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

Summary 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 in health service provision need to reflect new needs arising from demographic and disease ecology change. In malaria‐endemic coastal Kenya, we compared 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 biomedical services, rural and urban mothers' treatment‐seeking patterns were similar: most mothers sought only biomedical treatment (88%). Shop‐bought medicines were used first or only in 69% of the rural and urban fevers that were treated, and government or private clinics were contacted in 49%. A higher proportion of urban informal vendors stocked prescription‐only drugs, and urban mothers more likely to contact a private than a government facility. We conclude that improving self‐treatment has enormous potential to reduce morbidity and mortality in low‐income urban areas, as has frequently been 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.