Lay concepts and perceptions of malaria among the Acholi in post-conflict Gulu District, Northern Uganda: A Qualitative Study

Abstract Background Despite high malaria related burden, limited evidence exists on how local meanings of malaria interact with post conflict health system experiences among the Acholi in Gulu District. This study explored how lay concepts and perceptions of malaria influence health-seeking behavior among the Acholi in post conflict Gulu District, northern Uganda. Methods The study adopted a qualitative approach, with a case study design. Purposive sampling was used to recruit 25 participants into the study. Participants included different categories, such as healthcare providers and household members who provided different perspectives on the study objective. They were aged between 18 and 72 years. Semi-structured interviews was used for data collection and thematic analysis used for data analysis. Results Malaria was mainly understood through its symptoms, which were expressed through local terms such as ‘ two lyeto ,’ ‘ two atiba ,’ and ‘ two abubu .’ Explanations for its causes ranged from eating mangoes and exposure to cold, to spiritual forces. Malaria preventive practices were reported to include herbal remedies, fireplace smoke, and compound cleaning. Treatment seeking was influenced by perceived severity of malaria, health system experience, availability and trust in local remedies. People reportedly moved between traditional remedies, spiritual healing and biomedical interventions. Conclusion Malaria prevention and treatment seeking decisions among the Acholi were influenced by their lay concepts and perceptions of the disease and experiences with the health system. Malaria control interventions in this context and similar settings need to engage with community knowledge systems of disease to improve acceptance of recommended measures.