Patterns of health seeking behavior during episodes of childhood diarrhea:a study of Tzotzil-speaking Mayans in the highlands of Chiapas, Mexico

In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be infl uenced by local beliefs and cultural practices. Few studies have attempted to quantitatively evaluate health seeking behavior (HSB) for diarrheal dise ases in indigenous communities, while controlling for potential confounding factors such as parental education or socioeconomic status. A rapid ethnog raphic survey was conducted in Nabenchauc, Chiapas, to determine hypothetic al HSB patterns for each of four major types of childhood diarrhea. Additio nally, we examined the actual HSB for the last episode of childhood diarrhe al illness within the household. One hundred households participated in the survey; 94 households with child ren <5 years old reported a mean of 1.9 diarrheal episodes during the prece ding month. Households reported using a mean of 1.3 types of in-home remedi es. Oral rehydration therapy (ORT) was used in <2% of the 368 HSB patterns elicited for the four types of diarrhea. HSB patterns utilized an eclectic combination of traditional, allopathic, local and distant health care optio ns. A mean of 2.5 outside-the-home health care options were reported for ea ch diarrheal type; the local grocery store was reported in 245 (67%) of the hypothetical HSB patterns and as a first option in 199 (54%). Maternal and /or paternal education had little impact on hypothetical HSB, Households wi th lower SES were more likely to report using local grocery stores as a fir st option and were less likely to use options outside the village. The rapid ethnographic survey approach allows for assessment of changes in the approach to health carl option utilization in cultures incorporating ne w health care paradigms. Public health interventions targeting local stores may lead to increased use of ORT, thereby potentially reducing early morbi dity and mortality due to childhood diarrhea. (C) 1998 Elsevier Science Ltd . All rights reserved.