Effective community based malaria control programmes require an understanding of current perceptions of malaria as a disease and its severe manifestations. Quantitative and qualitative surveys of mothers on the Kenyan Coast suggest that fever is conceptualised in biomedical terms whereas the aetiology of severe malaria is perceived to be of more complex cultural origin. This is reflected in the treatments sought for convulsions. The results are discussed in the context of ethnographic factors. To be effective, future health information programmes must take cultural beliefs into account.
PIP: During April-May 1990 in Kenya, interviews were conducted with 883 mothers of children less than 10 years old and with 60 key informants to examine how the Mijikenda and Luo residents of Kilifi district in the Coast Province define convulsions and anemia and how this perception affects health seeking behavior. 56% of mothers reported convulsions as a childhood illness presenting with fever. 80% considered convulsions to be unpreventable. Of the 20% of mothers who thought they were preventable, 43% reported avoidance of mosquitoes as a way to prevent convulsions. 19% thought that charms and amulets prevent convulsions. 20% mentioned anemia. Based on a biomedical premise, Kilifi mothers tended not to react to anemia and especially childhood convulsions. They would react, however, when they took a biocultural explanatory position. They did not consider convulsions or anemia as complications of malaria, but as separate illnesses with different ethno-etiologies. The two conditions did not belong to the same explanatory models. One perceived convulsions as a serious noncommunicable and unavoidable childhood condition. Spirits were considered to be the cause of convulsions. The Mijikenda perceived natural processes as the cause of anemia: eating soil and spoiled food or sorcery. The Luo did not have a biocultural explanatory model for anemia. They considered it as lack of blood. They did not consider anemia to be life threatening. These findings have important implications for health interventions. For example, health workers should not remove amulets. They should emphasize to mothers during awareness raising interventions that anemia is a leading cause of malaria-related mortality.