Abstract
BackgroundSub-Saharan African wetlands, settlement areas to growing populations, expose their users to diseases as necessary health infrastructure remains underdeveloped.MethodsMixed methods were adopted to assess the health-seeking behaviour of different exposure groups (farmers, pastoralists, service sector workers) in a Kenyan wetland community. Based on a cross-sectional survey (n = 400), syndromic surveillance was linked to health-seeking event analysis. In-depth interviews with community members (n = 20) and experts (n = 8) enabled the integration of healthcare user and provider perspectives.ResultsHealth-seeking behaviour in the wetland was determined by physical/infrastructural, natural/environmental, financial/socioeconomic and social/demographic factors, as well as human/cultural aspects such as traditional preferences rooted in health beliefs. Community members had different strategies of coping with ill-health and few symptoms remained untreated. Whether via a health care facility admission, the visit of a chemist, or the intake of pharmaceuticals or medicinal plants: treatment was usually applied either via a healthcare service provider or by the community members themselves.An undersupply of easy-to-reach healthcare options was detected, and healthcare services were not available and accessible to all. The widely-practiced self-treatment of symptoms, e.g. by use of local medicinal plants, mirrors both potential healthcare gaps and cultural preferences of wetland communities.ConclusionsIntegrated into an overall health-promoting wetland management approach, widely accepted (cultural) realities of health-seeking behaviours could complement health sector service provision and help ensure healthy lives and promote well-being for all in wetlands.
Highlights
Sub-Saharan African wetlands, settlement areas to growing populations, expose their users to diseases as necessary health infrastructure remains underdeveloped
Little research has been carried out to determine the level of healthcare utilization among wetland users [7], it can be assumed that such ecosystems per se are not well equipped and even ‘underserved’ when it comes to human health infrastructure and service provision
The inhabitants of the Ewaso Narok Swamp live in an environment with multiple prevalent diseases: Data from the largest health care facility in the area indicate that malaria, gastrointestinal diseases, typhoid fever and diarrhoeal diseases are currently the main drivers for
Summary
Sub-Saharan African wetlands, settlement areas to growing populations, expose their users to diseases as necessary health infrastructure remains underdeveloped. In arid and semiarid parts of the world, many people cope with water scarcity and food insecurity by settling near wetlands. Such ecosystems are being used extensively and increasingly especially in Sub-Saharan Africa (SSA) [1], with adverse implications on the users’ exposure to water-related infectious diseases [2,3,4]. Little research has been carried out to determine the level of healthcare utilization among wetland users [7], it can be assumed that such ecosystems per se are not well equipped and even ‘underserved’ when it comes to human health infrastructure and service provision. This paper contributes to the knowledge base on health-seeking behaviour in wetlands by adopting a syndromic surveillance approach of self-reported symptoms [6] and related health-seeking event analysis of four different exposure groups in the Kenyan Ewaso Narok Swamp
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