Malaria:lay people's lived experience in Rigoma division, Nyamira district, Kenya

Abstract

This study was designed to investigate lay people's malaria lived experiences in Rigoma division, Nyamira district. Rigoma is situated in a malaria epidemic-prone region in the southwestern highlands of Kenya. It is inhabited by the agricultural Gusii community. The objectives of the study are; (1) to describe the factors that determine the health seeking behaviour of malaria patients, (ii) to investigate the lay peoples perceptions on malaria signs and symptoms, (iii) to establish the health care options available to malaria patients, and (iv) the patient's response time in seeking health care. Fieldwork was carried out during the months of January to March 2001. Data was mainly collected through case histories from 55 purposely selected respondents. The selected respondents must have suffered a bout of malaria within the last three weeks prior to the study. Additional data was obtained through direct observation and four Focus Group Discussions (FGDs) from the four locations in the division. This yielded qualitative and quantitative data. Qualitative data were thematically analysed, while quantitative data were summarised into frequencies and percentages. Further systematic data was collected (22 respondents) using free listing method and analysed using ANTHROPIC. Results are interpreted using Explanatory Models. Explanatory models were considered suitable for this study, as they are concerned with people's lived experiences with illness. The study results reveal that various factors influenced lay people's health seeking behaviour. Cost of treatment, distance from health facility, disease severity, patient's social networks and service delivery emerged as the common factors that influenced patients' health care choices. It is also clear from the 55 case histories that the respondents are fairly knowledgeable on malaria aetiology, its signs and symptoms and treatment. However this level of understanding did not seem to translate into proper control and preventive measures, as there existed some knowledge gaps. For instance. about 26 % of the respondents reported multiple causality for malaria, while the 12 respondents who provided health care to children in the study sample, found it difficult to diagnose malaria in children. This has greatly affected the lay people's coping strategies against malaria infection. The study further reveals that there are several treatment options available for malaria patients in the area. The options available to the people include; self-medication, local private and public health facilities. Indeed 87.3 % of the respondents began treatment at home and reported using formal health facilities as subsequent options. Generally, most respondents (81.8 %) took 1-3 days to seek medical care upon realization that they had malaria. Specifically, 43.6 % took one day, 21.8 % took two days and 16.4 % took three days. Only 18.2 % took over three days. To help bridge the existing knowledge gaps about malaria aetiology and its control and prevention measures, it is recommended that a public health education program be initiated in the area. There is also a-need for the health authorities to establish a monitoring and surveillance system, which will provide for proper forecasting of malaria epidemics in the area. Thus helping to mobilize resources for effective management of the epidemics. This will greatly help to check the high transmission rates associated with malaria epidemics. The scientific testing of the efficacy levels of the reported traditional remedies and the promotion of bed net use in the area are also recommended to be given due attention.