Abstract

PIP: An analysis of the types of treatment sought by mothers for their young children with diarrhea was carried out in 2 different regions of West Africa. The case of diarrhea was selected for study of therapeutic choices because it is a serious public health problem, the descriptions of symptoms provided by mothers usually correspond to biomedical terms, and supernatural causes are not usually assumed for it. The 2 study sites were the Akye country located in the forest zone of southeast Ivory Coast in the periurban area of abidjan, and the Moba-Gurma country in the savannah of northern Togo. In both study locations the population had similar alternatives for care, either modern biomedical services or traditional therapies of different types. Family therapies based on self medication without medical advise or on family therapies utilizing popular knowledge of plants were also available. The data were based on surveys of fertile-aged women about the most recent illnesses of their children and the treatment sought, surveys of traditional practitioners, and examinations of dispensary records in the Akye country. The 2 Akye villages studies had health dispensaries, traditional healers who were usually women, and family therapies based on local plants. Neither village had a pharmacy dispensing modern drugs, which locally available only through the dispensaries. The extent of treatment at home appeared to be underestimated by the mothers. 75% of Akye mothers sought modern treatment exclusively and 6% sought traditional treatment exclusively, of which 4% was provided by the family. 12% sought modern treatment 1st followed by traditional treatment based on plants, and 7% sought traditional treatment 1st followed by modern treatment. A regional hospital, dispensaries, maternal child health centers, and state pharmacies are available in Moba-Gurma country but do not yet cover the entire territory. In the traditional sectors, diviners are a principal element of Moba-Gurma social organization. They may direct their clients to counter-sorcerers or curers. Family therapies based on plants and passed down through generations are also common, especially for frequent ailments like diarrhea. Drugs smuggled in from Ghana or Nigeria are also available in small quantities in the markets. Among 120 cases of diarrhea in children analyzed in the Moba-Gurma country, 38 were treated exclusively by traditional therapies, 33% exclusively by modern therapies, 46 by traditional and then modern therapies, and 3 by modern and then traditional therapies. The symptoms had to be considered serious to prompt attendance at the dispensary or payment for medication. For disorders accompanied by vomiting or other symptoms, immediate attention at the dispensary was more common and became dependent on the availability of facilities and the distance. It appears that the type of care available conditions the choice of therapies.