Do rural and urban mothers differ in their choice of health providers when their children are ill? How does proximity to different health facilities affect a mother’s decision? These questions are important for health planners responding to rising urban poverty and ill health, as sub-Saharan Africa has the highest rates of urbanisation in the developing world.

A study carried out by the Kenya Medical Research Institute and the UK University of Oxford compared rural and urban mothers’ responses to childhood fevers on the malaria-endemic Kenyan Coast. Mothers were found to react in similar ways despite enormous differences in population structures and access to treatment providers.

Household responses to illness are influenced by socio-economic and cultural factors, and by ease of access to treatment sources. Urban populations are generally younger, better educated and more ethnically heterogeneous than rural people. They also have better access to a greater range of modern medical facilities. These differences were confirmed for the Kenyan Coast through demographic work and careful mapping of health providers.

Surveys involved rural resident mothers who had never lived in urban areas, and urban resident mothers who were mostly rural-urban migrants, all belonging to the same Mijikenda ethnic group. Malaria is the principal cause of childhood mortality in coastal Kenya, and a common cause of fever. Survey questions therefore focused on mothers’ responses to uncomplicated childhood fevers that took place in the two weeks before the survey. Surprisingly, the study showed that urban mothers do not use modern medical services and drugs more often or at an earlier stage than rural mothers. Other main findings of the study were:

• Most rural and urban mothers seek modern rather than traditional treatments.
• The most common response is to treat children at home using shop-bought drugs.
• Almost half of mothers who seek treatment contact a government or private clinic.
• Urban mothers are more likely to consult private clinics; rural mothers access government services more often.
• Mothers usually treat children at home with shop-bought drugs on the same day or the day after symptoms first appear; clinics, dispensaries and hospitals are more often contacted from the second day onwards.
• Most shops stock anti-fever and anti-malarial drugs; 40 percent of urban shops stock drugs that are currently prescription-only.

Home-treatment is as important in urban as it is in rural areas, and inappropriate use of shop-bought drugs is a key issue. Improving home-treatment has huge potential to reduce illness and mortality in rapidly growing urban populations, and to slow the spread of resistance to antimalarials. Strategies to improve home-treatment will need to:

• adapt approaches used in rural areas to the very different socio-cultural, demographic and health facility structure in urban settings
• investigate channelling interventions through the existing diverse range of health providers in cities
• capitalise on the continuing popularity of shop-bought drugs
• address the unregulated use of prescription-only drugs
• incorporate differing perspectives of a wide range of community members.

Source(s):
‘Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya’ by C. Molyneux, V. Mung’ala-Odera, T. Harpham and R. Snow, Tropical Medicine and International Health 4 (1999)

Funded by: The Wellcome Trust, UK; Kenya Medical Research Institute

id21 Research Highlight: 29 January 2001

Further Information:
Sassy Molyneux
Kenya Medical Research Institute (KEMRI)/
Wellcome Trust Centre for Geographic Medicine Research
PO Box 230
Kilifi
Kenya

Contact the contributor: Smolyneux@kilifi.mimcom.net

Other related links:
The Malaria Foundation has information on many malaria-related issues, including research, plus a forum for discussion.

Check the Roll Back Malaria site for the latest news and information on this WHO initiative.

The Multilateral Initiative on Malaria is an international collaboration for scientific research into malaria.

The Malaria Consortium provides an interface between research and operational aspects of malaria control.