In Sudan's South White Nile Province the development of a communication strategy for the diarrhoeal disease programme was preceded by the collection of data from community members and health personnel. A majority of health workers had only a limited knowledge of the community's methods of dealing with diarrhoea. Most of these workers had very negative attitudes towards mothers and home interventions. This information was vital for planning a comprehensive educational scheme for both health workers and communities.
PIP: The knowledge and attitudes of doctors and medical assistants, community health workers, and mothers of 0-4 year old children were assessed regarding diarrheal disease management in the Sudan's South White Nile Province. The operating assumption was that communication was a two- way exchange between health staff and mothers. The quality of this interaction was seen as related to the technical knowledge and skills of health workers and their attitudes towards traditional healers and the home management of diarrhea by clients. Knowledge was assessed with a quantitative instrument, and attitudes were obtained from an open ended qualitative interview with 12 questions. A convenience sample was drawn of 20 doctors and medical assistants responsible for diarrheal consisted of 2 medical assistants, a health education officer, a statistical technician, and a senior nurse. Training was provided for interviewers. The analysis of the qualitative data involved content analysis. The findings differentiated doctors and medical assistants from CHWS on their knowledge of popular terms and concepts. None of the formal providers had indepth knowledge of popular terms or an understanding of the relationship between a popular term and the community's approach to diagnosis and treatment of diarrhea. CHWs were more knowledgeable about terms but like the doctors, were unable to understand the connection of terms with diarrheal treatment. The explanation may be that all CHWs were men. Mothers differentiated 12-13 different types of diarrhea and treatment including home remedies, consultation with traditional healers, or office health service was related to the diarrhea type. The attitudes of doctors and CHWs toward traditional healers was that their practices were inappropriate, and doctors consequently tried to convince mothers that healers' practices were ineffective. All of the mothers considered traditional healers to be experts in the diagnosis and treatment of diarrhea and concerned for the community's well being. Traditional healers were rated as superior to health staff. Doctors and CHWs both categorized the treatment of the mothers as neglectful, inappropriate, or unscientific. Mothers' remedies included continued breastfeeding, and the feeding of yogurt, custard, rice, herbal tea, rice water, and fruit juice. Training of health staff to be less critical of traditional strategies and to develop better communications skills was suggested.