Academic journal article Journal of Health Population and Nutrition

Prevention of Diarrhoea in a Poor District of Santo Domingo, Dominican Republic: Practices, Knowledge, and Barriers

Academic journal article Journal of Health Population and Nutrition

Prevention of Diarrhoea in a Poor District of Santo Domingo, Dominican Republic: Practices, Knowledge, and Barriers

Article excerpt


Diarrhoea continues to be one of the commonest causes of high morbidity and mortality among young children in many parts of the developing world, including Latin America (1-2). Improved child caregiver practices may significantly reduce the incidence of diarrhoea in children (3-5). Consequently, health education promoting diarrhoea-prevention practices has been embraced as an important intervention by various programmes working in poor communities in developing countries.

Generic education packages have been developed to facilitate its widespread use in poor districts of the developing world. Messages focus on primary and secondary prevention of diarrhoea, such as washing hands before meals, breast-feeding, and use of oral rehydration salts (6-9). These interventions are relatively simple, and health education may seem to be an appropriate intervention. However, critical assumptions are made when health education is chosen as the intervention when a knowledge, attitude and practice study is not first conducted. The first assumption is that high rates of diarrhoea reflect deficiencies in prevention practices of caregivers. The second assumption is that deficits in the prevention practices are a function of deficits in biomedical knowledge (5,10-14). This leads to the use of educational materials based on a knowledge-deficit model even in cases where knowledge had not been assessed.

A number of "health education" interventions have been found to be successful in changing hygiene behaviours (4,15-16). However, baseline knowledge and change in knowledge with the intervention were not assessed in these reports. Even in the few studies that did assess knowledge, practices, and illness, there was a lack of reported assessment of knowledge about specific prevention practices, which are the core elements in generic health-education programmes (5,10-11). Other studies have focused on the change in knowledge after a health-education intervention without looking at an associated behaviour change (17-19). Overall, there is a paucity of evidence linking improvements in health knowledge to improvements in health practices for prevention of diarrhoea, and the data that are reported are limited (20).

The first aim of this study was to determine the extent of deficits in the diarrhoea-prevention practices. The second aim was to determine the association of these deficits with deficits in the biomedical knowledge and non-knowledge barriers. The hypothesis was that nonknowledge barriers might be more related to engagement in recommended diarrhoea-prevention practices than basic biomedical knowledge about these practices.


Setting: The study was conducted in Los Alcarrizos, a predominately poor periurban district of Santo Domingo, the capital of the Dominican Republic. Four poor barrios (locally defined communities or neighbourhoods) of this district were chosen. The barrios were chosen for two reasons: (i) a local child-malnutrition clinic frequently receives referrals from these communities, and (ii) local health-promotion groups had chosen these communities for health-education interventions.

Procedure: Two Dominican research assistants conducted interviews by visiting every fifth house along each road and path in each selected barrio. This sampling frame included all houses within each of the selected barrios, and was used for obtaining a non-biased representative sample. The research assistants explained the nature of the study to an adult in each selected house, and inquired if there was/were one or more children aged 5 years or less who presently lived in the house. If there was, and if a person who provided primary care to the child was available, that person was invited to participate in the interview. If a primary caretaker was not presently available or there was no one at home, the house would be visited up to two further times to conduct an interview. …

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