Treatment actions and treatment failure: case studies in the response to severe childhood febrile illness in Mali

Abstract

BackgroundAppropriate home management of illness is vital to efforts to control malaria. The strategy of home management relies on caregivers to recognize malaria symptoms, assess severity and promptly seek appropriate care at a health facility if necessary. This paper examines the management of severe febrile illness (presumed malaria) among children under the age of five in rural Koulikoro Region, Mali.MethodsThis research examines in-depth case studies of twenty-five households in which a child recently experienced a severe febrile illness, as well as key informant interviews and focus group discussions with community members. These techniques were used to explore the sequence of treatment steps taken during a severe illness episode and the context in which decisions were made pertaining to pursing treatments and sources of care, while incorporating the perspective and input of the mother as well as the larger household.ResultsEighty-one participants were recruited in 25 households meeting inclusion criteria. Children's illness episodes involved multiple treatment steps, with an average of 4.4 treatment steps per episode (range: 2–10). For 76% of children, treatment began in the home, but 80% were treated outside the home as a second recourse. Most families used both traditional and modern treatments, administered either inside the home by family members, or by traditional or modern healers. Participants’ stated preference was for modern care, despite high rates of reported treatment failure (52%, n=12), however, traditional treatments were also often deemed appropriate and effective. The most commonly cited barrier to seeking care at health facilities was cost, especially during the rainy season. Financial constraints often led families to use traditional treatments.ConclusionsHouseholds have few options available to them in moments of overlapping health and economic crises. Public health research and policy should focus on the reducing barriers that inhibit poor households from promptly seeking appropriate health care. Enhancing the quality of care provided at community health facilities and supporting mechanisms by which treatment failures are quickly identified and addressed can contribute to reducing subsequent treatment delays and avoid inappropriate recourse to traditional treatments.

Patterns of treatment-seeking behaviors among caregivers of febrile young children: a Ugandan multiple case study

“…In a few instances, caregivers were referred to higher level public health facilities for more invasive treatment without any treatment initiated at the primary external source. Thus, similar to what other researchers in sub-Sahara Africa have observed, caregivers in our study vacillated between multiple sources, travelling long distances and incurring numerous costs in an attempt to find a cure [ 32 , 38 , 39 ].…”

“…While just under half of the caregivers reported that they did not intend to seek external care when they initiated home management, all caregivers whose child did not improve sought treatment from an external source within the same/next day. The strategy to start with home management allows caregivers to wait in hope the less expensive home medicines will suffice, postponing direct and indirect expenses associated with seeking external treatment [ 32 ]. This approach also enables those wishing to seek further treatment to secure money, liquid assets, or find alternate source of labor to pay for these expenses [ 17 , 31 , 33 – 36 ].…”

“…The use of multiple treatments to manage children was common in our study. This practice of polypharmacy by caregivers likely occurs in hope that at least one approach or synergistic effects from the combination of treatments will help cure malaria in their child [ 17 , 32 ]. “Multiple treatments” included the use of multiple western medicines together, and sometimes in combination with supportive care and traditional remedies.…”

Rural-urban disparities in maternal immunization knowledge and childhood health-seeking behavior in Nigeria: A mixed method study

“…Cost was a major barrier to seeking treatment in the hospital. 34 In our study (FGDs), cost was considered an issue among the urban poor. They may borrow money to access formal healthcare thus exposing access gaps with their rural counterparts.…”

“…For both groups of women, cost was the most common reason for failing to do so, followed by distance to the health facility (HF) and illness not perceived as serious. 37 In poorresource settings, appropriate treatment is not even guaranteed in the health facilities 18,20,34 and mothers will still consult neighbouring unqualified healthcare providers 38 herbalists and diviners 20 after visiting the HFs. As reported by our urban discussants, fear of fake and substandard drugs drives some mothers to patronize traditional providers whom they consider more trustworthy.…”