Malaria in rural Burkina Faso: local illness concepts, patterns of traditional treatment and influence on health-seeking behaviour.
The literature on health care seeking behaviour in sub-Saharan Africa for children suffering from malaria is quite extensive. This literature, however, is predominantly quantitative and, inevitably, fails to explore how the local concepts of illness may affect people's choices. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge and lead to the development of more effective malaria control interventions.


METHODS
In a rural area of Burkina Faso, four local concepts of illness resembling the biomedical picture of malaria were described according to symptoms, aetiology, and treatment. Data were collected through eight focus group discussions, 17 semi-structured interviews with key informants, and through the analysis of 100 verbal autopsy questionnaires of children under-five diagnosed with malaria.


RESULTS
Sumaya, dusukun yelema, kono, and djoliban were identified as the four main local illness concepts resembling respectively uncomplicated malaria, respiratory distress syndrome, cerebral malaria, and severe anaemia. The local disease categorization was found to affect both treatment and provider choice. While sumaya is usually treated by a mix of traditional and modern methods, dusukun yelema and kono are preferably treated by traditional healers, and djoliban is preferably treated in modern health facilities. Besides the conceptualization of illness, poverty was found to be another important influencing factor of health care-seeking behaviour.


CONCLUSIONS
The findings complement previous evidence on health care-seeking behaviour, by showing how local concepts of illness strongly influence treatment and choice of provider. Local concepts of illness need to be considered when developing specific malaria control programmes.
Department of Tropical Hygiene and Public Health, Medical School, Ruprecht Karls Universität Heidelberg, INF 324, Heidelberg, Germany. Beiersmann@uni-heidelberg.de
Claudia
C
Beiersmann
Aboubakary
A
Sanou
Evelyn
E
Wladarsch
Manuela
M
De Allegri
Bocar
B
Kouyaté
Olaf
O
Müller
D000962:Antimalarials / Q000627:therapeutic use; D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D016488:Medicine, African Traditional; D009035:Mothers; D012424:Rural Population; D018571:Sentinel Surveillance; D011795:Surveys and Questionnaires
D000962:Antimalarials