Lay perceptions of malaria and therapeutic itinerary of resettled pregnant women in South Sudan

BACKGROUND: Approximately 95% of South Sudan is malaria-endemic and transmission is high throughout the year. Annually, 2.3 million people are at risk of malarial infection, but children under 5 years, pregnant women and their unborn children are particularly at high risk. Appropriate policies for malarial prevention and control require a better understanding of the populations' malarial perceptions and treatment itinerary. METHODS: A qualitative study was carried out to explore malarial lay perceptions and therapeutic itinerary among 30 resettled pregnant women in Unity State, South Sudan. RESULTS: The study showed that the therapeutic itinerary was prompted by fever and composed of five steps that were simultaneously or successively explored. The household and community constitute the first-line treatment options for fever. Interviewees relied on homemade remedies and concoctions, traditional healers' cures, magician's rituals and private formal and informal medicine vendors at the local market before seeking malarial diagnosis and treatment at the health centre. CONCLUSIONS: Improving capacities for proper identification and management of malarial fever at household and community level is a priority for reducing the delay in seeking timely and proper treatment. The formal health system may, in time, aspire to address the economic and cultural barriers within the system that contribute to delaying effective treatment-seeking.