Background
Methods
Study area
Data collection methods
Focus group discussions (FGDs)
In-depth interviews (IDIs)
Illness narrative interview (INI)
Data management and analyses
1 | Two moderators coded data independently |
2 | 10 % of data were independently coded and compared to ensure inter coder reliability and an agreement then reached on a coding tree |
3 | Themes were identified in advance and emerging themes were derived from data |
4 | Nvivo version 8 software was used for data management |
5 | Quotations were presented to illustrate themes. All quotes attributable to participants were anonimized |
6 | Major themes were clearly presented in the findings |
7 | There were descriptions of diverse cases and discussion of major themes |
Ethical issues
Results
Characteristics of respondents
Data collection method | Age ranges of participants | Education level of participants | ||
---|---|---|---|---|
Men | Women | Men | Women | |
Focus Group discussion | 25–80 | 18–45 | From no education to tertiary | From no education to senior high school |
INDEPTH Interview | 35–52 | 53–56 | From middle School leaving certificate to senior high school | From middle school leaving certificate to Midwifery |
Illness narrative interview | 36–60 | 18–55 | From no education- to general certificate of Education (ordinary level) | From no education to senior high school |
Community knowledge of ACT and availability of ACT at the community level
when I took that white and yellow, I only felt weak. That is the only thing I saw, apart from that, I did not experience any other side effect (FGD: Man)He gave me drugs; one is white and the other is yellow. He also gave me blood tonic and para. (INI: Woman)
The white and yellow isn’t available at the drug store (FGD, pregnant woman)
As said earlier, amodiaquine is very good for the people of Amoma [referring to artesunate-amodiaquine] (FGD, Man)
That is what I told you earlier that we do not sell drugs like artesunate–amodiaquine but we sell drugs like Quick Action [Caffein, Ephederine HCL, paracetamol] and efpac [acetylsalicylic acid, caffeine, paracetamol] which are always advertised on radio so if the person comes and we have to give him Efpac or Quick action, we tell him to take it three times a day (IDI, drug shop operator)
For malaria medicines we have malafan [sulfadoxine pyrimethamine, Amodiaquine syrup; first we have the tablet but now we do not get it that much and Kinaquin 442 [Chloroquine]. (IDI, Drug shop operator)
Experience with ACT
The drug causes you to sleep so when you take it you need to rest for about two to three hours else you become very weak (INI, woman)
Personally I feel dizzy when I take artesunate-amodiaquine without eating (INI: Man)
I came home just around this time. He asked me to take some of the drug so I took it. I also took some around one o’clock in the afternoon; he gave me three and asked me to try and take all in three days. So I took two in the morning and two in the afternoon; whilst taking it I felt the scent of the drug in my nose but I tried to swallow it. After taking it I felt like vomiting but I tried as much as possible to control it but I couldn’t so I had to vomit; that day I vomited a lot. (INI; pregnant woman)
…So I took two and half for two times, the moment you take the drug you feel dizzy. In about thirty minutes I felt sleepy, so I slept meaning the illness itself was cured. But with the sleep, no break, so my husband even asked whether I’ve taken some alcohol. (INI, Woman)
When you sleep three hours after taking the drug you will sweat and when you urinate you will see the difference. Thus the colour of your urine will change. (FGD: Man)
So after taking the drug, you realize that your temperature comes down; and with the weakness, you not even able to go out to urinate. So, having taken the drug and when it begins to work, you realize you’ve gained some strength and you‘re able to move about. (FGD: Pregnant woman)
Malaria health-seeking behaviour: the role of ACT
Type of anti-malarial monotherapy | Other medicines |
---|---|
Malafan (Sulfadoxine pyrimethamine) | Paracetamol |
Kinaquin 442 (Chloroquine) | Oral Rehydration Salt |
Chloroquine | Glucose |
Camoquine (Amodiaquine) | Cafenol (Acetaminophen, Caffeine) |
Amodiaquine syrup | Vitamin B complex |
Amodiaquine suspension | Quick Action (Caffein Ephedrine HCL, paracetamol) |
Local name of plant mentioned by respondents | English name of plant | Scientific name |
---|---|---|
“Duagyene-wuraa” | “Neam tree Leaves” |
Azadirachta indica
|
“Kashedua wuraa” | “Acacia tree Leaves” |
Acacia glauca
|
“Acheamponwuraa” | “Siam weed” |
Chromolaena odorata
|
“Amango-wuraa” | “Mango leaves” |
Magnifera indica
|
“Brofrewuraa-a-awo” | “Dried pawpaw leaves” |
Carica papaya
|
“Teek-wuraa” | “Teak leaves” |
Tectona grandis
|
Ankaa-twadee-wuraa | “Lime/Lemon leaves” |
Citrus vulgaris
|
I agree with him. When you treat it traditionally and it still persists then opt for orthodox treatment in the health facility. (FGD, Man)
I think that even if the herbs will help, one has to go to the hospital first to get treatment, so that upon returning, the herbs can be used to supplement so that it will help. So the hospital is the best way to help ourselves in treating malaria (FGD, Woman)
we only pushed ground ginger into her anus but it didn’t work so I bought drugs at the drug shop. it did not work either so I took her to the hospital. (IDI, caretaker of a child less than five years)
You send the patient to hospital and after that you also cut some herbs like mango leaves, lemon and the “Timforgor” [the name of a herb] that she mentioned and the lemon leaves are mixed together (FGD, Woman)
Category of people who must not take ACT
Pregnant women should not take it because from what people say the drug is powerful and melts blood so I think it is not good for them. (FGD: Man)
I said an anaemic; because the drug is powerful and works with blood so such a person should not take the drug. (FGD: Man)
Reasons for self-treatment, care-seeking at health facilities and chemical shops for uncomplicated malaria in the communities
If you realized you have malaria. We have transport problems to help us get to the health facility. You pluck some leaves, boil and take them (IDI, caretaker of a child less than five years)
Supposing you get malaria and have to go to the hospital, you’ll be required to pay; so if you don’t have money you give up and look for some herbs (FGD, Man)
My two year old child has been affected with malaria, and I’ve tried several times but did not work so I’m thinking of preparing herbs, as a support to see if that can work. So I believe that one can help (FGD caretaker of a child less than five years).
At the clinic, they have some machine. They will first take samples of your blood is to examine whether malaria parasites are in or not. So if it is found out that the parasites are in, you are given malaria treatment (FGD, man)
When the illness comes, I buy drugs but when it becomes very serious, I have to send the person to the health facility. (FGD, man)
The health facility is very far from here as a result after the day’s work or when we wake up and feel body pains all over, we get some pain killer from the drug store before we look for other source of treatment (FGD, Man)
If let us say I send the child to the clinic today being Friday, I’ll wait for a week to see if the child’s condition does not improve, then I’ll buy drugs at the store. I will not send him/her to the clinic again (FGD, caretaker of a child less than five years)
Malaria diagnosis and treatment practices
…when you look at the person and the way he is standing, thus if the person says I am feeling cold, dizzy then you realized that it is fever (IDI, Drug store operator).
We don’t have a laboratory so we look at symptoms to prescribe but when we give them the treatment too they become alright (IDI, an in charge of Health Centre).
For the under-fives, if we check and he is below the age that he cannot take the Amodiaquine and he is feverish we give para [paracetamol] and advice that they are taken to the hospital (IDI, a drug shop operator).
We do not give any pregnant woman drugs over here. At our workshops we are thought that when someone is pregnant it is only the doctor who can prescribe medicine for her so we do not sell malaria and other drugs to pregnant women (IDI, a drug shop operator).
Category of staff, hours of operation and type of services provided in health centres and chemical stores
I am a physician assistant but you know we have community health officers over there (she points to a section of the health facility). If any FP [Family planning] patient comes, they go to their [community health officer] office and I will be working at the consulting room (IDI, In-Charge, Health Center).
I work from 8 am to 5 pm on week days; after that when any case comes they come and call me sometimes on weekends. So I’ll work for 24 h (IDI, In-Charge, Health Center).
For the under-fives if we check and he is below the age that he cannot take the Amodiaquine and he is still feverish we give paracetamol and advice that they are taken to the hospital (IDI, drug shop operator).
Category of staff | Hours of operation | Type of services provided |
---|---|---|
Health Centre
| ||
Staff in-Charge of Health Centre (Enrolled nurse or a Physician Assistant)a
| 8 a.m.–5 p.m. during week days (official hours). A patient could call in at any time during the night or over the weekend | (1) In-charge of the day-to-day work at the health centre (2) Serve as consulting nurse in most medical cases that are reported at the health Centre including diagnosing and treatment of uncomplicated malaria (3) Refer patients to referral hospitals for further treatment if the patient’s condition is beyond their capacity |
Staff in-charge of history and records (community Health) | 8 a.m.–5 p.m. during week days (official hours). A patient could call in at any time during the night or over the weekend and could be called to assist consulting nurse | In charge of taking medical history and keeping of records of facility |
Staff in-charge of consulting (enrolled nurse or a Physician Assistant) | 8 a.m.–5 p.m. during week days (official hours). A patient could call in at any time during the night or over the weekend | Serve as consulting nurse in most medical cases that are reported at the health centre including diagnosing and treatment of uncomplicated malaria |
Staff in-charge of dispensary (Community Health Nurse) | 8 a.m.–5 p.m. during week days (official hours). A patient could call in at any time during the night or over the weekend and could be called to assist consulting nurse | In charge of dispensing of drugs to patients who call at the health centre |
Chemical store
| ||
Chemical store ownera
| 8 a.m.–5 p.m. during week days. A patient could call in at the drug store at any time during the night or over the weekend | (1) Diagnostics (2) Sale of medicines including anti-malarials (3) Counsel and advice clients to seek treatment at the health centre |
Chemical store assistant | Work from 8 a.m.–5 p.m. during week days. A patient could call in at the drug store at any time during the night or over the weekend. The assistant acts in the absence of the drug shop owner | (1) Diagnostics (2) Sale of medicines including anti-malarials (3) Counsel and advice clients to seek treatment at the health centre |