Abstract
BackgroundFebrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania.MethodsThirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions.ResultsStudy participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common.ConclusionThe results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.
Highlights
Febrile diseases in Sub-Saharan Africa cause acute and chronic illness
Determinants of actions taken during a suspected febrile illness episode within the socio-ecological model In this study, by using the socio-ecological model, various determinants were found to influence treatmentseeking behavior during self-reported febrile illness episodes as presented in Table 3 below
The findings of this study show that treatment-seeking behavior during a febrile illness episode is an iterative process influenced by various factors, as elaborated within the socio-ecological model
Summary
Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. Common symptoms that cut across several diseases include headache, general malaise, stomach pain and joint pain [3] Various diseases cause these symptoms in Africa, most often respiratory infections, urinary tract infections (UTIs), malaria, dengue fever, typhus, typhoid fever, brucellosis and leptospirosis to name but a few [4,5,6]. As a study in Tanzania found, there is a trend among health professionals to diagnose the cause of fever predominantly as malaria, urinary and upper respiratory tract infections, while leptospirosis, brucellosis and typhoid fever are rarely diagnosed This reduces the number of times appropriate treatment is given eroding trust in health care [3]
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