Recognition, Perceptions and Treatment Practices for Severe Malaria in Rural Tanzania: Implications for Accessing Rectal Artesunate as a Pre-Referral

被引:32
作者
Warsame, Marian [1 ,2 ]
Kimbute, Omari [2 ]
Machinda, Zena [2 ]
Ruddy, Patricia
Melkisedick, Majaha [2 ]
Peto, Thomas [2 ]
Ribeiro, Isabela [3 ]
Kitua, Andrew
Tomson, Goran [1 ]
Gomes, Melba [3 ]
机构
[1] Karolinska Inst, Div Int Hlth IHCAR, Stockholm, Sweden
[2] Natl Inst Med Res, Rectal Artesunate Study Team, Dar Es Salaam, Tanzania
[3] United Nations Dev Programme UNDP World Bank WHO, Geneva, Switzerland
来源
PLOS ONE | 2007年 / 2卷 / 01期
关键词
D O I
10.1371/journal.pone.0000149
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Objectives. Preparatory to a community trial investigating how best to deliver rectal artesunate as pre-referral treatment for severe malaria; local understanding, perceptions of signs/symptoms of severe malaria and treatment-seeking patterns for and barriers to seeking biomedical treatment were investigated. Methodology/Principal Findings. 19 key informant interviews, 12 in-depth interviews and 14 focus group discussions targeting care-givers, opinion leaders, and formal and informal health care providers were conducted. Monthly fever episodes and danger signs or symptoms associated with severe malaria among under-fives were recorded. Respondents recognized convulsions, altered consciousness and coma, and were aware of their risks if not treated. But, these symptoms were perceived to be caused by supernatural forces, and traditional healers were identified as primary care providers. With some delay, mothers eventually visited a health facility when convulsions were part of the illness, despite pressures against this. Although vomiting and failure to eat/suck/drink were associated with malaria, they were not considered as indicators of danger signs unless combined with another more severe symptom. Study communities were familiar with rectal application of medicines. Conclusions/Significance. Communities' recognition and awareness of major symptoms of severe malaria could encourage action, but perceptions of their causes and poor discrimination of other danger signs - vomiting and failure to feed - might impede early treatment. An effective health education targeting parents/guardians, decision-makers/advisors, and formal and informal care providers might be a prerequisite for successful introduction of rectal artemisinins as an emergency treatment. Role of traditional healers in delivering such medication to the community should be explored.
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页数:11
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