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Aarti Dhar
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Lack of trust inthe community healthcare system makes many Indians continue to seek treatment for malaria from traditional healers, says a new report

Safety cover:Mosquito net use is reportedly low.Photo: M. Srinath
Safety cover:Mosquito net use is reportedly low.Photo: M. Srinath

 Although people in India are aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers is prevalent. In a paper published in the latest edition of Malaria Journal, it has been said that the respondents expressed lack of trust in the community health workers due to frequent drug stock-outs.

The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services. Even the reported use of bed nets is low and the utilisation is determined by seasonality, affordability, and other beliefs.  

The paper ‘Community perceptions on malaria and care-seeking practices in endemic Indian settings: policy implications for the malaria control programme’ has been authored by Ashis Das, R.K. Das Gupta, Jed Friedman, Madan M. Pradhan, Charu C. Mohapatra and Debakanta Sandhibigraha.

The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilisation of services. 

A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment.

Apart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate community perceptions and practices on malaria management. Current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. The paper focuses on promoting active community involvement and ownership in malaria control and management through strengthening community based organisations. Further, the timely availability of drugs and commodities at the community level can improve their confidence in the public health system, the paper suggests. 

The 272 respondents consisted of 50 per cent females, three-quarter scheduled tribe community and 30 per cent students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the participants.  

India has the highest burden of malaria, particularly in Chhattisgarh, Odisha, Madhya Pradesh, Maharashtra and Andhra Pradesh. While official statistics put the number of deaths due to malaria over 400, international organisations and several studies have put the figure into thousands.  Close to 80 per cent of India’s 1.2 billion people are believed to be exposed to the disease.

As per the World Health Organisation guidelines, India has been taking measures like providing insecticide-treated mosquito nets (ITNs) and long-lasting insecticidal nets in affected areas. Till now, 18.4 million nets have been distributed across the country.

The number of patients tested by microscopic examination increased to a peak of 171 million worldwide in 2011, with India accounting for over 108 million blood slide examinations with those living in hills, tribal areas, and forested regions as also urban slums bearing the highest burden. However, the WHO in its report last year had said India was projected to see a decrease of 50-75 per cent in malaria case incidence by 2015.

The WHO’s World Malaria Report 2012 said a concerted effort by endemic countries, donors and global malaria partners during the past decade has led to strengthened malaria control around the world.

However, it warned that a significant slowdown in global funding of anti-malaria campaigns threatens to roll back the gains made against the preventable mosquito-borne disease over the last 10 years.


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