The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: results of a baseline survey.

In Sierra Leone, traditional treatment is at times used in lieu of seeking allopathic healthcare for major illnesses causing child death. This paper describes the nature of traditional treatment for diarrhea and fever (presumed malaria). Weighted analysis and multi-logistic regression was applied to a household cluster survey (n=5951) conducted in 4 districts in June 2010. Using structured questionnaires, heads of households, and caregivers of children under five years of age were interviewed about child morbidity and care seeking. A thematic analysis of qualitative data based on focus group discussions and in-depth interviews with family members from twelve villages in these same four districts, was also done. Illness-specific herbal remedies were described by respondents. Among 1511 children with diarrhea, 31% used traditional treatment. Among 3851 children with fever, 22% used traditional treatment. Traditional treatment for diarrhea was associated with being from a tribe other than the Mende, using government recommended salt sugar solution, not having a vaccine card, having more than two illnesses, and not seeking any allopathic medical treatment for diarrhea. For fever, traditional treatment was associated with being a tribe other than the Mende, having more than two illnesses, not having a vaccine card, Muslim religion, and not seeking any allopathic medical treatment for fever. Qualitatively, respondents describe herbalists as trusted with remedies that are seen to be appropriate due to the perceived cause of illness and due to barriers to seeking care from government providers. The social determinants of traditional treatment use and the prominent role of herbalists in providing them need to be addressed to improve child survival in Sierra Leone.