Local fever illness classifications: implications for home management of malaria strategies

Abstract

Summary Background The Ugandan Ministry of Health has adopted the WHO Home Based Fever Management strategy (HBM) to improve access to antimalarial drugs for prompt (<24 h) presumptive treatment of all fevers in children under 5 years. Village volunteers will distribute pre‐packed antimalarials free of charge to caretakers of febrile children 2 months to 5 years (‘Homapaks’). Objective To explore the local understanding and treatment practices for childhood fever illnesses and discuss implications for the HBM strategy. Methods Focus Group Discussions were held with child caretakers in three rural communities in Kasese district, West Uganda, and analysed for content in respect to local illness classifications and associated treatments for childhood fevers. Results Local understanding of fever illnesses and associated treatments was complex. Some fever illness classifications were more commonly mentioned, including ‘Fever of Mosquito’, ‘Chest Problem’, ‘the Disease’, ‘Stomach Wounds’ and ‘Jerks’, all of which could be biomedical malaria. Although caretakers refer to all these classifications as ‘fever’ treatment differed; some were seen as requiring urgent professional western treatment and others were considered severe but ‘non‐western’ and would preferentially be treated with traditional remedies. Conclusions The HBM strategy does not address local community understanding of ‘fever’ and its influence on treatment. While HBM improves drug access, Homapaks are likely to be used for only those fevers where ‘western’ treatment is perceived appropriate, implying continued delayed and under‐treatment of potential malaria. Hence, HBM strategies also need to address local perceptions of febrile illness and adapt information and training material accordingly.

The Role of Community Participation in Intermittent Preventive Treatment of Childhood Malaria in South-Eastern Ghana

“…The perceived reduction in morbidity may lead to improvement in general health and well-being of the children and the communities as a whole. This also confirmed suggestions made in earlier studies 15,[19][20][21][22][23] that the best approach to managing malaria in endemic zones is to introduce an intervention at the community level, especially for vulnerable groups and hard to reach areas. 18 Benefits of improved health are enormous as children had the strength to go to school, play and stay-off their caregivers.…”

It is Possible: Availability of Lymphedema Case Management in each Health Facility in Togo. Program Description, Evaluation, and Lessons Learned

“…This feature is similar to that in many other countries who use CHWs for similar activities. [23][24][25] The ability to use this extensive network of health staff enabled quicker implementation of services and ultimately more extensive patient enrollment. We found that 79% of the patients identified during an evaluation were enrolled in the program and 79% of the patients enrolled were making yearly dispensary visits.…”

Home and community management of acute respiratory infections in children in eight Ugandan districts

“…The local term for 'hot body' was used to ask about fever and, as biomedical terms to describe breathing rarely had exact equivalents in the local languages, 19 locally appropriate concepts of illness including symptoms of difficult and/or rapid breathing (DRB) were used for acute respiratory infection. This symptom combination and acronym will be in quotes throughout the paper to highlight that these are symptoms reported by mothers and do not necessarily correspond with clinical symptoms.…”