Abstract
Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities’ experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term “fever” referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients’ outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.
Highlights
The term “fever” has various definitions in different parts of the world
Illnesses and associated risk factors were perceived as having a medical or ethno etiological cause. This perception was influenced by the predominant culture or livelihood activity of the community. These illnesses were sometimes linked to specific etiological processes like viral or bacterial infections such as Anthrax, or more abstract metaphysical elements such as the influence of a Supreme Being, human agents of the supernatural or nature spirits such as malignant spirits of the wild, arising from a failure to appease these forces of nature during hunting expeditions as depicted by the observations shared by some of the informants (S2 Table)
The results from this study summarize communities’ understanding of fever and their emic conceptualizations of key pathways of febrile illness in western Uganda
Summary
“fever” is an elevation in body temperature that exceeds the normal average daily temperature ( 38.3 ̊C/101 ̊F) [1] It is the primary observable characteristic of several diseases of global importance such as malaria, neglected zoonotic infections, as well as many invasive bacterial and viral infections [2,3,4,5]. Most non-malarial febrile illnesses (NMFI) are misdiagnosed and treated as malaria despite the decline in malaria cases among febrile patients in Sub Saharan Africa. This leads to increased drug resistance and poor clinical outcomes [8,9]. The rise in these zoonotic diseases is driven by a host of factors including the increased interaction of humans and animals [15]
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