title: Recognition, perceptions and treatment practices for severe malaria in rural Tanzania: implications for accessing rectal artesunate as a pre-referral.
abstract: OBJECTIVE
  Preparatory to a community trial investigating how best to deliver rectal artesunate as pre-referral treatment for severe malaria; local understanding, perceptions of signs/symptoms of severe malaria and treatment-seeking patterns for and barriers to seeking biomedical treatment were investigated.
  
  
  RESULTS
  19 key informant interviews, 12 in-depth interviews and 14 focus group discussions targeting care-givers, opinion leaders, and formal and informal health care providers were conducted. Monthly fever episodes and danger signs or symptoms associated with severe malaria among under-fives were recorded. Respondents recognized convulsions, altered consciousness and coma, and were aware of their risks if not treated. But, these symptoms were perceived to be caused by supernatural forces, and traditional healers were identified as primary care providers. With some delay, mothers eventually visited a health facility when convulsions were part of the illness, despite pressures against this. Although vomiting and failure to eat/suck/drink were associated with malaria, they were not considered as indicators of danger signs unless combined with another more severe symptom. Study communities were familiar with rectal application of medicines.
  
  
  CONCLUSIONS
  Communities' recognition and awareness of major symptoms of severe malaria could encourage action, but perceptions of their causes and poor discrimination of other danger signs - vomiting and failure to feed - might impede early treatment. An effective health education targeting parents/guardians, decision-makers/advisors, and formal and informal care providers might be a prerequisite for successful introduction of rectal artemisinins as an emergency treatment. Role of traditional healers in delivering such medication to the community should be explored.
authors.affiliation: Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. dahan2004@hotmail.com
authors.forename: Marian
authors.initials: M
authors.lastname: Warsame
authors.forename: Omari
authors.initials: O
authors.lastname: Kimbute
authors.forename: Zena
authors.initials: Z
authors.lastname: Machinda
authors.forename: Patricia
authors.initials: P
authors.lastname: Ruddy
authors.forename: Majaha
authors.initials: M
authors.lastname: Melkisedick
authors.forename: Thomas
authors.initials: T
authors.lastname: Peto
authors.forename: Isabela
authors.initials: I
authors.lastname: Ribeiro
authors.forename: Andrew
authors.initials: A
authors.lastname: Kitua
authors.forename: Goran
authors.initials: G
authors.lastname: Tomson
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use; D000077332:Artesunate; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D016488:Medicine, African Traditional; D008875:Middle Aged; D011247:Pregnancy; D012017:Referral and Consultation; D013636:Tanzania; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate