Malaria in Liberian children and mothers: biocultural perceptions of illness vs clinical evidence of disease.

1046 non-hospitalized children and mothers from various regions of Liberia were studied to determine the relationships between their indigenous perceptions of malaria illness with on-going Plasmodium parasitemia and annual incidence of clinical malaria. Eleven pediatric and 14 maternal signs and symptoms of malaria were described, ranked by cultural severity, and evaluated biomedically. Between cultural perceptions of the severity of illness and biomedical evidence of the severity of disease, significant rank order correlations are observed for children (rho = 0.713, P less than 0.01) and mothers (rho = 0.875, P less than 0.001). Clinical, parasitological and cultural concordance were observed for 'anorexia', 'joint pain', 'abdominal tenderness', 'nausea', 'chills', 'severe headache', 'stomach pain', and 'dizziness'. Five other symptoms however either over or underpredicted observed levels of biomedically confirmed malaria: 'fever', 'convulsions', 'vomiting', 'body weakness' and 'psychological distress'. Biomedical studies revealed a parasite rate among children of 68.6%, a mean annual incidence of pediatric clinical malaria of 3.12; and a mean annual incidence of maternal clinical malaria of 2.42. Clinical malaria demonstrated a very early onset among newborns and a shift in acute parasitemia to a chronic status around 2.3 years of age. A significant positive linear correlation (r = 0.75, P less than 0.01) was observed between parasitological and clinical measures of malaria in children. The indigenous perspectives on malaria and the biomedically predictive powers of various biocultural symptoms are discussed and evaluated as an integrative and valuable means of assessing the impact of malaria in an endemic region.