Kamat Vinay R
University of British Columbia, Vancouver, BC, Canada.
Soc Sci Med. 2006 Jun;62(12):2945-59. doi: 10.1016/j.socscimed.2005.11.042. Epub 2006 Jan 5.
Economic considerations are often cited as important determinants of health-seeking behavior. This paper describes a situation in peri-urban Tanzania where user fees do not constitute the primary reason why mothers delay seeking prompt treatment at a public health facility for their young, febrile children. Mothers commonly believe that they are dealing with an ordinary fever and not malaria or any other serious illness complicated by fever. Hence, they engage in extended home-based treatment. Drawing upon an ethnographic study, this paper illustrates how cultural knowledge about disease symptomatology, cultural meanings associated with febrile illness, gender relations, and patterns of communication between health care providers and mothers significantly influence outcomes for childhood febrile illnesses. It is argued that an overemphasis on the correlation between user fees and treatment delays with regard to childhood illnesses tends to divert attention from other significant cultural factors and existing structural constraints that influence the dynamics of health care seeking and health outcomes. At a time when calls to implement artemisinine-based combination therapy as one of the front-line strategies in Tanzania are increasingly frequent, there is a need to pay closer attention to the contextual factors and socio-cultural dynamics that influence patterns of treatment-seeking for childhood malaria.
经济因素常被视为寻求医疗行为的重要决定因素。本文描述了坦桑尼亚城郊的一种情况，即使用费并非母亲们推迟为发热幼儿在公共卫生机构寻求及时治疗的主要原因。母亲们通常认为她们面对的只是普通发烧，而非疟疾或其他任何由发烧引发的严重疾病。因此，她们会进行长时间的家庭治疗。基于一项人种志研究，本文阐述了关于疾病症状的文化知识、与发热疾病相关的文化意义、性别关系以及医疗服务提供者与母亲之间的沟通模式如何显著影响儿童发热疾病的治疗结果。有人认为，过度强调使用费与儿童疾病治疗延误之间的关联，往往会使人们的注意力从其他重要的文化因素和现有的结构限制因素上转移，而这些因素会影响寻求医疗服务的动态过程和健康结果。在坦桑尼亚，将以青蒿素为基础的联合疗法作为一线治疗策略之一的呼声日益频繁之际，有必要更加密切地关注影响儿童疟疾治疗寻求模式的背景因素和社会文化动态。
