“So they believe that if the baby is sick you must give drugs…” The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa

A mixed method approach was used to investigate the treatment of childhood illnesses in Johannesburg and Soweto. In 2004, in-depth interviews were held with caregivers (n = 5), providers of traditional (n = 6) and Western (n = 6) health care, as well as 5 focus groups with black caregivers of children under 6 years. An utilisation-based survey was conducted with 206 black caregivers of children under 6 years of age at 1 public clinic in Soweto (n = 50), 2 private clinics (n = 50) in Johannesburg, 2 public hospitals (n = 53) from Johannesburg and Soweto and 2 traditional healers (n = 53) from Johannesburg and Orange Farm, an informal settlement on the outskirts of Johannesburg. Caregivers reported how they would respond to 4 common child health problems. Home treatments would be a common first resort particularly for diarrhoea (79%, mostly salt and sugar solution) and constipation (53%). In the case of constipation, the spuit [enema] was cited as a particularly effective home treatment method, particularly amongst TMP patients. Approximately 50% of caregivers would access a health care provider as a first resort for coughs. OTC medicines are commonly used for fever (63%), less-so for coughs (37%). Overall, higher SES respondents would be more likely to use over-the-counter (OTC) medicines and less likely than other groups to use home treatments. Shortages of medicines at clinics and caregiver beliefs about the efficacy of medicines affect health-care seeking behaviour. Medicines are not always used as intended or according to instructions and some products such as household detergents may be used medicinally. As well as the need for improving facility-readiness for delivering IMCI (Integrated Management of Childhood Illnesses), the patient–provider relationship is instrumental in improving the treatment of childhood illnesses.