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The Behavioural and Social Aspects of Malaria and Its Control

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The Behavioural and Social Aspects of Malaria and Its Control SEBbook.qxd 5.9.2003 14:50 Page 1 The behavioural and social aspects of malaria Social, Economic and Behavioural (SEB) Research Social, Economic and Behavioural and its control An introduction and annotated bibliography H. Kristian Heggenhougen Veronica Hackethal Pramila Vivek Foreword by Andrew Spielman UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) SEBbook.qxd 5.9.2003 14:50 Page 2 SEBbook.qxd 8.10.2003 16:09 Page I The behavioural and social aspects of malaria and its control An introduction and annotated bibliography H. Kristian Heggenhougen 1 Veronica Hackethal 2 Pramila Vivek 3 Foreword by Andrew Spielman 4 1 Medical Anthropologist, Boston University School of Public Health, Department of International Health 2 MD candidate at Columbia College of Physicians and Surgeons, New York, N.Y. 3 Harvard Medical International, Harvard Medical School, Boston 4 Entomologist, Prof. of Tropical Public Health, Dept of Immunology and Infectious Diseases, Harvard School of Public Health, Boston SEBbook.qxd 5.9.2003 14:50 Page II TDR/STR/SEB/VOL/03.1 © World Health Organization on behalf of the Special Programme for Research and Training in Tropical Diseases 2003. All rights reserved. The use of content from this health information product for all non-commercial education, training and information purposes is encouraged, including translation, quotation and reproduction, in any medium, but the content must not be changed and full acknowledgement of the source must be clearly stated. A copy of any resulting product with such content should be sent to TDR, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland. TDR is a World Health Organization (WHO) executed UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases. This information product is not for sale. The use of any information or content whatsoever from it for publicity or advertising, or for any commercial or income-generating purpose, is strictly prohib- ited. No elements of this information product, in part or in whole, may be used to promote any specific individual, entity or product, in any manner whatsoever. The designations employed and the presentation of material in this health information product, includ- ing maps and other illustrative materials, do not imply the expression of any opinion whatsoever on the part of WHO, including TDR, the authors or any parties cooperating in the production, concern- ing the legal status of any country, territory, city or area, or of its authorities, or concerning the delineation of frontiers and borders. Mention or depiction of any specific product or commercial enterprise does not imply endorsement or recommendation by WHO, including TDR, the authors or any parties cooperating in the produc- tion, in preference to others of a similar nature not mentioned or depicted. The views expressed in this health information product are those of the authors and do not neces- sarily reflect those of WHO, including TDR. WHO, including TDR, and the authors of this health information product make no warranties or representations regarding the content, presentation, appearance, completeness or accuracy in any medium and shall not be held liable for any damages whatsoever as a result of its use or appli- cation. WHO, including TDR, reserves the right to make updates and changes without notice and accepts no liability for any errors or omissions in this regard. Any alteration to the original content brought about by display or access through different media is not the responsibility of WHO, includ- ing TDR, or the authors. WHO, including TDR, and the authors accept no responsibility whatsoever for any inaccurate advice or information that is provided by sources reached via linkages or references to this health infor- mation product. Design: Lisa Schwarb SEBbook.qxd 5.9.2003 14:50 Page III TABLE OF CONTENTS ACKNOWLEDGEMENTS . V FOREWORD . VII CHAPTER 1 Introduction: Sociocultural and equity issues in malaria control . 1 CHAPTER 2 History and review of malaria . 21 CHAPTER 3 Perceptions about the aetiology and transmission of malaria . 37 CHAPTER 4 The acceptance and use of western technology versus local methods in malaria treatment . 49 CHAPTER 5 Malaria transmission and control: Human mobility, refugees and resettlement . 67 CHAPTER 6 Bednet usage and its acceptance at the local level . 87 CHAPTER 7 Gender relations and the special roles of women in malaria risk and control . 109 CHAPTER 8 Community participation and involvement in malaria control . 129 CHAPTER 9 Conclusion: Malaria control and its dependence on sociocultural understanding, social development, and equity . 147 ANNOTATED BIBLIOGRAPHY . 153 SEBbook.qxd 5.9.2003 14:50 Page IV SEBbook.qxd 5.9.2003 14:50 Page V ACKNOWLEDGEMENTS This publication was made possible through support provided by the Office of Health, Infectious Diseases, and Nutrition of the Global Bureau, U.S. Agency for International Development, under the terms of Grant No. HRN-A- • Acknowledgements 00-96-90010-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. We are also grateful for the substantial support provided by the UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR), and, in particular, we would like to thank Dr Carlos Morel, TDR's Director, and Dr Johannes Sommerfeld, Manager, Social, Economic and Behavioural Research (SEB), TDR. We wish to acknowledge Dr Jonathon Simon, Director, Center for International Health and Development (CIHD), Boston University School of Public Health, for his continued support of this effort which the authors carried out as part of their work at CIHD. We grate- fully acknowledge the contributions of Pritha Sen to Chapter Six: Gender relations and special roles of women in malaria risk and control. The man- uscript has benefited from the critical reviews and encouragement of our colleagues at CIHD, as well as from Professor Peter Brown at Emory University, two anonymous reviewers and from Prof. Christopher Curtis for comments on Chapter Two. A special thank you to our editor, Susan Pasternack, of Boston and to Scott Buquor and Lisa Schwarb for the layout. ] The behavioural and social aspects of malaria and its control its control and malaria aspects of social and behavioural The V SEBbook.qxd 5.9.2003 14:50 Page VI SEBbook.qxd 5.9.2003 14:50 Page VII FOREWORD Malaria is unique among diseases because its roots lie so deep within human • Foreword communities. The most dangerous vectors of malaria thrive mainly within the village environment. Logically, the adult vectors remain close to their noctur- nal source of human blood, and the developmental stages of these mosquitoes exploit the nearby accumulations of water that form where people have dis- turbed the natural drainage. The borrow pits made in the course of mud-brick construction, tyre tracks, and hoof-prints, for example, promote vector abun- dance in much of sub-Saharan Africa. Malaria then becomes a fixture of vil- lage life, exacting a continuous toll on the health of its host population while generating lethal outbreaks among visitors. As a result, malarious communi- ties tend to be isolated, with their economies frozen at a subsistence level. Productivity is impaired, and the societies that develop in such sites tend to resist change. Affected communities adapt to their isolated state by develop- ing behaviour patterns and social systems that help their members adjust to this reality. The vertically organised anti-malaria programmes that were launched before ] the 1990s could be conducted largely without reference to the behaviour and its control and malaria aspects of social and behavioural The the belief systems of the affected populations. Indoor residual insecticides, the hallmark of the eradication era, were applied uniformly across entire conti- nents. Although residents frequently denied the government spray teams entry to their homes and removed the insecticidal sprays from treated walls, their active participation was largely irrelevant to the intervention. Current anti- malaria programmes, however, generally are organised horizontally and depend heavily on resident participation. The recently launched Roll Back Malaria (RBM) Programme relies mainly on insecticide impregnated bednets (ITNs) and com- bination drug therapy (CT). ITNs must be hung by the people who are to sleep under them and they must be reimpregnated in a timely manner, frequently at the user's expense. Failure to sustain this intervention would result in increased sickness and death due to exposure of relatively non-immune people to new VII SEBbook.qxd 5.9.2003 14:50 Page VIII infections. CT requires a standard schedule of drug administration that relies on the cooperation and understanding of each affected person. Failure to adhere to the prescribed regimen would endanger the long-term efficacy of the regi- • Foreword men. Resident cooperation is even more crucial when environmental manage- ment or housing improvement becomes the intervention modality. These prac- tical reasons drive our current need for a solid understanding of the behav- ioural and social factors that influence malaria risk and that may inhibit or facilitate particular intervention modalities. No longer can interventions be conducted uniformly across broad regions; the problems tend to be local. This monograph commences with a thorough analysis
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