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Lopez AR, Brown CA. Knowledge, attitudes and practices regarding malaria prevention and control in communities in the Eastern Region, Ghana, 2020. PLoS One 2023; 18:e0290822. [PMID: 37647322 PMCID: PMC10468076 DOI: 10.1371/journal.pone.0290822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa countries including Ghana, the malaria burden remains unacceptably high and still a serious health challenge. Evaluating a community's level of knowledge, attitude, and practice (KAP) regarding malaria is essential to enabling appropriate preventive and control measures. This study aimed to evaluate knowledge of malaria, attitudes toward the disease, and adoption of control and prevention practices in some communities across the Eastern Region of Ghana. METHODS A cross‑sectional based study was carried out in 13 communities across 8 districts from January -June, 2020. Complete data on socio-demographic characteristics and KAP were obtained from 316 randomly selected household respondents by a structured pre-tested questionnaire. Associations between KAP scores and socio-demographic profiles were tested by Chi-square and binary logistic regression. Data analysis was done with SPSS version 26.0. RESULTS Most respondents (85.4%) had good knowledge score about malaria. Preferred choice of treatment seeking place (50.6%) was the health center/clinic. All respondents indicated they would seek treatment within 24 hours. Mosquito coils were the preferred choice (58.9%) against mosquito bites. Majority of households (58.5%) had no bed nets and bed net usage was poor (10.1%). Nearly half of the respondents (49.4%) had a positive attitude toward malaria and 40.5% showed good practices. Chi-square analysis showed significant associations for gender and attitude scores (p = 0.033), and educational status and practice scores (p = 0.023). Binary logistic regression analysis showed that 51-60 year-olds were less likely to have good knowledge (OR = 0.20, p = 0.04) than 15-20 year-olds. Respondents with complete basic schooling were less likely to have good knowledge (OR = 0.33, p = 0.04) than those with no formal schooling. A positive attitude was less likely in men (OR = 0.61, p = 0.04). Good malaria prevention practice was lower (OR = 0.30, p = 0.01) in participants with incomplete basic school education compared to those with no formal schooling. CONCLUSION Overall scores for respondents' knowledge, though good, was not reflected in attitudes and levels of practice regarding malaria control and prevention. Behavioral change communication, preferably on radio, should be aimed at attitudes and practice toward the disease.
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Affiliation(s)
| | - Charles Addoquaye Brown
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu, Accra, Ghana
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Maphane D, Ngwenya BN, Kolawole OD, Motsholapheko MR, Pagiwa V. Community Knowledge, Perceptions and Experiences on Healthcare Services for Malaria Prevention and Treatment in the Okavango Delta, Botswana. J Community Health 2022; 48:325-337. [PMID: 36436166 DOI: 10.1007/s10900-022-01172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/28/2022]
Abstract
This paper analyses community knowledge, perceptions, and experiences of effectiveness of healthcare service provision on malaria prevention/treatment in two disease-endemic villages of the Okavango Delta panhandle in northern Botswana. A stratified random sampling of 355 households was conducted in October-November 2015. Follow-up retrospective cohort interviews were undertaken in August 2016 from 79 households that reported malaria incidences during the household survey. Data were also collected from 16 key informant interviews and 2 focus group discussions participants. Descriptive statistics and content analyses were used to summarise quantitative and qualitative data, respectively. Results indicate that communities in the study sites had positive perceptions about efficiency of health services based on availability, accessibility and utilization, adequacy of prevention and treatment interventions. Local health clinics were crucial information channels used by respondents. Additionally, factors related to acceptability, availability and accessibility are likely to contribute to perceived effectiveness of the interventions provided by healthcare service providers. Affirmation of efficiency health service provision against malaria has public health implications for adherence to treatment/prevention and participation in community health education campaigns and program implementation in the Okavango Delta region.
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Affiliation(s)
- Dirontsho Maphane
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | - Barbara N Ngwenya
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | - Oluwatoyin D Kolawole
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | | | - Vincent Pagiwa
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana.
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Dubost JM, Kongchack P, Deharo E, Sysay P, Her C, Vichith L, Sébastien D, Krief S. Zootherapeutic uses of animals excreta: the case of elephant dung and urine use in Sayaboury province, Laos. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2021; 17:62. [PMID: 34711254 PMCID: PMC8552211 DOI: 10.1186/s13002-021-00484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite a widespread aversion towards faeces and urine, animal excreta are used in traditional medicine in many countries since centuries, but records are scattered and few therapeutic uses have been accurately documented while in the current context of emerging zoonoses such records may be of major interest. METHODOLOGY In this study, we investigated the therapeutic uses that mahouts in Xayaboury province, Lao PDR make of elephant urine and faeces as well as of the brood chamber that beetles (Heliocopris dominus) fashion from elephant dung. Semi-structured interviews were conducted with mahouts on elephant diet, health problems and responses to disease, andwhether they use elephant products. Data were supplemented by interviews with traditional healers. RESULTS Seven respondents reported the use of elephant urine in ethnoveterinary care for elephants and in human medicine in case of diabetes and otitis. 25 respondents reported therapeutic use of elephant faeces (EF) and elephant dung beetle brood chambers. The major indications are gastrointestinal and skin problems. Macerations or decoctions are drunk or used externally as a lotion. The mahouts attribute the therapeutic effectiveness of EFs to their content which includes the remains of many species from the elephant diet which they consider to be medicinal. DISCUSSION The indications of these uses are consistent with pharmacological and clinical studies highlighting the properties of different animals' urine and faeces and their curative potential tested in vivo. The acknowledgement by the mahouts of medicinal properties of elephant faecal bolus contrasts with the rare justifications of animal material use recorded in zootherapeutic studies, which falls within the symbolic domain. However, numerous studies highlight the preponderant role of the microbiota in physiological processes, raising the hypothesis of a curative action of EF, by rebalancing the user's microbiota. CONCLUSION The therapeutic uses of EF preparations despite their possible curative properties are a potential source of zoonotic transmission from elephants to humans. In the current context of globalisation of trade which favours the emergence of zoonoses and in relation with the issue of One Health, it becomes crucial to further document the zootherapeutic practices to prevent emerging diseases. As elephants and local related ethnoethological knowledge are threatened, documenting them is urgent to contribute to their preservation.
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Affiliation(s)
- Jean-Marc Dubost
- Museum National d'Histoire Naturelle-UMR 7206, Paris, France.
- UMR 152 Pharmadev, IRD, UPS, 35 chemin des maraîchers, Université Paul Sabatier, 31062, Toulouse, France.
| | | | - Eric Deharo
- UMR 152 Pharmadev, IRD, UPS, 35 chemin des maraîchers, Université Paul Sabatier, 31062, Toulouse, France
| | - Palamy Sysay
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao PDR
| | - Chithdavone Her
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao PDR
| | - Lamxay Vichith
- Department of Botany, Faculty of Natural Sciences, National University of Laos, Vientiane, Lao PDR
| | - Duffillot Sébastien
- Elephant Conservation Center, Nam Tien Reservoir, Xayabury District, Lao PDR
| | - Sabrina Krief
- Museum National d'Histoire Naturelle-UMR 7206, Paris, France
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Charlwood JD, Tomás EVE, Enosse S, Saija SP, Sahlholdt J, Filemon L, Kampango A. Utilization of a local 'Malaria Post' indicates that carers from a village in Mozambique respond appropriately to malaria attacks. Acta Trop 2021; 221:106017. [PMID: 34174198 DOI: 10.1016/j.actatropica.2021.106017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
As malaria elimination becomes a possibility the focus of interventions changes from vector control to disease control. It is important that treatment occurs early during an infection in order for it to be efficacious, especially at the population level. The time between the onset of symptoms and treatment seeking is, therefore, crucial. Following a census and an oral autopsy survey of the inhabitants of Furvela, a village in southern Mozambique, a malaria post (MP) where malaria was diagnosed and treated was established in 2001. The time between the onset of symptoms and attendance at the MP was determined and compared to the severity of disease. A cross-sectional survey was also conducted, in 2007, to determine prevalence amongst 235 children aged between 6 months and 15 years of age. Malaria was hyperendemic in the village and was responsible for most deaths reported from the two years prior to the start of the project. In the prevalence survey 74% of two-to-four-year-old children had malaria parasites. The likelihood of being parasite positive was significantly higher in children living in houses with roofs made of traditional materials compared to those living in houses with tin roofs. At the start of the project only 12% of residents owned or used a mosquito net, most of which were not treated with insecticide. However, even before any formal intervention, malaria declined in the village between 2001 and 2007, but there was a rebound in later years. Nevertheless, the relative proportion of patients who had to be referred to the hospital declined significantly in the latter years of the project, and the incidence of both Plasmodium ovale and P. malariae also decreased significantly. Overall 16698 patients, the majority of which were under one year of age, attended the MP between 2001 and 2010. The proportion of patients with a positive slide for P. falciparum remained relatively constant throughout the study (mean 0.66 std. dev. 0.3) Most of the patients came from the village of Furvela, or its environs, but some came from the nearby town, ostensibly because of the good treatment they received. Infection rates increased up to the first three years of life to a peak incidence of 92% at 31 months. Children with fever had higher parasite densities than those without fever. Mothers generally bought their children to the MP on the second day of symptoms but on the first day if they had fever. Older patients, with lower density infections, delayed in coming for treatment. These patients may harbour sub-microscopic gametocytes which would help maintain transmission in the village. Mothers acted appropriately in their treatment seeking behaviour. The establishment of village-based MPs are an effective way of providing adequate diagnosis and treatment in villages such as Furvela.
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Affiliation(s)
- Jacques D Charlwood
- DBL Centre for Health Research and Development, Department for Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Denmark; Mozambican-Danish Rural Malaria Initiative (MOZDAN), Morrumbene, Inhambane Province, Mozambique; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Lisbon, Portugal.
| | - Erzelia V E Tomás
- Mozambican-Danish Rural Malaria Initiative (MOZDAN), Morrumbene, Inhambane Province, Mozambique
| | | | - Sara P Saija
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Lourenço Filemon
- Mozambican-Danish Rural Malaria Initiative (MOZDAN), Morrumbene, Inhambane Province, Mozambique
| | - Ayubo Kampango
- Mozambican-Danish Rural Malaria Initiative (MOZDAN), Morrumbene, Inhambane Province, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique; Department of Zoology and Entomology, University of Pretoria, Pretoria, South Africa
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Svege S, Nkosi-Gondwe T, Lange S. "Satanism is witchcraft's younger sibling": Changing perceptions of natural and supernatural anaemia causality in Malawian children. PLoS One 2021; 16:e0250661. [PMID: 33930023 PMCID: PMC8087048 DOI: 10.1371/journal.pone.0250661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
In countries of sub-Saharan Africa, many children are admitted to hospital with severe forms of anaemia. The late hospital admissions of anaemic children contribute significantly to child morbidity and mortality in these countries. This qualitative study explores local health beliefs and traditional treatment practices that may hinder timely seeking of hospital care for anaemic children. In January of 2019, nine focus group discussions were conducted with 90 participants in rural communities of Malawi. The participants represented four groups of caregivers; mothers, fathers, grandmothers and grandfathers of children under the age of five. The Malawian medical landscape is comprised of formal and informal therapeutic alternatives–and this myriad of modalities is likely to complicate the healthcare choices of caregivers. When dealing with child illness, many participants reported how they would follow a step-by-step, ‘multi-try’ therapeutic pathway where a combination of biomedical and traditional treatment options were sought at varying time points depending on the perceived cause and severity of symptoms. The participants linked anaemia to naturalistic (malaria, poor nutrition and the local illnesses kakozi and kapamba), societal (the local illness msempho) and supernatural or personalistic (witchcraft and Satanism) causes. Most participants agreed that anaemia due to malaria and poor nutrition should be treated at hospital. As for local illnesses, many grandparents suggested herbal treatment offered by traditional healers, while the majority of parents would opt for hospital care. However, participants across all age groups claimed that anaemia caused by witchcraft and Satanism could only be dealt with by traditional healers or prayer, respectively. The multiple theories of anaemia causality combined with extensive use of and trust in traditional and complementary medicine may explain the frequent delay in admittance of anaemic children to hospital.
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Affiliation(s)
- Sarah Svege
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Thandile Nkosi-Gondwe
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Siri Lange
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
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Lewis EG, Whitton LA, Collin H, Urasa S, Howorth K, Walker RW, Dotchin C, Mulligan L, Shah B, Mohamed A, Mdegella D, Mkodo J, Zerd F, Gray WK. A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen. Aging Clin Exp Res 2020; 32:1959-1967. [PMID: 31811571 DOI: 10.1007/s40520-019-01406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. AIM To validate and further refine a frailty screening tool for SSA. METHODS Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our 'gold standard' diagnosis. RESULTS Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. DISCUSSION The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. CONCLUSIONS The B-FIT 2 should be externally validated.
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Affiliation(s)
- Emma Grace Lewis
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise A Whitton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Collin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kate Howorth
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Louise Mulligan
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bhavini Shah
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Ali Mohamed
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Joyce Mkodo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Zerd
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
- Department of Research and Development, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
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Hercik C, Cosmas L, Mogeni OD, Kohi W, Mfinanga S, Loffredo C, Montgomery JM. Health Beliefs and Patient Perspectives of Febrile Illness in Kilombero, Tanzania. Am J Trop Med Hyg 2020; 101:263-270. [PMID: 31115309 DOI: 10.4269/ajtmh.17-0862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This qualitative study assessed the knowledge and beliefs surrounding fever syndrome among adult febrile patients seeking health care in Kilombero, Tanzania. From June 11 to July 13, 2014, 10% of all adult (≥ 15 years) febrile patients enrolled in the larger syndromic study, who presented with an axillary temperature ≥ 37.5°C and symptom onset ≤ 5 days prior, were randomly selected to participate in an in-depth physician-patient interview, informed by Health Belief Model constructs. Interviews were audio recorded, translated, and transcribed. Transcripts were coded using NVivo Version 11.1, and the thematic content was analyzed by two separate researchers. Blood and nasopharyngeal/oralpharyngeal specimens were collected and analyzed using both acute febrile illness and respiratory TaqMan Array Cards for multipathogen detection of 56 potential causative agents. A total of 18 participants provided 188 discrete comments. When asked to speculate the causative agent of febrile illness, 33.3% cited malaria and the other 66.6% offered nonbiomedical responses, such as "mosquitoes" and "weather." Major themes emerging related to severity and susceptibility to health hazards included lack of bed net use, misconceptions about bed nets, and mosquito infestation. Certain barriers to treatment were cited, including dependence on traditional healers, high cost of drugs, and poor dispensary services. Overall, we demonstrate low concurrence in speculations of fever etiology according to patients, clinicians, and laboratory testing. Our findings contribute to the important, yet limited, base of knowledge surrounding patient risk perceptions of febrile illness and underscore the potential utility of community-based participatory research to inform disease control programs.
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Affiliation(s)
| | - Leonard Cosmas
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wanze Kohi
- Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Sayoki Mfinanga
- Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.,Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Christopher Loffredo
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya
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Nelson EUE, Uko IJ. Ethnomedical Beliefs and Utilization of Alcohol Herbal Remedy for Malaria in South-Coastal Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:119-126. [PMID: 30799761 DOI: 10.1177/0272684x18819978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied ethnomedical beliefs and utilization of alcohol herbal remedy for malaria in Uyo, south-coastal Nigeria. In-depth interviews were conducted with 213 respondents aged between 25 to 65 years, who were recruited through venue-based sampling. Malaria is recognized by its symptomatic presentations, which is reflected in different local names for the disease. Local etiological beliefs attribute malaria to mosquito bites, exposure to sunlight, fatigue, witchcraft, and excessive consumption of palm oil. There is a disease-specific preference for alcohol herbal remedies because they are accessible, affordable, and responsive to sociocultural realities. The therapy veils excessive consumption of alcohol with associated risks. Lack of quality control in production and dosage for the administration of these herbal remedies also put users at risk. Local beliefs should be integrated into malaria control programs to enhance community acceptance and participation. Herbal remedies should be subjected to regulation to ensure quality and minimize harms. Community health education should be mounted to improve knowledge of malarial transmission and promote utilization of appropriate health-care services.
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Affiliation(s)
| | - Ifureuwem J Uko
- 2 Department of Physical and Health Education, University of Uyo, Nigeria
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Awuah RB, Asante PY, Sakyi L, Biney AAE, Kushitor MK, Agyei F, de-Graft Aikins A. Factors associated with treatment-seeking for malaria in urban poor communities in Accra, Ghana. Malar J 2018; 17:168. [PMID: 29661191 PMCID: PMC5902882 DOI: 10.1186/s12936-018-2311-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/05/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Ghana, about 3.5 million cases of malaria are recorded each year. Urban poor residents particularly have a higher risk of malaria mainly due to poor housing, low socio-economic status and poor sanitation. Alternative treatment for malaria (mainly African traditional/herbal and/or self-medication) is further compounding efforts to control the incidence of malaria in urban poor communities. This study assesses factors associated with seeking alternative treatment as the first response to malaria, relative to orthodox treatment in three urban poor communities in Accra, Ghana. METHODS This cross-sectional study was conducted in three urban poor localities in Accra, Ghana among individuals in their reproductive ages (15-59 years for men and 15-49 years for women). The analytic sample for the study was 707. A multinomial regression model was used to assess individual, interpersonal and structural level factors associated with treatment-seeking for malaria. RESULTS Overall, 31% of the respondents sought orthodox treatment, 8% sought traditional/herbal treatment and 61% self-medicated as the first response to malaria. At the bivariate level, more males than females used traditional/herbal treatment and self-medicated for malaria. The results of the regression analysis showed that current health insurance status, perceived relative economic standing, level of social support, and locality of residence were associated with seeking alternative treatment for malaria relative to orthodox treatment. CONCLUSIONS The findings show that many urban poor residents in Accra self-medicate as the first response to malaria. Additionally, individuals who were not enrolled in a health insurance scheme, those who perceived they had a low economic standing, those with a high level of social support, and locality of residence were significantly associated with the use of alternative treatment for malaria. Multi-level strategies should be employed to address the use of alternative forms of treatment for malaria within the context of urban poverty.
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Affiliation(s)
| | | | - Lionel Sakyi
- Centre for Migration Studies, University of Ghana, Accra, Ghana
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Francis Agyei
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
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Attu H, Adjei JK. Local knowledge and practices towards malaria in an irrigated farming community in Ghana. Malar J 2018; 17:150. [PMID: 29615059 PMCID: PMC5883262 DOI: 10.1186/s12936-018-2291-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background Although malaria is endemic across Ghana, the risk is generally elevated for residents living in and around stagnant water bodies such as dams and irrigated farming projects. What knowledge do these at-risk populations have about the aetiology and symptoms of malaria? What are their coping strategies? And what interventions are needed to help improve the health outcomes of people living in high-risk malaria communities? Methods This study addressed these research questions with primary data, comprising both qualitative interviews and quantitative surveys, collected in Asutsuare—a rural irrigated farming community located in the Greater Accra Region of Ghana. Results Results from the fieldwork showed that awareness of malaria as a major health concern in the community was universal. Respondents also displayed a high knowledge of some common clinical symptoms of malaria. Yet, only 3% out of the total survey respondents of 337 indicated they immediately visit a health facility for treatment whenever they suspected malaria. The overwhelming majority (about 97%) indicated they only visit a healthcare facility for treatment if they felt the suspected malaria illness was severe and/or other treatment options had failed. Conclusion Malaria testing training for drug dispensing personnel as well as the provision of malaria testing kits in drug dispensing stores are necessary to facilitate early malaria screening and timely diagnosis particularly in rural endemic areas.
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Affiliation(s)
- Hector Attu
- Department of Geography & Resource Development, University of Ghana, Accra, Ghana.
| | - Jones K Adjei
- Department of Humanities & Social Sciences, Red Deer College, Red Deer, AB, Canada
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Amenu K, Szonyi B, Grace D, Wieland B. Important knowledge gaps among pastoralists on causes and treatment of udder health problems in livestock in southern Ethiopia: results of qualitative investigation. BMC Vet Res 2017; 13:303. [PMID: 29058605 PMCID: PMC5651631 DOI: 10.1186/s12917-017-1222-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/10/2017] [Indexed: 11/12/2022] Open
Abstract
Background Ethiopia has high prevalences of udder health problems including clinical and subclinical mastitis across production systems in different livestock species. Previous studies on udder health problems have largely focused on identification of mastitis causing microbial pathogens and associated risk factors. However, relatively little is known about the knowledge and beliefs of livestock keepers regarding udder health problems. An understanding of the beliefs on the other hand would facilitate effective communication between livestock keepers and animal health professionals. Therefore, this study aimed at exploring the knowledge and belief surrounding the causes, clinical signs and treatments for udder health problems in (agro-) pastoral communities in southern Ethiopia using qualitative investigation. Results The result showed that udder health problem, locally known as ‘dhukkuba muchaa’, which translates to ‘disease of teats’, was classified into three main types: (1) tick infestation (dirandisa), (2) swelling of udder often with pus discharge (nyaqarsa) and (3) acute mastitis caused by evil eye (buda) with ‘bloody milk’. Tick infestation was perceived to directly cause mechanical damage to udder tissue or to resulting in swelling leading to nyaqarsa. Our analysis also revealed the strong misperception that acute and severe swelling of udder was caused by evil eye. According to the pastoralists, cows with large udders in the late pregnancy are prone to evil eye infliction upon giving birth. The pastoralists often treat udder health problems by combining both modern and traditional methods. Removal of ticks by hand and acarcide application were the preferred methods for limiting tick infestation while swelling and evil eye cases were treated with antibiotics (e.g. oxytetracycline). The study also revealed that specific herbs, only known by the herbalists, were used for traditional treatment of udder health. Although this information could not be divulged at the time, it should form the subject of further investigation. Traditional treatment for evil eye was often administered through nostrils, raising questions about its effectiveness. Conclusion The narration given by the pastoralists in associating tick infestation with udder health problems was compatible with existing scientific evidences. In this respect, such local knowledge can be better utilized for the educational messages targeting control and management of tick infestation in livestock. However, the misperception of causes for acute udder swelling as evil eye can be problematic as far as the application of appropriate treatment and management of the problem is concerned. The misperception can significantly impact the welfare of animals and highlights the need for capacity building of the pastoralists on the causes and treatment of udder health problems.
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Affiliation(s)
- Kebede Amenu
- School of Veterinary Medicine, Hawassa University, P.O. Box 5, Hawassa, Ethiopia. .,International Livestock Research Institute, P. O. Box 5689, Addis Ababa, Ethiopia. .,Present address: Department of Microbiology, Immunology and Veterinary Public Health, College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O.Box 34, Bishoftu, Ethiopia.
| | - Barbara Szonyi
- International Livestock Research Institute, P. O. Box 5689, Addis Ababa, Ethiopia
| | - Delia Grace
- International Livestock Research Institute, P. O. Box 30709, Nairobi, Kenya
| | - Barbara Wieland
- International Livestock Research Institute, P. O. Box 5689, Addis Ababa, Ethiopia
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Muro F, Meta J, Renju J, Mushi A, Mbakilwa H, Olomi R, Reyburn H, Hildenwall H. "It is good to take her early to the doctor" - mothers' understanding of childhood pneumonia symptoms and health care seeking in Kilimanjaro region, Tanzania. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:27. [PMID: 28938895 PMCID: PMC5610440 DOI: 10.1186/s12914-017-0135-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/17/2017] [Indexed: 11/24/2022]
Abstract
Background Pneumonia is among the leading causes of avoidable deaths for young children globally. The main burden of mortality falls on children from poor and rural families who are less likely to obtain the treatment they need, highlighting inequities in access to effective care and treatment. Caretakers’ illness perceptions and care-seeking practices are of major importance for children with pneumonia to receive adequate care. This study qualitatively explores the caretaker concepts of childhood pneumonia in relation to treatment seeking behaviour and health worker management in Moshi urban district, Tanzania. Methods In May - July 2013 data was gathered through different qualitative data collection techniques including five focus group discussions (FGDs) with mothers of children under-five years of age. The FGDs involved free listing of pneumonia symptoms and video presentations of children with respiratory symptoms done, these were triangulated with ten case narratives with mothers of children admitted with pneumonia and eleven in-depth interviews with hospital health workers. Transcripts were coded and analysed using qualitative content analysis. Results Mothers demonstrated good awareness of common childhood illnesses including pneumonia, which was often associated with symptoms such as cough, flu, chest tightness, fever, and difficulty in breathing. Mothers had mixed views on causative factors and treatments options but generally preferred modern medicine for persisting and severe symptoms. However, all respondent reported access to health facilities as a barrier to care, associated with transport, personal safety and economic constraints. Conclusion Local illness concepts and traditional treatment options did not constitute barriers to care for pneumonia symptoms. Poor access to health facilities was the main barrier. Decentralisation of care through community health workers may improve access to care but needs to be combined with strengthened referral systems and accessible hospital care for those in need.
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Affiliation(s)
- Florida Muro
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania. .,Kilimanjaro Christian Medical Centre, P.O.Box 3010, Moshi, Tanzania.
| | - Judith Meta
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania
| | - Jenny Renju
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.,London School of Hygiene and Tropical Medicine (LSHTM), Keppel St, London, WICE7HT, UK
| | - Adiel Mushi
- The National Institute for Medical Research (NIMR), 3 Barack Obama Drive, P. O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Hilda Mbakilwa
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania
| | - Raimos Olomi
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, P.O.Box 3010, Moshi, Tanzania
| | - Hugh Reyburn
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania.,London School of Hygiene and Tropical Medicine (LSHTM), Keppel St, London, WICE7HT, UK
| | - Helena Hildenwall
- Department of Public Health Sciences, Global Health - Health System and Policy Research Group, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Pierce H, Gibby AL, Forste R. Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa. POPULATION RESEARCH AND POLICY REVIEW 2016; 35:581-597. [PMID: 28794575 PMCID: PMC5546145 DOI: 10.1007/s11113-016-9396-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.
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Affiliation(s)
- Hayley Pierce
- Department of Demography and Sociology, 2232 Piedmont Ave, University of California, Berkeley, Berkeley, CA 94720,
| | - Ashley Larsen Gibby
- Department of Sociology, 512 Oswald Tower, Penn State University, State College, Pennsylvania, 16801,
| | - Renata Forste
- Department of Sociology, 2025 JFSB, Brigham Young University, Provo, Utah 84602, Office phone: 801-422-3146, ,
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Hamooya BM, Chongwe G, Dambe R, Halwiindi H. Treatment-seeking behaviour for childhood fever among caretakers of Chivuna and Magoye rural communities of Mazabuka District, Zambia: a longitudinal study. BMC Public Health 2016; 16:762. [PMID: 27514688 PMCID: PMC4982399 DOI: 10.1186/s12889-016-3460-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/05/2016] [Indexed: 11/27/2022] Open
Abstract
Background Treatment-seeking for childhood fever among caretakers in most rural parts of African region is still a major challenge. The aim of this study was to determine the treatment seeking behaviour for fever in under-5 children of Magoye and Chivuna rural areas of Mazabuka district in Zambia. Methods Treatment-seeking behaviour was explored longitudinally among caretakers of 362 children aged 12–59 months with fever. The data was collected from caretakers using a structured interviewer-administered questionnaire at their homes. Chi-square test, one-sample test of proportions and logistic regression were the statistical methods used for data analysis. Results Of the 362 children with fever, 77 % of them had their treatment sought externally. In which 64 % had their treatment at health facility (HF), 18 % from community health workers (CHW), and 18 % from other sources. Early treatment (≤ 24 h) was sought for 42 % of the fever episodes. In dry season, a child had 1.53 times more likely to have early treatment compared to rainy season [OR 1.53; 95 % CI 1.30, 1.80; p < 0.001]. A child in Chivuna was less likely to have early treatment compared to one in Magoye [OR 0.62; 95 % CI 0.50, 0.76; p < 0.001]. Caretakers had a reduced chance of 27 % [OR 0.73; 95 % CI 0.56, 0.95; p = 0.022] of seeking early treatment if they took a child to other sources compared to a HF. Conclusion This study has revealed that seeking early and appropriate treatment was suboptimal in the study areas. Source of treatment, season and location were predictors of early treatment of fever among caretakers. Policies aimed at combating poor care-seeking behaviour should not omit to address these factors.
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Affiliation(s)
- Benson M Hamooya
- Ministry of Health, P.O Box 30205, Lusaka, Zambia. .,School of Medicine, Department of Public Health, The University of Zambia, P.O. Box 50110, Lusaka, Zambia.
| | - Gershom Chongwe
- School of Medicine, Department of Public Health, The University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Rosalia Dambe
- School of Medicine, Department of Public Health, The University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Hikabasa Halwiindi
- School of Medicine, Department of Public Health, The University of Zambia, P.O. Box 50110, Lusaka, Zambia
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Eugene-Ezebilo DN, Ezebilo EE. Home-based malaria management in children by women: Evidence from a malaria endemic community in sub-Saharan Africa. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abbey M, Bartholomew LK, Pappoe M, van den Borne B. Treating fever in children under 5 years of age: caregiver perceptions of community health worker services in Dangme West district, Ghana. Int Health 2015; 7:455-63. [PMID: 25925051 DOI: 10.1093/inthealth/ihv027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/20/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Integrated community case management of childhood illnesses is a key strategy to help reduce mortality in children under 5 years; particularly those with difficult access to treatment. However, the success of such strategies depends on community utilization of services. This study assessed community utilization, perceptions and related factors of community health worker services. METHODS Data were gathered from a cross-sectional survey among 562 caregivers and focus group discussions among 84 caregivers. Factors related to utilization of community health workers (CHWs) for management of childhood fevers were analyzed using logistic regression and focus group discussions to explore caregiver perceptions of CHW activities. RESULTS Utilization of CHWs for management of fever in under-5s was 59.4%. Caregivers who were exposed to the communication intervention were about four times more likely to use the services of the CHWs compared to those who were not exposed (OR 3.79; 95% CI: 2.62-5.49; p<0.001). Farmers were 84% more likely to use CHW services for children sick with fever compared to those who were unemployed (OR 1.84; 95% CI: 1.00-3.39; p=0.05). Caregiver perceptions of the program were generally positive; most caregivers expressed satisfaction with the CHW services, citing prompt treatment, friendliness and free medicines. Male involvement in the CHW program was comparatively low. CONCLUSIONS Dissemination of information among priority groups can enhance utilization of CHW services. Exploring the perspective of both men and women to gain in-depth understanding on their views on male involvement will be useful for planning appropriate strategies to get more males involved in community-based child health programs.
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Affiliation(s)
- Mercy Abbey
- Research and Development Division, Ghana Health Service, PM Bag 190 Accra, Ghana
| | - L Kay Bartholomew
- School of Public Health, University of Texas Health Science Centre, 1200 Herman Pressler, Suite W238 Houston, Texas 77030, USA
| | - Matilda Pappoe
- School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13 Legon, Accra, Ghana
| | - Bart van den Borne
- Department of Health Promotion, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Metta E, Bailey A, Kessy F, Geubbels E, Hutter I, Haisma H. "In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry. BMC Public Health 2015; 15:224. [PMID: 25886626 PMCID: PMC4358854 DOI: 10.1186/s12889-015-1504-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1504-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. .,Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Ajay Bailey
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Flora Kessy
- Mzumbe University, Box 20226, Dar es Salaam, Tanzania.
| | | | - Inge Hutter
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
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Adebayo AM, Akinyemi OO, Cadmus EO. Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria. PeerJ 2015; 3:e792. [PMID: 25755925 PMCID: PMC4349050 DOI: 10.7717/peerj.792] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/04/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women and under-five children, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Insecticide Treated Nets (ITN) by community members. Therefore, this study assessed the knowledge of malaria prevention among caregivers of under-five children and pregnant women in a rural community in Southwest Nigeria. Methodology. This is part of a larger malaria prevention study in rural Southwest Nigeria. A descriptive cross-sectional survey was conducted among pregnant women and caregivers of under-five children in Igbo-Ora, a rural town in Southwest Nigeria using a semi-structured, interviewer-administered questionnaire. Information was obtained on knowledge of malaria prevention, and overall composite scores were computed for knowledge of malaria prevention and ITN use. Data were analyzed using SPSS version 16. Associations between variables were tested using a Chi-square with the level of statistical significance set at 5%. Results. Of the 631 respondents, 84.9% were caregivers of under-five children and 67.7% were married. Mean age was 27.7 ± 6.3 years with 53.4% aged between 20 and 29 years. Majority (91.1%) had at least primary school education and 60.2% were traders. Overall, 57.7% had poor knowledge of malaria prevention. A good proportion (83.5%) were aware of the use of ITN for malaria prevention while 30.6% had poor knowledge of its use. Respondents who were younger (<30 years), had at least primary education and earn <10,000/per month had significantly poor knowledge of ITN use in malaria prevention. Majority (60.0%) respondents had poor attitude regarding use of ITNs. Conclusion. This study showed that the knowledge of malaria prevention is still low among under-five caregivers and pregnant women in rural Southwest Nigeria despite current control measures. There is a need for concerted health education intervention to improve the knowledge of rural dwellers regarding malaria prevention, including the use of ITN. This will go a long way to improving the reported low level of ownership and utilization of ITN in the rural areas.
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Affiliation(s)
- Ayodeji M Adebayo
- Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan , Ibadan , Nigeria
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan , Ibadan , Nigeria
| | - Eniola O Cadmus
- Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan , Ibadan , Nigeria
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Krawczyk A, Perez S, King L, Vivion M, Dubé E, Rosberger Z. Parents' decision-making about the human papillomavirus vaccine for their daughters: II. Qualitative results. Hum Vaccin Immunother 2015; 11:330-6. [PMID: 25692507 PMCID: PMC4514412 DOI: 10.4161/21645515.2014.980708] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/08/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
The goal of the study was to examine the reasons given by parents who accepted or refused the HPV vaccine for their daughters in the context of a free provincial school-based vaccination program. A random sample of parents of 9-10 y old girls completed a mail-in questionnaire. Parents' responses to 2 open-ended questions were assessed using content analysis. Coding themes were derived from the Health Belief Model. 806 parents returned and answered the relevant items. 88% of these parents decided to vaccinate their daughter. The primary reasons for parents' acceptance was the perceived benefits (e.g., health protection, cancer/HPV prevention) and cues to action (e.g., physician recommendation, trusting the school vaccine program). Reasons for parental refusal included barriers (e.g., fear of side effects) and low susceptibility (e.g., their daughter is not at risk). Both groups of parents had unanswered questions, doubts and often inaccurate information. This study provides unique insight into parents' perspectives concerning the decision making process for their daughter. There appears to be a need for accurate and complete information to assure informed HPV vaccine decision-making by parents and to increase HPV vaccine uptake.
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Affiliation(s)
- Andrea Krawczyk
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
| | - Samara Perez
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
| | - Leonora King
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
- Department of Psychiatry; McGill University; Montreal, QC, Canada
| | - Maryline Vivion
- Institut national de santé publique du Québec; Québec City, QC, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec; Québec City, QC, Canada
| | - Zeev Rosberger
- Department of Psychology; McGill University; Montreal, QC, Canada
- Lady Davis Institute for Medical Research; Jewish General Hospital; Montreal, QC, Canada
- Department of Psychiatry; McGill University; Montreal, QC, Canada
- Louise Granofsky Psychosocial Oncology Program; Segal Cancer Center; Jewish General Hospital; Montreal, QC, Canada
- Department of Oncology; McGill University; Montreal, QC, Canada
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Kassile T, Lokina R, Mujinja P, Mmbando BP. Determinants of delay in care seeking among children under five with fever in Dodoma region, central Tanzania: a cross-sectional study. Malar J 2014; 13:348. [PMID: 25182432 PMCID: PMC4159519 DOI: 10.1186/1475-2875-13-348] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early diagnosis and timely treatment of malaria is recognized as a fundamental element to the control of the disease. Although access to health services in Tanzania is improved, still many people seek medical care when it is too late or not at all. This study aimed to determine factors associated with delay in seeking treatment for fever among children under five in Tanzania. METHODS A three-stage cluster sampling design was used to sample households with children under five in Dodoma region, central Tanzania between October 2010 and January 2011. Information on illness and health-seeking behaviours in the previous four weeks was collected using a structured questionnaire. A multivariable logistic regression was used to investigate determinants of delay in treatment-seeking behaviour while accounting for sample design. RESULTS A total of 287 under-five children with fever whose caretakers sought medical care were involved in the study. Of these, 55.4% were taken for medical care after 24 hours of onset of fever. The median time of delay in fever care seeking was two days. Children who lived with both biological parents were less likely to be delayed for medical care compared to those with either one or both of their biological parents absent from home (OR = 0.42, 95% CI: 0.24, 0.74). Children from households with two to three under-five children were more likely to be delayed for medical care compared to children from households with only one child (OR = 1.54, 95% CI: 1.04, 2.26). Also, children living in a distance ≥5 kilometres from the nearest health facility were about twice (95% CI: 1.11, 2.72) as likely to delay to be taken for medical care than those in the shorter distances. CONCLUSION Living with non-biological parents, high number of under-fives in household, and long distance to the nearest health facility were important factors for delay in seeking healthcare. Programmes to improve education on equity in social services, family planning, and access to health facilities are required for better healthcare and development of children.
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Affiliation(s)
- Telemu Kassile
- />Faculty of Science, Sokoine University of Agriculture, PO Box 3038, Morogoro, Tanzania
| | - Razack Lokina
- />College of Social Sciences, University of Dar es Salaam, PO Box 35045, Dar es Salaam, Tanzania
| | - Phares Mujinja
- />School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Bruno P Mmbando
- />Tanga Research Centre, National Institute for Medical Research, PO Box 5004, Tanga, Tanzania
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Metta E, Haisma H, Kessy F, Hutter I, Bailey A. "We have become doctors for ourselves": motives for malaria self-care among adults in southeastern Tanzania. Malar J 2014; 13:249. [PMID: 24986165 PMCID: PMC4085372 DOI: 10.1186/1475-2875-13-249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompt and appropriate treatment of malaria with effective medicines remains necessary if malaria control goals are to be achieved. The theoretical concepts from self-care and the health belief model were used to examine the motivations for malaria self-care among the adult population. METHODS A qualitative study was conducted through eight focus group discussions with adult community members to explore their general opinions, views and perceptions of malaria and of its treatments. These groups were followed by 15 in-depth interviews of participants with a recent malaria experience to allow for an in-depth exploration of their self-care practices. The analysis followed principles of grounded theory and was conducted using Nvivo 9 qualitative data management software. RESULTS The self-treatment of malaria at home was found to be a common practice among the study participants. The majority of the participants practiced self-medication with a painkiller as an initial response. The persistence and the worsening of the disease symptoms prompted participants to consider other self-care options. Perceptions that many malaria symptoms are suggestive of other conditions motivated participants to self-refer for malaria test. The accessibility of private laboratory facilities and drug shops motivated their use for malaria tests and for obtaining anti-malarial medicines, respectively. Self-treatment with anti-malarial monotherapy was common, motivated by their perceived effectiveness and availability. The perceived barriers to using the recommended combination treatment, artemether-lumefantrine, were related to the possible side-effects and to uncertainty about their effectiveness, and these doubts motivated some participants to consider self-medication with local herbs. Several factors were mentioned as motivating people for self-care practices. These included poor patient provider relationship, unavailability of medicine and the costs associated with accessing treatments from the health facilities. CONCLUSIONS Malaria self-care and self-treatment with anti-malarial monotherapy are common among adults, and are motivated by both individual characteristics and the limitations of the existing health care facilities. There is a need for public health interventions to take into account community perceptions and cultural schemas on malaria self-care practices.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
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Spjeldnæs AO, Kitua AY, Blomberg B. Education and knowledge helps combating malaria, but not degedege: a cross-sectional study in Rufiji, Tanzania. Malar J 2014; 13:200. [PMID: 24885180 PMCID: PMC4058719 DOI: 10.1186/1475-2875-13-200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional medicine is readily available in Tanzania, and local terms like degedege is widely used for malaria-like illnesses, often associated with supernatural forces. Malaria prevention and intervention efforts can benefit from policy-makers' awareness of local perceptions and beliefs in the rural areas affected by malaria. This study measured knowledge, attitudes and behaviour towards malaria and malaria-like illnesses. METHODS A cross-sectional survey was conducted in a rural area in Rufiji, Tanzania. A case report form employing a scoring system was used to capture participants' knowledge of malaria and another for preventive actions against malaria. Logistic regression was used to assess factors associated with knowledge and preventive action. RESULTS Most of the participants possessed good knowledge about malaria transmission (82.1%), prevention (85.2%) and where to get treatment (96.4%). Fewer were familiar with fever (58.2%) and other common symptoms of malaria (32.7%), and even fewer actually put their knowledge into action. The action score measured the use of bed net, treatment of nets, indoor use of insecticide residual spraying (IRS), and proportion of households with tight windows, among the participants. As many as 35.7% scored zero on preventive actions, while 37.2% achieved a high action score. Education level and belonging to the age group 30 to 49 were significantly associated with higher knowledge. Education level was associated with higher score for preventive action (OR 2.3, CI 95% 1.2-1.4). Participants generally perceived degedege, a local name for an illness with convulsion, as different from malaria both with regards to cause and possible preventive and curative interventions. CONCLUSION Respondents considered degedege to have supernatural causes and to need treatment by a traditional healer. This may be one reason for care-seeking shopping and care-seeking delay. Regarding degedege as a separate entity may explain why malaria is not perceived as a serious health problem in the area, and why little preventive actions are taken. While the elders have high status in the society, their lack of knowledge of malaria may impact the care-seeking pattern of their families.
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Affiliation(s)
- Astrid Onarheim Spjeldnæs
- National Centre for Tropical Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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Metta E, Msambichaka B, Mwangome M, Nyato DJ, Dieleman M, Haisma H, Klatser P, Geubbels E. Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review. Glob Health Action 2014; 7:23439. [PMID: 24848655 PMCID: PMC4028932 DOI: 10.3402/gha.v7.23439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing the NCDs situation in Tanzania and identify gaps for advancing the NCD research and policy agenda. METHODOLOGY A literature search was performed on PubMed and Google scholar with full text retrieval from HINARI of English language articles published between 2000 and 2012. Documents were read to extract information on what Tanzanian actors were doing that contributed to NCDs prevention, treatment, and control, and a narration was written out of these. Reference lists of all retrieved articles were searched for additional relevant articles. Websites of organizations active in the field of NCDs including the Government of Tanzania and WHO were searched for reports and grey literature. RESULTS Lack of a specific and overarching NCD policy has slowed and fragmented the implementation of existing strategies to prevent and control NCDs and their determinants. The health system is not prepared to deal with the rising NCD burden although there are random initiatives to improve this situation. How the community is responding to these emerging conditions is still unknown, and the current health-seeking behavior and perceptions on the risk factors may not favor control of NCDs and their risk factors. CONCLUSION AND RECOMMENDATION There is limited information on the burden and determinants of NCDs to inform the design of an integrative and multisectorial policy. Evidence on effective interventions for NCD services in primary care levels and on community perceptions on NCDs and their care seeking is virtually absent. Research and public health interventions must be anchored in the policy, health system, and community platforms for a holistic response.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Dar es Salaam, Tanzania; ;
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- Faculty of Spatial Sciences, Population Research Centre, University of Groningen, Groningen, The Netherlands
| | - Paul Klatser
- Royal Tropical Institute, Amsterdam, The Netherlands
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Forero DA, Chaparro PE, Vallejo AF, Benavides Y, Gutiérrez JB, Arévalo-Herrera M, Herrera S. Knowledge, attitudes and practices of malaria in Colombia. Malar J 2014; 13:165. [PMID: 24885909 PMCID: PMC4113137 DOI: 10.1186/1475-2875-13-165] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/22/2014] [Indexed: 12/24/2022] Open
Abstract
Background Although Colombia has witnessed an important decrease in malaria transmission, the disease remains a public health problem with an estimated ~10 million people currently living in areas with malaria risk and ~61,000 cases reported in 2012. This study aimed to determine and compare the level of knowledge, attitudes and practices (KAP) about malaria in three endemic communities of Colombia to provide the knowledge framework for development of new intervention strategies for malaria elimination. Methods A cross-sectional KAP survey was conducted in the municipalities of Tierralta, Buenaventura and Tumaco, categorized according to high risk (HR) and moderate risk (MR) based on the annual parasite index (API). Surveys were managed using REDCap and analysed using MATLAB and GraphPad Prism. Results A total of 267 residents, mostly women (74%) were surveyed. Although no differences were observed on the knowledge of classical malaria symptoms between HR and MR regions, significant differences were found in knowledge and attitudes about transmission mechanisms, anti-malarial use and malaria diagnosis. Most responders in both regions (93.5% in MR, and 94.3% in HR areas) indicated use of insecticide-treated nets (ITNs) to protect themselves from malaria, and 75.5% of responders in HR indicated they did nothing to prevent malaria transmission outdoors. Despite a high level of knowledge in the study regions, significant gaps persisted relating to practices. Self-medication and poor adherence to treatment, as well as lack of both indoor and outdoor vector control measures, were significantly associated with higher malaria risk. Conclusions Although significant efforts are currently being made by the Ministry of Health to use community education as one of the main components of the control strategy, these generic education programmes may not be applicable to all endemic regions of Colombia given the substantial geographic, ethnic and cultural diversity.
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Abstract
PURPOSE This study, designed to complement a large population survey on prevalence of stroke risk factors, assessed knowledge and perception of stroke and associated factors. METHODS A population survey was conducted in urban Nansana and rural Busukuma, Wakiso district, central Uganda. Adult participants selected by multistage stratified sampling were interviewed about selected aspects of stroke knowledge and perception in a pretested structured questionnaire. RESULTS There were 1616 participants (71.8% urban; 68.4% female; mean age: 39.6 years ± 15.3). Nearly 3/4 did not know any stroke risk factors and warning signs or recognize the brain as the organ affected. Going to hospital (85.2%) was their most preferred response to a stroke event. Visiting herbalists/traditional healers was preferred by less than 1%. At multivariable logistic regression, good knowledge of stroke warning signs and risk factors was associated with tertiary level of education (OR 4.29, 95% CI 2.13-8.62 and OR 5.96, 95% CI 2.94-12.06), resp.) and self-reported diabetes (OR 1.97, 95% CI 1.18-3.32 and OR 1.84, 95% CI 1.04-3.25), resp.). CONCLUSION Knowledge about stroke in Uganda is poor although the planned response to a stroke event was adequate. Educational strategies to increase stroke knowledge are urgently needed as a prelude to developing preventive programmes.
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Abstract
Many people (including students of sociology) often wonder about the relevance of social sciences (especially sociology) to health issues. In general, it is often a challenge to discuss the nexus between social science and health. Why medical sociology? What does sociology have to do with medicine or health? This chapter aims to answer these questions. It starts with the meaning of sociology and its links to health studies—a definition and brief history of medical sociology and topic description of the discipline. All health problems are conceived as social problems, which are the core focus of sociological studies. This chapter explains the characteristics of social problems with regard to health issues. Health problems are viewed as parts of social pathologies by advancing the sociological dimensions of health problems. The chapter then attempts to re-explain the topical description of medical sociology (first advanced by David Mechanic in 1968) and includes some current issues. The topical descriptions specifically include social aetiology of disease, cultural beliefs and social response to illness, sociology of medical care and hospitals, sociology of psychiatry, social transition and health care, traditional medicine (alternative medicine), sociology of bioethics, health policy and politics, social epidemiology, sociology of dying and death, and medical education.
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Affiliation(s)
- Jimoh Amzat
- Department of Sociology, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Oliver Razum
- AG3 Epidemiology & Intern Public Health, Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany
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Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Health 2013; 18:1406-15. [PMID: 24103083 DOI: 10.1111/tmi.12191] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare actual and perceived causes of fever in northern Tanzania. METHODS In a standardised survey, heads of households in 30 wards in Moshi, Tanzania, were asked to identify the most common cause of fever for children and for adults. Responses were compared to data from a local hospital-based fever aetiology study that used standard diagnostic techniques. RESULTS Of 810 interviewees, the median (range) age was 48 (16, 102) years and 509 (62.8%) were women. Malaria was the most frequently identified cause of fever, cited by 353 (43.6%) and 459 (56.7%) as the most common cause of fever for children and adults, respectively. In contrast, malaria accounted for 8 (2.0%) of adult and 6 (1.3%) of paediatric febrile admissions in the fever aetiology study. Weather was the second most frequently cited cause of fever. Participants who identified a non-biomedical explanation such as weather as the most common cause of fever were more likely to prefer a traditional healer for treatment of febrile adults (OR 2.7, P < 0.001). Bacterial zoonoses were the most common cause of fever among inpatients, but no interviewees identified infections from animal contact as the most common cause of fever for adults; two (0.2%) identified these infections as the most common cause of fever for children. CONCLUSIONS Malaria is perceived to be a much more common cause of fever than hospital studies indicate, whereas other important diseases are under-appreciated in northern Tanzania. Belief in non-biomedical explanations of fever is common locally and has important public health consequences.
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Affiliation(s)
- Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
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Shahandeh K, Basseri HR, Sharifzadeh Y. An application of cultural model to assess and compare malaria prevention among Afghani migrant and Baluchi resident in the endemic area, southeastern Iran. J Immigr Minor Health 2013; 16:102-10. [PMID: 23775110 DOI: 10.1007/s10903-013-9850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To improve malaria control measures, taking into account local beliefs and practices are essential. In the present study, the PEN-3 culture model as a theoretical framework was employed to examine how health beliefs, behaviors and practices associated with malaria prevention in two communities, Afghani refugees and Bluchi residents in a malaria endemic area located in southeast of Iran. A mixed-methodology was designed by means of two quantitative surveys and qualitative focus groups. Cross-sectional survey using questionnaires combined with focus group discussions carried out by using a pre-coded questionnaire and eight qualitative focus groups were held. In total, 385 participants volunteered to take the cross-sectional survey, with 194 Afghanis, 191 Bluchis completing quantitative surveys and also 46 participated in the qualitative focus groups. Symptoms of malaria were the most frequently mentioned by both groups. A significant association between education level and knowledge on malaria transmission was also observed within both communities. Although the majority of respondents associated the disease transmission with mosquito bites only 16.5% Afghanis as compared to 63.4% Baluchis reported to use mosquito net. Data from focus group emerged three themes includes similarity in perception about malaria, difference in type of treatment and decision making and, finally resemblance to prevention of malaria in both communities. In the study, cultural differences in the recognition and interpretation of prevention and treatment of malaria within two communities were identified. Cultural match of Afghani and Baluchi perspective to malaria interventions and services will improve receptivity to, acceptance of, and salience of these efforts.
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Affiliation(s)
- Kh Shahandeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
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Household roles and care-seeking behaviours in response to severe childhood illness in Mali. J Biosoc Sci 2013; 45:743-59. [PMID: 23601075 DOI: 10.1017/s0021932013000163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region.
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Arulogun OS, Adeniyi JD, Asa S, Adegbenro CA. Why actions for early treatment of febrile illnesses in children are delayed by caregivers. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2013; 32:219-31. [PMID: 23353563 DOI: 10.2190/iq.32.3.e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study explored why actions for early treatment of febrile illnesses in children are delayed by caregivers of children less than five years in five Local Government Areas (LGAs) of southwestern Nigeria using four indicators: caregivers' perception of illness, notion of causation and seriousness, belief in efficacy of selected pathway, and the decision making process. Seven types of febrile illnesses (yellow fever, typhoid fever, ordinary fever/malaria, hot body fever, rain fever, cold fever, and headache fever) were identified and yellow fever was perceived as the most severe type (60.8%). Only 24.2% correctly identified an infected mosquito bite as the cause of ordinary fever/malaria. Use of leftover drugs at home (55.6%) was the main action taken and fathers were the main decisionmakers in all cases. Empowerment of women for improved knowledge on causation, severity, and importance of prompt action for a healthy outcome is recommended.
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Colvin CJ, Smith HJ, Swartz A, Ahs JW, de Heer J, Opiyo N, Kim JC, Marraccini T, George A. Understanding careseeking for child illness in sub-Saharan Africa: a systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria. Soc Sci Med 2013; 86:66-78. [PMID: 23608095 DOI: 10.1016/j.socscimed.2013.02.031] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 01/31/2023]
Abstract
Diarrhoea, pneumonia and malaria are the largest contributors to childhood mortality in sub-Saharan Africa. While supply side efforts to deliver effective and affordable interventions are being scaled up, ensuring timely and appropriate use by caregivers remains a challenge. This systematic review synthesises qualitative evidence on the factors that underpin household recognition and response to child diarrhoea, pneumonia and malaria in sub-Saharan Africa. For this review, we searched six electronic databases, hand searched 12 journals from 1980 to 2010 using key search terms, and solicited expert review. We identified 5104 possible studies and included 112. Study quality was appraised using the Critical Appraisal Skills Program (CASP) tool. We followed a meta-ethnographic approach to synthesise findings according to three main themes: how households understand these illnesses, how social relationships affect recognition and response, and how households act to prevent and treat these illnesses. We synthesise these findings into a conceptual model for understanding household pathways to care and decision making. Factors that influence household careseeking include: cultural beliefs and illness perceptions; perceived illness severity and efficacy of treatment; rural location, gender, household income and cost of treatment. Several studies also emphasise the importance of experimentation, previous experience with health services and habit in shaping household choices. Moving beyond well-known barriers to careseeking and linear models of pathways to care, the review suggests that treatment decision making is a dynamic process characterised by uncertainty and debate, experimentation with multiple and simultaneous treatments, and shifting interpretations of the illness and treatment options, with household decision making hinging on social negotiations with a broad variety of actors and influenced by control over financial resources. The review concludes with research recommendations for tackling remaining gaps in knowledge.
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Affiliation(s)
- Christopher J Colvin
- Centre for Infectious Disease Epidemiology and Research, Falmouth 5.49, School of Public Health and Family Medicine, University of Cape Town, Observatory 7925, Cape Town, South Africa.
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Bingham A, Gaspar F, Lancaster K, Conjera J, Collymore Y, Ba-Nguz A. Community perceptions of malaria and vaccines in two districts of Mozambique. Malar J 2012. [PMID: 23186030 PMCID: PMC3519522 DOI: 10.1186/1475-2875-11-394] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Malaria is a leading cause of mortality and morbidity in Mozambique, with nearly three-quarters of the country’s malaria-related deaths occurring in children younger than five years. A malaria vaccine is not yet available, but planning is underway for a possible introduction, as soon as one becomes available. In an effort to inform the planning process, this study explored sociocultural and health communications issues among individuals at the community level who are both responsible for decisions about vaccine use and who are likely to influence decisions about vaccine use. Methods Researchers conducted a qualitative study in two malaria-endemic districts in southern Mozambique. Using criterion-based sampling, they conducted 23 focus group discussions and 26 in-depth interviews. Implementation was guided by the engagement of community stakeholders. Results Community members recognize that malaria contributes to high death rates and affects the workforce, school attendance, and the economy. Vaccines are seen as a means to reduce the threat of childhood illnesses and to keep children and the rest of the community healthy. Perceived constraints to accessing vaccine services include long queues, staff shortages, and a lack of resources at health care facilities. Local leaders play a significant role in motivating caregivers to have their children vaccinated. Participants generally felt that a vaccine could help to prevent malaria, although some voiced concern that the focus was only on young children and not on older children, pregnant women, and the elderly. Probed on their understanding of vaccine efficacy, participants voiced various views, including the perception that while some vaccines did not fully prevent disease they still had important benefits. Overall, it would be essential for local leaders to be involved in the design of specific messages for a future malaria vaccine communications strategy, and for those messages to be translated into local languages. Conclusions Acceptance of routine childhood vaccines bodes well for a future malaria vaccine. Vaccinating children is a well-established routine that is viewed favourably in Mozambique. A communications strategy would need to build on existing immunization efforts and use trusted sources—including current government dissemination arrangements—to deliver health information.
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Affiliation(s)
- Allison Bingham
- PATH Kenya, PO Box 19128-40123, Mega City Building, Mezzanine Floor, Along Nairobi Road, Kisumu, Kenya.
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Ellis AA, Traore S, Doumbia S, Dalglish SL, Winch PJ. Treatment actions and treatment failure: case studies in the response to severe childhood febrile illness in Mali. BMC Public Health 2012; 12:946. [PMID: 23127128 PMCID: PMC3497867 DOI: 10.1186/1471-2458-12-946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/23/2012] [Indexed: 11/23/2022] Open
Abstract
Background Appropriate home management of illness is vital to efforts to control malaria. The strategy of home management relies on caregivers to recognize malaria symptoms, assess severity and promptly seek appropriate care at a health facility if necessary. This paper examines the management of severe febrile illness (presumed malaria) among children under the age of five in rural Koulikoro Region, Mali. Methods This research examines in-depth case studies of twenty-five households in which a child recently experienced a severe febrile illness, as well as key informant interviews and focus group discussions with community members. These techniques were used to explore the sequence of treatment steps taken during a severe illness episode and the context in which decisions were made pertaining to pursing treatments and sources of care, while incorporating the perspective and input of the mother as well as the larger household. Results Eighty-one participants were recruited in 25 households meeting inclusion criteria. Children's illness episodes involved multiple treatment steps, with an average of 4.4 treatment steps per episode (range: 2–10). For 76% of children, treatment began in the home, but 80% were treated outside the home as a second recourse. Most families used both traditional and modern treatments, administered either inside the home by family members, or by traditional or modern healers. Participants’ stated preference was for modern care, despite high rates of reported treatment failure (52%, n=12), however, traditional treatments were also often deemed appropriate and effective. The most commonly cited barrier to seeking care at health facilities was cost, especially during the rainy season. Financial constraints often led families to use traditional treatments. Conclusions Households have few options available to them in moments of overlapping health and economic crises. Public health research and policy should focus on the reducing barriers that inhibit poor households from promptly seeking appropriate health care. Enhancing the quality of care provided at community health facilities and supporting mechanisms by which treatment failures are quickly identified and addressed can contribute to reducing subsequent treatment delays and avoid inappropriate recourse to traditional treatments.
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Affiliation(s)
- Amy A Ellis
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bornman M, Schlemmer L, van der Walt T, van Dyk C, Bouwman H. Implications for health education and intervention strategies arising from children's caregivers concerns following successful malaria control. Trans R Soc Trop Med Hyg 2012; 106:408-14. [DOI: 10.1016/j.trstmh.2012.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 04/20/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022] Open
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Dillip A, Alba S, Mshana C, Hetzel MW, Lengeler C, Mayumana I, Schulze A, Mshinda H, Weiss MG, Obrist B. Acceptability--a neglected dimension of access to health care: findings from a study on childhood convulsions in rural Tanzania. BMC Health Serv Res 2012; 12:113. [PMID: 22571384 PMCID: PMC3405484 DOI: 10.1186/1472-6963-12-113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/09/2012] [Indexed: 11/23/2022] Open
Abstract
Background Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers’ and clients’ understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. Methods The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. Results The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1) 46% point increase among those who reported use of mosquito nets to prevent convulsion (2) 13% point decrease among caregivers who associated convulsion with ‘evil eye and sorcery’, 3) 14% point increase in prompt use of health facility and 4)16% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. Conclusion As an important dimension of access to health care ‘social acceptability’ seems relevant in studying illnesses that are perceived not to belong to the biomedical field, specifically in trans-cultural societies. Understanding the match between local and biomedical understanding of disease is fundamental to ensure acceptability of health care services, successful control and management of health problems. Our study noted some positive changes in community knowledge and management of convulsion episodes, changes which might be accredited to extensive health education campaigns in the study area. On the other hand it is difficult to make inference out of the findings as a result of small sample size involved. In return, it is clear that well ingrained traditional beliefs can be modified with communication campaigns, provided that this change resonates with the beneficiaries.
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Affiliation(s)
- Angel Dillip
- Ifakara Health Institute, Off Mlabani Passage, P.O.Box 53, Ifakara, Morogoro, Tanzania
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Nsagha DS, Elat JBN, Ndong PA, Tata PN, Tayong MNN, Pokem FF, Wankah CC. Feasibility of home management using ACT for childhood malaria episodes in an urban setting. DRUG HEALTHCARE AND PATIENT SAFETY 2011; 4:1-18. [PMID: 22328833 PMCID: PMC3273905 DOI: 10.2147/dhps.s25406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Over 90% of malaria cases occur in Sub-Saharan Africa, where a child under the age of 5 years dies from this illness every 30 seconds. The majority of families in Sub- Saharan Africa treat malaria at home, but therapy is often incomplete, hence the World Health Organization has adopted the strategy of home management of malaria to solve the problem. The purpose of this study was to determine community perception and the treatment response to episodes of childhood malaria in an urban setting prior to implementation of home management using artemisinin-based combination therapy (ACT). METHODS This qualitative exploratory study on the home management of malaria in urban children under 5 years of age used 15 focus group discussions and 20 in-depth interviews in various categories of caregivers of children under 5 years. One hundred and eighteen people participated in the focus group discussions and 20 in the in-depth interviews. The study explored beliefs and knowledge about malaria, mothers' perception of home management of the disease, health-seeking behavior, prepackaged treatment of malaria using ACT and a rapid diagnostic test, preferred channels for home management of uncomplicated malaria, communication, the role of the community in home management of malaria, and the motivation of drug distributors in the community. RESULTS The mothers' perception of malaria was the outcome of events other than mosquito bites. Home treatment is very common and is guided by the way mothers perceive signs and symptoms of malaria. Frequent change of malarial drugs by the national health policy and financial difficulties were the main problems mothers faced in treating febrile children. Rapid diagnostic testing and prepackaged ACT for simple malaria in children under 5 years would be accepted if it was offered at an affordable price. Tribalism and religious beliefs might hinder the delivery of home management of malaria. The availability of rapid diagnostic testing and ACT all year round is one of the challenges of home management of malaria. Although radio and television featured among the current sources of information within the community, meetings, churches, schools, and other public gatherings were the best venues for social mobilization, while community health workers and community leaders were the best sensitization agents for positive behavior change to adhere to home management of malaria. Monetary incentives should be offered to community drug distributors. This should be deducted from the combined price of ACT and rapid diagnostic testing. CONCLUSION For successful implementation of home management of malaria, there should be proper education, social mobilization of the population, and continuous monitoring and evaluation of field activities to ensure adequate stocks of ACT and rapid diagnostic testing within the framework of the intervention.
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Affiliation(s)
- Dickson S Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Simba DO, Kakoko D, Tomson G, Premji Z, Petzold M, Mahindi M, Gustafsson LL. Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania. Trans R Soc Trop Med Hyg 2011; 106:3-9. [PMID: 22099005 DOI: 10.1016/j.trstmh.2011.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 11/24/2022] Open
Abstract
A follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and non-adherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR)=2.45, 95% CI 1.35-4.45; adjusted OR=2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups.
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Affiliation(s)
- Daudi O Simba
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Suárez-Mutis MC, Coura JR, Massara CL, Schall VT. Effect of a participatory educational program on primary school teachers' knowledge of malaria. Rev Saude Publica 2011; 45:931-7. [PMID: 21845289 DOI: 10.1590/s0034-89102011005000060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 05/04/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe a participatory educational program for building up knowledge on malaria among primary school teachers in a highly endemic city. METHODS An observational study was conducted. A 40-hour course with a multidisciplinary and problematizing approach was held in 2008, including 46 teachers mainly from rural areas of the city of Barcelos, Northern Brazil. The participatory educational process was comprised of workshops and practical classes. A previously validated questionnaire was applied before and after the course to assess teachers' knowledge and subsequently analyzed using qualitative and quantitative approaches and open-response thematic analysis. RESULTS Prior to the course, teachers had little information about the transmission mechanisms, means of prevention, and the association between malaria and its vectors, and their health concepts were limited. After the course, teachers' knowledge of malaria increased and they reflected on their role in society. CONCLUSIONS The effect of the educational program on the construction of contextualized knowledge of malaria and health indicates the potential of the strategy developed. Continuing education processes are required for the maintenance of new knowledge and practices directed towards health promotion.
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Affiliation(s)
- Martha Cecilia Suárez-Mutis
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
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Hirji KF, Premji ZG. Pre-referral rectal artesunate in severe malaria: flawed trial. Trials 2011; 12:188. [PMID: 21824389 PMCID: PMC3171715 DOI: 10.1186/1745-6215-12-188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/08/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, have led the WHO to endorse rectal artesunate as a pre-referral treatment for severe malaria. In the light of its public health importance and because its scientific quality has not been assessed for a systematic review, our paper provides a detailed evaluation of the design, conduct, analysis, reporting, and practical features of this trial. RESULTS We performed a checklist-based and an in-depth evaluation of the trial. The evaluation criteria were based on the CONSORT statement for reporting clinical trials, the clinical trial methodology literature, and practice in malaria research. Our main findings are: The inclusion and exclusion criteria and the sample size justification are not stated. Many clearly ineligible subjects were enrolled. The training of the recruiters does not appear to have been satisfactory. There was excessive between center heterogeneity in design and conduct. Outcome evaluation schedule was not defined, and in practice, became too wide. Large gaps in the collection of key data were evident. Primary endpoints were inconsistently utilized and reported; an overall analysis of the outcomes was not done; analyses of time to event data had major flaws; the stated intent-to-treat analysis excluded a third of the randomized subjects; the design-indicated stratified or multi-variate analysis was not done; many improper subgroups were analyzed in a post-hoc fashion; the analysis and reporting metric was deficient. There are concerns relating to patient welfare at some centers. Exclusion of many cases from data analysis compromised external validity. A bias-controlled reanalysis of available data does not lend support to the conclusions drawn by the authors. CONCLUSIONS This trial has numerous serious deficiencies in design, implementation, and methods of data analysis. Interpretation and manner of reporting are wanting, and the applicability of the findings is unclear. The trial conduct could have been improved to better protect patient welfare. The totality of these problems make it a flawed study whose conclusions remain subject to appreciable doubt.
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Affiliation(s)
- Karim F Hirji
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania
| | - Zulfiqarali G Premji
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, United Nations Road, Da res Salaam, Tanzania
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Källander K, Kadobera D, Williams TN, Nielsen RT, Yevoo L, Mutebi A, Akpakli J, Narh C, Gyapong M, Amu A, Waiswa P. Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality. Popul Health Metr 2011; 9:44. [PMID: 21819604 PMCID: PMC3160937 DOI: 10.1186/1478-7954-9-44] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 08/05/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions. OBJECTIVE To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old. METHODS Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths. RESULTS At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home. CONCLUSION While delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.
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Affiliation(s)
- Karin Källander
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
- Department of Public Health Sciences, Division of International Health (IHCAR), Nobels Väg 9, Karolinska Institutet, Stockholm 17176, Sweden
- Malaria Consortium Africa, P.O box 8045, Kampala, Uganda
| | - Daniel Kadobera
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Epidemiological and Demographic Surveillance System (EPI-DSS) Group, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK
| | - Rikke Thoft Nielsen
- Bandim Health Project, Apartado 861, Bissau, 1004 Bissau Codex, Guinea-Bissau
- Statens Serum Institut, 5 Artillerivej, Copenhagen 2300, Denmark
| | - Lucy Yevoo
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Aloysius Mutebi
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
| | - Jonas Akpakli
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Clement Narh
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Alberta Amu
- Dodowa Health Research Centre, Ghana Health Service, P.O. Box 1, Dodowa, Ghana
| | - Peter Waiswa
- Department of Health Policy, Planning & Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
- Iganga/Mayuge Health & Demographic Surveillance Site (HDSS), P.O. Box 111, Iganga, Uganda
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Malaria self medications and choices of drugs for its treatment among residents of a malaria endemic community in West Africa. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60003-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Iwelunmor J, Idris O, Adelakun A, Airhihenbuwa CO. Child malaria treatment decisions by mothers of children less than five years of age attending an outpatient clinic in south-west Nigeria: an application of the PEN-3 cultural model. Malar J 2010; 9:354. [PMID: 21143854 PMCID: PMC3017534 DOI: 10.1186/1475-2875-9-354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/08/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Using the PEN-3 cultural model, this study sought to understand mothers treatment decisions about their child febrile illness by examining positive health beliefs and practices held by mothers, examine existential (unique) practices that are indigenous to mothers and have no harmful health consequences, and explore negative beliefs and practices that limit recommended responses to febrile illness in children. METHODS This qualitative study was conducted in the paediatric section of an outpatient clinic in south-west Nigeria. A total of 123 mothers with children less than five years of age with febrile illness diagnosed as malaria by physicians were individually interviewed on their treatment-seeking practices prior to visiting the clinic and their reasons for attendance at the clinic. RESULTS For some mothers interviewed, effective treatment from the clinic for their child's febrile illness, coupled with physician's approach with malaria diagnosis and treatment practices was important in generating positive maternal treatment-seeking responses to child febrile illness. In addition, beliefs related to a child teething highlighted existential decisions with treatment-seeking for child febrile illness in this setting. Finally, the belief that febrile illness is not all that severe despite noticeable signs and symptoms was a concerning negative perception shared by some mothers in this study. CONCLUSION The findings highlight the need to consider not only the responses that may serve as barriers to effective treatment, but also an acknowledgment of the positive and existential responses that are equally critical in influencing mothers' management of malaria in their children.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Biobehavioral Health, The Pennsylvania State University, 315 Health and Human Development East, University Park, PA 16802, USA
| | - Oladipo Idris
- Department of Family Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adeniyi Adelakun
- Department of Family Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Collins O Airhihenbuwa
- Department of Biobehavioral Health, The Pennsylvania State University, 315 Health and Human Development East, University Park, PA 16802, USA
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Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates. Int J Infect Dis 2010; 14:e967-73. [DOI: 10.1016/j.ijid.2010.05.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 04/11/2010] [Accepted: 05/18/2010] [Indexed: 11/23/2022] Open
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Kinung'hi SM, Mashauri F, Mwanga JR, Nnko SE, Kaatano GM, Malima R, Kishamawe C, Magesa S, Mboera LEG. Knowledge, attitudes and practices about malaria among communities: comparing epidemic and non-epidemic prone communities of Muleba district, North-western Tanzania. BMC Public Health 2010; 10:395. [PMID: 20602778 PMCID: PMC2910681 DOI: 10.1186/1471-2458-10-395] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/05/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Muleba district in North-western Tanzania has experienced malaria epidemics in recent years. Community knowledge, attitudes and practices are important in enhancing disease control interventions. This study investigated determinants of malaria epidemics in the study area in relation to household knowledge, attitudes and practice on malaria. METHODS A community based cross-sectional survey involving 504 study participants was conducted between April and June 2007 using a structured questionnaire focusing on knowledge, attitudes and practices of community members in epidemic and non-epidemic villages about malaria transmission, signs and symptoms, treatment, prevention and control. Multivariate logistic regression analysis was used to assess determinants of malaria epidemics. RESULTS A total of 504 respondents (males = 36.9%) were interviewed. Overall, 453 (90.1%) mentioned malaria as the most important disease in the area. Four hundred and sixty four respondents (92.1%) knew that malaria is transmitted through mosquito bite. A total of 436 (86.7%), 306 (60.8%) and 162 (32.1%) mentioned fever, vomiting and loss of appetite as major symptoms/signs of malaria, respectively. Of those interviewed 328 (65.1%) remembered the recent outbreak of 2006. Of the 504 respondents interviewed, 296 (58.7%) reported that their households owned at least one mosquito net. Three hundred and ninety seven respondents (78.8%) knew insecticides used to impregnate bed nets. About two thirds (63.3%) of the respondents had at least a household member who suffered from malaria during the recent epidemic. During the 2006 outbreak, 278 people (87.2%) sought treatment from health facilities while 27 (8.5%) obtained drugs from drug shops and 10 (3.1%) used local herbs. Logistic regression analysis showed that household location and level of knowledge of cause of malaria were significant predictors of a household being affected by epidemic. CONCLUSIONS Residents of Muleba district have high level of knowledge on malaria. However, this knowledge has not been fully translated into appropriate use of available malaria interventions. Our findings suggest that household location, ineffective usage of insecticide treated nets and knowledge gaps on malaria transmission, signs and symptoms, prevention and control predisposed communities in the district to malaria epidemics. It is important that health education packages are developed to address the identified knowledge gaps.
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Affiliation(s)
- Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Fabian Mashauri
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Joseph R Mwanga
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Soori E Nnko
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Godfrey M Kaatano
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Robert Malima
- National Institute for Medical Research, Amani Centre, P. O. Box 81, Muheza, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Stephen Magesa
- National Institute for Medical Research, Amani Centre, P. O. Box 81, Muheza, Tanzania
| | - Leonard EG Mboera
- National Institute for Medical Research, Headquarters, P.O. Box 9653, Dar-Es-Salaam, Tanzania
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Mboera LEG, Shayo EH, Senkoro KP, Rumisha SF, Mlozi MRS, Mayala BK. Knowledge, perceptions and practices of farming communities on linkages between malaria and agriculture in Mvomero District, Tanzania. Acta Trop 2010; 113:139-44. [PMID: 19854143 DOI: 10.1016/j.actatropica.2009.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/11/2009] [Accepted: 10/15/2009] [Indexed: 11/29/2022]
Abstract
This study was carried out to determine knowledge, perceptions and practices of farming communities on linkages between agriculture and malaria in Mvomero District in Tanzania. A total of 661 adult males and females were interviewed using a structured questionnaire. Most respondents (85.6%) were engaged in crop production. Significantly, a larger proportion (55.2%) of the respondents had primary school education (P<0.001). Majority (88.2%) respondents described malaria as the most important public health problem. However, only 48.2% of the respondents had high knowledge of malaria. The level of knowledge on malaria was associated with level of education of the respondent. Those who had attended at least primary school education were more knowledgeable that those without formal education. A significantly larger proportion (67%) of the respondents experienced most malaria episodes during the rainy season (P<0.001). Respondents with low knowledge on malaria experienced 2.3 times more malaria cases in their households than those with higher knowledge. Respondents with low knowledge preferred to seek care from health facilities (OR: 7.28) than those with high knowledge (OR: 0.15). Rice farming was significantly associated with malaria transmission compared to either maize or sugarcane farming (P<0.001). Cattle, sheep and goats were the domestic animals most frequently incriminated to create aquatic habitats for mosquito breeding. Householders with formal education (OR: 4.6, CI: 1.33-15.89, P-value=0.016) and higher knowledge (OR: 1.7, CI: 1.15-2.55, P-value=0.008) reported to incur large losses when having a malaria case than those without education/low knowledge. Majority (60.2%) of the respondent owned at least an insecticide treated mosquito net (ITN). Respondents with higher knowledge of malaria were likely to own at least an ITN than those with low knowledge (P<0.001). In conclusion, the knowledge on malaria and its linkage with agriculture among farming communities in Mvomero District is low. Malaria is a complex health problem and its control approach needs understanding of the environmental factors associated with agricultural practices. It therefore is important that education and communication messages on malaria targeting farming communities take into consideration local agricultural practices.
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Affiliation(s)
- Leonard E G Mboera
- National Institute for Medical Research, 2448 Ocean Road, P.O. Box 9653, Dar es Salaam, Tanzania.
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Kamat VR. Cultural interpretations of the efficacy and side effects of antimalarials in Tanzania. Anthropol Med 2009; 16:293-305. [DOI: 10.1080/13648470903246854] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vijayakumar KN, Gunasekaran K, Sahu SS, Jambulingam P. Knowledge, attitude and practice on malaria: a study in a tribal belt of Orissa state, India with reference to use of long lasting treated mosquito nets. Acta Trop 2009; 112:137-42. [PMID: 19631184 DOI: 10.1016/j.actatropica.2009.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 07/02/2009] [Accepted: 07/16/2009] [Indexed: 11/17/2022]
Abstract
Local knowledge and practice related to malaria is important for the implementation of culturally appropriate, sustainable and effective interventions. In this context, to know people's knowledge, attitude and practice on malaria and its prevention, a study was carried out in two districts viz., Malkangiri and Koraput of Orissa state in India, the former with ongoing insecticide treated mosquito nets (ITNs) programme and the latter without such programme (non-ITNs). Both qualitative and quantitative methods were used for data collection. The local concepts used for malaria describe only the biomedical symptoms of the disease although a few by meaning in local language reflect people's misconceptions about the cause of malaria. About 63% of the respondents mentioned mosquito bite as the cause for this disease and 65% considered malaria as a serious problem. Qualitative data showed that people from remote villages seek treatment from traditional healers, Disharis. About 64% of the respondents stated that avoiding mosquito bites could prevent malaria. Majority (99%) of the people reported using personal protection measures to avoid mosquito bites. Although, majority of the people were aware of the cause and prevention of malaria (about 70% stated sleeping under mosquito net prevents malaria), a sizable proportion still had misconceptions and hence appropriate communication strategies should be developed and imparted alongside ITNs/LLINs distribution for a behaviour change to adopt such preventive measures. Since, the tribes are habituated to seek treatment from traditional healers; they could be involved in motivating people to use ITNs/LLINs to protect from mosquito bites and malaria.
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Affiliation(s)
- K N Vijayakumar
- Vector Control Research Centre (ICMR), Medical Complex, Indira Nagar, Pondicherry 605006, India
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Foster D, Vilendrer S. Two treatments, one disease: childhood malaria management in Tanga, Tanzania. Malar J 2009; 8:240. [PMID: 19860900 PMCID: PMC2779815 DOI: 10.1186/1475-2875-8-240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 10/27/2009] [Indexed: 11/12/2022] Open
Abstract
Background In the Tanga District of coastal Tanzania, malaria is one of the primary causes of mortality for children under the age of five. While some children are treated with malaria medications in biomedical facilities, as the World Health Organization recommends, others receive home-care or treatment from traditional healers. Recognition of malaria is difficult because symptoms can range from fever with uncomplicated malaria to convulsions with severe malaria. This study explores why caregivers in the Tanga District of Tanzania pursue particular courses of action to deal with malaria in their children. Methods Qualitative data were collected through interviews with three samples: female caregivers of children under five (N = 61), medical practitioners (N = 28), and traditional healers (N = 18) in urban, peri-urban, and rural areas. The female caregiver sample is intentionally stratified to reflect the greater population of the Tanga District in level of education, marital status, gender of household head, religion, and tribal group affiliation. Qualitative data were counted, coded and analysed using NVivo7 software. Results Results indicate that a variety of factors influence treatment choice, including socio-cultural beliefs about malaria symptoms, associations with spiritual affliction requiring traditional healing, knowledge of malaria, and fear of certain anti-malaria treatment procedures. Most notably, some caregivers identified convulsions as a spiritual condition, unrelated to malaria. While nearly all caregivers reported attending biomedical facilities to treat children with fever (N = 60/61), many caregivers stated that convulsions are best treated by traditional healers (N = 26/61). Qualitative interviews with medical practitioners and traditional healers confirmed this belief. Conclusion Results offer insight into current trends in malaria management and have implications in healthcare policy, educational campaigns, and the importance of integrating traditional and biomedical approaches.
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Affiliation(s)
- Deshka Foster
- Program in Human Biology, Stanford University, Stanford, CA, USA.
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Maslove DM, Mnyusiwalla A, Mills EJ, McGowan J, Attaran A, Wilson K. Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2009; 9:26. [PMID: 19852857 PMCID: PMC2782321 DOI: 10.1186/1472-698x-9-26] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 10/25/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries. METHODS We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention. RESULTS The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39). CONCLUSION These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.
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Affiliation(s)
- David M Maslove
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Anisa Mnyusiwalla
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Edward J Mills
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Jessie McGowan
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Amir Attaran
- Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Population Health, University of Ottawa, Ontario, Canada
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