Two treatments, one disease: childhood malaria management in Tanga, Tanzania.
BACKGROUND
In the Tanga District of coastal Tanzania, malaria is one of the primary causes of mortality for children under the age of five. While some children are treated with malaria medications in biomedical facilities, as the World Health Organization recommends, others receive home-care or treatment from traditional healers. Recognition of malaria is difficult because symptoms can range from fever with uncomplicated malaria to convulsions with severe malaria. This study explores why caregivers in the Tanga District of Tanzania pursue particular courses of action to deal with malaria in their children.


METHODS
Qualitative data were collected through interviews with three samples: female caregivers of children under five (N = 61), medical practitioners (N = 28), and traditional healers (N = 18) in urban, peri-urban, and rural areas. The female caregiver sample is intentionally stratified to reflect the greater population of the Tanga District in level of education, marital status, gender of household head, religion, and tribal group affiliation. Qualitative data were counted, coded and analysed using NVivo7 software.


RESULTS
Results indicate that a variety of factors influence treatment choice, including socio-cultural beliefs about malaria symptoms, associations with spiritual affliction requiring traditional healing, knowledge of malaria, and fear of certain anti-malaria treatment procedures. Most notably, some caregivers identified convulsions as a spiritual condition, unrelated to malaria. While nearly all caregivers reported attending biomedical facilities to treat children with fever (N = 60/61), many caregivers stated that convulsions are best treated by traditional healers (N = 26/61). Qualitative interviews with medical practitioners and traditional healers confirmed this belief.


CONCLUSIONS
Results offer insight into current trends in malaria management and have implications in healthcare policy, educational campaigns, and the importance of integrating traditional and biomedical approaches.
Foster
Deshka
D
Program in Human Biology, Stanford University, Stanford, CA, USA. dsfoster@gmail.com
Vilendrer
Stacie
S
D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003469:Culture; D005260:Female; D005334:Fever / Q000150:complications / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008288:Malaria / Q000208:ethnology / Q000628:therapy*; D008297:Male; D016488:Medicine, African Traditional; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D012423:Rural Health; D012640:Seizures / Q000150:complications / Q000628:therapy*; D013636:Tanzania / Q000453:epidemiology