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Malaria risk behaviours, socio-cultural practices and rural livelihoods in southern Tanzania: Implications for bednet usage

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  • Dunn, Christine E.
  • Le Mare, Ann
  • Makungu, Christina

Abstract

Most malaria risk reduction strategies are firmly embedded in biomedical practices and public health perspectives. National and international programmes to 'control' malaria are particularly characterised by the promotion of public health interventions which converge on the disease vector, the malaria mosquito, notably through the use of indoor household spraying with insecticides, and the deployment of insecticide-treated bednets (ITNs). With convincing evidence for the effectiveness of ITNs in reducing the incidence of malaria, control programmes have emphasised the notion of 'scaling-up' bednet coverage. Much previous research on people's 'compliance' with bednet programmes has tended to focus on the quantification of bednet usage and on deriving explanations for 'non-compliance' based on household or individual indicators such as wealth, age, gender or educational level, or on climatic factors such as season and temperature. However, malaria risk behaviours are also rooted in wider aspects of local livelihoods, and socio-cultural beliefs and practices which interplay with the use and, crucially, non-use, of bednets. This paper draws on empirical data derived from in-depth, one-to-one semi-structured interviews, focus groups and participatory methods (mapping and diagramming) with participants in two villages in rural Tanzania to explore the nature of these practices and vulnerabilities, and their potential impact on malaria exposure risk. Participants included farmers and pastoralists, both men and women, as well as village 'officials'. By eliciting local understandings of malaria-related behaviours we explore how malaria risks are played out in people's everyday lives, and the circumstances and decision-making which underpin non-usage of bednets. Our findings reveal the importance of shifting sleeping patterns in response to livelihood needs and socio-cultural practices and events. These arrangements militate against the consistent and sustained use of the bednet which are called for by public health policies. In particular we demonstrate the importance of the spatial and temporal dimensions of farming practices and the role of conflict over access to shared land; the impact of livelihood activities on malaria risks for school-aged children; risk behaviours during 'special' socio-cultural events such as funeral ceremonies; and routine, outdoor activities around dawn and dusk and the gendered nature of these practices.

Suggested Citation

  • Dunn, Christine E. & Le Mare, Ann & Makungu, Christina, 2011. "Malaria risk behaviours, socio-cultural practices and rural livelihoods in southern Tanzania: Implications for bednet usage," Social Science & Medicine, Elsevier, vol. 72(3), pages 408-417, February.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:3:p:408-417
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    References listed on IDEAS

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    1. Hausmann Muela, Susanna & Muela Ribera, Joan & Mushi, Adiel K. & Tanner, Marcel, 2002. "Medical syncretism with reference to malaria in a Tanzanian community," Social Science & Medicine, Elsevier, vol. 55(3), pages 403-413, August.
    2. Stratton, Leeanne & O'Neill, Marie S. & Kruk, Margaret E. & Bell, Michelle L., 2008. "The persistent problem of malaria: Addressing the fundamental causes of a global killer," Social Science & Medicine, Elsevier, vol. 67(5), pages 854-862, September.
    3. Panter-Brick, Catherine & Clarke, Sian E. & Lomas, Heather & Pinder, Margaret & Lindsay, Steve W., 2006. "Culturally compelling strategies for behaviour change: A social ecology model and case study in malaria prevention," Social Science & Medicine, Elsevier, vol. 62(11), pages 2810-2825, June.
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    1. Pulford, Justin & Oakiva, Tania & Angwin, Angeline & Bryant, Miranda & Mueller, Ivo & Hetzel, Manuel W., 2012. "Indifferent to disease: A qualitative investigation of the reasons why some Papua New Guineans who own mosquito nets choose not to use them," Social Science & Medicine, Elsevier, vol. 75(12), pages 2283-2290.
    2. Cheryl L Russell & Adamu Sallau & Emmanuel Emukah & Patricia M Graves & Gregory S Noland & Jeremiah M Ngondi & Masayo Ozaki & Lawrence Nwankwo & Emmanuel Miri & Deborah A McFarland & Frank O Richards , 2015. "Determinants of Bed Net Use in Southeast Nigeria following Mass Distribution of LLINs: Implications for Social Behavior Change Interventions," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-15, October.

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