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An Anthropological Study on Local Community and Peripheral Health

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An Anthropological Study on Local Community and Peripheral Health An anthropological study on local community and peripheral health centre staff perceptions and practices regarding sleeping sickness in Vwaza Marsh Wildlife Reserve in Malawi by Alister C. Munthali, PhD Centre for Social Research, P.O. Box 280, Zomba. Malawi. Email: [email protected] Submitted to, Drugs for Neglected Diseases initiative, Geneva, Switzerland May, 2021 Zomba, Malawi Funded by: i TABLE OF CONTENTS Acronyms ..................................................................................................................................................... vi 1. Introduction ............................................................................................................................................. 1 2. Statement of the Problem ....................................................................................................................... 2 3. Objective .................................................................................................................................................. 3 3.1 Overall objective ................................................................................................................................. 3 3.2 Specific Objectives ............................................................................................................................. 3 4. Methodological approach ....................................................................................................................... 4 4.1 Study Design ....................................................................................................................................... 4 4.2 Study site ............................................................................................................................................. 4 4.3 Data collection methods ...................................................................................................................... 4 4.3.1 Non-participant observations ....................................................................................................... 4 4.3.2 Review of literature/documents ................................................................................................... 5 4.3.3 Key informant Interviews ............................................................................................................ 5 4.3.4 In-depth Interviews ...................................................................................................................... 5 4.3.5 Focus group discussions............................................................................................................... 5 4.4 Recruitment and training of research assistants .................................................................................. 5 4.5 Data management ................................................................................................................................ 6 4.6 Data analysis ....................................................................................................................................... 6 4.7 Ethical considerations ......................................................................................................................... 6 5. Results ....................................................................................................................................................... 7 5.1 Local terminologies for sleeping sickness .......................................................................................... 7 5.2 Signs and symptoms of sleeping sickness ........................................................................................... 7 5.3 Causes of sleeping sickness ................................................................................................................ 8 5.3.1 Biomedical explanation of causes of sleeping sickness ............................................................... 9 5.3.2 Witchcraft as a cause of sleeping sickness ................................................................................... 9 5.3.3 Other causes of kaskembe .......................................................................................................... 10 5.4 Sources of information on sleeping sickness .................................................................................... 11 5.5 Stigma and sleeping sickness ............................................................................................................ 13 5.6 Treatment of sleeping sickness ......................................................................................................... 14 5.6.1 Self-medication with medicines ................................................................................................. 14 5.6.2 Traditional healers ..................................................................................................................... 15 5.6.3 Seeking treatment from health facilities .................................................................................... 16 5.6.3.1 Diagnosis of sleeping sickness ............................................................................................ 16 5.6.3.2. Treatment from health facilities ......................................................................................... 17 5.7 Motivators to finish treatment ........................................................................................................... 18 5.7.1 The desire to get cured ............................................................................................................... 18 5.7.2 Seeing people with sleeping sickness recovering ...................................................................... 18 5.7.3 Treatment for sleeping sickness being administered at the health centres around Vwaza ......... 19 5.7.4 The drug should have minimal side effects ................................................................................ 19 5.7.5 Sensitization of communities about sleeping sickness treatment ............................................... 19 5.7.6 Other factors ............................................................................................................................... 20 5.8 Challenges in seeking treatment for seeking sickness ...................................................................... 20 5.8.1 Demand for diagnostic and treatment services among men is low ............................................ 21 5.8.2 Late diagnosis of sleeping sickness ........................................................................................... 21 5.8.3 Stockouts of medicines and other medical supplies ................................................................... 21 5.8.4 Transportation ............................................................................................................................ 22 ii 5.8.5 Lack of involvement of private clinics in the fight against sleeping sickness ........................... 23 5.8.6 The process of diagnosing sleeping sickness is painful ............................................................. 23 5.8.7 Lack of food items ..................................................................................................................... 24 5.8.8 Belief in traditional leaders ........................................................................................................ 25 5.8.9 Misperceptions about testing for sleeping sickness ................................................................... 26 5.8.10 Poor attitude of health workers ................................................................................................ 26 5.8.11 Lack of testing equipment ........................................................................................................ 27 5.8.12 Late communication of results from Rumphi .......................................................................... 27 5.8.13 Shortage of staff ....................................................................................................................... 28 5.8.14 Abandonment of hospitalization .............................................................................................. 28 5.9 Effects of sleeping sickness .......................................................................................................... 28 5.9.1 Effects of sleeping sickness on the individual and his family.................................................... 29 5.9.1.1. Impoverishment of families ............................................................................................... 29 5.9.1.2 Development of physical impairments................................................................................ 29 5.9.1. 3 A person is at risk of suffering from mental illness ........................................................... 31 5.9.1.4 Death of people with sleeping sickness .............................................................................. 31 5.9.1.5 School performance ............................................................................................................ 32 5.9.2 Effects on the community .......................................................................................................... 32 5.10 Coping with sleeping sickness ........................................................................................................ 32 5.10.1 Communities sometimes contribute money for transport for patients with
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