Health beliefs related to diarrhea in Haitian children: building transcultural nursing knowledge

Abstract

Regardless of where they live or under what circumstances, mothers throughout the world seem to have a compelling desire to provide the best possible health care for their children (Huston, 1979). Haitian mothers living in the Dominican Republic were no exception. The health beliefs and practices of these mothers related primarily to diarrhea among their children which demonstrated a concern and resourcefulness that is commendable. The results of this study clearly indicate the importance of transcultural nurses conducting culturally relevant research as a basis to develop sound health programs in developing countries. Diarrhea was identified as the single most important threat to a child's health in these communities. That mothers did not know about the correct ingredients and/or proportions for oral rehydration solutions (Western views) was of interest. Although the Dominican government makes some commercial packets of ORS, most of the women interviewed did not have ready access to this product. This finding reflected the need for transcultural nurses to offer to teach mothers how to make ORS using the sugar, salt, and water they had available. Since the mothers' perception that diarrhea was a dangerous threat to their children's health, was verified by childhood mortality statistics in the bateys, it would seem that ORS could make a significant impact on the health status of the children. Breastfeeding also was a major health belief factor associated with the treatment of diarrhea. Even though the majority of mothers believed breast feeding should be continued if a child had diarrhea, a number believed it should be discontinued. Nurses working with CHWs will need to emphasize the importance of breastfeeding and help them to develop creative ways of communicating this information to the mothers. The second most dangerous threat to the child identified by the mothers was respiratory ailments. This suggests a new area of concentration for future research and training of CHWs. A host of new questions related to respiratory problems such as health beliefs, causative factors, course of disease, traditional treatments, mortality rate, etc. need to be investigated. When transcultural nurses plan health care programs for women and children in other cultures, it is important to recognize the concerns mothers have for their children, and their intense desire to nature and care for them. In this study, mothers willingly participated and demonstrated active interest in learning to use methods to improve the health and well being of their children. It is well documented (Lieban, 1977) that established health beliefs are not automatically discarded when new knowledge is made available, but that exploration and incorporation of new information when presented in a culturally relevant framework does occur. An understanding of local beliefs surrounding health is fundamental to the development of appropriate transcultural nursing interventions.

PIP: Interviews conducted by community health workers with 83 Haitian women working in sugar cane fields in the Dominican Republic underscored the importance of understanding local health beliefs so that culturally appropriate interventions are implemented. The respondents all had at least 1 child under 5 years of age; their average age was 29 years and they had a mean parity of 4.9. The mothers identified gastrointestinal problems, chiefly diarrhea, as the greatest threat to their child's health. 82% of the mothers had at one time had a diarrheal episode among her children and 31% reported that a child currently had diarrhea; 16% said at least 1 child had died of diarrhea. Water, food, and microbes were identified as the major cause of diarrhea. Although not routinely cited as a cause of diarrhea, the evil eye (transmitted by male of female witches) was viewed by all but 1 mother as a powerful factor in child mortality. The foods mothers claimed they would give a child with diarrhea included lemonade, soups, bananas, and other fruit juices. Both cooking oil and milk were considered harmful. Of concern was the finding that 38% of mothers would discontinue breastfeeding during a diarrhea episode. None of the mothers had heard of oral rehydration; however, most were treating diarrhea with a solution prepared by pouring boiling water over herbs and leaves. This practice suggests that these mothers can be instructed to prepare oral rehydration solutions in which all ingredients are precisely measured. Since diarrhea is a major cause of child mortality in these Haitian communities in the Dominican Republic, promotion of oral rehydration could make a significant contribution to child survival. It is essential, however, that all such interventions incorporate existing beliefs and present new information in a culturally relevant framework.