‘I don’t want all my babies to go to the grave’: perceptions of preterm birth in Southern Malawi

Tolhurst, Rachel; Theobald, Sally; Kayira, Edith; Ntonya, C.; Kafulafula, George; Nielson, Jim; Broek, Nynke van den

doi:10.1016/j.midw.2006.09.003

Cited by 26 publications

(30 citation statements)

References 16 publications

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“…Female elders have previously been demonstrated to have an important role in treatment-seeking decision-making in Malawi [30–32]. Despite this, health education programmes in Malawi rarely seek to involve grandmothers [31].…”

Section: Discussionmentioning

confidence: 99%

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Ewing

Tolhurst

Kapinda

et al. 2016

Malar J

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BackgroundThis study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations. Qualitative data collection included 12 focus group discussions and 22 critical incident interviews conducted in the local language, with primary caregivers of children who had recently experienced a febrile episode.ResultsLow geographic accessibility to facilities inhibited care-seeking, sometimes by extending the ‘assessment period’ for a child’s illness episode, and led to delays in seeking formal treatment, particularly when the illness occurred at night. Although carers attempted to avoid incurring costs, cash was often needed for transport and food. Whilst in all communities fathers were normatively responsible for treatment costs, mothers generally had greater access to and control over resources and autonomy in decision-making in the matrilineal and matrilocal communities in the central part of the district, which were also closer to formal facilities.ConclusionsThis study illustrates the complex interplay between geographic access and gender dynamics in shaping decisions on whether and when formal treatment is sought for febrile children in Chikwawa District. Geographic marginality and cultural norms intersect in remote areas both to increase the logistical and anticipated financial barriers to utilising services and to reduce caretakers’ autonomy to act quickly once they recognize the need for formal care. Health education campaigns should be based within communities, engaging all involved in treatment-seeking decision-making, including men and grandmothers, and should aim to promote the ability of junior women to influence the treatment-seeking process. Both mothers’ financial autonomy and fathers financial contributions are important to enable timely access to effective healthcare for children with malaria.

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Section: Discussionmentioning

confidence: 99%

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Ewing

Tolhurst

Kapinda

et al. 2016

Malar J

Self Cite

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“…Women sometimes described feeling disrespected by health staff, whereas the nurses reported frustration when women did not heed their advice. Research commonly highlights that women complain of abuse, neglect, mistreatment or intimidation at health centers, while health workers describe women as unhelpful, [20], [44], [45], [46] and that reprimands from health staff can discourage attendance [30], [33], [47], [48], [49], [50], [51], [52], [53], [54].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Attendance at and Timing of Formal Antenatal Care: Results from a Qualitative Study in Madang, Papua New Guinea

et al. 2014

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BackgroundAppropriate antenatal care (ANC) is key for the health of mother and child. However, in Papua New Guinea (PNG), only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea.MethodsData were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members.ResultsAlthough generally reported to be important, respondents’ understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost) as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit.ConclusionsThis long-term in-depth study (the first of its kind in Madang, PNG) shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff’s attitudes towards pregnant women.

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“…This highlights an area requiring focused community-engagement and health promotion activities. Community-engagement can provide opportunities for community reflection on current practices and enable the community themselves to establish appropriate changes [37]. Involving influential decision-makers, such as grandmothers, has been shown to positively influence treatment-seeking behaviour [38].…”

Section: Discussionmentioning

confidence: 99%

“…Involving influential decision-makers, such as grandmothers, has been shown to positively influence treatment-seeking behaviour [38]. Consideration should also be given to involving non-formal providers, such as traditional healers, who hold local importance in treating such traditional causes of illness [37]. …”

Section: Discussionmentioning

confidence: 99%

Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi

et al. 2015

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BackgroundUniversal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced.MethodsQualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children.Findings and ConclusionThe phrase ‘kutentha thupi’, or ‘hot body’ was used to describe fever, the most frequently mentioned causes of which were malungo (translated as ‘malaria’), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1—Assessment; Phase 2—Seeking care outside the home; Phase 3—Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.

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‘I don’t want all my babies to go to the grave’: perceptions of preterm birth in Southern Malawi

Cited by 26 publications

References 16 publications

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Factors Affecting Attendance at and Timing of Formal Antenatal Care: Results from a Qualitative Study in Madang, Papua New Guinea

Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi

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