Appropriating "malaria": local responses to malaria treatment and prevention in Abidjan, Cote d'Ivoire.

A continuing dilemma for medical and public health professionals is the apparent lack of fit between global and local knowledge systems and technologies. This is illustrated in relationship to malaria, with implications in the management of the disease. Ethnographic research was conducted from 2003-2005 in urban Abidjan, Cote d'Ivoire, on community understandings of malaria and the relationship of this to its prevention and control. Malaria is referred to locally as palu, reflecting the incorporation of malaria into a local illness taxonomy. Although the labeling of malaria-related symptoms as palu has wide currency, preventive measures such as bed nets, as advocated by public health authorities, have not been accepted readily or evenly. Drawing on theoretical understandings of the introduction, transfer, and appropriation of concepts and material objects, we examine the processes of localization in relation to malaria in Abidjan, and in doing so, highlight the challenges for health professionals seeking to scale-up public health interventions.

The moment of sale: Treating malaria in Abidjan, Côte d'Ivoire.

Beyond home care without active treatment, the first step of home-based management of malaria (HMM) is the health provider-customer interactions that often lead to the purchase of drugs or herbs to treat symptoms. In Abidjan, Côte d'Ivoire, the quality and content of such interactions in pharmacies where antimalarials are sold officially, with illegal drug vendors and with herbal medicine sellers, vary considerably. Commercial encounters associated with adult illness episodes of locally identified malaria, observed in 2004-5, illustrate that customers present to sales points, on behalf of people who are ill, with a pre-established diagnosis and the intent of purchasing medication with which they have prior familiarity. Customers sought neither diagnosis nor clarification, and communication between vendor and customer was limited to minimal enquiries or suggestions. These findings have important implications related to the need for vendor training to support HMM and so ensure prompt and appropriate treatment outside clinical settings.

Social and cultural aspects of 'malaria' and its control in central Côte d'Ivoire.

BACKGROUND: A sound local understanding of preventive measures and health-seeking behaviour is important for the effective control of malaria. The purpose of this study was to assess the knowledge, attitudes, practices and beliefs of 'malaria' and its control in two rural communities of central Côte d'Ivoire, and to examine associations between 'malaria' and the households' socioeconomic status. METHODS: A cross-sectional household survey was carried out, using a combination of qualitative and quantitative methods. People's socioeconomic status was estimated, employing a household asset-based approach. RESULTS: Malaria was identified as djèkouadjo, the local folk name of the disease. Although people were aware of malaria-related symptoms and their association with mosquitoes, folk perceptions were common. In terms of treatment, a wide array of modern and traditional remedies was employed, often in combination. Individuals with a sound knowledge of the causes and symptoms of malaria continued to use traditional treatments and only a few people sleep under bed nets, whereas folk beliefs did not necessarily translate into refusal of modern treatments. Perceived causes of malaria were linked to the household's socioeconomic status with wealthier individuals reporting mosquitoes more frequently than poorer households. Bed nets were more frequently used in wealthier social strata, whereas other protective measures--perceived to be cheaper--were more prominent among the poorest. CONCLUSION: Equitable access to resources at household, community and health system levels are essential in order to enable community members to prevent and treat malaria. There is a need for community-based approaches that match health care services with poor people's needs and resources.