Social and behavioral factors in transmission and response to shigellosis.

Biomedical approaches to shigellosis tend to emphasize unique etiologic and clinical features of the disease, e.g., those related to the development of vaccines or case management. The biologic characteristics of the organism and sociocultural responses to it imply that it is unlikely that a purely technologic solution (vaccine) to shigellosis will be found soon. Infrastructural development (protected water supply and sanitary disposal of feces) may be too expensive to be feasible due to the economic, environmental, and demographic conditions in developing countries. Behavioral change to reduce the risk of transmission may be a more effective preventive strategy. Case management in developing countries will require prompt, appropriate action when symptoms of shigellosis occur. A general model of health-seeking behavior suggests patients' parents or guardians (anyone responsible for care of the child and for overseeing the child's health, e.g., older siblings or grandparents) will take no action if the symptoms are not recognized or are perceived as normal or if the condition is not evaluated as serious or treatable. It is not necessary for patients' parents or guardians to learn about etiologic models from medical practitioners to behave in ways that will reduce the risk of infection or to seek effective treatment. For example, hand washing may be promoted on the basis of symbolism. Agreement between potential patients or their guardians and health care providers on signs of potentially severe disease may be enough to bring them into effective contact.