Lay people’s responses to illness: An ethnographic study of anti-malaria behavior among the Abagusii of southwestern Kenya

Abstract

Malaria is re-emerging with a vengeance after near eradication a generation ago. In Africa, it kills between 1 and 2 million people, mostly children, each year and many more are incapacitated leading to enormous human and economic loss. I present data on responses to malaria among the Abagusii, an agricultural, Bantu-speaking people who inhabit the fertile rainy highlands of southwestern Kenya. Data on knowledge of common illnesses in Bomorenda, the site for the study, and malaria symptoms, were collected using systematic ethnographic methods. Malaria-focused narratives from 35 informants yielded additional ethnographic information of lay people’s responses. The study reveals that Abagusii have multiple notions of malaria causation. A majority (85.7%) consider the mosquito as the major cause of malaria. Other causes are eating sugary foods (57.1%) and witchcraft (34.3%). They assign naturalistic causation as well as associate malaria with environmental dangers. These findings support the indigenous contagion theory. Abagusii recognize the same symptoms as those in the clinical case definition of malaria. Using symptom salience as a measure of importance, headache (salience = .447), shivering (.393), fever (.226), vomiting (.188) and paining joints (.158) are the top five symptoms. Transition state probability results show that the longer the illness lasts, the more likely that the illness will be treated outside the home (transition probability =.772). Over 82% of lay people report self-treatment as a first choice (t). The percentage of people who use self-treatment drops to 12.5% at the time of second choice (t+1) and zero at time three (t+2) while those who seek treatment outside the home increases. Illnesses that last long are regarded as serious and patients prefer taking those illnesses to private or public health care facilities where they are likely to get specialized attention (Fisher’s exact test p < .0001, Cramer’s V = .719). Lay people in Gusii purchase a variety of drugs for malaria management from local shops. A cognitive map of informants reveals that they arrange these drugs along a dimension based on age of the patient and along a malaria–analgesic drugs dimension. Although informants have good knowledge regarding drug dosage, sometimes they get wrong information about the administration of different drugs. This has implications for the immediate management of malaria and for the long-term effects of improper use including the development of drug resistant parasites. Three quadratic assignment procedure (QAP) analyses indicate no gender differences with regard to lay people’s responses to malaria-focused ethnographic interviews and similarity among illnesses and malaria drugs. The r-square for the three QAP analyses range between 0.72 and 0.88. A biocultural model is used to show that ecological and cultural factors play an important role in sustaining mosquito density in Bomorenda. Farming practices and type of houses constructed provide optimal conditions for Anopheline mosquitoes that transmit Plasmodium parasites. The utility of the biocultural model is assessed and policy implications drawn.