“Tazomoka Is Not a Problem”. Local Perspectives on Malaria, Fever Case Management and Bed Net Use in Madagascar

Abstract

BackgroundAlthough its incidence has been decreasing during the last decade, malaria is still a major public health issue in Madagascar. The use of Long Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention strategy in Madagascar, however, it encounters some obstacles. The present study aimed to explore the local terminology related to malaria, information channels about malaria, attitude towards bed nets, and health care seeking practices in case of fever. This article presents novel qualitative findings about malaria. Until now, no such data has been published for Madagascar.MethodsA comparative qualitative study was carried out at four sites in Madagascar, each differing by malaria epidemiology and socio-cultural background of the populations. Seventy-one semi-structured interviews were conducted with biomedical and traditional caregivers, and members of the local population. In addition, observations of the living conditions and the uses of bed net were conducted.ResultsDue to the differences between local and biomedical perspectives on malaria, official messages did not have the expected impact on population in terms of prevention and care seeking behaviors. Rather, most information retained about malaria was spread through informal information circulation channels. Most interviewees perceived malaria as a disease that is simple to treat. Tazomoka (“mosquito fever”), the Malagasy biomedical word for malaria, was not used by populations. Tazo (“fever”) and tazomahery (“strong fever”) were the terms more commonly used by members of the local population to refer to malaria related symptoms. According to local perceptions in all areas, tazo and tazomahery were not caused by mosquitos. Each of these symptoms required specific health recourse. The usual fever management strategies consisted of self-medication or recourse to traditional and biomedical caregivers. Usage of bed nets was intermittent and was not directly linked to protection against malaria in the eyes of most Malagasy people.ConclusionsThis article highlights the conflicting understanding of malaria between local perceptions and the biomedical establishment in Madagascar. Local perceptions of malaria present a holistic vision of the disease that includes various social and cultural dimensions, rather than reflecting one universal understanding, as in the biomedical image. The consideration of this “holistic vision” and other socio-cultural aspects surrounding the understanding of malaria is essential in implementing successful control intervention strategies.

Reconstruction of Rift Valley fever transmission dynamics in Madagascar: estimation of force of infection from seroprevalence surveys using Bayesian modelling

“…To our knowledge, no RVF outbreaks were reported at this time in Madagascar. In 2002, a political crisis occurred in the country, weakening the health system3132, and because of this instability, outbreaks could have remained unnoticed.…”

Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information

“…Self-medication is common for many reasons in Madagascar (not least because it costs less than a medical consultation and also empowers the individual), but with abortion it is primarily because of the illegality of abortion [11][12][13]. Knowledge of the use of misoprostol for abortion has spread to all world regions since the 1990s [14][15][16], and this includes Madagascar.…”

Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: 3 anthropological studies LLIN use

“…The importance of malaria morbidity among 5 to 15-year-olds in Madagascar has already been considered by the Ministry of Health through the National Strategic Plan of 2018-2022, which envisages extending community malaria management to this age group through the Integrated Management of Childhood Illness (IMCI) [18]. Although the effectiveness of this policy has not been proven, it offers hope for 5 to 15-year-olds and has already led to a signi cant reduction in under ve mortality worldwide through precise diagnoses of the main childhood diseases, the provision of appropriate and combined treatment at the community level, the reinforcement of advice to health care providers, and accelerated referrals of severe cases [10,[19][20][21].…”

“…Among PCSs, LLINs are speci c in that their protective e cacy requires regular use, adherence to their use by the entire family, and accessibility [1]. The use of LLINs is intrinsically linked to people's perceptions of malaria, to their understanding of the modes of transmission, and to the ecological, economic and climatic context, and, moreover, to the representations of LLINs or the perceived vulnerabilities of certain groups of individuals to malaria (e.g., pregnant women and young children) [21,24]. Thus, this article aims to analyze LLINs as a sociocultural object and to identify the sociocultural contexts in which children aged 5 to 15 years grow up, in view of promotions of LLINs under the framework of malaria control strategies and policies implemented in Madagascar, factors that may determine their use.…”