This term literally means humidity or coolness and is known as 'illness of the cold'. Sumaya is most consistent with the biomedical definition of uncomplicated malaria. It is very frequent and found among all age groups. It is considered to be a serious illness. Cited symptoms are fever, weakness, cold, loss of appetite, general body pain, diarrhoea, and vomiting. Sumaya is perceived to be caused by natural factors such as the dirty environment, the climate (cold, wind) or certain kinds of food (e.g. too much sugar, too much condiment). Mosquitoes are usually not seen as the cause – mentioned only by one TBA and two guérisseurs who both stressed that it is a cause only during the rainy season.

This illness concept can be translated as 'displaced heart'. It is believed that the heart leaves its usual place in the body and shifts to another part (e.g. into the leg or the back). This can be caused by either natural factors, e.g. another illness such as severe sumaya, severe cough or other long-term or chronic disorders, or by supernatural factors such as the action of a sorcerer/an evil person. The two most significant symptoms of dusukun yelema are respiratory difficulties and vomiting. It is, thus, very close to the biomedical definition of respiratory distress syndrome. Other symptoms are fever, loss of appetite, and diarrhoea. Although considered to be not very frequent, dusukun yelema is perceived as very dangerous and often fatal.

The local concept of kono is very close to the biomedical picture of cerebral malaria and characterized by convulsions and coma. Kono is an illness exclusively restricted to young children (3 months – 5 yrs.). It is considered a very serious illness which has often fatal outcomes.

"In our community there is no child illness which is worse than kono." (guérisseur F, Mossi)

"Many children have died because of it." (young mother, FGD A, Bwamu)

Literally translated kono means bird, so one can say that it is the 'bird-illness'. The name is explained first by the fact that the movement of a child's arms during an attack resembles the movement of a bird's wings, and second by the belief that the cause of illness is also seen in the action of a bird. The bird provokes the illness whilst flying over a woman sleeping with her child outside during the night. If a pregnant woman sleeps outside during the night and the bird passes over her, the child may attract kono once born. Sumaya was also mentioned as a possible cause of kono. However, it must be stressed that the two are perceived as entirely different illnesses and not – as in biomedicine – as the mild and severe forms of the same disease, i.e. malaria.

Djoliban means "the blood is finished". This term in a biomedical sense describes a state of severe anaemia. The study population had not much knowledge about djoliban. According to the interviewees it is a very rare, but life-threatening illness. The main symptom of djoliban is that the body, eyes, and palms of the patient become pale. Further cited symptoms are fever, vomiting and loss of appetite. Causes may be a long-term or chronic illness, as well as sumaya, weakness, over-exertion, and insufficient food.

Sumaya is usually treated at home, by mothers themselves, using a mixture of herbs and modern drugs such as paracetamol and chloroquine. The herbal remedy – usually plant leaves – is generally prepared as decoction (boiled in hot water) and then applied to the child through bathing and/or drinking.

Two different treatments were mentioned by the old mothers of FGD A, Bwamu: they mentioned the use of ash (although it was not explained what kind of ash or how to use it) and burning the hooves of a donkey to apply the remnant into the infant's anus. One other treatment was mentioned in FGD C, old mothers, Mossi: blowing into the child's ears will help the child recover.

Mothers stated that this illness is usually treated by – in most cases female – guérisseurs performing a massage. Of the nine guérisseurs interviewed, five admitted to treat dusukun yelema – including both of the two female guérisseurs. They treat this condition with herbs or massages. These are often used in combination.

Nevertheless, some women treated this illness by themselves, using herbs and/or massages. In FGD A, Bwamu, a different treatment was mentioned by the young mothers: applying the ash of a burned mushroom (parkia biglobosa) onto the child's chest or grinding the shell of a tortoise to apply the powder onto the child's chest.

TBAs denied treating dusukun yelema. Two TBAs mentioned that they advice treatment-seeking mothers to visit a CSPS with their children. The other two stated that they are not visited by mothers whose children suffer from dusukun yelema, as guérisseurs are responsible for the cure of this illness:

"...mothers don't visit me, but there are guérisseurs who treat it. There are some who massage the children." (TBA A, Dafing).

Also with regard to kono, mothers and TBAs stated that the illness is treated by guérisseurs.

"You take the child to the guérisseurs who will give you some remedies." (TBA A, Dafing).

Seven of the interviewed guérisseurs explicitly stated that they treat kono. Herbal preparations are here one possible form of treatment. Often, roots are transformed into a powder which is added to water or thrown into a fire. The child has then to inhale the smoke of the fire or drink the water. The child is seldom bathed in the water. Only once was the introduction of the powder into the child's nostrils or anus mentioned. Besides these herbal treatments, guérisseurs cited several other treatment procedures, such as fabricating a feather chain (also given as protection), saying incantations or giving a massage.

The feather chains were also mentioned as a common form to heal kono by mothers and TBAs. Made out of the feathers of a bird, these chains are usually manufactured by the guérisseurs and may be directly purchased by them or bought on the local market and are tight around the child's neck, arm, wrist, or hip. There is a great variety of chains available, ranging from simple chains – only containing one feather – to more "luxurious" versions with several feathers, some of them stitched into small leather pockets.

One single mother (young mother, FGD C, Mossi) mentioned an additional treatment. She suggested that to treat kono, one needs to place the child on the ground below the edge of the house roof and to shed water down the roof onto the child to allow him to recover immediately.

Furthermore in one FGD (young mothers, Peulh), one verbal autopsy and in informal conversations it was mentioned that if a child with kono is brought to a health centre or hospital and receives an injection there, this would be fatal to the child.

The treatment for djoliban is considered to be the domain of the modern health facilities. People state that there is no indigenous ("African") remedy for it.

"There is no African remedy for this." (old mother, FGD B, Peulh)

"To be honest, African people don't have this remedy." (old mother, FGD C, Mossi)

If guérisseurs or TBAs diagnose djoliban they refer the patient to a modern health institution.

"Djoliban is rare, if this happens and I diagnose that it is djoliban, I refer the patient to the doctors." (Guérisseur C, Marka).

"It is our nurses who do it. Me, I don't heal it." (TBA D, Bwaba).

Only two or three respondents mentioned to treat djoliban – with plants. Two times it was added that feeding the child with specific food may also contribute to the cure.

Guérisseurs reported that they are used to refer patients to modern health facilities if the illness is not in their sphere of responsibility or if the patient does not improve after treatment.

"When you see that the products [the guérisseurs' traditional treatment] cannot heal, you bring him [the patient] to the hospital." (guérisseur A, Bwamu).

"If we are not able to treat the illness, we tell him [the patient] to visit a modern health center." (guérisseur D, Mossi).

Besides these referrals there is no collaboration between the two sectors, although the great majority of guérisseurs clearly stated that they would like to collaborate with the modern health institutions. This would in their view contribute to reducing the disease burden in Burkina Faso.

"If we unite to work together, that's what will bring forward the country. The illness, which exhausts us, will diminish." (guérisseur E, Marka).

"In fact it is the illness which has been the cause of our underdeveloppement. If someone doesn't know about a domain, someone else knows about it. If we unite we form one force." (guérisseur I, Marka).

However, the guérisseurs made only a few suggestions regarding how to implement such collaboration. For example, they suggested working together with the health staff in the modern health facilities by contributing with their knowledge about illnesses, by treating patients with their own medicaments, or by treating patients referred to them by the modern health institutions. Furthermore, the guérisseurs strongly pointed out that they do not feel appropriately recognized and respected by the staff of health centers and hospitals.

"If we poor people try to approach them [formal health staff], they don't respect us." (guérisseur C, Marka)

Among the 100 children with a post mortem diagnosis of malaria, there were 45 females and 55 males. 38 of the deceased children had lived in Nouna town and 62 in the surrounding villages. The great majority of the children (76%) had died during the first two years of life as well as during the first week after the onset of symptoms (72%).

In the VA questionnaires the respondents were specifically asked which illness in their view had caused the childrens' death. Table 1 shows the perceived causes of death according to the four local concepts of illness described earlier. Sumaya and kono were the most frequently mentioned malaria-related categories, while djoliban was only mentioned once and dusukun yelema was not mentioned. Furthermore there was a great variety of other illnesses listed, not only in Dioula, but also in other local languages.

The majority of children (58/100) were treated with a combination of modern and traditional methods. 25/100 (25%) were treated exclusively with modern methods and 14/100 (14%) were treated solely with traditional methods. Three children received no treatment at all. Looking at the cited local illness concepts, the majority of the sumaya and kono cases were treated with a mix of traditional and modern methods. In case of kono, a visit to a guérisseur was mentioned 7 times (33%). The only case of djoliban was also treated with a mixture of traditional and modern treatment.

Roughly half of the deceased children were not brought to a modern health facility during the final illness episode (n = 51). Lack of money (13/51) (25%) and a rapid progress to death (13/51) (25%) were the main reasons given to the question why no modern health facility was visited. In 17/51 (33%) questionnaires there was no specific reason stated.