Week 11: Seizures and Indian Food
We have two new guests at ENRECA House, Emil and Estrid (more Danes). They’re cool and have awesome Bose speakers that I keep in constant use now. I have a skype interview Monday afternoon for a Health Analytics internship with Results for Development for the spring, which as long as the internet cooperates should also be cool. They will send me a case over email that I will open and have an hour to try and problem solve my way through. Then I get on skype with them and walk them through my thought process and solution and then do normal interview stuff after that.
I also finished writing the first draft of my research final report and sent it to my supervisor and preceptor to look over Friday, so I’m getting closer and closer to finishing. To celebrate I spent the weekend in Tanga eating Indian Food and swimming in pools or the ever lovely Indian Ocean (which may or may not have had a hint of sewage because we chose to swim with the locals and not at the fancy pants Yacht Club but we won’t talk about that).
I’m sure they’ll find things for me to change in my report, but as of now this is the rundown of my study.
Febrile Convulsions are seizures occurring in children under the age of five years caused by high fever. The underlying cause for the fever can vary, but in places similar to my study area it is often related to malaria. In high-income countries, it is viewed as a scary but largely benign condition but in countries like Tanzania it seems to occur and result in further complications or death more frequently. Studies across Tanzania have found a wide variety of terms and beliefs surrounding fever, malaria, and convulsions that involve everything from demonic possession to the changing of the winds. 60% of the Tanzanian population relies on traditional healers and medicine which is important as studies have found an increase in morbidity and mortality when children experiencing convulsions are treated at home or by healers. Existing research in Tanzania is conflicting, with some regions expressing a unanimous belief that convulsions are a spiritual issue and others where 80% of the population would choose a hospital if their child had a convulsion. Sometimes traditional healers helped get patients to health facilities, sometimes they acted as a barrier or delaying factor. Plus, no one had done this type of research in Korogwe District. So, my study “Knowledge, Attitudes, and Practices among Mothers, Health Workers and Traditional Healers Surrounding Febrile Convulsions in Korogwe District, Tanzania” was born.
We had a focus group discussion with community health workers from two villages and conducted interviews with mothers, traditional healers, local health clinic staff (a clinical officer and a nurse), and two doctors from Korogwe District Hospital who also had experience in these communities.
Preliminary findings are as follows:
Beliefs and Impact on Health Seeking Behavior
· Febrile Convulsions are most commonly referred to as degedege or mchango in this community.
· The majority of community members believe that degedege is caused by fever, usually due to malaria, and the preferred course of management is rushing the child to a health facility
· There are still members of the community who attribute degedege to supernatural causes (most commonly demonic possession or “sighting of the moon”) and prefer to use traditional medicine but this seems to be a shrinking portion of the population. Traditional Healers report less and less people are coming to them for treatment of degedege
· A third segment of the population is unsure about the cause and sometimes end up switching between types of care, either trying one then switching once or rebounding back and forth between traditional and modern medicine
· Most members of the population did not know of any ways to prevent degedege even if they said it was caused by fever or malaria
· Perception of the cause of convulsion seems to be the most important factor in deciding between modern and traditional medicine. If you think it’s malaria, you’re probably going to go to the hospital. If you think it’s possession, you’re probably going to go to a healer. However, beliefs aren’t always mutually exclusive, and barriers such as distance to health facility, cost of treatment, transportation issues, and fear of harsh treatment from health workers who look down on traditional methods further complicate the decision making process.
Febrile Convulsion Management
· Home Management may consist of sponging, use of paracetamol or (rarely) antimalarials, use of traditional herbal remedies, magic charms, or urinating on the child
· Traditional Healer treatment mostly falls into four categories: herbal remedies (called mvumbasha), irritants (such as blowing smoke from burning tobacco leaves or elephant dung into the child’s face), scarification/tattooing (called chale), and the use of magic charms tied around the child’s limbs. If a child’s condition worsens they will then refer them to a health facility.
· Health Facility management usually went as follows: Stop convulsion with anticonvulsant -> Lower temperature with paracetamol or sponging -> Diagnose underlying cause -> Treat accordingly. However, lack of doctors, overreliance of inadequately trained assistant nurses, lack of drug and equipment supply, and improper triage prioritization of convulsions by lower level health staff often hinders this process.
Interesting Findings
· Mothers and community health workers commonly associated febrile convulsion with anemia, referred to as “deficiency/loss of blood”, and cited it and the desire for blood transfusion treatments as an important reason to go to a health facility. Even traditional healers cited “blood deficiency” as one of the main reasons they would refer a child to a health facility. None of the health clinic staff or district hospital doctors mentioned anemia or blood transfusions and as far as I know none of the reviewed literature mentioned it either (But I’m going to look into this more to see if this is truly a unique finding or if I just missed it in previous readings).
· Study after study done in Africa and Tanzania report the importance of consulting elders in the community when making important decisions and women’s relative lack of societal independence to make health decisions. However, all of the mothers interviewed in this study reported immediately and independently making the decision to seek care or treat at home on their own without consulting anyone.
So ya, pretty interesting stuff. It would also be interesting to look into identifying and biologically testing the herbal treatments they use. Studies near Dar es Salaam found that about 36% of the plants used by traditional healers had strong antimalarial properties and a good amount of others had anticonvulsant properties. There are hints at the possibility of increased collaboration between modern and traditional practitioners. We’ll see what the bosses say about my report.
Till next time.
