Factors Motivating Traditional Healer versus Biomedical Facility Use for Treatment of Pediatric Febrile Illness: Results from a Qualitative Study in Southwestern Uganda
Factors Motivating Traditional Healer versus Biomedical Facility Use for Treatment of Pediatric Febrile Illness: Results from a Qualitative Study in Southwestern Uganda
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DOI：
10.4269/ajtmh.19-0897
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发表时间：
2020-07-01
影响因子：
3.3
通讯作者：
Sundararajan, Radhika
中科院分区：
文献类型：
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作者：
Hooft, Anneka;Nabukalu, Doreen;Sundararajan, Radhika
疟疾和肺炎等发热性疾病是乌干达5岁以下儿童除新生儿期外最常见的死亡原因。可以通过在生物医学设施进行早期诊断和治疗来减轻其影响；然而，据估计，很大比例的乌干达人（70-80%）寻求传统治疗师作为他们的第一线医疗保健。本研究试图描述个体和结构对发烧儿童求医行为的影响。最低结构，定性访谈进行了34名儿童的照顾者提出的生物医学和传统治疗网站分别。我们确定了塑造发热儿童护理途径的六个主题：1)同行建议，2)对生物医学的信任，3)对传统医学的信任，4)对提供者和治疗方法的不信任，5)经济资源和获得卫生保健的机会，以及6)对儿童健康的看法。那些重视实验室检测和正规医学培训的人更喜欢生物医学提供者，而传统治疗师的偏好受到便利、同行推荐和对传统疾病原因的坚定信念的严重影响。然而，大多数照顾者在同一疾病周期内同时使用生物医学和传统疗法。生物医学系统通常被认为是传统治疗“失败”时的备份。旨在鼓励尽早向生物医学机构提供治疗的举措必须考虑到促使寻求传统治疗的个人和结构力量。教育项目和与传统治疗师的合作可能会增加生物医学转诊，减少对易受伤害/易感儿童进行适当护理和治疗的时间。
Febrile illnesses, such as malaria and pneumonia, are among the most common causes of mortality in children younger than 5 years in Uganda outside of the neonatal period. Their impact could be mitigated through earlier diagnosis and treatment at biomedical facilities; however, it is estimated that a large percentage of Ugandans (70-80%) seek traditional healers for their first line of medical care. This study sought to characterize individual and structural influences on health care-seeking behaviors for febrile children. Minimally structured, qualitative interviews were conducted for 34 caregivers of children presenting to biomedical and traditional healer sites, respectively. We identified six themes that shape the pathway of care for febrile children: 1) peer recommendations, 2) trust in biomedicine, 3) trust in traditional medicine, 4) mistrust in providers and therapies, 5) economic resources and access to health care, and 6) perceptions of child health. Biomedical providers are preferred by those who value laboratory testing and formal medical training, whereas traditional healer preference is heavily influenced by convenience, peer recommendations, and firm beliefs in traditional causes of illness. However, most caregivers concurrently use both biomedical and traditional therapies for their child during the same illness cycle. The biomedical system is often considered as a backup when traditional healing "fails." Initiatives seeking to encourage earlier presentation to biomedical facilities must consider the individual and structural forces that motivate seeking traditional healers. Educational programs and cooperation with traditional healers may increase biomedical referrals and decrease time to appropriate care and treatment for vulnerable/susceptible children.