O'Neill Sarah, Gryseels Charlotte, Dierickx Susan, Mwesigwa Julia, Okebe Joseph, d'Alessandro Umberto, Peeters Grietens Koen
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
School of Anthropology, University of Oxford, Oxford, UK.
Malar J. 2015 Apr 24;14:167. doi: 10.1186/s12936-015-0687-2.
As the disease burden in the Gambia has reduced considerably over the last decade, heterogeneity in malaria transmission has become more marked, with infected but asymptomatic individuals maintaining the reservoir. The identification, timely diagnosis and treatment of malaria-infected individuals are crucial to further reduce or eliminate the human parasite reservoir. This ethnographic study focused on the relationship between local beliefs of the cause of malaria and treatment itineraries of suspected cases.
An ethnographic qualitative study was conducted in twelve rural communities in the Upper River Region and the Central River Region in the Gambia. The data collection methods included in-depth interviews, participant observation, informal conversations, and focus group discussions.
While at first glance, the majority of people seek biomedical treatment for 'malaria', there are several constraints to seeking treatment at health centres. Certain folk illnesses, such as Jontinooje and Kajeje, translated and interpreted as 'malaria' by healthcare professionals, are often not considered to be malaria by local populations but rather as self-limiting febrile illnesses--consequently not leading to seeking care in the biomedical sector. Furthermore, respondents reported delaying treatment at a health centre while seeking financial resources, and consequently relying on herbal treatments. In addition, when malaria cases present symptoms, such as convulsions, hallucinations and/or loss of consciousness, the illness is often interpreted as having a supernatural aetiology, leading to diagnosis and treatment by traditional healers.
Although malaria diagnostics and treatment-seeking in the biomedical sector has been reported to be relatively high in the Gambia compared to other sub-Saharan African countries, local symptom interpretation and illness conceptions can delay or stop people from seeking timely biomedical treatment, which may contribute to maintaining a parasite reservoir of undiagnosed and untreated malaria patients.
在过去十年中，冈比亚的疾病负担已大幅减轻，疟疾传播的异质性变得更加明显，受感染但无症状的个体成为了传染源。识别、及时诊断和治疗疟疾感染个体对于进一步减少或消除人类寄生虫传染源至关重要。这项人种志研究聚焦于当地对疟疾病因的看法与疑似病例治疗行程之间的关系。
在冈比亚上河区和中河区的十二个农村社区开展了一项人种志定性研究。数据收集方法包括深度访谈、参与观察、非正式交谈和焦点小组讨论。
乍一看，大多数人会寻求生物医学治疗来应对“疟疾”，但在卫生中心寻求治疗存在一些限制因素。某些民间疾病，如被医护人员翻译并解释为“疟疾”的琼蒂诺杰（Jontinooje）和卡杰杰（Kajeje），当地居民通常不认为是疟疾，而是自限性发热疾病，因此不会前往生物医学领域就医。此外，受访者表示在筹集资金时会延迟在卫生中心的治疗，从而依赖草药治疗。此外，当疟疾病例出现抽搐、幻觉和/或意识丧失等症状时，这种疾病通常被解释为具有超自然病因，导致由传统治疗师进行诊断和治疗。
尽管据报道，与其他撒哈拉以南非洲国家相比，冈比亚生物医学领域的疟疾诊断和寻求治疗的比例相对较高，但当地对症状的解读和疾病观念可能会导致人们延迟或停止寻求及时的生物医学治疗，这可能有助于维持未诊断和未治疗疟疾病人的寄生虫传染源。
