Because it is a widely perplexing disease, one in five deaths in many countries each year is linked to malaria, particularly in sub-Saharan Africa. The battle against malaria is complex. At times it focuses on prevention, at other times on treatment and cure, and always on education. But an element that should never be overlooked is the role that cultural differences play in the design and implementation of malaria prevention strategies. Specifically, how can strategies be embedded in local customs, beliefs, and practices and become more impactful? This article explores the role that culture plays in malaria prevention. It also presents some examples with insights on how strategies can be adapted to local communities.
The Role of Culture in Malaria Prevention
Understanding Cultural Context
Culture is whatever the beliefs, practices, and social norms shared by the group. And because culture is so pervasive, it can guide important health behaviors, as well as attitudes toward prevention and treatment. Here is an example of the way culture can matter to the problem of malaria:
- Misconceptions About Disease Causes: Malaria is not always understood as a mosquito-borne disease in many communities. Instead, other causes can be attributed to malaria including spirits or curses. Misunderstanding the cause of disease can limit the acceptance of conventional treatments and disease prevention statistics. For example, accepting an insecticide-treated net (ITN) or indoor residential spraying (IRS) as a mosquito preventative if a community believes they’re being bitten by spirits.
- Traditional: Traditional medicines and practices could be integral parts of health care Some communities could be more inclined to stay away from modern medicine and still use herbs and other traditional medicines or treatments, for instance. Understanding these practices and integrating them with malaria prevention efforts could improve acceptability and compliance.
- Social Norms: Social norms and practices determine what is appropriate behavior. For instance, gender may affect who is expected to do household health practices such as using ITNs or seeking treatment for fever.
Tailoring Malaria Prevention Strategies to Local Communities
1. Conducting Community Assessments
It is important to undertake a community assessment before starting malaria prevention strategies. This includes the following:
- Engaging Local Leaders: Local leaders and traditional healers can be important sources of information on local beliefs on wellness, disease, and cure. They can also play a role in accepting new preventive approaches.
- Interviewing People in the Community: Surveying the members of a community and conducting focus groups can help identify popular misconceptions about malaria and desired health-seeking behavior.
- Mapping Social Dynamics: Who’s in charge? What are the gender roles? Who influences whom? These questions can help reveal the social fabric and what the household where the intervention will be conducted is like. This can then help practitioners design interventions according to local ways of doing things.
2. Integrating Traditional and Modern Practices
Taking the richness of those varied and often intimate cultural practices into account can contribute to the acceptance and effectiveness of modern malaria control interventions, such as:
- Working with Traditional Healers: Leveraging traditional healers to embed malaria prevention messages into traditional health practices can build on existing practices, to combine the best of both modern science and traditional knowledge. Training these healers in ITNs, prompt treatment, and anti-mosquito practices can bridge the cultural divide between traditional and modern medicine.
- Respect Traditional Beliefs: Although ACs may not change their behavior or perception of risk, respecting traditional beliefs and providing evidence-based information about malaria prevention at the same time could encourage community members to adopt preventive measures.
- Providing Culturally Relevant Materials: Write educational material such as pamphlets and posters in the native language, with images and designs that reflect the local culture. It makes the material more relevant to personal emotional experiences.
3. Customizing Communication Strategies
Appropriate communication is essential to effective malaria prevention. Communication strategies should be designed to fit the local cultural context. This process involves:
- Educational materials – providing the information in local languages – and communications should be in mother-tongue languages Ensure they are ’local-language friendly’.
- Leverage Local Media: Use local radio stations, local festivals, town hall meetings, and other existing media in the community to spread malaria prevention messaging.
- Mobilise Community Influencers: Identify and engage community ‘influencers’ (religious leaders, respected elders, local celebrities), using their endorsements to promote malaria-prevention messaging.
4. Adapting Prevention Measures
Malaria prevention measures should be adapted to align with local practices and conditions:
- ITNs: Promote ITNs by distributing insecticide-treated mosquito nets through government and NGO efforts. Ensure these nets align with local practices for effective use in each community. Engage locals in education campaigns to maximize their benefits and reduce malaria transmission. In some places, people might sleep on sleeping mats on the floor in a room that might also have mosquito nets.
- Indoor Residual Spraying (IRS): Consider the architecture and layout of the houses in your area. What materials are used to build homes in your area? What kinds of structures? Are there ways in which the IRS could be less effective or more effective, based on the architecture and layout of the houses in your area?
- Environmental Management: Tailor environmental management efforts designed to reduce mosquito production to local conditions and practices. For example, if communities rely on traditional water storage methods, target efforts to reduce mosquito breeding specifically within those practices. Implement strategies to manage standing water, such as promoting covered storage or introducing natural predators. Tailor interventions to fit local customs, ensuring greater community involvement and effectiveness in reducing mosquito populations.
5. Encouraging Community Participation
Community engagement is vital for the success of malaria control programs. To encourage community involvement, we can adopt certain strategies. These include
- Establish Local Committees: Set up community-sponsored committees to keep effective track of malaria prevention programs. This community engagement helps to ensure that approaches to preventing and treating malaria are appropriate and culturally relevant.
- Involving families: engage families in malaria prevention by organizing informative teaching and workshops based on family-specific circumstances and habits.
- Cultivating Ownership: Give opportunities for community members to participate in decision-making and implementation activities which in turn helps to cultivate ownership and commitment towards the malaria prevention intervention.
Case Studies and Examples
1. Case Study: Integrating Traditional Healers in Tanzania
Malaria prevention programs in Tanzania have had success in bringing traditional healers into health care by providing traditional healers with training in malaria and malaria prevention, as well as materials to pass on to patients. Since implementing this program, acceptance of ITNs and prompt treatment have both increased for communities relying on traditional remedies.
2. Case Study: Culturally Tailored Messaging in India
For example, in India malaria campaigns have adjusted messages to address local beliefs and practices: campaign staff use local dialects and visual symbols in their educational materials; they also work with local religious leaders to promote the use of ITNs and other preventive measures. This targeted approach to malaria prevention can significantly enhance community engagement with and buy-in for prevention.
In particular, cultural sensitivity can contribute to the success of malaria prevention. Customising malaria prevention programs to people’s local culture, and adapting public health information to address local cultural practices and beliefs, can improve their efficacy by maximising compliance and introducing additional pathways to engagement. Greater effectiveness results from culturally appropriate communication strategies to convey accurate diagnostics and uptake of preventive measures, improving services and treatment. By addressing cultural expectations in public health communication, understanding community beliefs and norms, incorporating traditional practices into the design of programs, tailoring prevention measures to optimize compliance, and relying on community participation and support, we can reduce the burden of malaria and its health impacts.
