Abstract
BackgroundUniversal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced.MethodsQualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children.Findings and ConclusionThe phrase ‘kutentha thupi’, or ‘hot body’ was used to describe fever, the most frequently mentioned causes of which were malungo (translated as ‘malaria’), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1—Assessment; Phase 2—Seeking care outside the home; Phase 3—Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.
Highlights
Universal access to and community uptake of malaria prevention and treatment strategies is critical to achieving current international targets for malaria reduction such as Millennium Development Goal 6 and the Global Malaria Action Plan to target the long-term eradication of malaria [1,2]
Artemisinin-based combination therapies (ACT) are highly efficacious, and prompt case management with ACTs is essential to reduce the global burden of malaria
Focus Group Discussions (FGDs) and Critical Incident Interviews (CIIs) participants provided a range of interpretations of febrile illness, resulting in different treatment-seeking approaches
Summary
Universal access to and community uptake of malaria prevention and treatment strategies is critical to achieving current international targets for malaria reduction such as Millennium Development Goal 6 and the Global Malaria Action Plan to target the long-term eradication of malaria [1,2]. Studies have highlighted the importance of considering the step-by-step process of treatment-seeking in order to establish where opportunities for successful treatment are lost [8,9]. These studies often consider primary sources of care and sources of allopathic medicine only. As a result of such syncretism, it is important that up-to-date studies are conducted, to ensure that appropriate messages are getting through. This is especially true after the introduction of new treatments. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced
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