Professional Documents
Culture Documents
AFRICA: Ethiopia, Kenya, Nigeria, Senegal Relational Varied level of trust in HCP
Dependence on others for purchase of
prescribed amount and instructions Broad social support for ORS
Multiple research methods Different messages from different sources
Qualitative inquiry in-depth interviews, Focus Group Discussions, observation (nurse vs. pharmacist vs. CHW)
Household & health facility surveys
Multiple target groups: Caregivers of children <5 y, Fathers, Grandmothers, Example of local typology of child diarrhea, Indonesia (adapted from Fahmida and Wibowo, 2011)
Community health workers, Formal & informal health care providers Actual health Perceived Perceived Perceived Pattern of
problem cause(s) problem health need care-seeking
STEP 2: Review & synthesize data Childhood Health care for No care-seeking
Not illness
Identify internal, external and relational barriers and enablers for key behaviours to development diarrhea not necessary (until severe stage)
60%
40%
80% Interventions must target all settings where care & decision-making are made (cf. Colvin 2013)
% used ORS or Zinc
Consider role played by middle layer of health care providers (e.g. CHWs);
community-based distribution addresses many of the current barriers
RESULTS Health Care Providers Need for strengthening formal health system function
Provider skills, including counseling
Behaviour: Provide Zinc & ORS as 1st line treatment for child diarrhea Continuous supply of zinc & ORS
BARRIERS ENABLERS
Professional opinions & prescribing practices Treating diarrhea with ORS (and in some cases, Zn) REFERENCES
Desire to be responsive to patient demands is the norm in their work environment Colvin CJ et al. (2013) Understanding careseeking for child illness in sub-Saharan Africa... Soc Sci Med 86, 66-78.
Lack of adequate training & supplies Broad access to zinc & ORS at community level Fahmida U. & Wibowo L. (2011) Formative Research on Diarrheal Disease Control Program in East and West Lombok Districts,
West Nusa Tenggara Province. SEAMO Regional Center for Food and Nutrition: Indonesia.
Hodgins S et al. (2013) Understanding where parents take their sick children...Global Health: Science and Practice 1, 328-358.
Behaviour: Counseling to improve adherence UNICEF (2012) Pneumonia and diarrhoea: tackling the deadliest diseases for the world's poorest children.
BARRIERS ENABLERS WHO (2004) Clinical Management of Acute Diarrhoea: WHO/UNICEF Joint Statement.
Inadequate training for counseling skills Currently counsel mothers to give fluids & ORS ACKNOWLEDGEMENTS
Different messages given to different providers Active follow-up at household level
Inadequate info transfer: care-seeker to caregiver Broad population-level knowledge & buy-in We are indebted to the organizations and individuals who conducted the formative research in each country. HealthBridges work was
funded by The Micronutrient Initiative. The Micronutrient Initiatives work is undertaken with the financial support of the
Government of Canada through the Department of Foreign Affairs, Trade and Development (DFATD) and other generous donors.
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