EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE Malaria, from natural to supernatural: a qualitative study of mothers’ reactions to fever (Dienga, Gabon)

Objective: Decision making for health care at the household level is a crucial factor for malaria management and control among young children. This study sought to determine exactly how mothers reacted when faced with fever in a child. Design: Qualitative study based on in depth semistructured interviews of mothers and free form discussion with traditional healers (Nganga). Setting: Village of Dienga, a rural area of Gabon (Central Africa). Participants: 12 mothers and three traditional healers. Results: All mothers thought that fever and malaria were identical. Mothers home treated or went to the village treatment centre, or both, on the last episode of fever, if they judged it to be "natural" fever. However, if fever was thought to be a result of malicious intent, then a Nganga was consulted first. It was believed that strong and above all persistent fever was "supernatural". In this case, traditional treatment was thought to be best. Conclusions: Results indicate that fever is perceived as a dual condition, with two distinct but non-mutually exclusive aetiologies (either "natural" or from witchcraft). In contrast with what is commonly believed, there seems to be no clear cut distinction between diseases suitable for management by western medicine and diseases to be managed solely by traditional health practitioners. Moreover, these data do not support the commonly held notion that the decision to seek western medicine to treat fever is considered a "last resort". Results strongly imply that some severe cases of fever, being initially considered supernatural, may partially or completely escape medical attention.