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Socio-cultural factors explaining timely and appropriate use of health facilities for degedege in south-eastern Tanzania

Dillip, A. and Hetzel, M. W. and Gosoniu, D. and Kessy, F. and Lengeler, C. and Mayumana, I. and Mshana, C. and Mshinda, H. and Schulze, A. and Makemba, A. and Pfeiffer, C. and Weiss, M. G. and Obrist, B.. (2009) Socio-cultural factors explaining timely and appropriate use of health facilities for degedege in south-eastern Tanzania. Malaria Journal, Vol. 8 , 144.

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Official URL: http://edoc.unibas.ch/dok/A5843327

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Abstract

BACKGROUND: Convulsions is one of the key signs of severe malaria among children under five years of age, potentially leading to serious complications or death. Several studies of care-seeking behaviour have revealed that local illness concepts linked to convulsions (referred to as degedege in Tanzanian Kiswahili) called for traditional treatment practices while modern treatment was preferred for common fevers. However, recent studies found that even children with convulsions were first brought to health facilities. This study integrated ethnographic and public health approaches in order to investigate this seemingly contradictory evidence. Carefully drawn random samples were used to maximize the representativity of the results. METHODS: The study used a cultural epidemiology approach and applied a locally adapted version of the Explanatory Model Interview Catalogue (EMIC), which ensures a comprehensive investigation of disease perception and treatment patterns. The tool was applied in three studies; i) the 2004 random sample cross-sectional community fever survey (N = 80), ii) the 2004-2006 longitudinal degedege study (N = 129), and iii) the 2005 cohort study on fever during the main farming season (N = 29). RESULTS: 71.1% of all convulsion cases were brought to a health facility in time, i.e. within 24 hours after onset of first symptoms. This compares very favourably with a figure of 45.6% for mild fever cases in children. The patterns of distress associated with less timely health facility use and receipt of anti-malarials among children with degedege were generalized symptoms, rather than the typical symptoms of convulsions. Traditional and moral causes were associated with less timely health facility use and receipt of anti-malarials. However, the high rate of appropriate action indicates that these ideas were not so influential any more as in the past. Reasons given by caretakers who administered anti-malarials to children without attending a health facility were either that facilities were out of stock, that they lacked money to pay for treatment, or that facilities did not provide diagnosis. CONCLUSION: The findings from this sample from a highly malaria-endemic area give support to the more recent studies showing that children with convulsions are more likely to use health facilities than traditional practices. This study has identified health system and livelihood factors, rather than local understandings of symptoms and causes relating to degedege as limiting health-seeking behaviours. Improvements on the supply side and the demand side are necessary to ensure people's timely and appropriate treatment: Quality of care at health facilities needs to be improved by making diagnosis and provider compliance with treatment guidelines more accurate and therapies including drugs more available and affordable to communities. Treatment seeking needs to be facilitated by strengthening livelihoods including economic capabilities
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Health Systems Research and Dynamic Modelling > Health Systems and Policies (de Savigny)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Health Interventions > Malaria Interventions (Lengeler)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Society, Gender and Health > Cultural Epidemiology (Weiss)
UniBasel Contributors:Obrist van Eeuwijk, Brigit and Lengeler, Christian and Weiss, Mitchell G. and Gosoniu, Dominic and Pfeiffer, Constanze D. and Hetzel, Manuel W
Item Type:Article, refereed
Bibsysno:Link to catalogue
Publisher:BioMed Central
ISSN:1475-2875
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:14 Sep 2012 07:19
Deposited On:14 Sep 2012 06:54

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