Disseminating knowledge about oral rehydration therapy (ORT) and zinc supplementation (ZS) in low-income countries is effective in preventing deaths due to diarrhea in children under 5 years of age;unfortunately there has been a decrease in ORT use in some Latin American countries. It is unknown why the number of children treated with ORT during episodes of diarrhea has declined in recent years. The long-term goal of this research program is to design a culturally-appropriate promotora de salud curriculum to address conditions associated with high mortality rates in children under 5 years old for use in low-income countries in Latin America. The overall objective of this application, which is the initial step toward attainment of the long-term goal, is to identify the factors which influence utilization of ORT and ZS in a low-income country, specifically Guatemala. The central hypothesis is that cultural norms in communication and health-seeking decision-making and the educational process employed in ORT training are predictors of the utilization of ORT with ZS in low-income countries. The rationale underlying the proposed research is that the identification of barriers to teaching and the utilization of ORT and ZS will facilitate the dissemination of knowledge through the use of local promotora programs, thereby preventing childhood deaths due to dehydration associated with diarrheal diseases. The central hypothesis will be tested by pursuing the following specific aims: 1) Identify the cultural and educational barriers to effectiv training in the use of homemade ORT and ZS in Guatemala;and 2) Disseminate accessible information via promotoras on the use of homemade ORT and ZS to prevent and treat dehydration resulting from diarrheal diseases in children under 5 years of age. With respect to expected outcomes, the work proposed is to create and disseminate a culturally-appropriate, accessible curriculum for homemade ORT and ZS for the indigenous Maya population of Guatemala. The contribution of the proposed research is expected to identify the factors which influence effective training and knowledge retention in ORT and ZS in Guatemala. The findings will allow expansion to similarly designed educational interventions focused on other high mortality rate conditions faced by Guatemala and other low-income countries. This contribution will be significant because recognition and early treatment of diarrhea will prevent unnecessary deaths due to dehydration in children less than 5 years old. The proposed research is innovative because it will use a culturally-informed, collaborative approach along with a literacy-appropriate curriculum to increase knowledge of ORT and ZS in a low-income country. This research will evaluate knowledge and utilization of ORT and ZS by parents, rather than just the change in knowledge levels of promotoras following training. These results are expected to have an important positive impact by improving the efficacy and sustainability of ORT education campaigns through encouraging local collaboration and ownership of program content.
The proposed research is relevant to public health because it will improve the efficacy and sustainability of oral rehydration therapy (ORT) and zinc supplementation (ZS) education campaigns and therefore contribute to the reduction of childhood diarrheal mortality. The design and implementation of a culturally-appropriate, accessible curriculum for ORT and ZS will provide a template that can be adapted and applied to other easily treatable, high mortality diseases in low-income countries. This proposed research is relevant to NIH's mission through its goal to lengthen life and reduce the burden of illness.