Recognizing childhood illnesses and their traditional explanations: exploring options for care-seeking interventions in the context of the IMCI strategy in rural Ghana.

OBJECTIVES: Interventions that promote appropriate care-seeking for severely ill children have the potential to substantially reduce child mortality in developing countries, but little is known about the best approach to address the issue. This paper explores the relative importance of illness recognition as a barrier to care-seeking and the feasibility and potential impact of improving recognition. METHODS: The study combined qualitative and quantitative methods including in-depth interviews exploring the local illness classification system, a Rapid Anthropological Assessment (RAA) recording narratives of recent episodes of child illness and a survey designed to test the hypotheses that emerged from the RAA. RESULTS: Several danger symptoms were not recognized by caregivers. There were recognition problems which may not be feasibly addressed in an intervention. Other significant care-seeking barriers included classifying certain illnesses as 'not-for-hospital' and untreatable by modern medicine; problems of access; and frequent use of traditional medicines. CONCLUSION: The recognition component of any care-seeking intervention should identify the type of recognition problem present in the community. Many of the care-seeking barriers identified in the study revolved around the local illness classification system, which should be explored and built on as part of any care-seeking intervention.