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Reporting diarrhoea through a vernacular term in Quechua-speaking settings of rural Bolivia.

  • Author(s): Pacheco, Gonzalo
  • Christen, Andri
  • Arnold, Benjamin
  • Hattendorf, Jan
  • Colford, John
  • Smith, Thomas
  • Mäusezahl, Daniel
  • et al.
Abstract

Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term kechalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of kechalera were collected for children aged less than five years. Reported kechalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported kechalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to kechalera. Mucus in the stool was also associated with kechalera; however, its presence in kechalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term kechalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of kechalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of kechalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia.

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