title: Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi.
abstract: BACKGROUND
  Universal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced.
  
  
  METHODS
  Qualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children.
  
  
  CONCLUSIONS
  The phrase 'kutentha thupi', or 'hot body' was used to describe fever, the most frequently mentioned causes of which were malungo (translated as 'malaria'), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1-Assessment; Phase 2-Seeking care outside the home; Phase 3-Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Ewing
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Tolhurst
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kapinda
authors.affiliation: The World Bank, Phnom Penh, Cambodia.
authors.forename: Miguel
authors.initials: M
authors.lastname: SanJoaquin
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Dianne J
authors.initials: DJ
authors.lastname: Terlouw
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Esther
authors.initials: E
authors.lastname: Richards
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
mesh_terms: D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000145:classification* / Q000150:complications / Q000628:therapy; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000150:complications; D008295:Malawi; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome