title: Role of traditional healers in the management of severe malaria among children below five years of age: the case of Kilosa and Handeni Districts, Tanzania.
abstract: BACKGROUND
  The current malaria control strategy of WHO centres on early diagnosis and prompt treatment using effective drugs. Children with severe malaria are often brought late to health facilities and traditional health practitioners are said to be the main cause of treatment delay. In the context of the Rectal Artesunate Project in Tanzania, the role of traditional healers in the management of severe malaria in children was studied.
  
  
  METHODS
  A community cross-sectional study was conducted in Kilosa and Handeni Districts, involving four villages selected on the basis of existing statistics on the number of traditional health practitioners involved in the management of severe malaria. A total of 41 traditional health practitioners were selected using the snowballing technique, whereby in-depth interviews were used to collect information. Eight Focus Group Discussions (FGDs) involving traditional health practitioners, caregivers and community leaders were carried out in each district.
  
  
  RESULTS
  Home management of fever involving sponging or washing with warm water at the household level, was widely practiced by caregivers. One important finding was that traditional health practitioners and mothers were not linking the local illness termed degedege, a prominent feature in severe malaria, to biomedically-defined malaria. The majority of mothers (75%) considered degedege to be caused by evil spirits. The healing process was therefore organized in stages and failure to abide to the procedure could lead to relapse of degedege, which was believed to be caused by evil spirits. Treatment seeking was, therefore, a complex process and mothers would consult traditional health practitioners and modern health care providers, back and forth. Referrals to health facilities increased during the Rectal Artesunate Project, whereby project staff facilitated the process after traditional medical care with the provision of suppositories. This finding is challenging the common view that traditional healers are an important factor of delay for malaria treatment, they actually play a pivotal role by giving "bio-medically accepted first aid" which leads to reduction in body temperature hence increasing chances of survival for the child. Increasing the collaboration between traditional healers and modern health care providers was shown to improve the management of severe malaria in the studied areas.
  
  
  CONCLUSIONS
  Traditional health care is not necessarily a significant impediment or a delaying factor in the treatment of severe malaria. There is a need to foster training on the management of severe cases, periodically involving both traditional health practitioners and health workers to identify modalities of better collaboration.
authors.affiliation: National Institute for Medical Research (NIMR), P O Box 9653 Dar es Salaam, Tanzania. emakundi@nimr.or.tz
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Makundi
authors.forename: Hamisi M
authors.initials: HM
authors.lastname: Malebo
authors.forename: Paulo
authors.initials: P
authors.lastname: Mhame
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Kitua
authors.forename: Marian
authors.initials: M
authors.lastname: Warsame
mesh_terms: D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use; D000077332:Artesunate; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D016488:Medicine, African Traditional; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012423:Rural Health; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D013636:Tanzania
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate