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