Sunday, February 06, 2011

Participatory approach to control intestinal infections in different socio economic and cultural settings in Sri Lanka

by Jayasinghe A, Wijesinghe PR.

Introduction:Intestinal infections endemic in one geographical area may cause outbreaks in other parts of the country. The common disease control strategies are not effective when applied uniformly in all areas as practices of inhabitants differ in different socio cultural and economical settings. Therefore, ascertaining knowledge, practice and behaviours of inhabitants and strategic planning with available resources are effective ways for disease control.

Objectives:
• To identify behavioural and administrative factors affecting control of intestinal diseases
• To design, implement, monitor and evaluate locality specific programs through participatory approach to control intestinal infections
• To prepare a comprehensive, national intestinal disease control program incorporating different locality specific programs

Methods :Six different groups of people in different localities were identified based on routine surveillance data on intestinal infections. These groups were Tamil speaking tea estate community in Badulla, Tamil and Sinhala speaking vegetable farmers from Nuwareliya district, Faddy cultivators from Anuradapura district, Moor community in Puttalam district and a seasonal migrant fishing community from an islet in Puttalam district and a Tamil speaking, semi urban community in Mannar district. Based on focus group discussions with inhabitants and on-site situational analysis, six different intestinal disease control programs were worked out with stakeholders through a participatory approach. Activities were monitored for a period of 12 months.

Results ;Though the knowledge on control measures of intestinal diseases was adequate, behaviours and practices were not satisfactory for controlling the disease. The priority given by divisional health authorities for surveillance and control of intestinal diseases were not up to the expected level. Available resources were proved to be adequate to reduce disease incidence by 50% when area specific problems were prioritised by the divisional health authorities and responsibility was shouldered by different stakeholders.




Recommendations:
A generic control program is not recommended for different socio-cultural groups. Locality specific disease control programs prepared through a participatory approach by divisional stakeholders is the best approach for effectiveness and sustainability of practical control programs.

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