Household responses to illness are influenced by socio-economic and cultural factors, and by ease of access to treatment sources. Urban populations are generally younger, better educated and more ethnically heterogeneous than rural people. They also have better access to a greater range of modern medical facilities. These differences were confirmed for the Kenyan Coast through demographic work and careful mapping of health providers. Surveys involved rural resident mothers who had never lived in urban areas, and urban resident mothers who were mostly rural-urban migrants, all belonging to the same Mijikenda ethnic group.
Malaria is the principal cause of childhood mortality in coastal Kenya, and a common cause of fever.
Survey questions therefore focused on mothers responses to uncomplicated childhood fevers that took place in the two weeks before the survey. Surprisingly, the study showed that urban mothers do not use modern medical services and drugs more often or at an earlier stage than rural mothers. The most common response is to treat children at home using shop-bought drugs. Almost half of mothers who seek treatment contact a government or private clinic. Improving home-treatment has huge potential to reduce illness and mortality in rapidly growing urban populations, and to slow the spread of resistance to antimalarials.