Bertrand Graz1, Merlin Willcox2, Diafara Berthé3, Denis-Luc Ardiet4, Jacques Falquet4, Drissa Diallo5, Sergio Giani6. 1. Community Health Association, Geneva, Switzerland bertrand.graz@chuv.ch. 2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 3. Field survey team, Sikasso, Mali. 4. Community Health Association, Geneva, Switzerland. 5. Department of Traditional Medicine (DMT), Bamako, Mali. 6. Aid to Development of Traditional Medicines (AIDEMET), Bamako, Mali.
Abstract
BACKGROUND: In 2003, a study in Mali showed that 87% of episodes of uncomplicated malaria were first treated at home. We investigated whether treatment-seeking patterns in Mali had changed 10 years later. METHODS: In 2013, we repeated the retrospective treatment-outcome study on 400 children with presumed malaria in the same area. RESULTS: Most children with reported uncomplicated malaria were still first treated at home (76% [196/258] in 2013 vs 85% in 2003; p=0.006), rather than in modern health centres (20% [52/258] in 2013 vs 12% in 2003; p=0.01). Overall, 58% of children with uncomplicated malaria were treated with herbal medicine alone, a significant increase from 24% 10 years earlier (p<0.001). This was associated with an increase in use of Argemone mexicana decoction from 8% to 26% (p<0.001), with a reported cure or improvement in 100% of cases among those aged >5 years. For severe malaria, first treatment was sought less often from a traditional healer compared with 10 years earlier (4% vs 32%; p<0.001) and more often from a modern health centre (29% vs 17%; p=0.04). CONCLUSIONS: Two trends that emerged are that there is a greater use of modern health facilities for treatment of severe malaria, and a greater use of traditional medicine alone for treatment of uncomplicated malaria.
BACKGROUND: In 2003, a study in Mali showed that 87% of episodes of uncomplicated malaria were first treated at home. We investigated whether treatment-seeking patterns in Mali had changed 10 years later. METHODS: In 2013, we repeated the retrospective treatment-outcome study on 400 children with presumed malaria in the same area. RESULTS: Most children with reported uncomplicated malaria were still first treated at home (76% [196/258] in 2013 vs 85% in 2003; p=0.006), rather than in modern health centres (20% [52/258] in 2013 vs 12% in 2003; p=0.01). Overall, 58% of children with uncomplicated malaria were treated with herbal medicine alone, a significant increase from 24% 10 years earlier (p<0.001). This was associated with an increase in use of Argemone mexicana decoction from 8% to 26% (p<0.001), with a reported cure or improvement in 100% of cases among those aged >5 years. For severe malaria, first treatment was sought less often from a traditional healer compared with 10 years earlier (4% vs 32%; p<0.001) and more often from a modern health centre (29% vs 17%; p=0.04). CONCLUSIONS: Two trends that emerged are that there is a greater use of modern health facilities for treatment of severe malaria, and a greater use of traditional medicine alone for treatment of uncomplicated malaria.