Public Health Research and Scheduled Tribes: An ethical lens.

In this commentary, it is argued that greater attention paid to ethical considerations related to doing Public Health Research with Scheduled Tribes (STs) should be prioritized. Given the high levels of health needs among STs as well as their high levels of deprivation, cultural oppression, and impingement on their rights, there is a need to revisit our research practices to contribute to better health and overall empowerment. Specific strategies that could be integrated into research practice are offered. The paper concludes with a call for the development of national guidelines for Public Health Research with STs.

Factors that Influence Effective Diarrhea Treatment Programs in Haitian Children.

Objectives: Childhood diarrhea is a major cause of morbidity and mortality in Haiti; a situation exacerbated by the cholera outbreak in 2010. Oral rehydration salts (ORS), when combined with zinc (ORS-zinc), is effective in preventing death and reduces severity of illness—yet their combined use remains low. An intervention to expand delivery of ORS-zinc is underway. To guide the scale up of the intervention, we conducted a qualitative study to identify caregivers’, influencers’ and healthcare providers’ knowledge, attitudes and practices related to diarrhea and its treatment. Methods: Study conducted in two departments in Haiti: North West, where ORS-zinc distribution has already begun, and North, where ORS-zinc will be implemented in 2014. Using rapid ethnographic methods, we conducted 1) semi-structured interviews with both health workers of traditional and modern medicine (n=16), 2) facility observations where child diarrhea is treated (n=4), 3) six focus group discussions (FGD) with caregivers (n= 62) and influencers (n=39). Results: All modern and most traditional health workers recommended ORS in their practice, however, only those already receiving the intervention prescribed zinc while a few modern practitioners in the non-intervention group had heard of it. Facility observations demonstrated a gap in how the use of ORS-zinc is explained to patients. FGD showed that care seeking behaviour is strongly influenced by perceptions of the type of diarrhea and availability of healthcare provider. Conclusions: Knowledge and attitudes affect the prescription and use of ORS-zinc. These findings will affect the design of targeted behavior change interventions for scaling up ORS-zinc in northern Haiti.