BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 Table 2: Common health problems of children reported by mothers, Adami Tulu District, Ethiopia, 2003. Afan Oromo term (n = 2087) Busaa Garaa kaasaa Dhukkuboota ijaa Gifira (Shiffee) Dhukkubboota hanqina nyaataan dhufan Cittoo Afuura kutaa Raammoo garaa keessaa a Multiple responses possible. and loss of appetite, while 24% reported fever, shivering/ chills, headache and back pain, but didn't mention loss of appetite. Similarly, fever, high body temperature, shivering, head- ache, thirsty, loss of appetite, vomiting and joint pain were reported in all FGDs as the main symptoms of malaria. The disease is recognized as malaria if one or more of these symptoms are manifested by a patient as illustrated below. "If the body is hot, headache prevails, a patient is thirsty and drinks lot of water, back pain occurs, and when the body is chilly, we then recognize that the illness is due to malaria". (FGD, Aneno village). Most of the participants in all FGDs identified two types of busaa: mild busaa and the severe type locally described as "busaa isa sammuu nama koru (nama maraachu)". They narrated the latter as the type of malaria that quickly moves to the brain to make the patient unconscious (lit- erally 'malaria of the brain'), and if left untreated, they said that one could either die or become mentally con- fused from it. Other participants also described this type of severe malaria as "bicaa wobaa" (a term borrowed from the Amharic word for yellow malaria). Signs and symp- toms that were well articulated by participants of the FGDs and in-depth interviews for mild malaria included fever, headache, loss of appetite, thirst, joint pain and n (%)a 2066 (99.0) 1183 (56.7) 715 (34.3) 516 (24.7) 332 (15.9) 98 (4.7) 95 (4.5) 87 (3.9) English equivalent Malaria Diarrhea Eye diseases Measles Malnutrition Scabies Shortness of breathing Intestinal parasitosis chills, whereas for those who presented with severe malaria included intense high-grade body fever (qaama gubee ibidda namatti qabsiisa), convulsion (ni gaggabsa), and mental confusion (sammuu koree nama maraacha). In general, nearly all respondents and participants of FGDs and in-depth interviews perceived that malaria could kill a person within a short period if left untreated. When the survey respondents were asked "Is malaria more serious for children or adults?", mothers (67.1%) thought that children were susceptible to contract malaria and develop severe illness, followed by a response that malaria was equally serious for both adults and children (29.3%). About 2% of the survey respondents, nevertheless, did not perceive malaria as a serious disease either to children or adults. In all FGDs and in-depth interviews it was recog- nized that busaa is an illness that affects all people, being more common among children and more severe to them. The effects of busaa during pregnancy were well articulated and understood by the participants, emphasizing the need for prompt actions. During the FGDs, although children and pregnant women were recognized as groups espe- cially vulnerable to malaria, adults were also acknowl- edged to be at risk of the disease. "Busaa affects both children and adults, but is more severe on children". It is serious and kills people. (In-depth inter- view, Abjata village). Table 3: Multiple symptoms of malaria as perceived by mothers, Adami Tulu District, Ethiopia, 2003. Fever Shivering and chills Headache Back pain Loss of appetite Major malaria symptoms reported by mothersa + + + + + + + + + + + + + + + + + - + - - + + - - - + - + - - - + + - a "+" indicates the citation of the symptom, while "-" shows that the symptom is not reported by mothers. b Percentage was calculated from 2024 mothers who reported fever n (%)b 576 (28.0) 486 (24.0) 279 (14.0) 289 (14.3) 75 (3.7) 45 (2.2) 38 (1.9) Page 5 of 12 (page number not for citation purposes)