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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Injections, cocktails and diviners: Therapeutic flexibility in the context of malaria elimination and drug resistance in Northeast Cambodia
PLoS ONE, Volume 8, No. 11, Article e80343, Year 2013
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Description
Background: Adherence to effective malaria medication is extremely important in the context of Cambodia's elimination targets and drug resistance containment. Although the public sector health facilities are accessible to the local ethnic minorities of Ratanakiri province (Northeast Cambodia), their illness itineraries often lead them to private pharmacies selling "cocktails" and artemether injections, or to local diviners prescribing animal sacrifices to appease the spirits. Methods: The research design consisted of a mixed methods study, combining qualitative (in-depth interviews and participant observation) and quantitative methods (household and cross-sectional survey). Results: Three broad options for malaria treatment were identified: i) the public sector; ii) the private sector; iii) traditional treatment based on divination and ceremonial sacrifice. Treatment choice was influenced by the availability of treatment and provider, perceived side effects and efficacy of treatments, perceived etiology of symptoms, and patient-health provider encounters. Moreover, treatment paths proved to be highly flexible, changing mostly in relation to the perceived efficacy of a chosen treatment. Conclusions: Despite good availability of anti-malarial treatment in the public health sector, attendance remained low due to both structural and human behavioral factors. The common use and under-dosage of anti-malaria monotherapy in the private sector (single-dose injections, single-day drug cocktails) represents a threat not only for individual case management, but also for the regional plan of drug resistance containment and malaria elimination. © 2013 Gryseels et al.
Authors & Co-Authors
Gryseels, Charlotte
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Uk, Sambunny
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Erhart, Annette
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Gerrets, René P.M.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Sluydts, Vincent
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Durnez, Lies
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Ribera, Joan Muela
Belgium, Tessenderlo
Partners for Applied Social Sciences Pass International
Muela, Susanna Hausmann
Belgium, Tessenderlo
Partners for Applied Social Sciences Pass International
Menard, Didier
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Heng, Somony
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
Sochantha, Tho
Cambodia, Phnom Penh
National Center for Parasitology, Entomology and Malaria Control
D'Alessandro, Umberto
Gambia, Banjul
Medical Research Council Laboratories Gambia
Coosemans, Marc H.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Antwerpen
Universiteit Antwerpen
Peeters-Grietens, Koen
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Tessenderlo
Partners for Applied Social Sciences Pass International
Statistics
Citations: 47
Authors: 14
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0080343
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Ethnographic Study
Study Approach
Qualitative
Quantitative
Mixed-methods