Volume 92, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of “traditional” versus “hospital” illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of . Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Greenwood BM, Bojang K, Whitty CJM, Targett GA, , 2005. Malaria. Lancet 365: 14871498.[Crossref] [Google Scholar]
  2. World Health Organization, 2013. World Malaria Report 2013. Available at: http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/. Accessed September 18, 2014. [Google Scholar]
  3. Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D'Alessandro U, Coosemans M, , 2006. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg 75: 219225. [Google Scholar]
  4. President's Malaria Initiative. Uganda: Malaria Operational Plan, 2014. Available at: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy14/uganda_mop_fy14.pdf. Accessed March 13, 2015.
  5. Dondorp AM, Fanello CI, Hendriksen ICE, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ, AQUAMAT group, , 2010. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet 376: 16471657.[Crossref] [Google Scholar]
  6. Krishna S, , 2012. Adjunctive management of malaria. Curr Opin Infect Dis 25: 484488.[Crossref] [Google Scholar]
  7. Obonyo CO, Vuvule J, Akhwale WS, Grobbee DE, , 2007. In-hospital morbidity and mortality due to severe malarial anemia in western Kenya. Am J Trop Med Hyg 77: 2328. [Google Scholar]
  8. Lutalo SKK, Bakyayita N, Lyimo E, Wanyana J, Sekitto G, Odiit A, Tumwesigire S, , 2000. Report on Monitoring and Evaluation of Roll Back Malaria in the African Region: Baseline Data for Uganda. Kampala, Uganda: Uganda Ministry of Health. Available at: http://pdf.usaid.gov/pdf_docs/pnadu090.pdf. [Google Scholar]
  9. Maslove DM, Mnyusiwalla A, Mills EJ, McGowan J, Attaran A, Wilson K, , 2009. Barriers to the effective treatment and prevention of malaria in Africa: a systematic review of qualitative studies. BMC Int Health Hum Rights 9: 26.[Crossref] [Google Scholar]
  10. Winch PJ, Makemba AM, Kamazima SR, Lurie M, Lwihula GK, Premji Z, Minjas JN, Shiff CJ, , 1996. Local terminology for febrile illnesses in Bagamoyo District, Tanzania and its impact on the design of a community-based malaria control programme. Soc Sci Med 42: 10571067.[Crossref] [Google Scholar]
  11. Mwenesi H, Harpham T, Snow RW, , 1995. Child malaria treatment practices among mothers in Kenya. Soc Sci Med 40: 12711277.[Crossref] [Google Scholar]
  12. Kengeya-Kayondo JF, Seeley JA, Kajura-Bajenja E, Kabunga E, Mubiru E, Sembajja F, Mulder DW, , 1994. Recognition, treatment seeking behaviour and perception of cause of malaria among rural women in Uganda. Acta Trop 58: 267273.[Crossref] [Google Scholar]
  13. De Beadrap P, Nabsumba C, Grandesso F, Turyakira E, Schramm B, Boum Y, Etard J-F, , 2011. Heterogenous decrease in malaria prevalence in children over a 6-year period in south-western Uganda. Malar J 10: 132.[Crossref] [Google Scholar]
  14. McKombie SC, , 1996. Treatment seeking for malaria: a review of recent research. Soc Sci Med 43: 933945.[Crossref] [Google Scholar]
  15. Beiersmann C, Aboubakary S, Wladarsch E, De Allegri M, Kouyaté B, Müller O, , 2007. Malaria in rural Burkina Faso: local illness concepts, patterns of traditional treatment and influence on health-seeking behaviour. Malar J 6: 106.[Crossref] [Google Scholar]
  16. Houngbedji CA, N'Dri PB, Hürlimann E, Yapi RB, Silué KD, Soro G, Koudou BG, Acka CA, Assi SB, Vounatsou P, N'Goran EK, Fantodji A, Utzinger J, Raso G, , 2015. Disparities of Plasmodium falciparum infection, malaria-related morbidity and access to malaria prevention and treatment among school-aged children: a national cross-sectional survey in Côte d'Ivoire. Malar J 14: 7.[Crossref] [Google Scholar]
  17. Sachs J, Malaney P, , 2002. The economic and social burden of malaria. Nature 415: 680685.[Crossref] [Google Scholar]
  18. World Health Organization, 1990. Severe and complicated Malaria. Trans R Soc Trop Med Hyg 84 (Suppl 2): 165. [Google Scholar]
  19. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K, , 2013. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 40: 112.[Crossref] [Google Scholar]
  20. Corbin J, Strauss A, , 2008. Basics of Qualitative Research. 3rd edition. London, United Kingdom: Sage Publications. [Google Scholar]
  21. Hsieh HF, Shannon SE, , 2005. Three approaches to qualitative content analysis. Qual Health Res 15: 1277.[Crossref] [Google Scholar]
  22. Konde-Lule J, Gitta SN, Lindfors A, Okuonzi S, Onama VON, Forsberg BC, , 2010. Private and public health care in rural areas of Uganda. BMC Int Health Hum Rights 10: 29.[Crossref] [Google Scholar]
  23. Uganda National Household Survey Findings 2009/2010. Uganda Bureau of Statistics. Available at: http//:www.ubos.org/UNHS0910/chapter7.Average%20Monthly%20Household%20Income.html. Accessed September 21, 2014.
  24. Ingstad B, Munthali AC, Braathen SH, Grut L, , 2012. The evil circle of poverty: a qualitative study of malaria and disability. Malar J 11: 15.[Crossref] [Google Scholar]
  25. Chourasia MK, Abraham VJ, John J, , 2014. Household training vs. mass campaigns: a better method of health communication for preventing malaria. Trop Doct 44: 196200.[Crossref] [Google Scholar]
  26. Gomes MF, Warsame M, Nasemba N, Singlovic J, Kapinga A, Mwakuyse S, Mrango Z, , 2010. Gaining time: early treatment of severe pediatric malaria in Tanzania. Drug Dev Res 71: 9298. [Google Scholar]
  27. Makundi EA, Malebo HM, Mhame P, Kitua AY, Warsame M, , 2006. Role of traditional healers in the management of severe malaria among children below five years of age: the case of Kilosa and Handeni Districts, Tanzania. Malar J 5: 58.[Crossref] [Google Scholar]
  28. Espino F, Manderson L, Acuin C, Domingo F, Ventura E, , 1997. Perceptions of malaria in a low endemic area in the Philippines: transmission and prevention of disease. Acta Trop 63: 221239.[Crossref] [Google Scholar]
  29. Williams HA, Jones CO, , 2004. A critical review of behavioral issues related to malaria control in sub-Saharan Africa: what contributions have social scientists made? Soc Sci Med 59: 501523.[Crossref] [Google Scholar]
  30. Audet CM, Sidat M, Blevins M, Moon TD, Vergara A, Vermund SH, , 2012. HIV knowledge and health-seeking behavior in Zambézia Province, Mozambique. SAHARA J 9: 4146.[Crossref] [Google Scholar]
  31. Bodeker G, Kabatesi D, King R, Homsy J, , 2009. A regional task force on traditional medicine and AIDS. Lancet 355: 1284.[Crossref] [Google Scholar]
  32. Bodeker G, Carter G, Burford G, Dvorak-Little M, , 2006. HIV/AIDS: traditional systems of health care in the management of a global epidemic. J Altern Complement Med 12: 563576.[Crossref] [Google Scholar]
  33. Homsy J, King R, Tenywa J, Kyeyune P, Opio A, Balaba D, , 2004. Defining minimum standards of practice for incorporating African traditional medicine into HIV/AIDS prevention, care, and support: a regional initiative in eastern and southern Africa. J Altern Complement Med 10: 905910.[Crossref] [Google Scholar]
  34. Farmer P, , 2004. An anthropology of structural violence. Curr Anthropol 45: 305325.[Crossref] [Google Scholar]
  35. Farmer PE, Nizeye B, Stulac S, Keshavjee S, , 2006. Structural violence and clinical medicine. PLoS Med 3: e449.[Crossref] [Google Scholar]
  36. Sachs JD, , 2005. The End of Poverty. London, United Kingdom: Penguin Press. [Google Scholar]

Data & Media loading...

  • Received : 05 Dec 2014
  • Accepted : 13 Feb 2015
  • Published online : 06 May 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error