Health-seeking behaviour and beliefs around sore throat in The Gambia: a qualitative study

Abstract

Group A Streptococcus (StrepA) bacteria causes a broad spectrum of diseases. The most common manifestations of StrepA infection are sore throat and pus-producing skin infections such as impetigo. Complications of StrepA infection lead to inflammation in the bones, muscles, joints, and internal organs causing acute rheumatic fever and rheumatic heart disease (RHD). In The Gambia, the RHD burden is thought to be very high. However, epidemiological data is minimal, and StrepA control programmes do not exist. This study aims to explore common beliefs and practices related to sore throats among primary caregivers of children, and healthcare providers in a community with a high StrepA disease burden. This will inform the design of preventative strategies for StrepA-related sequelae. Four informal conversations with providers and fifteen semi-structured interviews with caregivers were conducted in the peri-urban area of Sukuta, The Gambia. Sampling was purposive and gradual, beginning from households identified to have recently experienced sore throat through a parallel cohort study. Themes explored in qualitative analysis included: sore throat causal attributions and diagnoses, care practises, health-seeking behaviour, and perceived barriers to using the biomedical sector. Sore throats were typically perceived to affect one child in a family, disproportionately or exclusively. Sore throats are rarely perceived as life-threatening, and awareness of links between sore throat and ARF or RHD was not reported among caregivers or providers in this study population. Most cases of sore throat are initially managed at home using traditional medicine which delays resort to antibiotics, though in two instances of severe pain with the presence of exudate, fear that the child’s life was at risk prompted care-seeking through the formal health system. Our findings can inform the development of tailored strategies to increase community knowledge of the potential long-term consequences of sore throats and appropriate care-seeking, alongside improvements in the health system, to prevent StrepA sequelae effectively.