‘This diarrhoea is not a disease …’ local illness concepts and their effects on mothers’ health seeking behaviour: a qualitative study, Shuhair, Yemen

BACKGROUND Globally, about seven million children under the age of five died in 2011. Local illness concepts are thought to be related to inappropriate health-seeking behaviour, and therefore, lead to child mortality. The aim of this study was to contribute to the definition of common local illness concepts with their effects on health-seeking behaviour for common childhood illnesses. METHODS A qualitative focus group study was conducted between April 1 and 6, 2013. Participants were drawn purposefully from the vaccination unit at Shuhair Health Centre in Yemen. Four focus group discussions were conducted. The total number of participants was 31 mothers with at least one child under the age of five with a history of fever, diarrhoea, cough, or difficulty breathing during the 14 days preceding the study. Data was collected and analysed using micro-interlocutor analysis. RESULTS The mean age of the participants was 31 years (SD ± 4). There was remarkable concordance in local illness concepts across the focus groups. During focus group discussions, six local illness concepts (Senoon, lafkha, halib, didan, raqaba, and ayn) were mentioned. Local illness concepts determined the type of treatment. Most of these illnesses were not treated medically. Lafkha, halib, raqaba, and ayn were always classified as "not for medical treatment", whereas senoon and didan as sometimes "not for medical treatment". For medical symptoms, i.e. fever, diarrhoea, cough, and difficulty breathing, medical therapy was usually an option; these were classified as never or sometimes "not for medical treatment". Mothers trust in traditional medicine and believe that it is always beneficial and never harmful. The participants do not disclose traditional medicine use with their doctors because doctors oppose these practices and are not open enough to these types of treatment. CONCLUSIONS Local illness concepts for common child illnesses are widespread, and they determine the type of treatment used. Interventions to improve children's health should use local illness concepts to educate parents. Traditional medicine as a treatment option in primary care should be considered.