Limits of health education: Barriers to oral rehydration use among Ghanaian mothers

Abstract

Childhood diarrhea is one of the leading causes of childhood morbidity and mortality in West African communities. In the Ejisu-Juaben region of Ghana, oral rehydration solution (ORS) sachets are provided by the district hospital by nurses working in surrounding communities and by community drugstores to combat diarrhea and replenish electrolytes that have been depleted as a result of diarrhea. Previous research from the Ejisu-Juaben region, part of the Ashanti region, found that 92% of mothers had heard of ORS and 86.6% could describe its preparation, but only 28.4% had used ORS to treat their child’s last episode of diarrhea (Kendell et al., 2009). The purpose of this study is to determine potential barriers to the use of ORS in these communities. Qualitative interviews were conducted with 91 mothers, eight public health nurses, five community volunteers and five drugstore owners in the Ejisu-Juaben region. Additionally, focus groups were held with mothers. Mothers knew where to obtain ORS, could correctly demonstrate its preparation and identify it as an effective treatment. The primary reasons given for not using ORS were its expense and use of alternative treatments. The latter includes herbs boiled in water, herbal enemas, sand enemas and innocuous foods; the primary reasons for choosing these treatments over ORS include availability of home remedies and adherence to tradition. While public health education is vital to improving overall health in developing countries, education does not always predict compliance with medically proven health practices. This is particularly true when cost and tradition are barriers to behavioral change. A diarrhea treatment that bridges traditional and modern methods while mitigating cost barriers could potentially increase use, thereby decreasing