Intra-Household Relations and Treatment Decision-Making for Childhood Illness: A Kenyan Case Study

Abstract

This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers’ responses to childhood fevers in the last 2 weeks (n=317), and to childhood convulsions in the previous year (n=43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual and group interviews, primarily with women (n=223). Responses to convulsions were more likely than responses to fevers to include a healer consultation (p<0·0001), and less likely to include the purchase of over-the-counter medications (p<0·0001). Mothers received financial or advisory assistance from others in 71% (n=236) of actions taken outside the household in response to fevers. In-depth interviews suggested that general agreement on appropriate therapy results in relatively few intra-household conflicts over the treatment of fevers. Disputes over perceived cause and appropriate therapy of convulsions, however, highlighted the importance of age, gender and relationship to household head in intra-household relations and treatment decision-making. Although mothers’ treatment-seeking preferences are often circumscribed by these relations, a number of strategies can be drawn upon to circumvent ‘inappropriate’ decisions, sometimes with implications for future household responses to similar syndromes. The findings highlight the complexity of intra-household relations and treatment decision-making dynamics. Tentative implications for interventions aimed at improving the home management of malaria, and for further research, are presented.

Community concepts of malaria-related illness with and without convulsions in southern Ghana

“…Reliance on traditional healers, especially for MRI-CP, however, remains a problem, inasmuch as this results in many children not receiving timely antimalarial treatment. The use of a mix of traditional remedies (herbal and rituals) and biomedical treatments are consistent with the literature [5,10-12,22]. …”

“…convulsion negative, MRI-CN) [4,5]. Many studies argue that convulsions, often considered unrelated to MRI, lead to a significant alteration in the meanings of the illness experience and behaviour, indicating more frequent reliance on traditional healers as the primary source of treatment or in combination with biomedicine [4,6-12]. …”

Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria

“…The relatively minimal use of traditional healers for treatment of uncomplicated malaria in this study was also noted in previous studies in Nigeria [25] and elsewhere [31]. The implication is that they are not important providers of treatment for mild febrile illnesses but are usually consulted for severe illnesses like convulsion, which is perceived to be better managed by them [32,33]. It is only if the problem persists that the child is then taken to hospital, which results in considerable delay in referral to a health facility as was also noted in coastal Tanzania [34].…”

A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia

“…For example, only convulsions that were accompanied by high fever were regarded as 'big malaria' or severe malaria. Tchinda and others [22] in their study showed that anaemia, hypoglycemia and jaundice were recognized by caretakers as complications of malaria, this was not identified in the Nakonde study [23-25]. These parameters are critical foundations for an intervention strategy into home-based management of malaria.…”