A qualitative study among rural mothers classification of the lay etiologies of childhood cough was conducted in Bohol island, the Philippines, the site of an ARI control research project which tested the effectiveness of the WHO developed acute respiratory infections standardized case management algorithm. The study aimed to look into lay models of etiology of childhood cough and the influence of these perceptions of causation on mothers health seeking behavior and healer choices.
Some 111 mothers participated in the study, 48 identified from among those whose child was admitted to hospital, while 63 were identified from volunteer health workers list of mothers with children under five years old. Case histories and illness histories were elicited from the hospital-based sample while the community-based mothers participated in focus group discussions and indepth interviews using hypothetical situations.
Cough was attributed primarily to the folk category piang, a sprain or dislocation of tissues or nerves, due to falls or mishandling of the child. Mothers believed that this condition can only be diagnosed and treated by the manghihilot; midwives or physicians are not capable of diagnosing nor managing piang. The belief that the child has piang drives the mother first to the manghihilot (masseur), and she will make multiple manghihilot referrals to confirm or refute their suspicions.
The current program to reduce ARI mortality, specifically pneumonia, is primarily curative. Its success depends on the caretakers ability to recognize fast breathing and to seek antibiotic treatment as soon as it is observed. The significance of this folk etiology is its contribution to delays in seeking treatment, particularly because rapid breathing is regarded as a sign, not only of pneumonia, but of piang as well. The development of health education messages should take into consideration folk etiologies of cough and explore ways to use these information in communicating cough etiology using the why approach. The role of folk healers in disease control programs like ARI should also be explored.