Intra-Household Relations and Treatment Decision-Making for Childhood Illness: A Kenyan Case Study

This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers’ responses to childhood fevers in the last 2 weeks ( n =317), and to childhood convulsions in the previous year ( n =43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual and group interviews, primarily with women ( n =223). Responses to convulsions were more likely than responses to fevers to include a healer consultation ( p <0·0001), and less likely to include the purchase of over-the-counter medications ( p <0·0001). Mothers received financial or advisory assistance from others in 71% ( n =236) of actions taken outside the household in response to fevers. In-depth interviews suggested that general agreement on appropriate therapy results in relatively few intra-household conflicts over the treatment of fevers. Disputes over perceived cause and appropriate therapy of convulsions, however, highlighted the importance of age, gender and relationship to household head in intra-household relations and treatment decision-making. Although mothers’ treatment-seeking preferences are often circumscribed by these relations, a number of strategies can be drawn upon to circumvent ‘inappropriate’ decisions, sometimes with implications for future household responses to similar syndromes. The findings highlight the complexity of intra-household relations and treatment decision-making dynamics. Tentative implications for interventions aimed at improving the home management of malaria, and for further research, are presented.