Perceptions of childhood diarrhoea and its treatment in rural Zimbabwe

In the course of a study on the acceptability and feasibility of home-based oral rehydration therapy in rural Zimbabwe, information was collected on attitudes and beliefs about diarrhoea and on action taken in response to an episode of diarrhoea in a child. Diarrhoea was found to be a perceived threat at community and family level and numerous possible causes of diarrhoea were described which were assigned to two broad classes: (1) 'physical' causes, such as a polluted environment, diet and teething and (2) 'social and spiritual' causes such as those associated with a depressed fontanelle. These domains were not, however, mutually exclusive; 76% of the described episodes of diarrhoea were attributed to 'physical' causes, 15% to 'social and spiritual' causes and 8% to a combination of both. Reported utilization rates of the formal health services were unexpectedly high. In contrast, we recorded a low demand for indigenous herbalists (n'angas). Home management was common and comprised the administration of indigenous herbal remedies, of sugar and salt solutions, of over-the-counter drugs or of enemas. These remedies were given on their own or alongside the treatment prescribed by a health worker. A number of variables were examined to assess their influence on health-seeking behaviour: perceived cause and severity of the illness, socio-demographic characteristics of the respondent or child and accessibility of the health services. Of these factors only perceived cause was a significant predictor for the utilization of the formal health services: illness ascribed to 'physical' causes or to a combination of 'physical' and 'social and spiritual' causes were brought to the attention of a representative of the formal health services more often than illness ascribed to 'social or spiritual' causes only (62 and 59 vs 46%). Health care activities should build upon local perceptions about illness and its control. New practices, such as oral rehydration therapy, may be acceptable if they are congruous with the underlying belief system and if they are promoted by health workers who are sensitive to the needs and priorities of the communities in which they operate.