Beiersmann Claudia, Sanou Aboubakary, Wladarsch Evelyn, De Allegri Manuela, Kouyaté Bocar, Müller Olaf
Department of Tropical Hygiene and Public Health, Medical School, Ruprecht Karls Universität Heidelberg, INF 324, Heidelberg, Germany.
Malar J. 2007 Aug 8;6:106. doi: 10.1186/1475-2875-6-106.
The literature on health care seeking behaviour in sub-Saharan Africa for children suffering from malaria is quite extensive. This literature, however, is predominantly quantitative and, inevitably, fails to explore how the local concepts of illness may affect people's choices. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge and lead to the development of more effective malaria control interventions.
In a rural area of Burkina Faso, four local concepts of illness resembling the biomedical picture of malaria were described according to symptoms, aetiology, and treatment. Data were collected through eight focus group discussions, 17 semi-structured interviews with key informants, and through the analysis of 100 verbal autopsy questionnaires of children under-five diagnosed with malaria.
Sumaya, dusukun yelema, kono, and djoliban were identified as the four main local illness concepts resembling respectively uncomplicated malaria, respiratory distress syndrome, cerebral malaria, and severe anaemia. The local disease categorization was found to affect both treatment and provider choice. While sumaya is usually treated by a mix of traditional and modern methods, dusukun yelema and kono are preferably treated by traditional healers, and djoliban is preferably treated in modern health facilities. Besides the conceptualization of illness, poverty was found to be another important influencing factor of health care-seeking behaviour.
The findings complement previous evidence on health care-seeking behaviour, by showing how local concepts of illness strongly influence treatment and choice of provider. Local concepts of illness need to be considered when developing specific malaria control programmes.
关于撒哈拉以南非洲地区患疟疾儿童的就医行为的文献颇为丰富。然而，这些文献主要是定量研究，不可避免地未能探讨当地的疾病观念如何影响人们的选择。理解当地的疾病观念及其对就医行为的影响可以补充现有知识，并有助于制定更有效的疟疾控制干预措施。
在布基纳法索的一个农村地区，根据症状、病因和治疗方法描述了四种类似于疟疾生物医学症状的当地疾病观念。通过八次焦点小组讨论、对关键信息提供者的17次半结构化访谈以及对100份五岁以下被诊断为疟疾儿童的口头尸检问卷进行分析来收集数据。
Sumaya、dusukun yelema、kono和djoliban被确定为四种主要的当地疾病观念，分别类似于单纯性疟疾、呼吸窘迫综合征、脑型疟疾和严重贫血。发现当地的疾病分类会影响治疗和提供者的选择。虽然Sumaya通常采用传统和现代方法相结合的方式治疗，但dusukun yelema和kono最好由传统治疗师治疗，而djoliban最好在现代医疗机构治疗。除了疾病观念之外，贫困被发现是就医行为的另一个重要影响因素。
研究结果通过展示当地的疾病观念如何强烈影响治疗和提供者的选择，补充了先前关于就医行为的证据。在制定具体的疟疾控制计划时，需要考虑当地的疾病观念。
