Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya

Authors

  • C. S. Molyneux,

    1. Kenya Medical Research Institute (KEMRI)/Wellcome Trust Centre for Geographic Medicine Research, Kilifi, Kenya
    2. Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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  • V. Mung'ala-Odera,

    1. Kenya Medical Research Institute (KEMRI)/Wellcome Trust Centre for Geographic Medicine Research, Kilifi, Kenya
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  • T. Harpham,

    1. The Kenya Medical Research Institute/Wellcome Trust Collaborative Programme, Nairobi, Kenya
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  • R. W. Snow

    1. Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
    2. Department of Urban Policy and Planning, South Bank University, London, UK
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correspondence Sassy Molyneux, Kenya Medical Research Institute (KEMRI)/ Wellcome Trust Centre for Geographic Medicine Research, P.O. Box 230, Kilifi, Kenya. E-mail: Smolyneux@kilifi.mimcom.net

Abstract

Summary Urbanization is an important demographic phenomenon in sub-Saharan Africa, and rural-urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments in health service provision need to reflect new needs arising from demographic and disease ecology change. In malaria-endemic coastal Kenya, we compared lifelong rural (= 248) and urban resident (= 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biomedical services, rural and urban mothers' treatment-seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop-bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription-only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self-treatment has enormous potential to reduce morbidity and mortality in low-income urban areas, as has frequently been argued for rural areas. However, because of the underlying socio-economic, cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.

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