A study on presumptive diagnosis and home management of childhood malaria among Nomadic Fulani in Demsa, Nigeria

Magister Public Health - MPHDespite their high level of exposure, vulnerability and uniquely itinerant culture, the local knowledge of the nomadic Fulani population is not taken into account in the development of Nigeria’s home management of malaria policy. Programme-relevant information for extending access to an ethnographic study of factors that nomads use for presumption of malaria in children was collected from dry-season campsites in Demsa Local Government Area of Northeastern Nigeria. Mothers of under-five children with previous experiences at presumptive malaria management from 9 randomly selected nomadic Fulani camps were interviewed. The obtained information was used to develop a guide for key informant interviews of nomadic Fulani cultural consultants and elders, health service providers and policymakers. Findings indicate that nomads presume malaria when a child has “hot body” or lack appetite. Nomads believe that fever accumulates in the body as one steps on wet grounds during the rains. The nascent disease is triggered by the consumption of fruits that resemble the colour of urine such as the light complexioned skin of the Fulani. Fever is therefore regarded as natural affliction of the Fulani for which there is no cure. All fevers are referred to as paboje and expected to go away on the third recrudescence. Fever that persists after the third recurrence is called djonte which is treated at home without health facility support. Besides physical accessibility, the unfriendliness and lack of respect of health personnel for nomadic Fulani culture were reasons for avoiding health facilities. These factors encourage home management of djonte with antimalaria on the presumption that they are all malaria-induced. The nomads are willing to participate in interventions that will improve management of fevers and malaria among them. Although this preliminary study provides the foundation for appreciating the basis of home management of malaria among the nomads, complementary quantitative information will be required for holistic understanding of how these factors may interrelate to influence malaria intervention programme for the nomadic Fulani.South Afric

Illness-related practices for the management of childhood malaria among the Bwatiye people of north-eastern Nigeria

BACKGROUND: A wide range of childhood illnesses are accompanied by fever,, including malaria. Child mortality due to malaria has been attributed to poor health service delivery system and ignorance. An assessment of a mother's ability to recognize malaria in children under-five was carried out among the Bwatiye, a poorly-served minority ethnic group in north-eastern Nigeria. METHODS: A three-stage research design involving interviews, participatory observation and laboratory tests was used to seek information from 186 Bwatiye mothers about their illness-related experiences with childhood fevers. RESULTS: Mothers classified malaria into male (fever that persists for longer than three days) and female (fever that goes away within three days) and had a system of determining when febrile illness would not be regarded as malaria. Most often, malaria would be ignored in the first 2 days before seeking active treatment. Self-medication was the preferred option. Treatment practices and sources of help were influenced by local beliefs, the parity of the mother and previous experience with child mortality. CONCLUSION: The need to educate mothers to suspect malaria in every case of febrile illness and take appropriate action in order to expose the underlying "evil" will be more acceptable than an insistence on replacing local knowledge with biological epidemiology of malaria. The challenge facing health workers is to identify and exploit local beliefs about aetiology in effecting management procedures among culturally different peoples, who may not accept the concept of biological epidemiology

Factors Affecting Perceived Stigma in Leprosy Affected Persons in Western Nepal

Background There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among leprosy affected person attending the Green Pastures Hospital, Pokhara municipality of western Nepal. Methods A cross-sectional study was conducted among 135 people affected by leprosy at Green Pastures Hospital and Rehabilitation Centre. Persons above the age of 18 were interviewed using a set of questionnaire form and Explanatory Model Interview Catalogue (EMIC). In addition, two sets of focused group discussions each containing 10 participants from the ward were conducted with the objectives of answering the frequently affected EMIC items. Results Among 135 leprosy affected persons, the median score of perceived stigma was 10 while it ranged from 0–34. Higher perceived stigma score was found in illiterate persons (p = 0.008), participants whose incomes were self-described as inadequate (p = 0.014) and who had changed their occupation due to leprosy (p = 0.018). Patients who lacked information on leprosy (p = 0.025), knowledge about the causes (p = 0.02) and transmission of leprosy (p = 0.046) and those who had perception that leprosy is a severe disease (p<0.001) and is difficult to treat (p<0.001) had higher perceived stigma score. Participants with disfigurement or deformities (p = 0.014), ulcers (p = 0.022) and odorous ulcers (p = 0.043) had higher perceived stigma score. Conclusion The factors associated with higher stigma were illiteracy, perceived economical inadequacy, change of occupation due to leprosy, lack of knowledge about leprosy, perception of leprosy as a severe disease and difficult to treat. Similarly, visible deformities and ulcers were associated with higher stigma. There is an urgent need of stigma reduction strategies focused on health education and health awareness programs in addition to the necessary rehabilitation support

Assessing the Effectiveness of a Community Intervention for Monkeypox Prevention in the Congo Basin

Human monkeypox is a potentially severe illness that begins with a high fever soon followed by the development of a smallpox-like rash. Both monkeypox and smallpox are caused by infection with viruses in the genus Orthopoxvirus. But smallpox, which only affected humans, has been eradicated, whereas monkeypox continues to occur when humans come into contact with infected animals. There are currently no drugs specifically available for the treatment of monkeypox, and the use of vaccines for prevention is limited due to safety concerns. Therefore, monkeypox prevention depends on diminishing human contact with infected animals and preventing person-to-person spread of the virus. The authors describe a film-based method for community outreach intended to increase monkeypox knowledge among residents of communities in the Republic of the Congo. Outreach was performed to ∼23,600 rural Congolese. The effectiveness of the outreach was evaluated using a sample of individuals who attended small-group sessions. The authors found that among the participants, the ability to recognize monkeypox symptoms and the willingness to take ill family members to the hospital was significantly increased after seeing the films. In contrast, the willingness to deter some high-risk behaviors, such as eating animal carcasses found in the forest, remained fundamentally unchanged