Maternal perceptions of acute respiratory infections in children under 5 in rural South Africa

Abstract

Summaryobjectives To assess maternal ability to recognize respiratory distress and to identify local beliefs and practices around respiratory infections in rural KwaZulu/Natal, South Africa.methods A descriptive study: 15 knowledgeable mothers were shown a video of 10 children with respiratory distress and four normal children. Mothers were asked to describe perceived types, signs, symptoms, causes of and actions taken for each child. Sensitivity and specificity were calculated for maternal recognition of respiratory distress (chest indrawing, fast breathing) shown on the video. A focus group discussion with six mothers was held to corroborate and refine individually reported local concepts.findings Maternal recognition of respiratory distress was good (sensitivity 91.3%, 95% CI: 86.8-95.8%; specificity 95%, 95%CI: 89.5-100%), with little variation between mothers (kappa ¼ 0.704).Mothers described 12 'local types of respiratory illness', each with its own name and its own welldefined set of signs and symptoms. They were classifiable into five causative categories: supernatural, natural, tuberculosis, cold weather and unknown, indicating that perceptions of causation differed greatly from biomedical concepts. For illnesses of perceived supernatural causation, mothers were reluctant to seek medical care and antibiotics were deemed inappropriate. Traditional remedies were preferred instead.conclusion Knowledge of local vocabulary and concepts about respiratory infections is essential to design strategies for health care workers to communicate with mothers about respiratory disease, so that mothers will seek timely medical care, provide continued safe, supportive home care and comply with antibiotic treatment.

Determinants of delay in care‐seeking for febrile children in eastern Uganda

“…2007). Fast breathing has also been found to be easier for caretakers to recognize than other chest symptoms like chest in‐drawing (Kauchali et al. 2004).…”

Influences on Healthcare-seeking during Final Illnesses of Infants in Under-resourced South African Settings

“…Interventions that involve other family members or that disseminate behaviour-change messages to the broader community may further promote these messages, particularly in settings where autonomy of women in decision-making is limited (3,32). These messages should be sensitive to local explanatory models of illness causation and cultural practices (7). Public health staff also should be sensitized, particularly given that many have a negative view towards traditional healing and healers (33).…”

“…These include poverty (1), distance to facilities (2), previous negative experiences of mothers with treatment (3), unequal household gender relations (3-5), and women's control of household expenditure (6). Mothers’ explanatory models of illness also impact whether or not and from where they seek treatment (7,8) as do assessments of severity of illness (5,8). …”

Inherent illnesses and attacks: an ethnographic study of interpretations of childhood Acute Respiratory Infections (ARIs) in Manhiça, southern Mozambique

“…Some studies have suggested that caretakers can recognise early respiratory distress (an indicator of an ARI) [4,8,9]. However, other research indicated that caretakers do not clearly recognise the signs and symptoms of ARIs: fast breathing or chest indrawing may not be recognised, or may be wrongly attributed to fever rather than a respiratory infection [10-13].…”

“…Research in South Africa and Uganda, for example, identified many local terms that included the biomedical symptoms of pneumonia and respiratory infections [9,14]. In a recent study in Guinea Bissau, 12% of women and 29% of men had heard of the term 'pneumonia', and only one person out of 620 knew that antibiotics could be used to treat pneumonia [15].…”