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Health Beliefs and Patient Perspectives of Febrile Illness in Kilombero, Tanzania
Christine Hercik
Christine Hercik
Georgetown University, Washington, District of Columbia;
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Leonard Cosmas
Leonard Cosmas
Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya;
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Ondari D. Mogeni
Ondari D. Mogeni
Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya;
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Wanze Kohi
Wanze Kohi
Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania;
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Sayoki Mfinanga
Sayoki Mfinanga
Muhimbili Research Centre, National Institute of Medical Research, Dar es Salaam, Tanzania;
Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania;
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Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania;
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Christopher Loffredo
Christopher Loffredo
Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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Joel M. Montgomery
Joel M. Montgomery
Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya;
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This qualitative study assessed the knowledge and beliefs surrounding fever syndrome among adult febrile patients seeking health care in Kilombero, Tanzania. From June 11 to July 13, 2014, 10% of all adult (≥ 15 years) febrile patients enrolled in the larger syndromic study, who presented with an axillary temperature ≥ 37.5°C and symptom onset ≤ 5 days prior, were randomly selected to participate in an in-depth physician–patient interview, informed by Health Belief Model constructs. Interviews were audio recorded, translated, and transcribed. Transcripts were coded using NVivo Version 11.1, and the thematic content was analyzed by two separate researchers. Blood and nasopharyngeal/oralpharyngeal specimens were collected and analyzed using both acute febrile illness and respiratory TaqMan Array Cards for multipathogen detection of 56 potential causative agents. A total of 18 participants provided 188 discrete comments. When asked to speculate the causative agent of febrile illness, 33.3% cited malaria and the other 66.6% offered nonbiomedical responses, such as “mosquitoes” and “weather.” Major themes emerging related to severity and susceptibility to health hazards included lack of bed net use, misconceptions about bed nets, and mosquito infestation. Certain barriers to treatment were cited, including dependence on traditional healers, high cost of drugs, and poor dispensary services. Overall, we demonstrate low concurrence in speculations of fever etiology according to patients, clinicians, and laboratory testing. Our findings contribute to the important, yet limited, base of knowledge surrounding patient risk perceptions of febrile illness and underscore the potential utility of community-based participatory research to inform disease control programs.
Author Notes
Disclosure: The funding agency (USAID) had no part in the design of this study or analysis of results.
Disclaimer: The findings and conclusions of this study are those of the authors and do not necessarily represent the views of the U.S. CDC, the Kenya Medical Research Institute (KEMRI), the National Institute for Medical Research (NIMR), or Georgetown University.
Authors’ addresses: Christine Hercik, Georgetown University, Washington, DC, E-mail: cah227@georgetown.edu. Leonard Cosmas and Joel M. Montgomery, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (US CDC), Nairobi, Kenya, E-mails: leocosmas@gmail.com or ztq9@cdc.gov. Ondari D. Mogeni, Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya, E-mail: ondarim@gmail.com. Wanze Kohi and Sayoki Mfinanga, Muhimbili Research Center, National Institute of Medical Research, Dar es Salaam, Tanzania, E-mails: wanzejoyce@hotmail.com and gsmfinanga@yahoo.com. Christopher Loffredo, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, E-mail: cal9@georgetown.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Chizema-Kawesha E, Miller JM, Steketee RW, Mukonka VM, Mukuka C, Mohamed AD, Miti SK, Campbell CC, 2010. Scaling up malaria control in Zambia: progress and impact 2005–2008. Am J Trop Med Hyg 83: 480–488.
-
2.
Manuel RJ, Reyes F, Tesfamariam A, 2005. Change in epidemiology of malaria infections in a rural area in Ethiopia. J Travel Med 12: 155–156.
-
3.
O’Meara WP, Bejon P, Mwangi TW, Okiro EA, Peshu N, Snow RW, Newton CR, Marsh K, 2008. Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya. Lancet 372: 1555–1562.
-
4.
O’Meara WP, Mangeni JN, Steketee R, Greenwood B, 2010. Changes in the burden of malaria in sub-Saharan Africa. Lancet Infect Dis 10: 545–555.
-
5.
D’Acremont V, Lengeler C, Genton B, 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J 9: 240.
-
6.
Guerra CA, Gikandi PW, Tatem AJ, Noor AM, Smith DL, Hay SI, Snow RW, 2008. The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide. PLoS Med 5: e38.
-
7.
Mmbando BP, Segeja MD, Msangeni HA, Sembuche SH, Ishengoma DS, Seth MD, Francis F, Rutta AS, Kamugisha ML, Lemnge MM, 2009. Epidemiology of malaria in an area prepared for clinical trials in Korogwe, north-eastern Tanzania. Malar J 8: 165.
-
8.
WHO, 2012. World Malaria Report. Available at: https://www.who.int/malaria/publications/world_malaria_report_2012/report/en/. Geneva, Switzerland: World Health Organization.
-
9.
Crump JA et al. 2013. Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 7: e2324.
-
10.
Biggs HM et al. 2011. Leptospirosis among hospitalized febrile patients in northern Tanzania. Am J Trop Med Hyg 85: 275–281.
-
11.
Bouley AJ et al. 2012. Brucellosis among hospitalized febrile patients in northern Tanzania. Am J Trop Med Hyg 87: 1105–1111.
-
12.
Assenga JA, Matemba LE, Muller SK, Mhamphi GG, Kazwala RR, 2015. Predominant leptospiral serogroups circulating among humans, livestock and wildlife in Katavi-Rukwa ecosystem, Tanzania. PLoS Negl Trop Dis 9: e0003607.
-
13.
Heinrich N et al. 2015. High seroprevalence for spotted fever group rickettsiae, is associated with higher temperatures and rural environment in Mbeya region, Southwestern Tanzania. PLoS Negl Trop Dis 9: e0003626.
-
14.
Biggs HM, Hertz JT, Munishi OM, Galloway RL, Marks F, Saganda W, Maro VP, Crump JA, 2013. Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania. PLoS Negl Trop Dis 7: e2589.
-
15.
Biggs HM, Galloway RL, Bui DM, Morrissey AB, Maro VP, Crump JA, 2013. Leptospirosis and human immunodeficiency virus co-infection among febrile inpatients in northern Tanzania. Vector Borne Zoonotic Dis 13: 572–580.
-
16.
Hertz JT et al. 2012. Chikungunya and dengue fever among hospitalized febrile patients in northern Tanzania. Am J Trop Med Hyg 86: 171–177.
-
17.
Chipwaza B, Mugasa JP, Selemani M, Amuri M, Mosha F, Ngatunga SD, Gwakisa PS, 2014. Dengue and Chikungunya fever among viral diseases in outpatient febrile children in Kilosa district hospital, Tanzania. PLoS Negl Trop Dis 8: e3335.
-
18.
Heinrich N et al. 2012. High seroprevalence of Rift Valley fever and evidence for endemic circulation in Mbeya region, Tanzania, in a cross-sectional study. PLoS Negl Trop Dis 6: e1557.
-
19.
Mtango FD, Neuvians D, Korte R, 1989. Magnitude, presentation, management and outcome of acute respiratory infections in children under the age of five in hospitals and rural health centres in Tanzania. Trop Med Parasitol 40: 97–102.
-
20.
Nadjm B, Mtove G, Amos B, Walker NF, Diefendal H, Reyburn H, Whitty CJ, 2012. Severe febrile illness in adult hospital admissions in Tanzania: a prospective study in an area of high malaria transmission. Trans R Soc Trop Med Hyg 106: 688–695.
-
21.
D’Acremont V, Kilowoko M, Kyungu E, Philipina S & Sangu W et al. 2010. Etiology of fever in children from urban and rural Tanzania. Am J Trop Med Hyg 83: 16–17.
-
22.
Comoro C, Nsimba SE, Warsame M, Tomson G, 2003. Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district–implications for malaria control. Acta Trop 87: 305–313.
-
23.
Chibwana AI, Mathanga DP, Chinkhumba J, Campbell CH Jr., 2009. Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi. Malar J 8: 219.
-
24.
Rosenstock I, Stretcher V, Becker M, 1994. The health belief model and HIV risk behavior change. Preventing AIDS: Theories and Methods of Behavioral Interventions. New York, NY: Plenum Press, 5–24.
-
25.
Janz NK, Champion VL, Strecher VJ, 2002. The health belief model. Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass, 45–66.
-
26.
Phuanukoonnon S, Brough M, Bryan JH, 2006. Folk knowledge about dengue mosquitoes and contributions of health belief model in dengue control promotion in northeast Thailand. Acta Trop 99: 6–14.
-
27.
Thompson F, Caltabiano ML, 2009. The health belief model and dengue fever preventative behaviours: a pilot programme. Int J Health Promot Educ 48: 0–19.
-
28.
Sundararajan R, Mwanga-Amumpaire J, Adrama H, Tumuhairwe J, Mbabazi S, Mworozi K, Carroll R, Bangsberg D, Boum Y, Ware NC, 2015. Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: a qualitative study in southwestern Uganda. Am J Trop Med Hyg 92: 933–940.
-
29.
Amuge B, Wabwire-Mangen F, Puta C, Pariyo GW, Bakyaita N, Staedke S, Kamya M, Olico-Okui, 2004. Health-seeking behavior for malaria among child and adult headed households in Rakai district, Uganda. Afr Health Sci 4: 119–124.
-
30.
Wong LP, AbuBakar S, 2013. Health beliefs and practices related to dengue fever: a focus group study. PLoS Negl Trop Dis 7: e2310.
-
31.
Wong LP, AbuBakar S, Chinna K, 2014. Community knowledge, health beliefs, practices and experiences related to dengue fever and its association with IgG seropositivity. PLoS Negl Trop Dis 8: e2789.
-
32.
Shabani SS, Ezekiel MJ, Mohamed M, Moshiro CS, 2015. Knowledge, attitudes and practices on Rift Valley fever among agro pastoral communities in Kongwa and Kilombero districts, Tanzania. BMC Infect Dis 15: 363.
-
33.
Orimadegun AE, Ilesanmi KS, 2015. Mothers’ understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control. J Fam Med Prim Care 4: 226–231.
-
34.
Pilkington H, Mayombo J, Aubouy N, Deloron P, 2004. Malaria, from natural to supernatural: a qualitative study of mothers’ reactions to fever (Dienga, Gabon). J Epidemiol Community Health 58: 826–830.
-
35.
Ibidapo CA, 2005. Perception of causes of malaria and treatment-seeking behaviour of nursing mothers in a rural community. Aust J Rural Health 13: 214–218.
-
36.
Agu AP, Nwojiji JO, 2005. Childhood malaria: mothers’ perception and treatment-seeking behavior in a community in Ebonyi state, South East Nigeria. J Comm Med Prim Health Care 17: 45–50.
-
37.
Chandler CI, Jones C, Boniface G, Juma K, Reyburn H, Whitty CJ, 2008. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study. Malar J 7: 53.
-
38.
Baltzell K, Elfving K, Shakely D, Ali AS, Msellem M, Gulati S, Mårtensson A, 2013. Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar. Malar J 12: 37.
-
39.
Oesterholt MJ, Bousema JT, Mwerinde OK, Harris C, Lushino P, Masokoto A, Mwerinde H, Mosha FW, Drakeley CJ, 2006. Spatial and temporal variation in malaria transmission in a low endemicity area in northern Tanzania. Malar J 5: 98.
-
40.
Chipwaza B, Mugasa JP, Mayumana I, Amuri M, Makungu C, Gwakisa PS, 2014. Community knowledge and attitudes and health workers’ practices regarding non-malaria febrile illnesses in eastern Tanzania. PLoS Negl Trop Dis 8: e2896.
-
41.
Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA, 2013. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Health 18: 1406–1415.
-
42.
NBS, 2011. 2010 Tanzania Demographic and Health Survey. Available at: https://dhsprogram.com/pubs/pdf/FR243/FR243%5B24June2011%5D.pdf.
-
43.
NBS, 2013. 2012 Population and Housing Census. Available at: http://catalog.ihsn.org/index.php/catalog/4618/download/58601.
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