The behavioural and social aspects of malaria and its control : an introduction and annotated bibliography

Overview

This monograph commences with a thorough analysis of the perception of malaria as a disease. How is the condition identified? Does the designation suggest an unrealistic etiology in a manner that impedes corrective measures? Does malaria impress local people as an important disease? Perhaps these traditional perceptions provide useful clues that would otherwise have eluded students of the subject.

The effect of human movement on malaria is treated extensively. Migrants, tourists, and military personnel, of course, serve as fuel for the lethal malarial fevers. But far more complex is the effect of externally funded development projects, which create fundamental malaria-promoting physical, economic, and social change in a region. Exotic vectors and novel antigenic variants of the pathogen may thereby be introduced into a region. Human mobility exposes non-immune people to new malaria infections and creates new antigenic combinations that continuously confound the immune systems of the more sessile existing residents of endemic sites. If visitors to endemic sites experience such difficulty, how effectively does the presence of this disease impede social and economic change? The presence of migrants confounds antimalaria operations because such people tend to fall through the cracks of formal health-care delivery systems. The monograph provides a comprehensive and authoritative overview of the resulting complexity.

Although Western therapeutic regimens and case-management systems dominate in planned anti-malaria interventions, traditional practices and informally blended Western regimens comprise a large part of the mix. A section of the monograph discusses the difficulties imposed by the clash between "Northern" and traditional modes of response to disease episodes, while demonstrating that the North has much to learn from the South. These informally prescribed regimens threaten our developing reliance on strategies based on CT for preventing the loss of drug efficacy. The remedy-seeking attitudes of affected populations therefore become central to anti-malaria policy. Traditional case-management practices may render the strategy of CT unsustainable. An understanding of these social forces is essential.