Management of Childhood Diarrhoea in Rural Ghana: The Case of Pute in The Dangme-East District

Abstract

The main thrust of this study is to investigate how childhood diarrhoea is managed at Pute - a rural community in Ghana. The study aims at eliciting local perceptions of childhood diarrhoea, including cause(s), consequences, and appropriate treatment, so as to unearth some of the social and cultural factors that may influence health-seeking behaviour in diarrhoeal episodes. To understand fully folk concepts of diarrhoea and its treatment, it was necessary to describe the social and institutional setting within which illness episodes are managed in order to lay the basis for interpreting findings from the study. To this end, the social structure of Pute was outlined. Pute is a small Dangme-speaking rural community, located some 118 kilometers from central Accra. It is predominantly a fishing community in which descent and kinship groupings form the basis of social, economic, religious and political organisations. Contact with Western society has set in motion a process of change which is gradually promoting a breakdown of traditional cosmology. In order to obtain in-depth information on folk nosologies of childhood diarrhoea and its treatment, three major methodological approaches were used. These are interviewing, focus group discussions and observation. The conceptual framework that was used for organising field data on ethnomedical models of diarrhoeal illness is a cultural construction that establishes a web of relationship among social factors, illness experience, help-seeking and outcome. The study has shown that folk classificatory systems for diarrhoea based mainly on physical notions of etiology determined to a very large extent therapeutic choices and hence help-seeking patterns. In particular, it has been shown that, the interpretations of specific diarrhoeal illness episodes, and specific health-seeking actions of mothers were not merely shaped by signs and symptoms, and that a wide range of factors enter into the establishment of illness identification and health-care decision-making. These include classification of a diarrhoeal ailment, perceived seriousness, availability of regimens and efficacy of treatment, all of which were found to be deeply rooted in ethnomedical models of diarrhoeal illness and its treatment. As a consequence, it has been found that, the widespread use of pharmaceuticals, especially antibiotics in the treatment of childhood diarrhoea should be considered a product of the local socio-cultural system in which illness episodes occur. To this end, it is being suggested that, programme planners for the control of diarrhoeal diseases need to take cognisance of popular health culture and home care behaviour in rural settings such as Pute, if the promotion of ORT (including ORS) as the most effective modern approach to the treatment of most childhood diarrhoeas is to become effective. This thesis is in five main parts with sub-divisions under each chapter. Chapter one, which sets out the introduction outlines the problem, objectives, the conceptual framework, the methodological approach to the study, the usefulness of the study as well as its broad limitations. Chapter two, is devoted to a review of literature related to diarrhoeal illness management in different cultural contexts of the world. Chapter three takes a look at the social organisation of the people under study and their general world-view. Chapter four presents the main findings and interpretation of analysed field data. Chapter five is a summary of main findings, policy implications of the study as well as suggested areas for further research.