Meegan Culturally-based health promotion programmes

Culturally-based health promotion programmes
J Jaime Miranda aEmail Address, Rosa Malca a, Eduardo Bedriñana a, Efraín Loayza a
Sir
Michael Elmore Meegan and colleagues (Aug 25, p 640)1 report a decrease in mortality rates due to neonatal tetanus in five Massai areas (sub-Saharan Africa) after introduction of a culturally-based health promotion approach.
Promotion activities were done by local community actors in the intervention areas, whereas in control areas, such activities were done by local Ministry of Health staff.
Although the study period was almost 20 years, the death rates in children younger than 6 weeks fell sharply after the first year of intervention and has not risen again in the past 11 years.
In view of such spectacular change, we wonder whether Meegan and colleagues promoted this approach to other communities, rather than just continuing with the analysis for such a long time. Moreover, we would like to know if they transferred this knowledge to local sustainable actors such as Ministry of Health bodies.
We disagree with the long observation period because the study control areas could have benefited from this culturally based approach for at least 11, if not 18, years.
Culturally-adequate approaches result in wider local acceptance and higher compromise with local actors, thereby providing greater chances of sustainability. Our experience with culturally adequate delivery services implemented on rural health facilities from the Peruvian Andes reflects this outcome. In Peru there is a high maternal mortality rate (around 215 per 100 000 by 2000). More than 80% of mothers die at home despite an adequate number of antenatal care visits.2 Women in the Andes generally delivered their babies at home because of fear and shame from using modern delivery methods that do not accord with local cultural beliefs.3 We took into account the requirements of rural people and negotiated with local Ministry of Health staff. So far, after 9 months of implementation, the number of institutional deliveries is rising, and is contributing to lower maternal mortality.
References
1 Meegan ME, Conroy RM, Lengeny SO, Renhault K, Nyangole J. Effect on neonatal tetanus mortality after a culturally-based health promotion programme. Lancet 2001; 358: 640-641. Summary | Full Text | PDF(59KB) | CrossRef | PubMed
2 Guerra V. Lucha contra la muerte materna, Ayacucho. Salud Para Todos 2001; 1: 6. PubMed
3 Investigation report: provision of culturally adequate sexual and reproductive health services in rural communities affected by violence. Ayacucho, Peru: Health Unlimited, Peruvian Programme, 2000.