Communal Health Research Articles

Urban Bodies: Communal Health in Late Medieval English Towns and Cities by Carole Rawcliffe (review)

Reviewed by: Urban Bodies: Communal Health in Late Medieval English Towns and Cities by Carole Rawcliffe Meg Bernstein Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities (Woodbridge: The Boydell Press, 2013) 445 pp. Rawcliffe has long been one of the clearest and loudest voices on the topic of medieval health, healing, and hospitals; among her myriad publications in that field are Leprosy in the Middle Ages (2006) and Medicine for the Soul: the Life, Death, and Resurrection of an English Medieval Hospital (1999). In Urban Bodies, Rawcliffe departs from her previous works that focused primarily on case studies in Norwich, where she is based at the University of East Anglia. In this book, she looks broadly at English health in terms of the urban population; she also makes frequent mention of useful comparanda on the continent. The result is a study that is both usefully broad while also remaining extremely attentive to specific documentary sources. Urban Bodies is composed of an introduction, six chapters thoughtfully organized into thematic subsections, and a conclusion. Additionally, Rawcliffe provides an appendix titled “National and Urban Epidemics, 1257–1530,” which remediates the problem of cataloguing some of the smaller and lesser-known outbreaks. Paragraph long descriptions provide references to documentary evidence for each case, which is illuminating to the reader, and reflective of an impressive facility with a tremendous number of sources. The first chapter, “Less Mud-Slinging and More Facts,” sets the historiographical stage for Rawcliffe’s project. Here, she carefully combats the Victorian idea that England in the Middle Ages was foul, polluted, and populated by people uninterested in improving poor conditions. Instead, she establishes a more nuanced picture of the period, writing about vernacular texts [End Page 292] on health-related topics, including manuals on disease prevention, and the laws created by and censures delivered to public officials on the topics of sanitation and disease prevention (46–49). In the second chapter, “Urban Bodies and Urban Souls,” Rawcliffe addresses the civic concerns of public health in later medieval England; this chapter picks up on the pun of the title which addresses both physical bodies and corporate identity. She acknowledges the commonly held belief that plague was punishment for sins by God, and discusses the institution by both prelates and kings of acts of public contrition to seek forgiveness for sin (94–95). Here she considers the notion of cleanliness and health as civic virtues, as well as the material effects of plague. She addresses the impact of depopulation due to disease on the urban landscape, showing that developed areas reverted, parish churches were closed, and building projects were halted due to pestilence (70). The remaining four chapters, “Environmental Health,” “Water,” “Food and Drink,” and “Sickness and Debility,” deal with specific thematic issues. Each of these is divided into between six and ten subsections, which address such diverse themes as “Vicious dogs and marauding pigs,” “Cooks and pie-bakers,” and “Care for the sick poor.” In “Environmental Health,” Rawcliffe discusses waste management, smells, and fire prevention. She examines London’s comparatively early waste pick-up system (137), showing that all classes, not just the elite, sought waste management. The chaos of the urban environment is evidenced by reports of stray animals wandering the streets and sometimes engaging in scuffles, but laws and bans enacted against these practices shows the widespread desire for containment (154–155). “Water” deals with the expulsion of waste and the challenge of sourcing clean water. The chapter opens with Rawcliffe gesturing to the crucial role of the friars in initiating these systems, and argues against the idea that ruling elites were “disinclined either to promote schemes for the amelioration of public water supplies, or even to shoulder the burden of maintaining whatever rudimentary facilities were already in place” (179–180). This chapter also addresses the medical beliefs about water, including the importance of Arabic texts such as Ibn-Sina’s Canon of Medicine, which discussed the health risks of consuming infected water (189). Rawcliffe showed that some of the trades were the worst offenders in terms of water purity, but that “the considerable sums of money expended on aqueducts, conduits, dike, wells and gutters...

How patients experience antral irrigation.

BACKGROUNDAntral irrigation earlier had an important role in the diagnosis and treatment of rhinosinusitis. Nowadays, it is often considered too unpleasant. However, the experience of patients of this procedure has been very seldom evaluated. Nor has the effect on pain in rhinosinusitis been evaluated. The aim of this study was to evaluate patients’ experience of discomfort and pain during antral irrigation. We also assessed facial pain caused by rhinosinusitis before the procedure and pain soon after the procedure.METHODSDoctors and 121 patients completed their questionnaires independently after antral irrigation in a university clinic, in a private hospital, and at a communal health center.RESULTSPatients experienced mild pain during antral irrigation (mean and median visual analog scale score: <3). Their experience of pain during antral irrigation was closely comparable to pain during dental calculus scaling. Facial pain assessed before antral irrigation decreased quickly after the procedure.CONCLUSIONSAntral irrigation was well tolerated as an outpatient procedure. The procedure seems to relieve facial pain caused by the disease quickly. The role of antral irrigation in the treatment of acute rhinosinusitis will need further investigation.

Urban Bodies: Communal Health in Late Medieval English Towns and Cities, by Carole Rawcliffe

Bodies: Communal in Late Medieval English Towns and Cities, by Carole Rawcliffe. Woodbridge, The Boydell Press, 2013. xiv, 431 pp. $99.00 US (cloth). Despite Carole Rawcliffe's protest that Bodies is in many respects a preliminary sortie (p. 7) into the largely unstudied subject of late medieval communal health, it can hardly be considered such. Examining the period of dynamic change between 1250 and 1530, Rawcliffe's book is an ambitious and foundational study of medieval English communities' collective efforts protect themselves from sickness, debility and disease (p. 2). She consults an impressive number of civic records to which she adds archaeological and some ecclesiastical evidence, all with an eye to examining the role played by central government, urban authorities, craft guilds ... and ordinary householders in the collective battle against privation and disease (p. 7). Her investigation includes larger and prosperous centres and also looks at smaller and poorer communities. Bodies's most successful feature is its accessibility and relevance to nonspecialists as well as academic researchers interested in medical, urban, environmental, social, and cultural history. Rawcliffe's first order of business is combatting the myth of the excessively filthy Middle Ages. For too long medieval sanitation has been viewed through the eyes of the Victorian sanitary campaigners, medical positivists, and Monty Python. The villages and towns of medieval England were certainly not clean by modern standards. There were ongoing and sometimes overwhelming problems of dirt and disease, especially in places which were compromised by warfare or economic downturn--she discusses Carlisle for example (pp. 7, 174); but, medieval England was certainly not the sanitary backwater that it has been made out to be. A mixture of royal reform, civic leaders' desire for order, guild pride, the emergent gentries' identification of cleanliness with moral righteousness, and the longstanding tradition of town folk's engagement in civic life resulted in regular and broadly supported sanitation measures. Perhaps the most useful aspect of Rawcliffe's work and the crux upon which her overall argument rests is her second chapter's contextualization of civic society's practice of hygiene as a spiritual and moral necessity. In Urban Bodies, Souls she draws on numerous instances of the civic body being described as a well-governed human body--as in John of Salisbury's Policraticus (p. 78)--in order to show how sanitary measures were applied with equal force to plague or prostitution, civic officials' immorality or pigpens. Rogations were good for public health and so were laws that closed the stews because they contributed to the salubrious nature of the lanes and signified civic dignity and the righteousness of its governors and inhabitants. These are the beliefs that produced the adage about cleanliness' proximity to Godliness. Environmental Health explains why late medieval medical knowledge, grounded in classical and Arabic texts, led civic governors to vigorously combat the infectious and venomous fumes and vapours (p. 123) that were part of urban life. While medieval urbanites had a much higher tolerance for refuse than their present-day counterparts, they nonetheless tackled their refuse problems aggressively, especially in periods of recurring plague. Rawcliffe presents compelling evidence for the importance of public works and sanitary regulations: the maintenance of paved streets; employment of rakers, cleaners, and gong fanners; maintenance of latrines, cesspits, and privies; regulation of butchers, threatening dogs, and runaway pigs; attempts to regulate noxious smoke from wood and sea coal in homes, forges and other industry; and, organized attempts at fire prevention. …

Antimicrobial and antiproliferative prospective of kosinostatin – a secondary metabolite isolated from Streptomyces sp.

Cancer is a communal health hazard worldwide. The present investigation attempts to evaluate antimicrobial and anticancer potential of kosinostatin on mammary carcinoma cell line (MCF-7). The anticancer and antiproliferative activities of kosinostatin were analyzed on MCF cell line by MTT assay and cytotoxicity assays like lactate dehydrogenase (LDH) and glutathione (GSH). The secondary metabolite kosinostatin exhibited its apoptotic nature by expressing p53 protein. Collectively, the results acquired from this study promise that kosinostatin shows the potent anticancer activity.

Physicians' perceived barriers to management of sexually transmitted infections in Vietnam.

BackgroundSexually transmitted infections (STIs) are a public health problem in Vietnam with sub-optimal care in medical practice. Identifying practitioners’ perceived barriers to STI care is important to improve care for patients with STIs.MethodsA cross-sectional survey was conducted among 451 physicians. These physicians were dermatology and venereology (D&V) doctors, obstetrical/gynaecological (Ob/Gyn) doctors, general practitioners, and assistant doctors working in health facilities at provincial, district and communal levels in three provinces in Vietnam.ResultsAlmost all (99%) respondents mentioned at least one barrier to STI care. The barriers were “lack of STI training” (57%), “lack of professional resources” (41%), “lack of time” (38%), “lack of reimbursement” (21%), “lack of privacy/confidentiality” (17%), “lack of counselling” (15%), and “not the role of primary care provider” (7%). Multivariable logistic regression analysis showed that “lack of professional resources” was associated with respondents being in medical practice for ten years or under (vs. 11–20 years), and working at district or communal health facilities (vs. provincial facilities); “lack of time” were associated with respondents being female, seeing more than 30 patients a week (vs. <15 patients/week); and “lack of privacy/confidentiality” was associated with physicians’ seeing more than 30 patients a week (vs. <15 patients/week).ConclusionThe study has identified several barriers to STI care in medical practice in Vietnam. Results of the study can be used to improve areas in STI care including policy and practice implications.

Carole Rawcliffe, Urban Bodies. Communal Health in Late Medieval English Towns and Cities

TSEG (Tijdschrift voor Sociale en Economische Geschiedenis) - The Low Countries Journal of Social and Economic History, is het Nederlands-Vlaamse vaktijdschrift op het gebied van de sociale en economische geschiedenis

Access of older persons to health insurance and health-care services in viet nam: current state and policy options

In this paper, we show that health insurance and health-care services have been expanded in Viet Nam over the past decade and had the potential to reach various groups of older persons (defined as those aged 60 or more). Yet, a number of challenges still remain that greatly influence the current health-care system as regards affordability and adequate service provision. The most critical of these issues is that the most vulnerable groups among older persons have lower access rates and a greater financial burden (that is, out-of-pocket expenses). To deal with those issues, we suggest certain policy directions, including developing communal health systems and guaranteeing the financial sustainability of the health insurance fund by monitoring both service providers and users.

Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval Towns and Cities

Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval Towns and Cities

Urban bodies: communal health in late medieval English towns and cities

Rawcliffe continues with her mission to clean up Middle Ages. In earlier work she has already given us scholarly yet sympathetic portrayals of English medicine, hospitals, and welfare for lepers. Now she widens her scope to public health. Her argument is clear, simple and convincing. Through efforts of crown and civic authorities, mercantile elites and popular interests, English towns and cities aspired to a far healthier, less polluted environment than previously supposed. All major sources of possible infection were regulated, from sounds and smells to corrupt matter - and to immorality. Once again Professor Rawcliffe has overturned a well-established orthodoxy in history of pre-modern health and healing. Her book is a magnificent achievement. Peregrine Horden, Royal Holloway University of London. This first full-length study of public health in pre-Reformation England challenges a number of entrenched assumptions about insanitary nature of urban life during the golden age of bacteria. Adopting an interdisciplinary approach that draws on material remains as well as archives, it examines medical, cultural and religious contexts in which ideas about welfare of communal body developed. Far from demonstrating indifference, ignorance or mute acceptance in face of repeated onslaughts of epidemic disease, rulers and residents of English towns devised sophisticated and coherent strategies for creation of a more salubrious environment; among plethora of initiatives whose origins often predated Black Death can also be found measures for improvement of water supply, for better food standards and for care of sick, both rich and poor. Carole Rawcliffe is Professor of Medieval History, University of East Anglia.

Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities. Woodbridge: Boydell Press, 2013. xiii + 431pp. 28 illustrations. 4 maps. Bibliography. £60.00.

Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities. Woodbridge: Boydell Press, 2013. xiii + 431pp. 28 illustrations. 4 maps. Bibliography. £60.00. - Volume 41 Issue 2

The Men’s Shed: Providing Biopsychosocial and Spiritual Support

Community Men's Sheds (CMS) have been a unique approach within Australia for addressing and promoting men's health and well-being issues by providing biopsychosocial support. Given the decline of traditional religious influence, and the contemporary understanding of 'spirituality', it can be argued that CMS may also develop and demonstrate characteristics of a communal spirituality. This research aimed to explore the individual and community contribution of CMS in terms of men's health and well-being and subsequently whether CMS programmes satisfied the contemporary and consensus understanding of spirituality. A qualitative case study was undertaken combining both participant observation over a 6-month period and semi-structured in-depth interviews with 21 men of varying ages and occupations attending a Melbourne suburban CMS (Victoria, Australia). Thematic analysis indicated that the CMS provided a number of health and well-being benefits at individual, family, community and public health levels. These included increased self-esteem and empowerment, respite from families, a sense of belonging in the community and the opportunity to exchange ideas relating to personal, family, communal and public health issues. It is concluded that CMS, through the provision of an appropriate spatial context and organizational activities, encourage intra-personal and inter-personal reflection and interaction that subsequently results in men meaningfully, purposefully and significantly connecting with the moment, to self, to others and to their environment-and thus, CMS not only provides biopsychosocial support but can also deliver spiritual support.

The Workplace and Communal Health

The Workplace and Communal Health

A Collaborative Mental Health Research Agenda in a Community of Poor and Underserved Latinos

The goal of this project was to engage community members and grassroots organizations in a discussion regarding perceived mental health needs and priorities of the population of underserved Latinos in Montgomery County, Maryland. Community-based participatory research was used to establish structures for participation and to design studies that effectively address local mental health needs. Four focus groups with 30 Latino lay health promoters and 20 key informant interviews were conducted to ascertain communal mental health needs and priorities. The main issues that emerged included mental health stigma, consequences of immigration-related stress, violence and alcoholism, and concerns about psychotropic medications. Ideas to address these issues and foster wellness through research were generated during a community-based workshop that included consumers, primary care and mental health clinicians, researchers, and representatives of local organizations and federal agencies. The product of this process was an implementable mental health research agenda, which is presented and discussed.

The Workplace and Communal Health

Historically, public health has received more attention than occupational health. Since entire populations were vulnerable, including the affluent, interest in communal health preceded that of issues relating to specific trades. The importance of sanitation and clean drinking water were recognized early on but this was largely lost in the Middle Ages. Epidemics were the subject of fear and the concept of spread of contagious disease is very old. However, there were many wrong hypotheses concerning how disease was transmitted and what the harmful agents underlying infection disease actually were. The causality of disease remained speculative until the identification of bacterial pathogens.

Self-Care, Stress Management, and Primary Care: From Salutogenesis and Health Promotion to Mind-Body Medicine

Stress is a major concern in medicine and the social and health sciences nowadays. In fact, not only are stress-associated ailments and diseases rapidly growing, that is, virtually everywhere in the modern world, but also the cost of treatment and “collateral damage,” for example, in occupational health or the economy as a whole, seems to increase exponentially—for example, see [1, 2]. This may be due to a more recent phenomenon called “burn-out”; however, there is clear evidence that myocardial infarction, stroke, depression, anxiety, and even some disease-prone immune processes, including proinflammation as a common disease denominator that is critically associated with stress [3], are continuously gaining recognition in medicine and bear clear relation upon stress and its (patho)physiology [4]. Thus, preventive and therapeutic options to reduce and prevent stress and, simultaneously, improve stress management skills are strongly needed. Mindfulness-based programs and other mind-body medical and cognitive behavioral strategies to (better) deal with stress are taught and evaluated at many places, including academic medical sites and universities [5]; however, their outcome is usually measured in terms of clinical improvements with disease states, inhibition of disease progression, or cure and relapse prevention. Since primary care and health promotion can be seen as the first line of defense in medicine and, yet, as setting-oriented “places” where resistance resources, health protection, resiliency, and salutogenesis are facilitated in more complex situations and modalities, it should and will incorporate self-care-oriented means, techniques, and strategies to lower stress at all levels and improve self- or stress management skills of the population as a whole—and of each single individual under treatment. Research in this area is evolving and it focuses on the many aspects that contribute to a healthy and more stress-resilient life-style, hence, looking not only at tangible disease outcomes but also at quality of life, happiness, flourishing, subjective well-being, optimism, and so on—for example, see [6]. With this special issue, we invited investigators to contribute original research as well as review articles that could stimulate the continuing efforts to understand the molecular, (patho)physiological, neurobiological, and, particularly, clinical factors that underlie stress and stress management programs or related interventions. Furthermore, we were interested in articles that focused on any mind-body medical, CAM, cognitive behavioral, or mindfulness-based technique that is believed or said to alleviate stress and the negative outcomes of its burden, that is, examining these interventions in clinical or out-patient and setting-oriented areas, including work-place, occupational and communal health, and, especially of interest, primary care. As expected, we received a broad array of papers and were able, following rigorous review procedures, to accept a couple of them that still cover the whole picture we had originally thought of. Papers on the effectiveness of a happiness training (positive psychology intervention) or on progressive muscle relaxation (PMR) during lunch breaks in the field of occupational health are now included, as are studies on the applicability and effectiveness of mind-body interventions and more complex programs, including mindfulness-based approaches or self-compassion training, in depression, in anxiety, or in general distress. Various settings are depicted, including the military or school and education. Finally, a focus lies on salutogenesis and resource-orientation in general practice. We hope this special issue meets the expectations of its readers, as it positively exceeded ours as editors. We are happy to herewith launch this special issue and open the discussion on the aspects raised. Tobias Esch Gregory L. Fricchione Stefanie Joos Michael Teut

Has Vietnam Health care funds for the poor policy favored the elderly poor?

BackgroundThe elderly population is increasing in Vietnam. Access to health services for the elderly is often limited, especially for those in rural areas. User fees at public health care facilities and out-of-pocket payments for health care services are major barriers to access. With the aim of helping the poor access public health care services and reduce health care expenditures (HCE), the Health Care Funds for the Poor policy (HCFP) was implemented in 2002. The aim of this study is to investigate the impacts of this policy on elderly households.MethodsElderly households were defined as households which have at least one person aged 60 years or older. The impacts of HCFP on elderly household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 3,957 elderly households in 2001, 2003, 2005 and 2007, of which 509 were classifies as “treated” (i.e. covered by the policy). Variables included in a logistic regression for estimating the propensity scores to match the treated with the control households, were household and household-head characteristics.ResultsIn the first time period (2001–2003) there were no significant differences between treated and controls. This can be explained by the delay in implementing the policy by the local governments. In the second (2001–2005) and third period (2001–2007) the utilizations of Communal Health Stations (CHS) and go-to-pharmacies were significant. The treated were using CHS and pharmacies more between 2001 and 2007 while control households decreased their use.ConclusionThe main findings suggest HCFP met some goals but not all in the group of households having at least one elderly member. Utilization of CHS and pharmacies increased while the change in HCE as a proportion of total expenditures was not significant. To some extent, private health care and self-treatment are replaced by more utilization of CHS, indicating the poor elderly are better off. However, further efforts are needed to help them access higher levels of public health care (e.g. district health centers and provincial/central hospitals) and to reduce their HCE.

Does the organizational model of the maternity health clinic have an influence on women’s and their partners’ experiences? A service evaluation survey in Southwest Finland

BackgroundIn high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC). At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC & CHC) where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC & CHC, influence on women’s and their partners’ service experiences.MethodsA comparative, cross-sectional service evaluation survey was used. Women (N = 995) and their partners (N = 789) were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics.ResultsWomen who had used the combined MHC & CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC’s model was related to several aspects of the service which were evaluated “good” (the content of the service) or “much” (the amount of the service). Significant differences accumulated favoring the combined MHC & CHCs’ model. Twelve aspects of the service were ranked more often as “good” or “much” by the parents who had used the combined MHC & CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs.ConclusionsBased on the women’s and partners’ experiences an organizational model of the combined MHC & CHC where the same nurse will take care of family during pregnancy and after birth of the child was preferred. This model also provides greater amount of home visits and peer support than the separate MHC.

Public Health and the Law

Promoting and protecting the public's health in the United States and abroad are intricately tied to laws and policies. Laws provide support for public health measures, authorize specific actions among public and private actors, and empower public health officials. Laws can also inhibit or restrict efforts designed to improve communal health through protections for individual rights or structural principles of government. Advancing the health of populations through law is complex and subject to constant tradeoffs. This column seeks to explore the role of law in the interests of public health through scholarly and applied assessments across a spectrum of key issues. The first of these assessments focuses on a critical topic in emergency legal preparedness.

Agentic and Communal Traits and Health

The authors examined whether agentic and communal traits are associated with relationship and health outcomes among adolescents with and without diabetes. They interviewed 263 teens (average age 12; 132 Type 1 diabetes; 131 healthy) on an annual basis for 5 years. The authors measured agency, communion, unmitigated agency, and unmitigated communion as well as parent and peer relationship quality, psychological distress, and diabetes health. In concurrent and lagged multilevel models, unmitigated communion and unmitigated agency were associated with poor relationship outcomes and greater psychological distress for those with and without diabetes. In lagged analyses, unmitigated communion predicted deterioration in diabetes health. Communion and agency were associated with positive relationship and health outcomes, with the former being stronger than the latter. These results underscore the need to focus on unmitigated agency and unmitigated communion when studying the implications of personality for health during adolescence.

Perspectives on child diarrhoea management and health service use among ethnic minority caregivers in Vietnam

BackgroundIn Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.MethodsThe study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.ResultsThis study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.ConclusionsIn order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.