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Pontificia Universidad Católica Del Ecuador Facultad De Medicina

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Pontificia Universidad Católica Del Ecuador Facultad De Medicina PONTIFICIA UNIVERSIDAD CATÓLICA DEL ECUADOR FACULTAD DE MEDICINA ESPECIALIZACIÓN EN MEDICINA FAMILIAR Y COMUNITARIA DISERTACIÓN PREVIA A LA OBTENCIÓN DEL TITULO DE ESPECIALISTA EN MEDICINA FAMILIAR Y COMUNITARIA TEMA: PRINCIPALES CONOCIMIENTOS, ACTITUDES Y PRÁCTICAS CULTURALES QUE INFLUYEN EN EL USO DE ANTICONCEPTIVOS EN LA POBLACIÓN KICHWA OTAVALO DE LA PARROQUIA DE SAN ROQUE, DEL CANTÓN ANTONIO ANTE DE LA PROVINCIA DE IMBABURA AÑO 2016. Autoras: DRA. ROSA MAYTA ZAPATA DRA. PATRICIA VALVERDE Dra. ELVA ARIAS TERÁN Directora Antropólogo Social, MSc, Dr. (c). Alexis Rivas Director metodológico 1 TÍTULO PRINCIPALES CONOCIMIENTOS, ACTITUDES Y PRÁCTICAS CULTURALES QUE INFLUYEN EN EL USO DE ANTICONCEPTIVOS EN LA POBLACIÓN KICHWA OTAVALO DE LA PARROQUIA DE SAN ROQUE, DEL CANTÓN ANTONIO ANTE DE LA PROVINCIA DE IMBABURA AÑO 2016 2 TABLA DE CONTENIDO RESUMEN…………………………………………………………… …….. 8 ABSTRACT…………………………………………………………………..10 INTRODUCCIÓN……………………………………………………………12 CAPÍTULO I………..………………………………………………………...14 Problema de Investigación……..……………………………………………..14 CAPÍTULO II…………………………………….……………..…………….18 Marco Teórico ……………………………………………….……………….18 2.1 Caracterización socio-geográfica de la parroquia de San Roque………………………………………………………………………….18 2.2 Cuál es el fundamento histórico - filosófico de la cultura de los pueblos andinos kichwas?...............................................................................................24 2.3 Historia del desarrollo humano y la reproducción…….………………33 2.4 Ciclo reproductivo y sexualidad en las comunidades indígenas………………………………………………………………………36 2.5 Matrimonio, familia e hijos/as ………………………………………..37 2.6 La familia indígena…………………………………………….……...39 2.7 Salud sexual y reproductiva desde la visión de la medicina occidental………………………………………………………………..…….45 2.8 Barreras para la anticoncepción ………………………………...…….66 2.9 Competencias culturales……………………….………………...……69 3 CAPÍTULO III………………………………….……………………………71 Metodología de la Investigación…….……………………………………….71 Pregunta de investigación ……………………………………………………71 Objetivos……………………………………………………………………..71 Objetivo General……………………………………………………………...71 Objetivos Específicos…………………………………………………………71 Métodos y Técnicas….….………………………………………………….....72 CAPÍTULO IV………………………….…………………………………….77 Resultados ……………………………………………………………………77 4.1 Conocimientos actitudes y prácticas ancestrales sobre los métodos anticonceptivos………………………………………………………………..77 4.2 Conocimientos actitudes y prácticas sobre los métodos anticonceptivos de la medicina occidental……………………………………………………….100 4.3 A través de los ojos de los prestadores de salud……………………........119 CAPÍTULO V …………………………………………………………........143 Discusión…………………………………………………………………….143 CAPÍTULO VI………………………………………………………………155 Conclusiones…………………………………………………………...…….155 Recomendaciones………………………………………………...………….158 BIBLIOGRAFÍA…….…………………………………………………........161 ANEXOS………….……………………………………………...………….167 4 ÍNDICE DE TABLAS Tabla No. 1 Número de consultas para anticoncepción en el CS de San Roque año 2014………………………………………………………………………………….15 Tabla No. 2 Número de consultas para anticoncepción en el Centro de Salud de San Roque año 2015……………………………………………………...………….…..15 Tabla: 3 Factores climáticos de la Parroquia de San Roque……………………..….18 Tabla No. 4: Población de la parroquia de San Roque según sexo…...………….….18 Tabla No.5: Proyección poblacional de la Parroquia de San Roque……….…….…19 Tabla No. 6: Tasas de crecimiento poblacional de la Parroquia de San Roque..…...19 Tabla No. 7: Población de la parroquia de San Roque según su autoidentificación étnica…………………………..……………………………………………………20 Tabla No. 8: Distribución de Barrios y Comunidades de la parroquia de San Roque………………………………………………………………………………..20 Tabla No. 9: Equipamiento del Centro de Salud de San Roque……..………..…….21 Tabla No. 10: Diferencias entre la Cosmovisión Andina y la Cosmovisión Occidental …………………………………………………………………………………….....25 Tabla No. 11: Cuadro comparativo entre los Paradigmas Médico Occidental y Andino……………………………………………………………………………….29 Tabla No. 12: Pautas de natalidad, según los modos de producción…………….….33 Tabla No. 13: Roles de género en la familia y la comunidad ……………………....39 Tabla No. 14: Eficacia de los métodos anticonceptivos según el índice de Pearl......46 5 Tabla No. 15: Tasa de embarazo (%) durante el primer año de uso de anticonceptivos……………………………………………………………………...48 Tabla No. 16: Clasificación de los criterios médicos de elegibilidad………….....…51 Tabla No. 17: Criterios de elección de los anticonceptivos hormonales combinados………………………………………………………………………….56 Tabla No. 18: Eficacia de los anticonceptivos hormonales con gestágenos…….…..59 Tabla No. 19 Efectos Secundarios De Los Métodos Anticonceptivos……….……..60 Tabla No. 20: Grupos Focales y entrevistas realizadas……………………….….....73 Tabla n° 21: Conocimientos, actitudes y prácticas culturales en anticoncepción en población kichwa Otavalo de San Roque ………………………...… 153 6 ÍNDICE DE FOTOGRAFÍAS Fotografía No. 1: Planta Brugmansia Arborea …….……………………………………84 Foto No. 2: Planta de Yerba madre…………………..….…………………………..93 Foto No. 3: Grupo Focal con Parteras y parteras…………………………..…….….94 Foto No. 4: Grupo focal con personal de salud de Atuntaqui….........……………..141 Foto No. 5: Socialización del trabajo de titulación con la comunidad Cerotal.……162 Foto. No. 6: Socialización de trabajo de titulación con comunidad de Jatun Rumy……………………………………………………………………………….162 Foto No. 7: Grupo focal con Hombres de la comunidad de Jatun Rumy………………………………………………………………………………163 Foto No. 8 Grupo focal con mujeres comunidad Jatun Rumy…………………… 163 Foto No. 9: Grupo focal con Adultos Mayores, Comunidad de Pucará……………………………………………………………………………...164 Foto No. 10: Entrevista con Partera de la Comunidad de Pucará ……………………………………………………………………………….……..164 Foto No. 11: Entrevista con mujeres de la comunidad de Pucará………………………………………………………………………………165 Foto No. 12: Entrevista con mujeres de la comunidad de Pucará Alto………………...................................................................................................165 Foto No. 13: Entrevista con miembros de una familia en la comunidad de La Esperanza………………………………………………………………………….166 7 RESUMEN En el Ecuador porcentaje de conocimiento de al menos un método anticonceptivo en las mujeres indígenas es del 87.3 % en comparación con las mujeres mestizas, blancas o de otra etnia con un 98.9%. En cuanto al uso de al menos un anticonceptivo son menores en las mujeres indígenas 65.8%. (Freire, Ramirez, Belmont, & Mendieta, 2015) El presente trabajo de investigación denominado “Principales conocimientos, actitudes y prácticas culturales que influyen en el uso de anticonceptivos en la población Kichwa Otavalo de la parroquia de San Roque, del cantón Antonio Ante de la provincia de Imbabura año 2016”, además de investigar el nivel de desarrollo de las competencias interculturales en anticoncepción, de los médicos y obstetrices de: Centro de Salud de San Roque y la consulta externa de Ginecología Hospital Básico Antonio Ante de la provincia de Imbabura. El diseño del estudio es de tipo cualitativo, con la población de autoidentificación étnica Kichwa Otavalo de las comunidades de Pucará, Jatun Rumy y La Esperanza; género, masculino y femenino, con edades comprendidas entre 20 a 85 años; se recopiló la información primaria, con el uso de entrevistas semiestructuradas, de manera individual así como también el trabajo con grupos focales con la población indicada además de parteras /ros comunitarios, personal médico de: Centro de Salud de San Roque y del Hospital Básico Antonio Ante, hasta obtener la saturación de la misma, procesando la información de forma manual. 8 Permitiendo reconocer que el Pueblo Kichwa Otavalo de la Parroquia de San Roque, posee conocimientos y prácticas ancestrales de anticoncepción, tales como el encaderamiento y la ingesta de infusión de semillas como el aguacate. Además de constatar la aceptación hacia los métodos anticonceptivos, el limitado conocimiento de los mismos, acompañado de una marcada presencia de mitos y temores, así como factores socioculturales que inciden en la aceptación o rechazo de los métodos. En cuanto a las competencias interculturales de los prestadores de servicios de salud se reflejó que ninguno de los profesionales tiene conocimientos del idioma Kichwa, además de revelar el limitado uso de los criterios de elegibilidad. 9 ABSTRACT In Ecuador, the percentage of Indigenous female knowledge of contraceptives methods was approximately 87.3%. However, the knowledge of contraceptives methods was approximately 98.9% in mixed blood, whites, and other ethnic groups. Approximately 65.8% of Indigenous women used less contraceptive methods than other ethnic groups (Freire, Ramirez, Belmont, & Mendieta, 2015). This investigative research is called “Important knowledge, cultural practices that influenced the use of contraceptive in the population Kichwa Otavalo, in the small town Parroquia of San Roque, town of Antonio Ante, province of Imbabura in 2016.” Furthermore, the research was about cultural competencies in contraception management of the medical providers and obstetrics from the Centro de Salud de San Roque and the Hospital Basico Antoni Ante of outpatient Gynecology, province of Imbabura. The qualitative research was developed with the ethnic group Kichwa Otavalo in the communities of Pucara, Jatun Rumy and La Esperanza. The populations represented were men and women between 20 to 85 years old. The researcher interviewed the population using standards interview formats. The interview was conducted
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