The WHO guidelines recommend that personal interviews at the household level should focus on mothers as the prospective respondents. In our case this presented a few problems. In Uganda the reality is that health seeking behaviour normally involves the entire family. With the diffusion of injections to the domestic sphere, there is a gender division of roles in the various activities that surround the use of injections. The husband is normally responsible for making the decision about the treatment form, purchase and storing of needles and syringes; the wife is responsible for either providing the injection or taking the child to a provider facility and therefore might have information related to source of injection, medicine injected and symptoms for which the injection was provided. Within the household, the wife and daughters might be responsible for boiling the equipment. Given such a context of injection use, it was left to the individual household to identify the prospective respondent. Additional information provided by any other member of the household was considered important and was recorded.
Other methodological problems experienced were associated with the use of the hypothetical tracer condition method. In-depth interviews with a limited number of households in Busoga from both remote and urban settings indicated that it is rather intricate to use the idea of scale of illness’ to evaluate the appropriateness of injection use. The medical construction of what constituted a mild and serious illness was not coherent with the lay people’s perception. At the local level, most of the illnesses were regarded as mild or serious depending on the length of time the illness took to be cured, response to oral therapy and the role adopted by the sick person - getting admitted in hospital, taking to bed at home or failure to perform normal duties. Informants indicated that any illness which persists, with or without treatment, is serious enough to justify the use of injection therapy including cough and common cold. Although mild in nature, a common cold was never taken for granted, as it is believed to be a prelude to a more serious disease such as malaria. Other informants expressed the view that nearly every illness appeared mild at its onset, hence no illness should be ignored. The people therefore justified the use of injection as a preventive measure.
Lay people also perceived serious illnesses as those which could cause anemia and dehydration. They were also perceived to be those diseases that get to the bones, joints....”really deep into the body”. These diseases might render the patient restless, lead to rise in body temperature, loss of strength, loss of appetite and general body weakness. Meanwhile all tracer conditions which were symptomatic of measles (there was an outbreak of measles in at least three communities in Busoga) - such as diarrhoea in children, vomiting, unproductive cough and fever (perceived rise in body temperature) - were also regarded as serious.
Our study treated various tracer conditions as single disease entities. However, during the two weeks recall period we discovered that often people complain of several symptoms. An injection is not always given to one isolated tracer condition, but sometimes to a patient with a combination of symptoms. This poses complexities in applying tracer conditions to evaluate the appropriateness of injection use. Perhaps in future household surveys it will be necessary to adjust tools to this reality.