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"We have become doctors for ourselves": motives for malaria self-care among adults in southeastern Tanzania.

Citation: 
Emmy Metta, Hinke Haisma, Flora Kessy et al. "We have become doctors for ourselves": motives for malaria self-care among adults in southeastern Tanzania. Malaria Journal 2014, 13:249 (2 July 2014)
Abstract / Summary: 
Abstract Background: Prompt and appropriate treatment of malaria with effective medicines remains necessary if malaria control goals are to be achieved. The theoretical concepts from self-care and the health belief model were used to examine the motivations for malaria self-care among the adult population.   Methods: A qualitative study was conducted through eight focus group discussions with adult community members to explore their general opinions, views and perceptions of malaria and of its treatments. These groups were followed by 15 in-depth interviews of participants with a recent malaria experience to allow for an in-depth exploration of their self-care practices. The analysis followed principles of grounded theory and was conducted using Nvivo 9 qualitative data management software.   Results: The self-treatment of malaria at home was found to be a common practice among the study participants. The majority of the participants practiced self-medication with a painkiller as an initial response. The persistence and the worsening of the disease symptoms prompted participants to consider other self-care options. Perceptions that many malaria symptoms are suggestive of other conditions motivated participants to self-refer for malaria test. The accessibility of private laboratory facilities and drug shops motivated their use for malaria tests and for obtaining anti-malarial medicines, respectively. Self-treatment with anti-malarial monotherapy was common, motivated by their perceived effectiveness and availability. The perceived barriers to using the recommended combination treatment, artemether-lumefantrine, were related to the possible side-effects and to uncertainty about their effectiveness, and these doubts motivated some participants to consider self-medication with local herbs. Several factors were mentioned as motivating people for self-care practices. These included poor patient provider relationship, unavailability of medicine and the costs associated with accessing treatments from the health facilities.   Conclusions: Malaria self-care and self-treatment with anti-malarial monotherapy are common among adults, and are motivated by both individual characteristics and the limitations of the existing health care facilities. There is a need for public health interventions to take into account community perceptions and cultural schemas on malaria self-care practices.
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Selected extracts: 
'Malaria self-care and self-treatment with anti-malarial monotherapy are common among adults, and are motivated by both individual characteristics and the limitations of existing health care facilities. Several factors were mentioned as motivating people for self-care practices. These included poor patient provider relationship, unavailability of medcine and the costs associated with accessing treatments from the health facilities. There is a need for public health interventions to take into account community perceptions and cultural schemas on malaria self-care practices.'
 
'There appears to be a large reservoir of medical knowledge in the community on malaria and its treatments. This might be due to the social marketing interventions in the area, coupled with individuals' multiple exposure to bouts of the disease and to its treatments. Thus, self-diagnosis and self-prescription were often reported by the study participants.'
 
'The perceptions that some malaria symptoms resemble those associated with a urinary tract infection (UTI) or typhoid were among the reasons cited for choosing to take a malaria test. The participants observed that self-diagnosis could lead to the wrong choice of medications, leaving the true cause of the condition untreated, and thus prolonging the duration of the illness'
 
'Alternative medicines, such as neem tree roots and leaves (mwarobaini), were frequently mentioned as being used for treating malaria in the community... many people doubt the efficacy of the recommended treatments for malaria, and thus prefer to use local herbs.'
 
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Emmy Metta, Hinke Haisma, Flora Kessy et al.

Year published: 
2014
Month published: 
July