Gender and treatment-seeking for child malaria in Ghana

Growing evidence suggests that behaviour related to health is influenced by gender.   However the role of women and men in decisions to seek treatment for malaria has rarely been considered.  How does gender influence treatment-seeking behaviour for children with malaria?

Researchers from theLiverpool School of Tropical Medicine, UK and the Ghana Health Service designeda study to examine household gender roles and responses to malaria.  The research was conducted over 18 monthsbetween 2000 and 2002 in three districts of the Volta region of Ghana.

Communities in the study areadescribe malaria using a word that is most commonly translated into English as‘fever’. Most people who participated in the study used herbal medicines orlocally bought drugs as their first choice treatment for fever. A child withconvulsions would most often be taken to the ‘elders’, who have some knowledgeof traditional treatment. The majority of parents said they would seek prompttreatment at a clinic or hospital if the traditional treatment did not producea cure.

Significant findings include:

• Women are increasingly taking on ‘male’ roles asproviders as well as carers, while no corresponding change is occurring inmen’s behaviour.
• In all communities it was seen as a man’s role topay for medical treatment, but some women complained that they did notalways do so.
• Single mothers were at a particular disadvantagebecause the fathers of their children did not feel a responsibility toprovide for the children.
• Some men refused to pay for treatment that theydid not agree to in advance, resulting in delays in seeking treatment ifthe man was away at the time of illness.
• Husband and in-laws could refuse to allow amother to take a child to hospital if they did not agree on the type oftreatment to be sought.
• A woman who seeks treatment in defiance of herhusband may pay for it from her own resources, but risks blame if thetreatment fails.

These findings reveal thatwhere a woman disagrees with her husband or family elders over appropriatetreatment, or lacks financial support from a male relative, formal treatmentfor her children may be delayed or not sought at all. It is important tounderstand a woman’s options and choices to pay for care and influence decisionmaking in the family.

Implications for policy andpractice include:

• Improving women’s access to income wouldstrengthen their bargaining positions to influence what treatment issought for children and when.
• More research is needed to understand how farwomen’s responsibility for children’s health care and health care paymentsthreatens their ability to gain economic and social independence.
• The role of fathers and household elders indeciding what care is sought for a child suggests that they should beexplicitly targeted in malaria education strategies.
• Women’s power to make decisions has been linkedto improved health of both women and children. A better understanding isneeded of what factors enable different groups of women to ‘dare todisagree’ with husbands or other family members.
• Approaches to managing malaria should include agender perspective which takes account of how social and economic power ofwomen and men can influence the household’s response to ill health.
• Health-seeking behaviour should be considered inthe context of individual and household livelihoods, so that itssocio-economic impacts are considered as well as its health outcomes.