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J Epidemiol Community Health. Oct 2004; 58(10): 826–830.
PMCID: PMC1763324

Malaria, from natural to supernatural: a qualitative study of mothers' reactions to fever (Dienga, Gabon)

Abstract

Objective: Decision making for health care at the household level is a crucial factor for malaria management and control among young children. This study sought to determine exactly how mothers reacted when faced with fever in a child.

Design: Qualitative study based on in depth semistructured interviews of mothers and free form discussion with traditional healers (Nganga).

Setting: Village of Dienga, a rural area of Gabon (Central Africa).

Participants: 12 mothers and three traditional healers.

Results: All mothers thought that fever and malaria were identical. Mothers home treated or went to the village treatment centre, or both, on the last episode of fever, if they judged it to be "natural" fever. However, if fever was thought to be a result of malicious intent, then a Nganga was consulted first. It was believed that strong and above all persistent fever was "supernatural". In this case, traditional treatment was thought to be best.

Conclusions: Results indicate that fever is perceived as a dual condition, with two distinct but non-mutually exclusive aetiologies (either "natural" or from witchcraft). In contrast with what is commonly believed, there seems to be no clear cut distinction between diseases suitable for management by western medicine and diseases to be managed solely by traditional health practitioners. Moreover, these data do not support the commonly held notion that the decision to seek western medicine to treat fever is considered a "last resort". Results strongly imply that some severe cases of fever, being initially considered supernatural, may partially or completely escape medical attention.

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Selected References

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  • Nchinda TC. Malaria: a reemerging disease in Africa. Emerg Infect Dis. 1998 Jul-Sep;4(3):398–403. [PMC free article] [PubMed]
  • Kidane G, Morrow RH. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet. 2000 Aug 12;356(9229):550–555. [PubMed]
  • Perdiguero E, Bernabeu J, Huertas R, Rodríguez-Ocaña E. History of health, a valuable tool in public health. J Epidemiol Community Health. 2001 Sep;55(9):667–673. [PMC free article] [PubMed]
  • Lam TP. Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese. J Epidemiol Community Health. 2001 Oct;55(10):762–765. [PMC free article] [PubMed]
  • McCombie SC. Treatment seeking for malaria: a review of recent research. Soc Sci Med. 1996 Sep;43(6):933–945. [PubMed]
  • McCombie SC. Self-treatment for malaria: the evidence and methodological issues. Health Policy Plan. 2002 Dec;17(4):333–344. [PubMed]
  • Feyisetan BJ, Asa S, Ebigbola JA. Mothers' management of childhood diseases in Yorubaland: the influence of cultural beliefs. Health Transit Rev. 1997 Oct;7(2):221–234. [PubMed]
  • Breman JG. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2):1–11. [PubMed]
  • Snow RW, Craig M, Deichmann U, Marsh K. Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population. Bull World Health Organ. 1999;77(8):624–640. [PMC free article] [PubMed]
  • Greenwood BM, Bradley AK, Greenwood AM, Byass P, Jammeh K, Marsh K, Tulloch S, Oldfield FS, Hayes R. Mortality and morbidity from malaria among children in a rural area of The Gambia, West Africa. Trans R Soc Trop Med Hyg. 1987;81(3):478–486. [PubMed]
  • Greenwood B. Malaria mortality and morbidity in Africa. Bull World Health Organ. 1999;77(8):617–618. [PMC free article] [PubMed]
  • Deloron P, Ringwald P, Luty AJ, Renaut A, Minh TN, Mbessy JR, Millet P. Relationships between malaria prevalence and malaria-related morbidity in school children from two villages in central Africa. Am J Trop Med Hyg. 1999 Jul;61(1):99–102. [PubMed]
  • Domarle O, Migot-Nabias F, Mvoukani JL, Lu CY, Nabias R, Mayombo J, Tiga H, Deloron P. Factors influencing resistance to reinfection with Plasmodium falciparum. Am J Trop Med Hyg. 1999 Dec;61(6):926–931. [PubMed]
  • Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. BMJ. 2000 Jan 8;320(7227):114–116. [PMC free article] [PubMed]
  • Mwenesi HA, Harpham T, Marsh K, Snow RW. Perceptions of symptoms of severe childhood malaria among Mijikenda and Luo residents of coastal Kenya. J Biosoc Sci. 1995 Apr;27(2):235–244. [PubMed]
  • Tarimo DS, Lwihula GK, Minjas JN, Bygbjerg IC. Mothers' perceptions and knowledge on childhood malaria in the holendemic Kibaha district, Tanzania: implications for malaria control and the IMCI strategy. Trop Med Int Health. 2000 Mar;5(3):179–184. [PubMed]
  • Molyneux CS, Mung'Ala-Odera V, Harpham T, Snow RW. Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya. Trop Med Int Health. 1999 Dec;4(12):836–845. [PubMed]
  • Baume C, Helitzer D, Kachur SP. Patterns of care for childhood malaria in Zambia. Soc Sci Med. 2000 Nov;51(10):1491–1503. [PubMed]
  • Mwenesi H, Harpham T, Snow RW. Child malaria treatment practices among mothers in Kenya. Soc Sci Med. 1995 May;40(9):1271–1277. [PubMed]
  • Espino F, Manderson L. Treatment seeking for malaria in Morong, Bataan, the Philippines. Soc Sci Med. 2000 May;50(9):1309–1316. [PubMed]
  • Miguel CA, Tallo VL, Manderson L, Lansang MA. Local knowledge and treatment of malaria in Agusan del Sur, The Philippines. Soc Sci Med. 1999 Mar;48(5):607–618. [PubMed]
  • Muela Susanna Hausmann, Ribera Joan Muela, Mushi Adiel K, Tanner Marcel. Medical syncretism with reference to malaria in a Tanzanian community. Soc Sci Med. 2002 Aug;55(3):403–413. [PubMed]
  • Oberländer L, Elverdan B. Malaria in the United Republic of Tanzania: cultural considerations and health-seeking behaviour. Bull World Health Organ. 2000;78(11):1352–1357. [PMC free article] [PubMed]
  • Snow RW, Armstrong JR, Forster D, Winstanley MT, Marsh VM, Newton CR, Waruiru C, Mwangi I, Winstanley PA, Marsh K. Childhood deaths in Africa: uses and limitations of verbal autopsies. Lancet. 1992 Aug 8;340(8815):351–355. [PubMed]
  • Alonso PL, Bowman A, Marsh K, Greenwood BM. The accuracy of the clinical histories given by mothers of seriously ill African children. Ann Trop Paediatr. 1987 Sep;7(3):187–189. [PubMed]
  • Théra MA, D'Alessandro U, Thiéro M, Ouedraogo A, Packou J, Souleymane OA, Fané M, Ade G, Alvez F, Doumbo O. Child malaria treatment practices among mothers in the district of Yanfolila, Sikasso region, Mali. Trop Med Int Health. 2000 Dec;5(12):876–881. [PubMed]
  • Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001 May 5;322(7294):1115–1117. [PMC free article] [PubMed]

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