Patterns of care for childhood malaria in Zambia

• Published in: Social science & medicine (1982) 2000-11, Vol.51 (10), p.1491-1503
• Main Authors: Baume, Carol, Helitzer, Deborah, Kachur, S.Patrick
• Format: Article
• Language: English
• Subjects: Access to health care; Antimalarials - administration & dosage; Biological and medical sciences; Blood Diseases; Child mortality; Child, Preschool; Children; Children & youth; Chloroquine - administration & dosage; Diachronic analysis; Drug Combinations; Female; Fever; Fever - etiology; Fever - therapy; Health care; Health Care Services; Health Care Surveys - methods; Health Care Utilization; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Health-seeking behavior; Health-seeking behavior Malaria Fever Zambia Treatment-seeking Resort to care; Help Seeking Behavior; Helpseeking; Human protozoal diseases; Humans; Infant; Infectious diseases; Interviews as Topic; Malaria; Malaria - drug therapy; Malaria - physiopathology; Male; Medical beliefs; Medical sciences; Medical treatment; Mothers; Parasitic diseases; Patient Acceptance of Health Care; Protozoal diseases; Pyrimethamine - administration & dosage; Resort to care; Seizures - etiology; Seizures - therapy; Sulfadoxine - administration & dosage; Synchronic analysis; Traditional Medicine; Treatment-seeking; Tropical medicine; Zambia
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(00)00049-6

Malaria is a major cause of death among children in many parts of the world, even though simple and effective treatments exist. This study examines care-seeking patterns and barriers to appropriate treatment for Zambian children with fever or convulsions, two key symptoms of malaria. The study focuses on community perceptions of and response to febrile illness, using illness narratives as the primary data collection vehicle. The 154 detailed narratives indicate that mothers recognize fever and treat promptly, and consider chloroquine in conjunction with anti-pyretics to be the appropriate treatment. Synchronic and diachronic analyses show that most treatment begins at home, although the majority of cases are also seen in the formal health system. However, whether treated at home or taken to the health center, most children do not receive appropriate care — in this case, a 3-day course of chloroquine — because of problems of access and lack of understanding of the importance of giving the full dose. Further, those children who continue to have fever despite receiving chloroquine seldom receive the recommended second-line treatment with sulfadoxine-pyrimethamine. Most children with symptoms of convulsions are taken to the health center, but are more likely than children with simple malaria to receive traditional treatments as well.