title: Maternal perceptions of acute respiratory infections in children under 5 in rural South Africa.
abstract: OBJECTIVE
  To assess maternal ability to recognize respiratory distress and to identify local beliefs and practices around respiratory infections in rural KwaZulu/Natal, South Africa.
  
  
  METHODS
  A descriptive study: 15 knowledgeable mothers were shown a video of 10 children with respiratory distress and four normal children. Mothers were asked to describe perceived types, signs, symptoms, causes of and actions taken for each child. Sensitivity and specificity were calculated for maternal recognition of respiratory distress (chest indrawing, fast breathing) shown on the video. A focus group discussion with six mothers was held to corroborate and refine individually reported local concepts.
  
  
  RESULTS
  Maternal recognition of respiratory distress was good (sensitivity 91.3%, 95% CI: 86.8-95.8%; specificity 95%, 95%CI: 89.5-100%), with little variation between mothers (kappa = 0.704). Mothers described 12 'local types of respiratory illness', each with its own name and its own well-defined set of signs and symptoms. They were classifiable into five causative categories: supernatural, natural, tuberculosis, cold weather and unknown, indicating that perceptions of causation differed greatly from biomedical concepts. For illnesses of perceived supernatural causation, mothers were reluctant to seek medical care and antibiotics were deemed inappropriate. Traditional remedies were preferred instead.
  
  
  CONCLUSIONS
  Knowledge of local vocabulary and concepts about respiratory infections is essential to design strategies for health care workers to communicate with mothers about respiratory disease, so that mothers will seek timely medical care, provide continued safe, supportive home care and comply with antibiotic treatment.
authors.affiliation: Africa Centre for Health and Population Studies, Mtubatuba, SKwaZula/Natal, South Africa.
authors.forename: Shuaib
authors.initials: S
authors.lastname: Kauchali
authors.forename: Nigel
authors.initials: N
authors.lastname: Rollins
authors.forename: Ruth
authors.initials: R
authors.lastname: Bland
authors.forename: Jan
authors.initials: J
authors.lastname: Van den Broeck
mesh_terms: D000208:Acute Disease; D000328:Adult; D001294:Attitude to Health; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D010465:Perception; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000523:psychology; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000523:psychology; D012423:Rural Health; D012680:Sensitivity and Specificity; D013019:South Africa