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Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations

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Abstract

A sunken soft-spot or fontanel is a sign for dehydration in infants. Around the world, folk illnesses, such as caída de la mollera in some Latin American cultures, often incorporate this sign as a hallmark of illness, but may or may not incorporate re-hydration therapies in treatment strategies. This report describes a study of lay descriptions of causes, symptoms, and treatments for caída de la mollera in three diverse Latin American populations. A mixed-methods approach was used. Representative community-based samples were interviewed in rural Guatemala, Guadalajara, Mexico, and Edinburgh, Texas, with a 132 item questionnaire on the causes, susceptibility, symptoms, and therapies for caída de la mollera. Cultural consensus analysis was used to estimate community beliefs about caída. Interviews conducted in rural Guatemala (n = 60), urban Mexico (n = 62), and rural Texas on the Mexican border (n = 61) indicated consistency in thematic elements within and among these three diverse communities. The high degree of consistency in the illness explanatory models indicated shared beliefs about caída de la mollera in each of the communities and a core model shared across communities. However, an important aspect of the community beliefs was that rehydration therapies were not widely endorsed. The consistency in explanatory models in such diverse communities, as well as the high degree of recognition and experience with this illness, may facilitate communication between community members, and health care providers/public health intervention planners to increase use of rehydration therapies for caída de la mollera. Recommendations for culturally informed and respectful approaches to clinical communication are provided.

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Notes

  1. We would like to gratefully acknowledge Drs. Margarita Kay, Arthur Rubel, Kaja Finkler, and Peter Guarnaccia for their comments regarding folk illness interview questions. Any errors or omissions are our own responsibility.

  2. To estimate the community prevalence of recognition and belief in Caída de la Mollera as an illness, we used the number of people who were approached to participate in the study, whether or not they believed in caídaas the denominator. Thus, the community prevalence for belief in caída was: 97.5 % (39/40) in Guatemala, 85 % (40/47) in Mexico, and 82 % (41/50) in Texas.

  3. Although our set of questions was balanced to include both positive and negative questions about caída de la mollera, the proportion of positive items in our answer sets was low (<26 %. Table 2), but not significantly different across the three samples (Chi Square p = 0.21). Additional analyses were performed to check the stability of the results. First, estimates of cultural knowledge scores were compared using match and covariance methods and found to be highly correlated (0.78 Guatemala, 0.71 Mexico, and 0.65 Texas), suggesting low response bias, especially at the Latin American sites. Second, analyses were repeated with a larger proportion of positive items by randomly omitting half of the negative themes, leaving 85 of the original 132 questions, and increasing the proportion of positive items to 41 %. The covariance estimates of cultural knowledge obtained from the full 132 item and the 85 item subset were strongly correlated: 0.97 Guatemala, 0.91 Mexico, and 0.99 Texas. Classification of answers changed on 2 % of answers, principally from “–” to either “yes” or “no.” Thus, results indicate that the results appear to be accurate and stable.

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Acknowledgments

This project was funded by National Science Foundation Grant #BNS-9204555 to S. Weller.

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Authors and Affiliations

  1. Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA

    Lee M. Pachter

  2. Center for the Urban Child, Section of General Pediatrics, St. Christopher’s Hospital for Children, 160 East Erie Ave, Philadelphia, PA, 19134, USA

    Lee M. Pachter

  3. Department of Preventive Medicine and Community Health and Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Susan C. Weller

  4. Department of Anthropology, University of South Florida, Tampa, FL, USA

    Roberta D. Baer

  5. UIESS, IMSS, Guadalajara, Guadalajara, Mexico

    Javier E. Garcia de Alba Garcia

  6. University of Texas, Edinburg, TX, USA

    Mark Glazer

  7. Department of Anthropology, Northern Arizona University, Flagstaff, AZ, USA

    Robert Trotter

  8. Medical Entomology Research and Training Unit, Centers for Disease Control and Prevention (CDC), Guatemala City, Guatemala

    Robert E. Klein

  9. Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Eduardo Gonzalez

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  1. Lee M. Pachter
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Correspondence to Lee M. Pachter.

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Pachter, L.M., Weller, S.C., Baer, R.D. et al. Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations. J Immigrant Minority Health 18, 1066–1075 (2016). https://doi.org/10.1007/s10903-015-0259-0

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