Skip to main content Accessibility help


  • AMY A. ELLIS (a1) (a2), SEYDOU DOUMBIA (a3), SIDY TRAORÉ (a4), SARAH L. DALGLISH (a1) and PETER J. WINCH (a1)...


Malaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region.


Corresponding author

1Corresponding author. Email:


Hide All
Adams, A., Cekan, J. & Sauerborn, R. (1998) Towards a conceptual framework of household coping: reflections from rural West Africa. Africa: Journal of the International African Institute 68(2), 263283.
Adams, A. M. & Castle, S. (1994) Gender relations and household dynamics. In Sen, G., Germain, A. & Chen, L. C. (eds) Population Policies Reconsidered: Health, Empowerment, and Rights. Department of Population and International Health, Distributed by Harvard University Press Boston, MA, p. xiv.
Adams, A. M., Madhavan, S. & Simon, D. (2002) Women's social networks and child survival in Mali. Social Science & Medicine 54(2), 165178.
Aubel, J., Toure, I. & Diagne, M. (2004) Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change. Social Science & Medicine 59(5), 945959.
Aubel, J., Toure, I., Kone, D., Malakova, N., Waltensperger, K. & Balde, D. (2005) Role of grandmothers in maternal and child health: multiple country study results. International Forum for Social Sciences & Health World Congress. Yditepe University, Istanbul.
Breman, J. G., Alilio, M. S. & Mills, A. (2004) Conquering the intolerable burden of malaria: what's new, what's needed: a summary. American Journal of Tropical Medicine and Hygiene 71 (Supplement), 115.
Castle, S. E. (1993) Intra-household differentials in women's status: household function and focus as determinants of children's illness management and care in rural Mali. Health Transition Review 3(2), 137157.
Castle, S. (1994) The (re)negotiation of illness diagnoses and responsibility for child death in rural Mali. Medical Anthropology Quarterly 8(3), 314335.
Castle, S. E. (1995) Child fostering and children's nutritional outcomes in rural Mali: the role of female status in directing child transfers. Social Science & Medicine 40(5), 679693.
Chibwana, A., Mathanga, D., Chinkhumba, J. & Campbell, C. J. (2009) Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi. Malaria Journal 8, 219226.
Comoro, C., Nsimba, S. E., Warsame, M. & Tomson, G. (2003) Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district – implications for malaria control. Acta Tropica 87(3), 305313.
Diallo, D., Graz, B., Falquet, J., Traore, A. K., Giani, S., Mounkoro, P. al. (2006) Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome. Transactions of the Royal Society of Tropical Medicine and Hygiene 100(6), 515520.
Dondorp, A. M. & Day, N. P. (2007) The treatment of severe malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 101(7), 633634.
Findley, S. E., Medina, D. C., Sogoba, N., Guindo, B. & Doumbia, S. (2010) Seasonality of childhood infectious diseases in Niono, Mali. Global Public Health 5(4), 381394.
Frankel, A. & Lalou, R. (2009) Health-seeking behaviour for childhood malaria: household dynamics in rural Senegal. Journal of Biosocial Science 41(1), 119.
Iwelunmor, J., Idris, O., Adelakun, A. & Airhihenbuwa, C. O. (2010) Child malaria treatment decisions by mothers of children less than five years of age attending an outpatient clinic in south-west Nigeria: an application of the PEN-3 cultural model. Malaria Journal 9, 354359.
Kaona, F. A. & Tuba, M. (2005) A qualitative study to identify community structures for management of severe malaria: a basis for introducing rectal artesunate in the under five years children in Nakonde District of Zambia. BMC Public Health 5(1), 28.
McCombie, S. C. (2002) Self-treatment for malaria: the evidence and methodological issues. Health Policy and Planning 17(4), 333344.
Madhavan, S. & Adams, A. (2003) Women's networks and the social world of fertility behavior. International Family Planning Perspectives 29(2), 5868.
Maslove, D., Mnyusiwalla, A., Mills, E., Mcgowan, J., Attaran, A. & Wilson, K. (2009) Barriers to the effective treatment and prevention of malaria in Africa: a systematic review of qualitative studies. BMC International Health and Human Rights 9(1), 26.
Molyneux, C. S., Murira, G., Masha, J. & Snow, R. W. (2002) Intra-household relations and treatment decision-making for childhood illness: a Kenyan case study. Journal of Biosocial Science 34(1), 109131.
Mwenesi, H. A. (2005) Social science research in malaria prevention, management and control in the last two decades: an overview. Acta Tropica 95(3), 292297.
Okoko, B. J. & Yamuah, L. K. (2006) Household decision-making process and childhood cerebral malaria in The Gambia. Archives of Medical Research 37(3), 399402.
Okeke, T. A. (2010) Improving malaria recognition, treatment and referral practices by training caretakers in rural Nigeria. Journal of Biosocial Science 42(03), 325339.
Pfeiffer, J. (2003) Cash income, intrahousehold cooperative conflict, and child health in central Mozambique. Medical Anthropology 22(2), 87130.
Pfeiffer, J., Gloyd, S. & Ramirez Li, L. (2001) Intrahousehold resource allocation and child growth in Mozambique: an ethnographic case-control study. Social Science & Medicine 53(1), 8397.
PMI (2011) Country Profile: Mali. President's Malaria Initiative.
Rose-Wood, A., Doumbia, S., Traore, B. & Castro, M. C. (2010) Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006. Malaria Journal 9, 319329.
Sauerborn, R., Berman, P. & Nougtara, A. (1996) Age bias, but no gender bias, in the intra-household resource allocation for health care in rural Burkina Faso. Health Transition Review 6.
Soares Magalhães, R. J. & Clements, A. C. A. (2011) Mapping the risk of anaemia in preschool-age children: the contribution of malnutrition, malaria, and helminth infections in West Africa. PLoS Med 8(6), e1000438.
Tolhurst, R., Amekudzi, Y. P., Nyonator, F. K., Bertel Squire, S. & Theobald, S. (2008) “He will ask why the child gets sick so often”: The gendered dynamics of intra-household bargaining over healthcare for children with fever in the Volta Region of Ghana. Social Science & Medicine 66(5), 11061117.
Tolhurst, R. & Nyonator, F. K. (2006) Looking within the household: gender roles and responses to malaria in Ghana. Transactions of the Royal Society of Tropical Medicine and Hygiene 100(4), 321326.
UNICEF (2007) Malaria and Children, Progress in Intervention Coverage. UNICEF and Roll Back Malaria, New York, p. 76.
WHO (2004) Scaling up Home-based Management of Malaria – from Research to Implementation. WHO, Geneva.
WHO/UNICEF (2012) Joint Statement: Integrated Community Case Management (iCCM). WHO/UNICEF, Geneva and New York.
Whyte, S. R. & Kariuki, P. W. (1991) Malnutrition and gender relations in Western Kenya. Health Transition Review 1(2).
Williams, H. A., Jones, C., Alilio, M., Zimicki, S., Azevedo, I., Nyamongo, I., Sommerfeld, al. (2002) The contribution of social science research to malaria prevention and control. Bulletin of the World Health Organanization 80(3), 251252.
Williams, H. A. & Jones, C. O. (2004) A critical review of behavioral issues related to malaria control in sub-Saharan Africa: what contributions have social scientists made? Social Science & Medicine 59(3), 501523.
Zeitlin, M. F., Megawangi, R., Kramer, E., Colletta, N. D., Babatunde, E. D. & Garman, D. (1995) Strenghtening the Family – Implications for International Development. United Nations University, Tokyo.


  • AMY A. ELLIS (a1) (a2), SEYDOU DOUMBIA (a3), SIDY TRAORÉ (a4), SARAH L. DALGLISH (a1) and PETER J. WINCH (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed