Health care switching behaviour of malaria patients in a Kenyan rural community
Introduction
Patients ordinarily use multiple sources of health care, whose choice is partly determined by the recognition of disease symptoms (Colson, 1971; Forster & Anderson, 1978; Feierman, 1981; Young, 1981; Scrimshaw & Hurtado, 1987; Hunte & Sultana, 1992; Snow, Schellenberg, Forster, Mung’ala, & Marsh 1994), perceptions of disease seriousness (Young, 1981; Ryan & Martinéz, 1996) as well as cost, distance, religious beliefs and quality of health care (e.g. Airey, 1992; Beckerleg, 1994; Amuyunzu, 1998). Using as case study the Gusii, a rural community in southwestern Kenya, I show how lay people switch from one health care source to another as time passes and as their condition persists. The term “lay people” as used throughout this paper refers to non-health professionals involved in the management of their own health problems or of the health problems of people they know.
As in many other areas of the developing world (e.g. Young, 1981; Ryan & Martinéz, 1996; Ryan, 1998), several treatment alternatives are available to lay people in Gusii. The alternatives include the application of a home remedy, self-medication with pharmaceuticals bought over-the-counter on the open market, herbal therapies provided by traditional healers as well as care provided by health centers or hospitals. A patient may also choose not to seek any therapeutic intervention (Nyamongo, 1998). Lay people choose from these treatment alternatives based on the perceived effectiveness of the particular alternatives.
In theory, treatment options are available to all seekers although, in practice, not all are utilized. This may be due to several reasons, the main one being the cost of accessing the particular health care alternative. The search for therapy may follow any one of a number of therapeutic alternatives available (Young, 1981; Hunte & Sultana, 1992) though the treatment outcomes may be unknown to patients. In fact, patients do not always get the anticipated outcome and they have no sure way to determine the type of treatment alternative that will yield the desired state or the best results.
Though unable to pre-determine treatment outcomes, patients still must prioritize their decisions. They must first order the alternatives available according to some rules of preference and they must decide on a strategy with a perceived good chance of leading to the desired results (Fjellman, 1976). If a particular treatment choice fails, patients or the person(s) responsible for their health may make new choices. As time passes, and if the illness persists, the patient becomes desperate and receptive to therapy suggested by others (Feierman, 1981; Agyepong, 1992). Deciding what treatment option to take does not always follow the same sequence in the same individual during different episodes of an illness nor need it be the same in different individuals. I show in this paper that although the majority (>80%) of lay people in Gusii rely on self-treatment as a first choice, there is a drastic reduction on use of self-treatment in subsequent choices for an illness episode. Furthermore, there is extensive switching between health care alternatives available to the patients. The decisions made by lay people can be considered as part of a chain reaction whose outcome cannot be predicted conclusively a priori.
Section snippets
Study site and data
Data were obtained from Bomorenda location in Suneka division of Kisii district over a 10-month period inclusive of the high season for malaria transmission. The area is densely populated with people whose primary occupation is small-scale agriculture. They cultivate tea, some coffee, bananas, groundnuts as well as subsistence food crops. They sell their farm produce at the local market to raise money for other activities including paying for health services.
Gusii is a high altitude area
Lay people's treatment choices
Lay people in Gusii go through different malaria treatment transitions. These are self-treatment, public health care facilities, private health care facilities, consulting a herbalist (or using herbs) as well as not doing anything. The proportion of people using self-treatment (82.9%) drops with second (12.5%) and third (0%) choices, but it increases for those using public facilities. About 38% of the people reported use of private health facilities as second treatment choice up from 5.7% and
Conclusion
Studies on health care seeking behaviour provide important information on what patients do when faced with a health problem. This study reveals that the vast majority of patients (>82%) switch from self-treatment to other alternatives of health care, usually available outside the home, if their condition persists. The results concur with Kroeger (1983), Ryan (1995), Weller, Ruebush, and Klein (1997) and Muela, Ribera, and Tanner (1998). In his study, Ryan (1995, p. 166) found that in a Kom
Acknowledgements
I would like to thank informants in Bomorenda, Suneka Division for providing the information on which this paper is based. Wenner Gren Foundation, The Deans’ Committee, University of Nairobi, and Department of Anthropology, University of Florida provided financial support during fieldwork and write-up period. H. Russell Bernard, Mary K. Amuyunzu-Nyamongo and two anonymous reviewers gave invaluable comments.
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