Pharmaceuticals in a medical pluralistic society: Socio-cultural interpretation and appropriation of antimalarials in a rural Abagusii Community in South Western Kenya
The availability and popularity of pharmaceuticals (including antimalarial drugs) in the developing world has increasingly been a subject of scientific interest. However, we have a paucity of studies on how people in different socio-cultural contexts have incorporated these phamaceuticals into their health seeking practices. This study explored the socio-cultural interpretation and appopriation of pharmaceuticals in two malarious villages in Kisii County. Specifically, the study sought to understand the actual antimalarial drug intake and the reasoning that drives behaviours surrounding their use. The study also investigated the Abagusii people's situated ideas and notions of antimalarials - the most commonly used pharmaceuticals in the area. The change of first-line treatment guidelines for malaria by the Kenyan government was also examined in the context of local realities in which antimalarial drugs are made available and used. The study was conducted in Mosocho and Raganga villages of Kisii County. The study design was longitudinal and involved cross-sectional data collection at different times over a period of 12 months. Both qualitative and quantitative data collection techniques were applied. These mixed methods included: village census and mapping, free listing, structured interviews, in-depth interviews, focus group discussions and longitudinal household malaria case studies. Descriptive statitical analysis was done using SPSS software package for questionnare data and qualitiative data was manually processed and analyzed through thematic analysis. The study findings revealed that the therapetic field in Mosocho and Raganga villages is characterized by medical pluralism. It also showed that both formal and informal sale of Western pharmaceuticals are common in the community and that local populations generally prefer to subordinate their local notions of meaning to those of biomedical explanation. The study findings showed that medical ‘knowledge’ or presentation about malaria had become part of a popular representation of malaria in the community. The connection with mosquitoes (chiumbu) was consistent in the two villages. The study revealed that lay people in the community, while aware of the change in malaria treatment guidelines, have nevertheless limited knowledge on the factors that motivated the government to make such changes. Health workers too, as expected, understood the reasons for the change but ironically were still prescribing SP drugs as a first line antimalarial drug. This unexpected behaviour from health providers poses a big challenge to effective implementation of the new policy guidelines as prescribed by the government. In conclusion, it is noted that the existence of plural medical systems in society requires constant renegotiations and new relational dynamics among the various health avenues that need to be taken into consideration by public health practitioners. The study recommends that future introduction of new treatment drugs should be sensitive to context-based ethnographic realities for effective up-take of these drugs.