A community perspective on changes in health related to diarrhea in northeastern Brazil

Background: Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. Objective: To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. Methods: This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. Results: Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. Conclusions: Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.