Open Access Research article

Inherent illnesses and attacks: an ethnographic study of interpretations of childhood Acute Respiratory Infections (ARIs) in Manhiça, southern Mozambique

Lianne Straus1, Khátia Munguambe23, Quique Bassat124, Sonia Machevo23, Christopher Pell15, Anna Roca12 and Robert Pool15*

Author Affiliations

1 Barcelona Centre for International Health Research (CRESIB), Hospital Clinic/Institut d'Investigacions Biomediques, University of Barcelona, Rosselló 132, 08036 Barcelona, Spain

2 Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, CP 1929, Rua 12, Maputo, Moçambique

3 Faculdade de Medicina, Universidade Eduardo Mondlane, Mozambique

4 CIBER Epidemiología y Salud Pública (CIBERESP), Spain

5 Centre for Global Health and Inequality, University of Amsterdam, OZ Achterburgwal 185, 1012 DK, Amsterdam, The Netherlands

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BMC Public Health 2011, 11:556  doi:10.1186/1471-2458-11-556

Published: 13 July 2011



Pneumonia is a leading cause of childhood hospitalisation and child mortality in Africa. This study explores local interpretations of Acute Respiratory Infections (ARIs), focusing on caretakers of children under five in the context of hospital care seeking.


The study took place in Manhiça, southern Mozambique and used Focused Ethnographic Study tools (FES) including field exercises and interviews.


Understandings of terms used to describe ARIs differed between caretakers and hospital staff. Children's sicknesses that hospital staff diagnosed as ARIs were interpreted by caretakers as intermittent "attacks" of xifuva, a permanent, inherent and incurable chest illness. Caretakers thought that it was possible to manage and treat the attacks, which were caused by immediate natural factors such as food or the weather, but not the underlying illness, which was seen as having more indirect and social causes. Explanations of illness could not be neatly separated into pluralistic categories, but were characterised by syncretism, with "lay" and "biomedical" terms and concepts intermingling in practical care-seeking interactions between caretakers and health staff.


Health promotion should take into account the syncretism involved in explanations of ARIs in the context of practical care seeking for children. In doing so, it should draw upon lay interpretations and terminologies in order to stress the importance of seeking hospital care for all xifuva-type illnesses as well as seeking care for any subsequent attacks of an already diagnosed xifuva. However, this should be undertaken with awareness that the meanings of the terms used in practical care-seeking interactions may change over time. Health communication about ARIs should therefore be ongoing and evidence-based, even if ARIs appear to be well understood.