Maternal responses to childhood fevers: a comparison of rural and urban residents in coastal Kenya

Urbanization is an important demographic phenomenon in sub-Saharan Africa, and rural-urban migration remains a major contributor to urban growth. In a context of sustained economic recession, these demographic processes have been associated with a rise in urban poverty and ill health. Developments i n health service provision need to reflect new needs arising from demograph ic and disease ecology change. In malaria-endemic coastal Kenya, we compare d lifelong rural (n = 248) and urban resident (n = 284) Mijikenda mothers' responses to childhood fevers. Despite marked differences between the rural and urban study areas in demographic structure and physical access to biom edical services, rural and urban mothers' treatment-seeking patterns were s imilar: most mothers sought only biomedical treatment (88%). Shop-bought me dicines were used first or only in 69% of the rural and urban fevers that w ere treated, and government or private clinics were contacted in 49%. A hig her proportion of urban informal vendors stocked prescription-only drugs, a nd urban mothers more likely to contact a private than a government facilit y. We conclude that improving self-treatment has enormous potential to redu ce morbidity and mortality in low-income urban areas, as has frequently bee n argued for rural areas. However, because of the underlying socio-economic , cultural and structural differences between rural and urban areas, rural approaches to tackle this may have to be modified in urban environments.