Fake malaria and hidden parasites - the ambiguity of malaria

Lay perspectives and health-seeking behaviour for malaria were investigated in an ethnographic study carried out in a village in south-eastern Tanzania. The inhabitants have easy access to hospital services and education, programmes, and as a result, biomedical knowledge on malaria is comparatively high. However the cultural model of malaria does not always explain all the events that occur during an actual illness episode, e.g. when the disease cannot be detected at the hospital or the symptoms persist despite antimalarial treatment. Under these circumstances, the model of malaria may be complemented with the logic of witchcraft. This can lead people to consult sequentially both biomedical and traditional health services for the same illness episode. The consequences can include non-compliance with treatment or delay in seeking diagnosis or treatment. Our analysis offers elements for the understanding of aspects of the dynamics of reinterpretation and health-seeking behaviour for malaria, particularly in the phase after diagnosis and treatment at a biomedical health facility. The research is presented with an applied perspective. We propose specific recommendations that could be discussed with health promoters. © Cecil G. Helman 2008.