Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

naval; and feeding child boiled banana, rice/sago porridge, or popped corn ground into flour.Traditional methods, such as holding (kaer) the stomach, was believed to be effective for a churningstomach (kabun dulas) where no diarrhoea was present.There were four main groups of causes associated with diarrhoea, as detailed in Figure 5 below:breastfeeding, contamination, foods eaten and seasons. Other causes identified included teething,incomplete vaccination, worms and anin tama kabun (literally: wind + enter + stomach).Figure 5 - Reported causes of diarrhoea• Breastfeeding: mother continues to breastfeed while pregnant, mother does not cover her chestand her milk becomes cold (malirin), mother does not drink hot water, mother eats hard food(to’os), mother eats poorly or food considered wrong (salah).• Contamination (foer): child plays in dirty water, child drinks un-boiled water, child does not batheor wash hands, child plays in dirt and dust, child’s nails not cut, open drainage near house, strongwinds bring dust, uncovered food eaten.• Food consumption in child: eats hard food (to’os), eats late i.e. already hungry, eats pig fat or oil,eats sour food such as tamarind, drinks formula milk, nutrition problem in child.• Seasonal: child consumes unripe leafy greens in wet season or new season leafy greens mixed withold greens or unripe fruits such as mango.Delay in deciding to take a child to a health facility may occur where parents perceive seriousdiarrhoea to be caused by custom (neglected customary duty or social transgression). Parents maysuspect (deskonfia) that this is the case if they are aware of a pre-existing unresolved social matter,or they know they have neglected customary duties. In many cases, however, parents take a child toa health facility after home remedies do not effect a cure. If this treatment is also not effective (fordiarrhoea due to custom neither traditional nor modern medicine will work), then they will carry outa ritual to determine whether custom is the cause.Family members may carry out the ritual to determine the cause and then take steps towardsresolving the problem themselves, or they may engage a healer-shaman (matan dook). Other actionsreported that related to belief in custom as cause of diarrhoea included praying to God (Maromak)for help, or calling on (hamulak) the ancestors (matebian) to overcome the effect of the malevolentaction, or attending the ritual house. Additionally, people may pray to God or the ancestors to makepotent, or enspirit, the traditional medicine (root, bark, leaves) used to cure the child.Interaction with health providers for diarrhoeaWhere custom was not considered to be the cause, or had already been determined and resolved,and parents took a child suffering from diarrhoea to a health facility they were generally satisfiedwith the outcome. This resulted from rapid diagnosis and effective treatment relieving thesymptoms.However, if a child’s symptoms were not relieved, or returned, and the parents took the child back tothe facility, several informants felt that they were interrupting, even annoying (satia beibeik), thestaff. In two cases, parents reported being asked to explain why they had come back with their childwhen they had been previously referred elsewhere. In the first, the parents of a 16-month old childTimor-Leste Health Care Seeking Behaviour Study | 200936