeutic agent for treating diarrhea | Drugs: Metronidazole (43 %) and Erythromycin + Metronidazole (12 %) were cited as commonly used “therapeutic agents” for diarrhea treatment | |||||
South East Asia | |||||||||
Mushtaque et al., 1991 [55] | Bangladesh | Qualitative study: “Socioanthopologic methods,” Central Bangladesh (year not specified), villagers | Food: Certain types of diarrhea require withholding foods that are normally part of the diet | General: Treatments considered appropriate depend on the local classification of the diarrhea | |||||
BF: Injection of breast milk into woman used to correct “polluted” breast milk | |||||||||
Singh et al., 1994 [43] | India | Quantitative study: Structured interviews (208), Jaipur District (year not specified), Mothers of children <5 years | Feeding: Mothers believe intestine becomes weak and child unable to digest heavy foods (roti and milk) during episode | ||||||
Feeding: Tea water and banana believed to help reduce frequency of diarrhea | |||||||||
Chandrashekar et al., 1995 [25] | India | Qualitative study: Semi-structured interviews (300), Rural South India 1991, Mothers of children age 3 days - 17 months | Feeding: Elderly relatives are source of information on feeding practices | BF: Some caregivers believe breastfeeding should be restricted when mother is experiencing diarrhea or respiratory infection | |||||
Buch et al., 1995 [119] | India | Quantitative study: Structured interview (1600), Kashmir 1992, Caregivers of infants with acute diarrhea attending hospital pediatric OPD | Feeding: 19 % of caregivers believe child should have complete dietary restriction | Drugs: 55 % of caregivers believe diarrhea should be treated with antidiarrheal & antispasmodic drugs, while 32 % should be treated with drugs and ORT | |||||
Fluid: 77 % believe milk should be restricted | |||||||||
Bhatia et al., 1999 [54] | India | Quantitative study: Structured interview (120), Rural Chandigarh 1996, Mothers of children <5 years | Feeding: 47 % of mothers believe certain foods/fluids should be restricted including chapatti, milk and pulses | ||||||
Datta et al., 2001 [120] | India | Quantitative study: Structured interview (75), Rural Maharashtra 2000, Caregivers of children <5 years attending hospital pediatric OPD | BF: 16 % of caregivers not aware child has to be given breastfeeding during episode of diarrhea | ||||||
Vyas et al., 2009 [121] | India | Quantitative study: Structured interview (380), Ganhinagar district (year not specified), Women of reproductive age (15–44) | BF: 52 % of women did not know breastfeeding should be continued during episode | ||||||
Food: 50 % did not know other foods should be continued | |||||||||
Bolam et al., 1998 [122] | Nepal | Quantitative study: Structured interview (105), Kathmandu 1994–1996, Women delivering at Kathmandu General Hospital | BF: 3 months postpartum, 53 % of mothers did not know to continue BF during episode | ||||||
Adhikari et al., 2006 [123] | Nepal | Quantitative study: Structured interview (510), Kathmandu 2005, Married women age 18–38 from 2 village development committees | BF: 7 % of women believe breastfeeding aggravates diarrhea | ||||||
Ansari et al., 2012 [24] | Nepal | Qualitative study: FGDs (2) and IDIs (8), Morang 2010, Mothers of children <45 months with diarrhea in the previous 6 months | General: Elders recommend traditional treatment practices | Food: Spicy, oily and rotten food commonly believed to be harmful | General: Certain types of diarrhea are perceived to be manageable with ORS/SSW, while others require traditional/spiritual methods. | ||||
BF: Breast milk sometimes considered harmful | |||||||||
Baclig et al., 1990 [58] | Thailand | Mixed method study: FGDs (2) and structured interviews (98), Tambon Korat and Koongyang (year not specified), Mothers and grandmothers of children <5 years | Feeding: Mothers believe no changes should be made to the child’s diet to manage poh (a mild self-limiting diarrhea) | ||||||
Pylypa et al., 2009 [18] | Thailand | Qualitative study: Semi-structured interviews (200) as part of ethnographic study, Rural Northeast Thailand 2000–2001, Caregivers of children <5 years, traditional healers, and health providers | General: Grandmothers and elders are important sources of information for classifying/managing diarrhea | Fluid/BF: Some mothers restricted water or breast milk out of concern that it would make diarrhea worse, belief child could not drink much because he was small, or would vomit | Food: Most mothers didn’t change quantity/type of food given for diarrhea occurring in normal developmental stages (not illness) although expected children would eat less in than normal | Medicines were frequently obtained from health workers – most clinicians consulted gave antibiotics routinely for watery diarrhea, and for diarrhea with fever | Drugs: Some mothers took the medicines themselves to pass to infants through breast milk | ||
Drugs: Medicines were commonly administered for childhood diarrhea considered illness | |||||||||
Western Pacific | |||||||||
Okumura et al., 2002 [70] | Vietnam | Quantitative study: Structured interviews (505), 4 Provinces of Vietnam 1997, Mothers of children <5 years | Antibiotics to be stocked at home (55 % of households) for various anticipated symptoms as if they were panaceas | ||||||
Le et al., 2011 [69] | Vietnam | Qualitative study: IDIs (5) and FGDs (4), Ha Tay province (year not specified), Mothers of children <5 years and health workers/drug sellers | Drugs: Drugs bought on drug seller recommendation or previous prescriptions | Western medicine considered necessary but more dangerous than traditional therapy | Drugs are available without prescription and small amount can be purchased to give for 2–3 days | ||||
Rheinlander et al., 2011 [67] | Vietnam | Qualitative study: Semi-structured interviews (43), FGDs (3), and observations, Ethnic minorities in Lao Cai 2008, Caregivers of children <7 years with diarrhea in the past month | General: Elders are in charge of deciding, preparing, and administering treatment for a sick child | Drugs: Medicines chosen based on perceived compatibility with the child and the disease | Antibiotics perceived as very powerful and potentially harmful compared to natural medicines | Drugs: common to receive 2–4 prescribed drugs for diarrhea | |||
Drugs: To limit intake and harm of western drugs, caregivers gave smaller doses than prescribed, or shifted from one drug to another if recovery was slow |