Abstract
BackgroundGlobally, diarrhea remains a leading killer of young children. In Sierra Leone, one in seven children die before their fifth birthday and diarrhea is a leading cause. Studies that emphasize the demand-side of health interventions -- how caregivers understand causation and prevention of diarrhea -- have been neglected in research and programming.MethodsWe undertook applied qualitative research including 68 in-depth interviews and 36 focus group discussions with mothers, fathers and older female caretakers to examine the causes and prevention of childhood diarrhea in villages near and far from health facilities across four rural districts. Verbal consent was obtained.ResultsRespondents reported multiple, co-existing descriptions of causation including: contaminated water and difficulties accessing clean water; exposure to an unclean environment and poor food hygiene; contaminated breast milk due to sexual intercourse, overheated breast milk or bodily maternal conditions such as menstruation or pregnancy; and dietary imbalances and curses. Respondents rarely discussed the role of open defecation or the importance of handwashing with soap in preventing diarrhea.ConclusionsCategorizing behaviors as beneficial, harmful, non-existent or benign enables tailored programmatic recommendations. For example, respondents recognized the value of clean water and we correspondingly recommend interventions that reinforce consumption of and access to clean water. Second, respondents report denying “contaminated” breast milk to breastfeeding children. This is a harmful practice that merits attention. Third, the role of open defecation and poor hygiene in causing diarrhea is less understood and warrants introduction or clarification. Finally, the role of exposed feet or curses in causing diarrhea is relatively benign and does not necessitate programmatic attention. Further research supportive of communication and social mobilization strategies building on these findings is required to ensure that improved understanding regarding diarrhea causation translates into improved diarrhea prevention.
Highlights
Diarrhea remains a leading killer of young children
The qualitative study design was informed by and adhered to principles of applied qualitative research [9,24] that focuses on a specific illness, addresses programmatic concerns related to diarrhea, and draws from experiences of actual cases of sick children
English is the official language of Sierra Leone and Krio is the lingua franca, but in Pujehun and Kailahun, Mende is generally spoken; in Kambia and Tonkolili, Temne is generally spoken
Summary
In Sierra Leone, one in seven children die before their fifth birthday and diarrhea is a leading cause. Located on the west coast of Africa, Sierra Leone has an estimated population of 4.9 million [1]. It emerged in 2002 from 11 years of civil war, and today has some of the world’s poorest people and worst health indicators [2]. For Africa as a whole, diarrhea is estimated to cause 25% of mortality for children-under-five [4]. In Sierra Leone, it is the leading cause of child mortality [5]. In rural areas where the most common source of drinking water is surface water (40%), only 4% of households treat their water and the most common type or method of toilet facility is an open latrine (35%) or open defecation (33%) [1]
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