Elsevier

Acta Tropica

Volume 87, Issue 3, August 2003, Pages 305-313
Acta Tropica

Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district—implications for malaria control

https://doi.org/10.1016/S0001-706X(03)00113-XGet rights and content

Abstract

Knowledge on local understanding, perceptions and practices of care providers regarding management of childhood malaria are needed for better malaria control in urban, peri-urban and rural communities. Mothers of under five children attending five purposively selected public health facilities in the Kibaha district, Tanzania, were invited to participate in 10 focus group discussions (FGDs). The health workers of these facilities were included in six other FGDs to elicit their professional views. Analysis was done using interpretative and qualitative approaches. Both health workers and all mothers were clear about the signs and symptoms of homa ya malaria, a description consistent with the biomedical definition of mild malaria. Although most of the mothers related this to mosquito bites, some did not. Mothers also described a severe childhood illness called degedege, consistent with convulsions. Most of the mothers failed to associate this condition with malaria, believing it is caused by evil spirits. Urinating on or fuming the child suffering from degedege with elephant dung were perceived to be effective remedies while injections were considered fatal for such condition. Traditional healers were seen as the primary source of treatment outside homes for this condition and grandmothers and mother in-laws are the key decision makers in the management. Our findings revealed major gaps in managing severe malaria in the study communities. Interventions addressing these gaps and targeting mothers/guardians, mother in-laws, grandmothers and traditional healers are needed.

Introduction

Malaria is the leading cause of morbidity and mortality in children in Tanzania (Kilama and Kihamia, 1991). Adequate case management—early recognition and prompt treatment—has been and still continues to be the basis for malaria control here as in most of Sub-Saharan Africa (National Malaria Control Programme, 1990, WHO, 1993). Formal health service has been the primary focus for the National Malaria Control Programme in the country. However, surveys carried out in some African countries revealed that malaria in children is first recognised and responded to at home (Mwenesi et al., 1995a, McCombie, 1996). This is further supported by the reports of frequent self-treatment with antimalarials stocked at home and/or bought at drug shops (Massele et al., 1993, Mnyika et al., 1995, Nsimba et al., 1999).

Understanding local knowledge, perceptions and practices of malaria management has become the focus of research during the last decade. Studies from Kenya and Ghana reported that mothers had good knowledge in recognising symptoms suggestive of malaria (Ruebush et al., 1995, Ahorlu et al., 1997). However, surveys from Tanzania and Nigeria reported the contrary (Rooth and Björkman, 1992, Molineaux and Gramiccia, 1980). Other studies revealed that convulsions, a prominent condition in severe malaria, were not associated with malaria by caretakers but rather to supernatural cause (Mwenesi et al., 1995b, Winch et al., 1995, Ahorlu et al., 1997). Traditional healers were reported to be the focal point for consultation.

As part of a malaria project aiming to develop context specific interventions to improve the quality of malaria case management, we investigated the local understanding, perceptions and practices of caretakers on management of childhood malaria in urban, peri-urban and rural settings.

Section snippets

Study area and population

The study was conducted between July and September 1999 in the Kibaha district located 40 kms north west of Dar-es-Salaam. The area is highly endemic for malaria (Nsimba et al., 1999) and is populated by the Zaramo, Doe, Kwavi and Ndengeleko tribes.

In order to assess the knowledge, perceptions and practices about childhood malaria, mothers with sick children attending five purposively selected health facilities were targeted. The district had in total 10 public health facilities serving urban (n

Ethical approval

The study was approved by the Muhimbili University College of Health Sciences (MUCHS) Human Ethics Committee, Tanzania. Permission were obtained from the regional and district administrative authorities. Informed consent was also obtained from the mothers and health workers in the studied facilities. Mothers with severely ill children were not included in the study. Discussions with the health workers were held after their consultation hours.

Results

Demographic characteristics of the participants are presented in Table 1. All but one of participants accompanying children under 5 years were mothers. The remaining one was a female guardian of a child. The majority of the mothers aged between 21–30 years. Most described their occupation either as housewives (32%) or peasants (49%). The rest were petty traders or civil servants. The age profile of the health workers ranged from 20s to 40s. They were 4 Clinical Officers, 6 Assistant Clinical

Discussion

Focus groups as qualitative research methods can be used successfully to assess needs, develop interventions, test new ideas or programmes, improve existing programmes and generate a range of ideas on a particular subject. Although we used FGDs in a more interpretative and evaluative way (Moser and Kalton, 1971), FGDs have been used as an interactive method in behavioural interventions (Hadiyono et al., 1996), and also as a follow up in assessing effects after interventions (Kachur et al., 1999

Acknowledgements

We thank mothers and health workers for participating in the study and the district authorities in Kibaha for their co-operation. Special thanks go to our research assistants, Mr Adiel Mushi and Mr Huruma Kisaka, for note taking during the FGDs. Professor Amos Massele (Dept of Clinical Pharmacology-MUCHS, co-ordinator of the malaria research group) and Dr Edmund. J. Kayombo-Institute of Traditional Medicine (MUCHS) gave valuable comments during the revision of this manuscript. Financial support

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