[e-drug] Home management of childhood diarrhoea in southern Mali

["Kirsten Myhr" <myhr@online.no>]

E-DRUG: Home management of childhood diarrhoea in southern Mali
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Ellisa AA , Wincha P, Daoub Z, Gilroya KE, Swedberg Eb, Home management
of childhood diarrhoea in southern Mali-Implications for the
introduction of zinc treatment. Social Science & Medicine 2007; 64(3):
701-712. doi:10.1016/j.socscimed.2006.10.011
Johns Hopkins School of Public Health Baltimore, MD, USA
Save the Children USA, Mali 

Available online 13 November 2006.

Abstract
Diarrhoea remains one of the leading killers of young children. A recent
meta-analysis demonstrated that a two-week course of zinc tablets once
daily significantly reduces the severity and duration of diarrhoea and
mortality in young children (Bhutta et al., 2000. Therapeutic effects of
oral zinc in acute and persistent diarrhea in children in developing
countries: Pooled analysis of randomized controlled trials. American
Journal of Clinical Nutrition, 72(6), 1516-1522). 

Formative research is being conducted in a number of countries to prepare for the large-scale
promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community
level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or
anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies.

 As parents often deem ORS insufficient and judge that an
additional treatment should be combined with ORS to cure diarrhoea, the
concept of joint therapy of zinc and ORS should be well accepted in the
community. Mothers-in-law and fathers, who play a significant role in
decisions to seek treatment for sick children, as well as traditional
healers, should also be considered when designing new programs to
promote zinc. Similarities with formative research conducted for a
previous generation of diarrhoea control programmes are discussed.

Keywords: Diarrhoea; Zinc; Oral rehydration therapy; Ethnomedicine;
Child health; Mali

Kirsten Myhr
Co-moderator
"Kirsten Myhr" <myhr@online.no>