title: Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome.
abstract: Use of official health services often remains low despite great efforts to improve quality of care. Are informal treatments responsible for keeping a number of patients away from standard care, and if so, why? Through a questionnaire survey with proportional cluster samples, we studied the case histories of 952 children in Bandiagara and Sikasso areas of Mali. Most children with reported uncomplicated malaria were first treated at home (87%) with modern medicines alone (40%), a mixture of modern and traditional treatments (33%), or traditional treatment alone (27%). For severe episodes (224 cases), a traditional treatment alone was used in 50% of the cases. Clinical recovery after uncomplicated malaria was above 98% with any type of treatment. For presumed severe malaria, the global mortality rate was 17%; it was not correlated with the type of treatment used (traditional or modern, at home or elsewhere). In the study areas, informal treatments divert a high proportion of patients away from official health services. Patients' experience that outcome after standard therapeutic itineraries is not better than after alternative care may help to explain low use of official health services. We need to study whether some traditional treatments available in remote villages should be considered real, recommendable first aid.
authors.affiliation: Département de Médecine Traditionnelle (DMT), Bamako, Mali.
authors.forename: Drissa
authors.initials: D
authors.lastname: Diallo
authors.forename: Bertrand
authors.initials: B
authors.lastname: Graz
authors.forename: Jacques
authors.initials: J
authors.lastname: Falquet
authors.forename: Abdel Kader
authors.initials: AK
authors.lastname: Traoré
authors.forename: Sergio
authors.initials: S
authors.lastname: Giani
authors.forename: Pakuy Pierre
authors.initials: PP
authors.lastname: Mounkoro
authors.forename: Adama
authors.initials: A
authors.lastname: Berthé
authors.forename: Massambou
authors.initials: M
authors.lastname: Sacko
authors.forename: Chiaka
authors.initials: C
authors.lastname: Diakité
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000401:mortality / Q000628:therapy*; D008302:Mali; D016488:Medicine, African Traditional; D010342:Patient Acceptance of Health Care; D012423:Rural Health; D012651:Self Medication / Q000706:statistics & numerical data*; D016896:Treatment Outcome