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LOCAL ILLNESS TERMS AND THE NEW HOME BASED FEVER MANAGEMENT STRATEGY IN UGANDA Källander K
1
, Nsungwa-Sabiiti J
2,3
, Nsabagasani X
4
, Pariyo G
2
, Tomson G
1,5
and Peterson S
1 (1) Division of International Health (IHCAR), Karolinska Institutet, Sweden (2) Institute of Public Health, Makerere University, Uganda (3) Department of Clinical Pharmacology, Makerere University, Uganda (4) Makerere Institute of Social Research, Makerere University, Uganda (5) Medical Management Centre, Karolinska Institutet, Sweden
Background
• The WHO strategy Home Management of Malaria (HMM) is priority in many African countries and has been adopted by the Ugandan Ministry of Health • The aim is to improve access to antimalarial drugs for prompt presumptive treatment of all fevers in children under-five.
• Village volunteers distribute pre-packed antimalarials free of charge to caretakers of febrile children 2 months to 5 years (“Homapaks”).
Study Objective
• To explore local understanding and treatment practices for childhood fever illnesses • To discuss the implications for Home Management of Malaria strategies.
Methods Study population
• Ten FGDs of 8 to 14 participants were held with child caretakers in three rural villages in Kasese district, West Uganda
Data collection and Analysis
• An interview guide was used covering e.g. fever recognition, home management and care seeking practices • Tape-recorded data were transcribed, translated into English and analysed manually, applying open codes freely within the structure of the interview guide.
Results Recognition and labelling of childhood fevers
• ‘Fever’ was recognised as a common illness term, locally referred to as “Omutsutsa”. • Season, type and combination of symptoms and treatment outcome were some of the parameters used to label and classify the ‘fever’ • Six major fever related ailments were discerned (see Figure 1)
First response to acute symptoms
• Most caretakers took action immediately after realising that the child is sick. • Immediate actions included informing and consulting neighbours and relatives, “cooling down” the symptoms, “washing the stomach” and giving left over drugs.
Treatment options
• People often switch between traditional and western treatments. If western drugs did not work, the caretaker would switch to herbs. • The treatment process varied according to how symptoms were classified and how the illness evolved. • Some illness classifications were preferentially treated traditionally whereas others were seen to need western drugs
O M U S U T S A
Ekyikenyera:
‘Chest problem’
Ekikangarara:
‘Jerks’
Omusutsa owe miibu:
‘Fever of the mosquito’ Vomiting Shivering Diarrhoea
Ekibale:
‘Stomach stone’
Ekirwere:
‘The disease’ Difficult/abnormal breathing Cough Chest pain Very body body Convulsions Gasping breathing Swelling in abdomen Yellow faeces Swollen legs Pale skin Diarrhoea Convulsions
Ebironda ebyo muanda:
‘Stomach wounds’ Extremely hot body Persistent diarrhoea Wounds around mouth and anus
B I O M E D I C A L M A L A R I A
Rush to hospital Rush to hospital Treat with western drugs – antipyretic or antimalarial Wash stomach with local herbs Herbal treatment
H E R B A L
Herbal treatment
W E S T E R N
Hot Body
Initial action in home: tepid sponging, herbs, western drugs
Figure 1.
Schematic representation of the link between Hot Body and selected local ‘fever’ classifications. Associated first-line care-seeking actions and possible relation to biomedical malaria is indicated.
Discussion
• There was a mismatch between the emic (local) and etic (biomedical) definitions of fever • Most local fever illness classifications manifest symptoms of possible biomedical malaria. • Only one local fever illness classification, ‘fever of the mosquito’ is seen as needing early use of antimalarials. • Two local illness classifications, ‘stomach stone’ and ‘the disease’ had symptoms indicating chronic and severe malaria respectively, but were only taken for western care if herbal treatment failed.
Conclusions
• Homapaks will likely be used promptly only for local illness classifications where “western” treatment is considered appropriate. • Unless HMM strategies address local practices and adapt the information to the cultural context, the result may be continued delay und under-treatment of possible malaria. • Research is needed on the effectiveness of HMM strategies including community acceptance and use of Homapaks in relation to local traditional practices, as well as drug compliance studies.