Treatment practices for degedege, a locally recognized febrile illness, and implications for strategies to decrease mortality from severe malaria in Bagamoyo District, Tanzania.

Malaria remains one of the chief causes of mortality among young children in sub-Saharan Africa. Verbal autopsies for cases of childhood mortality in Bagamoyo District, Tanzania demonstrated that degedege, a locally defined illness of children characterized by fever and convulsions, is frequently treated by traditional healers. To investigate this further, an ethnographic study was carried out in one village that included in-depth interviews with 14 traditional healers and 3 focus groups with parents. Parents and traditional healers were unanimous in their conviction that degedege requires traditional treatments, at least initially, and that these treatments are effective. While traditional healers do refer cases that are not improving to the District Hospital, this frequently occurs late in the course of the illness, after one or more stages of traditional treatments. The prognosis will thus be poor for those children who are suffering from severe malaria. Consideration should be given to enlisting the support of traditional healers in efforts to improve treatment for severe malaria, including teaching them how to distinguish febrile convulsions from cases of severe malaria.

A population-based survey of the prevalence of refractive error in Malawi.

Refractive errors, particularly myopia, are a common problem in industrialized countries, but the impression exists that myopia may be relatively uncommon in non-industrialized societies. We conducted a population-based survey of refractive error in two groups of Malawians: a group of rural agricultural workers (n = 510) and a group of students at an urban teachers' college (n = 534). The overall prevalence of myopia was low; 2.5% (95% confidence interval 1.3%, 3.7%) of participants had an error of -0.5 D or greater. The mean refractive error (right eye) in the urban student group was +0.52 D compared to +0.62 D among the rural agricultural workers and the excess myopia was accounted for by significant myopia (> or = -0.75 D) in a few individuals, rather than an overall shift towards myopia within the urban student group. Among the rural agricultural workers, literacy predicted refractive error (right eye), with a mean of +0.59 D in the rural literate compared to +0.67 D in the rural illiterate. These findings support the notion that myopia is uncommon in non-industrialized societies and that it is associated with increased literacy but we have not identified specific risk factors within this group to predict the occurrence of significant myopia. In settings such as Malawi, refractive services should be targeted to urban centers, where more educated populations are likely to be found.