Abstract:
Background: Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and
these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment
and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be
understood. The objective of this study was to explore, using the socio-ecological model, the determinants of
treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania.
Methods: Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in
Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal
husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic
infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment seeking actions.
Results: Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age,
expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood
activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs
and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed
and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking
appropriate health care and the consultation of medically unqualified individuals was very common.
Conclusion: The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the
socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through
community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and
better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and
to reduce reliance of patients on unqualified persons.
