Homapaks will likely be used promptly only for local illness classifications where

1
 Källander K1, Nsungwa-Sabiiti J2,3 ,
Nsabagasani X4, Pariyo G2, Tomson G1,5 and
Peterson S1 (1)   Division of International
Health (IHCAR), Karolinska Institutet, Sweden
(2)   Institute of Public Health, Makerere
University, Uganda (3)   Department of Clinical
Pharmacology, Makerere University, Uganda (4)  
Makerere Institute of Social Research, Makerere
University, Uganda (5) Medical Management
Centre, Karolinska Institutet, Sweden
LOCAL ILLNESS TERMS AND THE NEW HOME BASED FEVER
MANAGEMENT STRATEGY IN UGANDA
Methods
Background
Study Objective

• Study population
• Ten FGDs of 8 to 14 participants were held with
  child caretakers in three rural villages in
  Kasese district, West Uganda
• Data collection and Analysis
• An interview guide was used covering e.g. fever
  recognition, home management and care seeking
  practices
• Tape-recorded data were transcribed, translated
  into English and analysed manually, applying open
  codes freely within the structure of the
  interview guide.

• The WHO strategy Home Management of Malaria (HMM)
  is priority in many African countries and has
  been adopted by the Ugandan Ministry of Health
• The aim is to improve access to antimalarial
  drugs for prompt presumptive treatment of all
  fevers in children under-five.
• Village volunteers distribute pre-packed
  antimalarials free of charge to caretakers of
  febrile children 2 months to 5 years
  (Homapaks).

• To explore local understanding and treatment
  practices for childhood fever illnesses
• To discuss the implications for Home Management
  of Malaria strategies.

Results

• Recognition and labelling of childhood fevers
• Fever was recognised as a common illness term,
  locally referred to as Omutsutsa.
• Season, type and combination of symptoms and
  treatment outcome were some of the parameters
  used to label and classify the fever
• Six major fever related ailments were discerned
  (see Figure 1)

B I O M E D I C A L M A L A R I A
Ekyikenyera Difficult/abnormal
breathing Chest problem Cough Chest pain
Ekikangarara Very body body Jerks Convuls
ions Gasping breathing
O M U S U T S A

• First response to acute symptoms
• Most caretakers took action immediately after
  realising that the child is sick.
• Immediate actions included informing and
  consulting neighbours and relatives, cooling
  down the symptoms, washing the stomach and
  giving left over drugs.

Omusutsa owe miibu Vomiting Fever of the
mosquito Shivering Diarrhoea
Ekibale Swelling in abdomen Stomach
stone Yellow faeces Swollen legs

• Treatment options
• People often switch between traditional and
  western treatments. If western drugs did not
  work, the caretaker would switch to herbs.
• The treatment process varied according to how
  symptoms were classified and how the illness
  evolved.
• Some illness classifications were preferentially
  treated traditionally whereas others were seen to
  need western drugs

Ekirwere Pale skin The disease Diarrhoea
Convulsions
Ebironda ebyo muanda Extremely hot body Stomach
wounds Persistent diarrhoea Wounds around
mouth and anus
Hot Body
Initial action in home tepid sponging, herbs,
western drugs
Figure 1. Schematic representation of the link
between Hot Body and selected local fever
classifications. Associated first-line
care-seeking actions and possible relation to
biomedical malaria is indicated.
Discussion
Conclusions
Contact

• Homapaks will likely be used promptly only for
  local illness classifications where western
  treatment is considered appropriate.
• Unless HMM strategies address local practices and
  adapt the information to the cultural context,
  the result may be continued delay und
  under-treatment of possible malaria.
• Research is needed on the effectiveness of HMM
  strategies including community acceptance and use
  of Homapaks in relation to local traditional
  practices, as well as drug compliance studies.

Presenter Karin Källander, MSc, PhD student Div
International Health (IHCAR), Dept Public Health
Sciences, Karolinska Institutet, SE - 171 76
Stockholm, Sweden, Phone [phone] Email
karin.kallander_at_phs.ki.se

• There was a mismatch between the emic (local) and
  etic (biomedical) definitions of fever
• Most local fever illness classifications manifest
  symptoms of possible biomedical malaria.
• Only one local fever illness classification,
  fever of the mosquito is seen as needing early
  use of antimalarials.
• Two local illness classifications, stomach
  stone and the disease had symptoms indicating
  chronic and severe malaria respectively, but were
  only taken for western care if herbal treatment
  failed.