title: Intra-household relations and treatment decision-making for childhood illness: a Kenyan case study.
abstract: This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers' responses to childhood fevers in the last 2 weeks (n=317), and to childhood convulsions in the previous year (n=43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual and group interviews, primarily with women (n=223). Responses to convulsions were more likely than responses to fevers to include a healer consultation (p<0.0001), and less likely to include the purchase of over-the-counter medications (p<0.0001). Mothers received financial or advisory assistance from others in 71% (n=236) of actions taken outside the household in response to fevers. In-depth interviews suggested that general agreement on appropriate therapy results in relatively few intra-household conflicts over the treatment of fevers. Disputes over perceived cause and appropriate therapy of convulsions, however, highlighted the importance of age, gender and relationship to household head in intra-household relations and treatment decision-making. Although mothers' treatment-seeking preferences are often circumscribed by these relations, a number of strategies can be drawn upon to circumvent 'inappropriate' decisions, sometimes with implications for future household responses to similar syndromes. The findings highlight the complexity of intra-household relations and treatment decision-making dynamics. Tentative implications for interventions aimed at improving the home management of malaria, and for further research, are presented.
authors.affiliation: Kenya Melical Research Institute, Centre for Geographic Medicine Research, Kilifi.
authors.forename: C S
authors.initials: CS
authors.lastname: Molyneux
authors.forename: G
authors.initials: G
authors.lastname: Murira
authors.forename: J
authors.initials: J
authors.lastname: Masha
authors.forename: R W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005191:Family Characteristics / Q000208:ethnology*; D005195:Family Relations / Q000208:ethnology*; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011159:Population Surveillance; D012380:Role; D012640:Seizures / Q000453:epidemiology / Q000208:ethnology*; D012938:Social Perception