Dust or disease? Perceptions of influenza in rural Southern Malawi

PLoS One. 2019 Apr 22;14(4):e0208155. doi: 10.1371/journal.pone.0208155. eCollection 2019.

Abstract

Influenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities' ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi. We conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups. Respondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza. Our findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers. Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents' interest in further information and support informed health seeking and engagement with future influenza interventions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child, Preschool
  • Community Health Workers
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Infant
  • Influenza, Human / epidemiology*
  • Influenza, Human / prevention & control
  • Influenza, Human / therapy
  • Malawi / epidemiology
  • Parents
  • Patient Education as Topic
  • Poverty

Grants and funding

Funding for the study came from the United States Centers for Disease Control and Prevention under the grant number CDC424. Dr Nicola Desmond was the grant recipient. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.