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Non-communicable diseases (NCDs)

  Combining surveillance data with local knowledge

Mortality data for 1,715 deaths from Agincourt HDSS (2014-15) was analysed and combined with community-based research in villages with varied characteristics on epilepsy and stroke.Routine Surveillance Data 2014-15

Local knowledge

 Detailed understandings of signs, symptoms and severity: For stroke: loss of function/sensation, paralysis and memory loss. For epilepsy: uncontrollable movements, fainting, frothing at the mouth and incontinence. Physiological causes of stroke known as high salt intake, high BP, low levels of physical activity and poor diet.

Stress as a cause: Stress frequently described as a result of poverty and significant risk factor contributing to the exacerbation e.g. poor diet contributing to risk .

Traditional beliefs on causes and care seeking: ‘Xifulana’ traditional term for stroke and ‘Ringhadi’ referred to a snake in the abdomen thought to be causative for epilepsy. Hospital treatment for stroke caused by a curse perceived to be damaging. 

Access to care limited: Despite traditional medicine use, poverty described as directly impacting abilities to pay for travel to clinics/pharmacies, and to obtain medications. Transport to clinics and clinic opening hours described as unsatisfactory, and in clinics, long waiting times described.

Perceptions of low quality of care: Interpersonal care in clinics, particularly confidentiality, recounted as problematic. Mistrust in clinic staff significantly deters individuals from attending clinics.