A qualitative study of how affected individuals or their caregivers respond to suspected malaria infection in rural Papua New Guinea

This paper presents findings from a qualitative study that sought to identify the ways in which affected individuals or their caregivers respond to a suspected malaria infection and to illuminate the rationale underlying the decision-making process. In-depth interviews (IDIs) were conducted with a sub-sample (n = 44) of participants in a country-wide household survey who reported experiencing, or caring for someone who experienced, a suspected malaria infection in the two weeks before the survey. All IDIs were completed between March and July 2011. Analysis was informed by a general inductive methodology. The most commonly reported response involved the use of antimalarial medication and some form of traditional remedy prepared in the home. Reported treatment responses were frequently consistent with a stepped-care approach to disease management, the first step of which was characterized by convenience and was often relatively generic in nature. Seeking assistance from a formal health care provider was the exception amongst study participants, with fewer than half attending a health facility during the target illness episode. A number of barriers to health service access were reported; however, a range of other factors contributed to the decision not to seek formal health care such as perceived severity of illness, positive past experiences using home-based treatments and the aforementioned preference for utilizing convenient 'treatment' options in the first instance. Traditional healers were rarely considered an appropriate treatment option for malaria.