Malaria-Related Health-Seeking Behaviour and Challenges for Care Providers in Rural Ethiopia: Implications for Control

Abstract

A range of activities are currently underway to improve access to malaria prevention and control interventions. As disease control strategies change over time, it is crucial to understand the health-seeking behaviour and the local socio-cultural context in which the changes in interventions operate. This paper reflects on how people in an area of seasonal malaria perceive the causes and transmission of the disease, and what prevention and treatment measures they practise to cope with the disease. It also highlights some of the challenges of malaria treatment for health care providers. The study was undertaken in 2003 in Adami Tulu District in south-central Ethiopia, where malaria is a major health problem. Pre-tested structured questionnaires and focus group discussions were conducted among men and women. Malaria, locally known as busa, was perceived as the most important cause of ill health in the area. Respondent's perception and knowledge about the cause and transmission of the disease were relatively high. The newly introduced insecticide-treated nets were not popular in the area, and only 6.4% of households possessed at least one. The results showed that patients use multiple sources of health care for malaria treatment. Public health facilities, private clinics and community health workers were the main providers of malaria treatment. Despite higher treatment costs, people preferred to use private health care providers for malaria treatment due to the higher perceived quality of care they offer. In conclusion, effort in the prevention and control of malaria should be intensified through addressing not only public facilities, but also the private sector and community-based control interventions. Appropriate and relevant information on malaria should be disseminated to the local community. The authors propose the provision of effective antimalarial drugs and malaria prevention tools such as subsidized or free insecticide-treated nets.

Knowledge, attitudes and practice about malaria in rural Tigray, Ethiopia

“…In Ethiopia, knowledge about malaria transmission has ranged from 17.3 to 63% (6, 12). Though formal education has been discussed as a possible explanation of a better knowledge about the cause of malaria (6), it seems not to be the case given the low educational level in this population.…”

A review of malaria transmission dynamics in forest ecosystems

“…Certain tribes believe that malaria is caused by spirits, angry deities, black magic, or consider it a self-limiting fever in countries like India [167] and southwest Ethiopia [165]. Low cost treatment with traditional medicines, good accessibility and good communication with quacks are preferred most in remote forest areas far from government health centers as reported in rural Ethiopia [168]. In the forest areas health seeking is directly related to culture, faith and affordability of the health care [21,165].…”

Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings

“…Though many patients perceive the quality of care provided in the private sector to be better than in the public sector [70], evidence to support this is lacking [47, 71–76]. Regulatory frameworks that ensure quality of healthcare services may exist but be poorly enforced [77], which may result in poor availability and use of diagnostics [78, 79], over-prescription or overpricing of drugs [80–82] or inappropriate and substandard treatment through ineffective first-line drugs, counterfeit artemisinin-based combinations, artemisinin monotherapies (AMTs) and poor case management [83–91], which are challenges raised by a quarter of the key informants.…”