Perceptions about malaria among Brazilian gold miners in an Amazonian border area: perspectives for malaria elimination strategies.

BACKGROUND: Mining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge. The environment of the mines contributes to the proliferation of vector mosquitoes and the precarious housing conditions facilitate transmission of the disease. Understanding gold miners' perceptions is essential for the formulation of strategies to fight malaria. A qualitative study was carried out in the municipality of Calçoene, state of Amapá, Brazilian Amazon adjointining the municipality of Oiapoque, that is in the border area with French Guiana and Suriname. METHODS: A semi-structured interview was applied to an intentional sample of 29 miners, a number determined by the theoretical saturation criterion. Thematic analysis was adopted to obtain the results and the Cohen's Kappa index was calculated to verify the agreement between observers during coding. RESULTS: The agreement between observers was verified by a Cohen's Kappa index of 0.82. Analysis of the interviews showed that gold miners were subjected to prejudice from the community due to forest diseases that they can transmit, and their activities are often associated with crime. When the miners return to their hometown after a period of mining, the urban population blames them for the onset of diseases such as malaria. Most participants in the survey did not know how malaria transmission occurs, and associated its occurrence with contaminated water and food. Participants reported not being afraid of the disease, trusting the diagnosis and available treatment, though this depends on where they are treated. The use of therapeutic resources, such as medicinal plants and medicines acquired in the illegal market, is very common in this population. Despite the challenges identified by the research subjects, they believe that the disease can be controlled, or the cases reduced, but there was low acceptability for a possible mass drug administration (MDA) intervention. CONCLUSION: Despite a recent reduction in malaria prevalence in Brazil, there are still vulnerable populations, such as gold miners, who help to perpetuate the existence of the disease in the Amazon. The lack of knowledge regarding how the transmission of malaria occurs, associated with myths regarding this and the use of traditional health practices and illegal drugs for the treatment of the disease without a specific diagnosis, jeopardizes the country's efforts to eliminate malaria. It is necessary to implement control programmes in these populations, especially those who frequently travel around the border region and to remote locations, which are difficult regions for health teams to access, thus hindering diagnostic and treatment actions. For this reason, understanding the perceptions of these individuals as well as their customs, beliefs and lifestyle, can assist in the production of targeted educational material and adoption of strategies in the elimination of malaria in the country.

Rapid ethnographic assessment for potential anti-malarial mass drug administration in an outbreak area of Santo Domingo, Dominican Republic.

BACKGROUND: In the Dominican Republic, a recent outbreak of malaria in the capital, Santo Domingo, threatens efforts to eliminate the disease. Mass drug administration (MDA) has been proposed as one strategy to reduce transmission. The success of MDA is contingent upon high levels of acceptance among the target population. To inform the design of future MDA campaigns, this rapid ethnographic assessment examined malaria-related knowledge and attitudes toward malaria MDA among residents of a transmission focus in Santo Domingo. METHODS: In October 2019, a rapid ethnographic assessment was conducted in the Los Tres Brazos transmission focus, which had not previously received MDA. National malaria programme staff conducted 61 structured interviews with key informants, recorded observations, and held 72 informal conversations. Using a grounded theory approach, data were analysed during three workshop sessions with research team members. RESULTS: Among those who had heard of malaria in the structured interviews (n = 39/61; 64%), understanding of the disease was largely based on personal experience from past outbreaks or through word-of-mouth. Community health workers (promotores) were trusted for health information and malaria diagnosis more so than professional clinicians. No participant (0%) was familiar with malaria MDA. After learning about MDA, almost all study participants (92%) said that they would participate, seeing it as a way to care for their community. Reasons for not participating in future MDA included not trusting drug administrators, feeling reluctant to take unprescribed medicine, and fear of missing work. Additional identified challenges to MDA included reaching specific demographic groups, disseminating effective MDA campaign messages, and managing misinformation and political influence. CONCLUSION: Residents appear accepting of MDA despite a lack of prior familiarity. Successful MDA will depend on several factors: fostering relationships among community-based health workers, clinicians, community leaders, and others; developing clear health messages that use local terms and spreading them through a variety of media and social networks; and contextualizing MDA as part of a broader effort to promote community health.

Community perception of malaria in a vulnerable municipality in the Colombian Pacific.

BACKGROUND: Malaria primarily affects populations living in poor socioeconomic conditions, with limited access to basic services, deteriorating environmental conditions, and barriers to accessing health services. Control programmes are designed without participation from the communities involved, ignoring local knowledge and sociopolitical and cultural dynamics surrounding their main health problems, which implies imposing decontextualized control measures that reduce coverage and the impact of interventions. The objective of this study was to determine the community perception of malaria in the municipality of Olaya Herrera in the Colombian Pacific. METHODS: A 41-question survey on knowledge, attitudes, and practices (KAP) related to malaria, the perception of actions by the Department of Health, and access to the health services network was conducted. RESULTS: A total of 134 adults were surveyed, in whose households a total of 671 people lived. According to the survey data, about 80% of the household members included teenagers and children, out of which 61% had malaria at one time, and for 75.3%, this disease is a persistent problem. In spite of this, 57.2% of people who fell ill due to malaria were never visited by health personnel for a follow up. This population claimed that responsibility for who should prevent the disease is shared between each person and the Department of Health. However, personal actions were focused on using mosquito nets, ignoring other important practices to prevent bites. Despite campaigns by the Department of Health, 11.9% of respondents did not know how malaria was transmitted, and 8.96% thought it was transmitted through water. Also, 43.5% said that the Department of Health did not do any work to control malaria and 16% did not know if any action was taken. CONCLUSIONS: In spite of the knowledge about malaria and the efforts of the Department of Health to prevent it, the community actions do not seem to be consistent with this knowledge, as the number of cases of malaria is still high in the area.

Prevalence of malaria and lymphatic filariasis in bateyes of the Dominican Republic.

BACKGROUND: The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural 'company towns' called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease. METHODS: From March to April 2016, a cross-sectional, cluster survey was conducted across Dominican bateyes stratified into three regions: southwest, north and east. A household questionnaire (n = 776), captured demographics, ethnic origin, mobility patterns, malaria intervention coverage, and knowledge, and recent fever and treatment-seeking. Two individuals per household (n = 1418) were tested for malaria parasites by microscopy and rapid diagnostic test (RDT) and LF antigen by filariasis test strip (FTS). Population-level estimates and confidence intervals (CI) were computed adjusting for the survey design. Two-sided t-tests compared differences in knowledge scores. RESULTS: No (0%) blood sample was Plasmodium-positive by microscopy or RDT. Six individuals were FTS-positive (0.5%; 95% CI: 0.2-1.5), but none (0%) of these were microfilariae-positive. Most batey residents were born in the DR (57.8%), documented (85.0%), and permanent residents (85.1%). Very few respondents (9.4%) reported travel to Haiti in the past year. Overall, half (53.8%) of respondents owned a bed net, and 82.3% of net owners reported using it the previous night. Indoor residual spraying (IRS) differed by region (range: 4.7%-61.2%). Most of those with recent fever sought care (56.0%), yet only 30.5% of those seeking care were tested for malaria. Compared to Dominican-born populations, Haitian-born respondents more frequently reported recent fever, did not seek care for the fever, had not heard of malaria, and could not name symptoms or prevention methods. CONCLUSIONS: Malaria and LF transmission appear absent or extremely low in Dominican bateyes, which are a mixture of Haitian and Dominican residents. Travel to Haiti is rare, meaning risk of malaria and LF importation is low. Addressing identified gaps in intervention coverage, malaria knowledge, treatment seeking and service delivery will improve the quality of surveillance for these diseases, particularly among marginalized populations and promote island-wide elimination.

[Knowledge, attitudes, perceptions and community practices for urban malaria. Tumaco, Colombia]. / Conocimientos, actitudes, percepciones y prácticas comunitarias sobre la malaria urbana. Tumaco, Colombia.

OBJECTIVE: To describe the condition of malaria in the District 5 of San Andres de Tumaco-Nariño-Colombia, with regards to knowledge, attitudes, perceptions, and community practices. METHODS: A cross-sectional study was conducted between January and May 2014. Logistic analysis of the CAP-PP survey of the Pan American Health Organization (PAHO) was carried out. Statistical modeling was adjusted through the logarithm of likelihood test, the Pseudo R2, the Akaike's Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Results. The variables that influence the disease of malaria are: taking medicines, malaria tests and vector control by spraying at home. It is important to keep clean ditches around the house in order for people to be protected against the disease. CONCLUSION: Although the population reported having knowledge, attitudes, community practices, and perceptions about the issue, these do not generate protection against the disease. Variables such as carrying out activities in the family and ignorance about the name of the mosquito that transmits malaria must be taken into account for the formulation of community intervention plans.

OBJETIVO: Describir el padecimiento de la malaria en la Comuna 5 de San Andrés de Tumaco-Nariño, Colombia, en cuanto a conocimientos, actitudes, percepciones, y prácticas comunitarias. MATERIALES Y MÉTODOS: Estudio de corte transversal, realizado entre enero y mayo de 2014. Se realizó análisis logístico de la encuesta CAP-PP de la Organización Panamericana de la Salud (OPS). El modelamiento estadístico se ajustó a través del test del logaritmo de la verosimilitud, el Pseudo R2, el Akaike's Information Criterion (AIC) y el Bayesian Information Criterion (BIC). Resultados Las variables que influyen en el padecimiento de la malaria son: tomar medicamentos, examen para malaria y control de vectores mediante rociamiento en casa. Es importante mantener las zanjas limpias alrededor de la vivienda para protegerse contra la enfermedad. CONCLUSIÓN: A pesar de que la población manifiesta tener conocimientos, actitudes, prácticas comunitarias y percepciones, estas no generan protección contra la enfermedad. Variables como la realización de actividades en la familia y el desconocimiento del nombre del mosquito que trasmite la malaria deben ser tenidas en cuenta para la formulación de planes de intervención comunitaria.

Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru.

BACKGROUND: In Peru, despite decades of concerted control efforts, malaria remains a significant public health burden. Peru has recently exhibited a dramatic rise in malaria incidence, impeding South America's progress towards malaria elimination. The Amazon basin, in particular the Loreto region of Peru, has been identified as a target for the implementation of intensified control strategies, aiming for elimination. No research has addressed why vector control strategies in Loreto have had limited impact in the past, despite vector control elsewhere being highly effective in reducing malaria transmission. This study employed qualitative methods to explore factors limiting the success of vector control strategies in the region. METHODS: Twenty semi-structured interviews were conducted among adults attending a primary care centre in Iquitos, Peru, together with 3 interviews with key informants (health care professionals). The interviews focussed on how local knowledge, together with social and cultural attitudes, determined the use of vector control methods. RESULTS: Five themes emerged. (a) Participants believed malaria to be embedded within their culture, and commonly blamed this for a lack of regard for prevention. (b) They perceived a shift in mosquito biting times to early evening, rendering night-time use of bed nets less effective. (c) Poor preventive practices were compounded by a consensus that malaria prevention was the government's responsibility, and that this reduced motivation for personal prevention. (d) Participants confused the purpose of space-spraying. (e) Participants' responses also exposed persisting misconceptions, mainly concerning the cause of malaria and best practices for its prevention. CONCLUSION: To eliminate malaria from the Americas, region-specific strategies need to be developed that take into account the local social and cultural contexts. In Loreto, further research is needed to explore the potential shift in biting behaviour of Anopheles darlingi, and how this interacts with the population's social behaviours and current use of preventive measures. Attitudes concerning personal responsibility for malaria prevention and long-standing misconceptions as to the cause of malaria and best preventive practices also need to be addressed.

Pre-travel malaria chemoprophylaxis counselling in a public travel medicine clinic in São Paulo, Brazil.

BACKGROUND: Malaria is one of the most prevalent parasitic diseases in the world and represents a threat to travellers visiting endemic areas. Chemoprophylaxis is the prevention measure used in travel medicine, avoiding clinical manifestations and protecting against the development of severe disease and death. METHODS: Retrospective and descriptive analysis of malaria prevention data in travellers was recorded from a travel medicine clinic in São Paulo, Brazil, between January 2006 and December 2010. All the medical records of travellers, who had travelled to areas with risk of disease transmission, including Brazil, were analysed. Demographic characteristics of travellers, travel details and recommendations for preventing malaria were also seen. RESULTS: During the study period, 2836 pre-travel consultations were carried out on 2744 individuals (92 were consulted twice). The most common reasons for travelling were tourism and work. The most common destinations were Africa (24.5%), Europe (21.2%), Asia (16.6%) and locations within Brazil (14.9%). In general prophylaxis against malaria was recommended in 10.3% of all the consultations. African destinations vs Asian, Brazilian and other destinations and length of stay ≤30 days were independently associated with the higher odds of chemoprophylaxis recommendation after the logistic regression. CONCLUSION: The prophylaxis against malaria was recommended in 10.3% of the consultations. The authors believe that a coherent measure of malaria prevention in Brazil and for international travellers would be to recommend for all parts of the North Brazil, avoidance of mosquito bites and immediate consultation of a physician in case of fever during or after the journey is recommended.

Malaria knowledge and treatment adherence in a Brazilian Amazon community.

INTRODUCTION: Malaria remains an important public health problem despite recent scientific breakthroughs regarding knowledge about malaria and treatment strategies. The objective of this study was to analyze malaria patients' knowledge about the disease, its treatment and prevention, linking it to drug treatment adherence. METHODOLOGY: A descriptive, cross-sectional, epidemiological survey study was conducted in the district of Três Fronteiras-MT. The study included 618 individuals who were interviewed and examined for Plasmodium infection. Of the 52 patients diagnosed with malaria, 27 were visited at home for an interview about malaria knowledge and treatment adherence. Treatment adherence was evaluated by self-reports and drug conference. RESULTS: A total of 18 patients had satisfactory knowledge (66.6%) and 9 were evaluated as having unsatisfactory knowledge (33.4%) about malaria. Of the 27 malaria patients, 21 (77.8%) reported having taken all the medication as prescribed, in the correct period of time and dosage, and had no medication tablets remaining. The majority (72.2%) of patients who had satisfactory knowledge, as well as the majority (88.8%) of those who had unsatisfactory knowledge, adhered to the malaria treatment. CONCLUSIONS: This study revealed a high proportion of patients with satisfactory prior knowledge about malaria and revealed that this knowledge was not related to disease treatment adherence. These results have implications for planning strategies for malaria control in the region and could contribute to the reduction in the cases of non-adherence to malaria treatment.

Conocimientos, actitudes y prácticas sobre la malaria en la población indígena guna de la comarca de Madungandí, Panamá, 2012 / Knowledge, attitudes and practices regarding malaria in the indigenous Guna population of the Madungandí region, Panamá, 2012

Introducción. Las encuestas sobre comportamientos, actitudes y prácticas permiten determinar el grado de conocimiento de la población sobre la malaria o paludismo, así como las actitudes y prácticas que contribuyen a su transmisión. Objetivo. Identificar los conocimientos, actitudes y prácticas que favorecen la transmisión de la malaria en la población indígena guna de Madungandí. Materiales y métodos. Se hizo un estudio transversal mediante una encuesta a los jefes de familia de una muestra de 40 % de las viviendas en tres comunidades con alta incidencia de malaria. La encuesta se hizo con encuestadores gunas e integrantes del equipo de investigación, y con la ayuda de un traductor. El análisis se hizo en Epi-Info 6.04. Resultados. El rango de edad de los encuestados fluctuaba entre los 20 y los 70 años. Todos los encuestados indicaron pertenecer a la etnia guna y hablar su lengua; 64 % eran del sexo masculino y 30 % eran analfabetas. La mitad de los encuestados (51 %) manifestó haber enfermado de malaria, por lo menos, una vez en los últimos ocho años y 89 % reconoció la enfermedad como un problema de salud. El 63 % manifestó que el médico tradicional "inadule" curaba la malaria, y 78 % practicaba la "fuma de la pipa" y la "quema del cacao" para prevenirla. Conclusión. Dado el limitado conocimiento sobre la malaria y su vector, así como la actitud de colaboración de la población guna, es necesario iniciar programas educativos y de participación comunitaria para mejorar las prácticas de prevención y control en las comunidades, y disminuir así la incidencia de la enfermedad en la comarca de Madungandí.

Introduction: Knowledge, attitudes and practices surveys allow to determine the degree of knowledge on the management of malaria in a given population, as well as the attitudes and practices that contribute or not to its transmission. Objective: To identify the knowledge, attitudes and practices that favor or not the transmission of malaria in the indigenous Guna population of Madungandí. Materials and methods: A cross-sectional study was conducted by applying a survey to the heads of the families in a sample of 40% of households in three communities with high malaria incidence. Local Guna residents and translators were part of the research team that applied the questionnaires. The statistical analysis was performed in Epi-Info 6.04. Results: The age range of those surveyed was between 20 and 70 years. All responders indicated that they belonged to and spoke the language of the Guna ethnic group, 64% were male and 30% were illiterate. Half (51%) of the responders declared they had suffered malaria at least once in the last eight years, and 89% accepted that malaria was a health problem. Sixty-three per cent responded that their traditional doctors, “inadule”, cured malaria and 7.0 % practiced the “pipe smoking” and “cocoa burn” rituals to prevent the disease. Conclusion: Considering the limited knowledge about malaria and its vector, as well as the willingness to collaborate shown by the Guna population, it is essential to initiate educational and participative programs to improve control and prevention activities in the communities aimed at achieving a reduction in malaria incidence in the Madungandí indigenous region.

[Knowledge, attitudes and practices regarding malaria in the indigenous Guna population of the Madungandí region, Panamá, 2012]. / Conocimientos, actitudes y prácticas sobre la malaria en la población indígena guna de la comarca de Madungandí, Panamá, 2012.

INTRODUCTION: Knowledge, attitudes and practices surveys allow to determine the degree of knowledge on the management of malaria in a given population, as well as the attitudes and practices that contribute or not to its transmission. OBJECTIVE: To identify the knowledge, attitudes and practices that favor or not the transmission of malaria in the indigenous Guna population of Madungandí. MATERIALS AND METHODS: A cross-sectional study was conducted by applying a survey to the heads of the families in a sample of 40% of households in three communities with high malaria incidence. Local Guna residents and translators were part of the research team that applied the questionnaires. The statistical analysis was performed in Epi-Info 6.04. RESULTS: The age range of those surveyed was between 20 and 70 years. All responders indicated that they belonged to and spoke the language of the Guna ethnic group, 64% were male and 30% were illiterate. Half (51%) of the responders declared they had suffered malaria at least once in the last eight years, and 89% accepted that malaria was a health problem. Sixty-three per cent responded that their traditional doctors, “inadule”, cured malaria and 7.0 % practiced the “pipe smoking” and “cocoa burn” rituals to prevent the disease. CONCLUSION: Considering the limited knowledge about malaria and its vector, as well as the willingness to collaborate shown by the Guna population, it is essential to initiate educational and participative programs to improve control and prevention activities in the communities aimed at achieving a reduction in malaria incidence in the Madungandí indigenous region.

Another risk to US travelers--malaria.

To individualize preventive measures, rely on reported risk data for specific destinations, planned activities, and patient comorbidities.

[Cultural domains pertaining to malaria: an approach to non-institutional knowledge]. / Los dominios culturales de la malaria: una aproximación a los saberes no institucionales.

INTRODUCTION: Malaria control policies have not fully achieved the expected results due to little consideration of cultural aspects, among other factors. OBJECTIVE: To explore the cultural domains pertaining to this disease in an endemic Colombian population, in order to both design and implement effective action plans. MATERIALS AND METHODS: A convenience sampling was conducted to select inhabitants from 12 villages in Tierralta, Córdoba. In order to generate free-lists, participants were asked about their communities' health problems, causes of malaria, control measures and those responsible for malaria control. Smith's indexes were calculated for each item answered. RESULTS: Between 30 and 38 individuals per village participated in the study (N=401). The mean age was 40.24 years (standard deviation (SD)=14.22) and women were 45.39% of the total. Participants recognized malaria and respiratory infections as the primary health problems in the community (median Smith's indexes: 0.83 and 0.63, respectively). A lack of environmental interventions was identified as the main determinant of malaria (median Smith's index: 0.65). Finally, the health care center (median Smith's index: 0.71) and health professionals (median Smith's index: 0.52) were identified as those most responsible for malaria control. CONCLUSIONS: The design of programs to reduce the impact of malaria requires developing interventions or initiatives that are adapted to the community's needs, demands and available resources. Free-listing is proposed as an effective tool to collect information about cultural domains related to health.

Los dominios culturales de la malaria: una aproximación a los saberes no institucionales / Cultural domains pertaining to malaria: An approach to non-institutional knowledge

Introducción. Las políticas de control de la malaria o paludismo no han logrado todos los resultados esperados, debido, entre otras razones, a la poca consideración prestada a los aspectos culturales. Objetivo. Explorar los dominios culturales en torno a esta enfermedad en una población colombiana asentada en zona endémica, con el propósito de diseñar e implementar planes de intervención efectivos. Materiales y métodos. Mediante muestreo por conveniencia se seleccionaron residentes de 12 veredas de Tierralta, Córdoba. Con el fin de generar listados libres, se les preguntó a los participantes sobre los problemas de salud en la comunidad, las causas de la malaria, las medidas de control y los responsables de aplicarlas. Para cada uno de estos ítems se calcularon índices de Smith. Resultados. Participaron entre 30 y 38 personas por vereda (n=401), con una edad promedio de 40,24 años (desviación estándar (DE)=14,22); las mujeres representaban 45,39 % del total de la población. El grupo de participantes reconoció la malaria y las infecciones respiratorias como los problemas de salud más importantes de la comunidad (mediana de los índices de Smith: 0,83 y 0,63, respectivamente). Se reconoció la falta de intervención en las condiciones ambientales como el factor más importante generador de la malaria (mediana del índice de Smith=0,65). Por último, los participantes identificaron al centro de salud (mediana del índice de Smith=0,71) y a los profesionales de la salud (mediana del índice de Smith=0,52) como los principales responsables del control de la malaria. Conclusiones. El diseño de programas para la reducción del impacto de la malaria exige la formulación de intervenciones o iniciativas que involucren la perspectiva de las comunidades y se adapten a las necesidades, demandas y recursos disponibles. La técnica de listados libres se propone como una alternativa eficiente de recolección de información sobre los dominios culturales relacionados con la salud.

Introduction: Malaria control policies have not fully achieved the expected results due to little consideration of cultural aspects, among other factors. Objective: To explore the cultural domains pertaining to this disease in an endemic Colombian population, in order to both design and implement effective action plans. Materials and methods: A convenience sampling was conducted to select inhabitants from 12 villages in Tierralta, Córdoba. In order to generate free-lists, participants were asked about their communities´ health problems, causes of malaria, control measures and those responsible for malaria control. Smith´s indexes were calculated for each item answered. Results: Between 30 and 38 individuals per village participated in the study (N=401). The mean age was 40.24 years (standard deviation (SD)=14.22) and women were 45.39% of the total. Participants recognized malaria and respiratory infections as the primary health problems in the community (median Smith´s indexes: 0.83 and 0.63, respectively). A lack of environmental interventions was identified as the main determinant of malaria (median Smith´s index: 0.65). Finally, the health care center (median Smith´s index: 0.71) and health professionals (median Smith´s index: 0.52) were identified as those most responsible for malaria control. Conclusions: The design of programs to reduce the impact of malaria requires developing interventions or initiatives that are adapted to the community´s needs, demands and available resources. Free-listing is proposed as an effective tool to collect information about cultural domains related to health.

Práticas e saberes socioculturais sobre saúde, doença e morte de crianças de 0 a 5 anos de idade, na comunidade de Mopeia (Moçambique) / Socio-cultural practices and awareness about health, disease and death of children aged between 0-5 at Mopeia Community (Mozambique)

Estudo qualitativo que tem como objetivo compreender os significados socioculturais relacionados à saúde, doença e morte de crianças de 0 a 5 anos na comunidade de Mopeia tendo por objeto as campanhas sanitárias governamentais em Moçambique, particularmente, vacinação de crianças, utilização de redes mosquiteiras e amamentação exclusiva até os 6 meses de idade. Através do método etnográfico e particularmente da observação participante, do uso de diário de campo e entrevistas semidiretivas, no sentido de captar as vinculações das práticas e saberes socioculturais com os elementos do contexto de vida da comunidade, realizou-se o trabalho de campo entre os meses de Julho e Setembro de 2010. Os resultados apontam que certas praticas socioculturais relacionadas à falta de higiene e saneamento do meio, à não-amamentação exclusiva até os 6 meses, bem como ao uso incorreto das redes mosquiteiras, associadas às limitações na efetividade das intervenções sanitárias, podem estar contribuindo para a mortalidade de crianças menores de 5 anos por doenças preveníveis. Observou-se também que há falta de consonância entre os programas de intervenção de saúde pública, particularmente as medidas mecânicas para o controle de certas doenças preveníveis, como a malária e a diarréia, através de campanhas sanitárias e a realidade de vida das populações. Neste contexto, há necessidade de se articular as campanhas sanitárias com as práticas socioculturais da região, concomitantemente com a disponibilidade e expansão de infra-estruturas básicas, para que haja mais eficácia na intervenção das políticas de saúde pública na luta contra a redução da mortalidade de menores de 5 anos por doenças preveníveis.

This qualitative study seeks to understand the socio-cultural meanings about health, disease and death of children aged between 0-5 at Mopeia community. Its object is the government run health campaigns in Mozambique, particularly children vaccination, mosquito nets use, exclusive breast feeding up to six years of age. By applying the ethnographic method, particularly through participative observation, field diary and interviews to capture the relationship between the practices, the socio-cultural knowledge and the individuals of the community, a field work was carried out between July and September 2010. The results show that some socio-cultural practices like lack of hygienic practices and community sanitation, non exclusive breast feeding up to six years of age, the improper use of mosquito nets, associated to the shortage of health care assisance can be contributing to the mortality of children under five by preventable diseases. It was also observed that there is a mismatch between public health programs, particularly those addressed to preventable diseases like malaria and diarrhea and the reality of the community. Thus, there is the need to match the campaigns to the socio-cultural practices in the region, make available and expand infrastructure for primary health care to boost the efficacy of the intervention in public health policies aimed at fighting and reducing the death rates by preventable diseases of children under five years of age.

Knowledge, beliefs, and practices in relation to malaria transmission and vector control in Guatemala.

As part of an effort to involve community members in malaria control activities, we studied knowledge, beliefs, and practices of residents of both the Pacific coastal plain and northeastern Guatemala related to malaria transmission and Anopheles albimanus control. Most residents recognized the role of mosquitoes in malaria transmission, but few knew how mosquitoes acquired their infections or understood the risk of having an untreated person in their midst. If this were more widely known, residents might put greater pressure on infected patients to seek timely and appropriate antimalarial treatment. Seventy-three percent of families owned one or more bed nets; however, even though most informants believed that bed nets help protect against malaria, the major reason for using them was to prevent nuisance mosquito bites. It is concluded that efforts should be made to promote bed net use by seeking ways to make them more affordable and by emphasizing their effectiveness as a barrier to nuisance mosquitoes. Although residents have a very positive opinion of the National Malaria Service spray teams, it is proposed that cooperation might be improved if malaria workers would emphasize the fact that house spraying reduces the numbers of nuisance mosquitoes and other pest insects, rather than focusing solely on malaria prevention, which most informants believed was less important. This study emphasizes the importance of understanding community beliefs and practices when planning or evaluating vector control activities.

Every day life in new settlement areas and malaria control strategies.

PIP: There is a constant increase of new malaria cases in Brazil; 98% from the Amazon region, mainly in prospecting areas and new settlements. Available disease control strategies are inadequate in the face of this complex problem. The multiple and interrelated causality factors instead demand a transdisciplinary approach. The author used interviews, open agenda investigative meetings, field observations, photography, tape recordings, a field diary, and other methods to document and understand the challenges malaria poses in recently opened human settlement areas in rural Brazil. She lived with the people, visited their workplaces, talked to groups about life, interviewed men who work in the area, and spent time with pastoral agents of the Roman Catholic Church. Study findings are presented with direct citations from her subjects. The ethical dimensions of research practice are also considered.^ieng