The household ecology of disease transmission: Childhood illness in a Yucatan Maya community (Mexico).

摘要

This research takes its significance from the fact that it employs a broadly designed model, the Household Ecology of Disease Transmission, which is structured not only to encompass a description of elements that affect childhood illness at the household level, but also includes relevant elements in the cultural and social environments in which the household is situated. The key objectives of the project are: to identify elements in the household environment that contribute to instances of childhood illnesses; to identify shared community explanatory models of childhood illnesses; to determine if differences in religious affiliation correlate with differences choices of health care services for sick children; and to determine how the pluralistic medical system used by community members impacts the health of its children. Methodologies employed included time spent in observation and conversations in numerous households, informal interviews with various key informants, enumeration of a social census, the use of conversations and open-ended questionnaires to elicit the vocabulary concerning childhood illnesses, interviews with sets of parents to elicit explanatory models of childhood illnesses, home visits and interviews with parents of children whose cases are included in the morbidity survey, and numerous interviews with various types of health care practitioners, community health committee members, and officials at various levels.; Information elicited from the explanatory models and from actual cases of childhood illnesses demonstrates that ideas of childhood disease etiology do not include a biomedical concept of contagion. Specifically, findings show that one diarrhea-related disease, yax ta, is not classified in the same way as are other diarrheal diseases, and it is less likely to be reported to health authorities or treated with oral rehydration therapy. Findings show that another type of diarrhea, sac ta, is commonly improperly treated by purging, and that bouts of diarrhea, in general, may be improperly treated with antibiotics and anti-diarrheal medications. Further, the study shows that parents are unaware of the primary symptoms of childhood pneumonia. The research also finds that there are differences in choices of care providers between Catholics and Protestants for treatment of childhood illnesses. Catholics are more likely to use the local primary care clinic, and are more likely to seek care from local traditional practitioners. In contrast, Protestants are more likely to use home remedies and over the counter medications, but are also more likely to seek care for their children from uncredentialed biomedical providers in a neighboring community.; The findings show that children are at risk illness because of factors of structural poverty, including lack of adequate clean water, lack of sanitation and waste disposal facilities, and indoor air pollution from wood used for cooking. Finally, the study shows that, though attendance at the local health clinic has increased, parents spend relatively large sums of money on care for their children outside the community. Parents voice concerns that the clinic frequently lacks drugs and supplies, and that they feel a lack of control over the course of treatment they will receive there.