title: Home treatments alone or mixed with modern treatments for malaria in Finkolo AC, South Mali: reported use, outcomes and changes over 10 years.
abstract: BACKGROUND
  In 2003, a study in Mali showed that 87% of episodes of uncomplicated malaria were first treated at home. We investigated whether treatment-seeking patterns in Mali had changed 10 years later.
  
  
  METHODS
  In 2013, we repeated the retrospective treatment-outcome study on 400 children with presumed malaria in the same area.
  
  
  RESULTS
  Most children with reported uncomplicated malaria were still first treated at home (76% [196/258] in 2013 vs 85% in 2003; p=0.006), rather than in modern health centres (20% [52/258] in 2013 vs 12% in 2003; p=0.01). Overall, 58% of children with uncomplicated malaria were treated with herbal medicine alone, a significant increase from 24% 10 years earlier (p<0.001). This was associated with an increase in use of Argemone mexicana decoction from 8% to 26% (p<0.001), with a reported cure or improvement in 100% of cases among those aged >5 years. For severe malaria, first treatment was sought less often from a traditional healer compared with 10 years earlier (4% vs 32%; p<0.001) and more often from a modern health centre (29% vs 17%; p=0.04).
  
  
  CONCLUSIONS
  Two trends that emerged are that there is a greater use of modern health facilities for treatment of severe malaria, and a greater use of traditional medicine alone for treatment of uncomplicated malaria.
authors.affiliation: Community Health Association, Geneva, Switzerland bertrand.graz@chuv.ch.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Graz
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Merlin
authors.initials: M
authors.lastname: Willcox
authors.affiliation: Field survey team, Sikasso, Mali.
authors.forename: Diafara
authors.initials: D
authors.lastname: Berthé
authors.affiliation: Community Health Association, Geneva, Switzerland.
authors.forename: Denis-Luc
authors.initials: DL
authors.lastname: Ardiet
authors.affiliation: Community Health Association, Geneva, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Falquet
authors.affiliation: Department of Traditional Medicine (DMT), Bamako, Mali.
authors.forename: Drissa
authors.initials: D
authors.lastname: Diallo
authors.affiliation: Aid to Development of Traditional Medicines (AIDEMET), Bamako, Mali.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D029001:Herbal Medicine / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008302:Mali; D016488:Medicine, African Traditional / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012651:Self Medication / Q000639:trends*
keywords: Malaria; Natural products; Plasmodium; Rural health; Traditional medicines; Treatment-seeking