The social experience of malaria treatment-seeking: pathways, gender, and inequality in Jimma Zone, Ethiopia

BACKGROUND: Malaria remains one of the most persistent public health challenges in Ethiopia, where its meaning and treatment are shaped not only by biological causes but also by cultural beliefs and social inequalities. Despite increased awareness and government-led control efforts, the disease continues to affect communities in endemic areas. This study examined how communities in Jimma City understand and manage malaria, specifically focusing on how local beliefs, gender roles, and economic barriers shape treatment choices. METHOD: An ethnographic study was conducted in Jimma City, southwest Ethiopia. Data were collected through in-depth interviews (n = 32), key informant interviews (n = 8), two focus group discussions, participant observation, and document review. Participants included household members affected by malaria, traditional healers, religious leaders, community elders, and health professionals. Interviews were conducted in Afaan Oromo and Amharic, transcribed verbatim, translated into English, and analyzed using thematic analysis. RESULT: Malaria was understood through overlapping cultural and biomedical explanatory models. Local terms such as buda (evil eye), busa (seasonal fever), and sekera (killer disease) shaped how symptoms were recognized and interpreted. Treatment-seeking followed a pluralistic pathway, commonly beginning with home remedies, herbal treatments, and prayer, followed by biomedical care when symptoms worsened or persisted. Gender dynamics strongly influenced care-seeking: females were typically the first to recognize illness and provide care but often lacked decision-making authority and financial control, contributing to delays in accessing treatment. Males' occupational and social activities increased their exposure to malaria risk. Structural barriers including poverty, drug stockouts, transport constraints, inadequate housing, and weak health infrastructure further constrained timely and effective care. CONCLUSION: In Jimma City, malaria is experienced as a social as well as biomedical condition, embedded in local belief systems, gender relations, and structural inequalities. Malaria control efforts that focus solely on biomedical interventions risk overlooking the social realities that shape treatment-seeking behavior. Effective and sustainable malaria control requires engagement with local explanatory models, strengthening women's decision-making power, and addressing systemic barriers that perpetuate vulnerability.