What affects utilization of malaria control services? A qualitative approach to understanding community perception in highly malarious Gadchiroli district, Maharashtra, India

Abstract

National Vector Borne Disease Control Programme (NVBDCP) data have shown that nearly half of all malaria deaths in India occur in tribal-dominated areas. The present study took a qualitative approach to understanding community perceptions and practices related to malarial infection and anti-malarial programmes. Twelve focus group discussions and 26 in-depth interviews of Accredited Social Health Activists (ASHAs) were conducted in nine villages in the district of Gadchiroli, Maharashtra state in India in June 2016. A total of 161 village residents (94 males and 67 females) participated in the focus group discussions and 26 health workers participated in the in-depth interviews. Data were analysed using the content analysis approach. The findings revealed widespread misconceptions about malaria among village residents, and low use of preventive measures and anti-malarial services. Ignorance and treatment by unqualified traditional healers delay effective treatment seeking. Furthermore, failure to maintain drug compliance adds to the gravity of the problem. The study identified the social and behavioural factors affecting treatment uptake and use of treatment facilities in the study area. These should help the development of the behavioural change communication arm of any control strategy for malaria through improving community participation, so improving preventive practices and optimizing utilization of anti-malarial services.

Assessing community knowledge, attitude and practices to strengthen communication strategy for Malaria Elimination Demonstration Project in Mandla

“…A small section of the respondents also mentioned about the misuse of LLIN. Similar observations were revealed in the Gadchiroli study [ 8 ].…”

“…The size and geographical terrain of Mandla, the endemicity of malaria, weak socio-economic status and the ability to retain field staff were the key challenges considered by the project at the onset of the study. These barriers have been well observed in studies conducted in other areas having similar geo-climatic and socio-cultural environment [ 3 – 8 ]. In the local tribal communities, the treatment-seeking behaviour is poor and help is sought only when the situation becomes serious.…”

“…A clear understanding of the knowledge, attitudes and practices of a particular community is instrumental in guiding and developing Behaviour Change Communication (BCC) campaigns to achieve a stronger impact [ 13 ]. A qualitative study conducted at Gadchiroli district of Maharashtra, which is predominantly a tribal area of Maharashtra, also revealed similar misconceptions on transmission dynamics of malaria existed and act as an impediment in malaria control [ 8 ]. Another study revealed that misconceptions about causes and prevention of malaria adversely influenced the use of preventive measures against malarial infections [ 10 ].…”

Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh

“…This study also demonstrated that considerably more scheduled tribe households had malaria cases compared others social group households. The reasons for it may be the lifestyle of tribal communities, compounded by mass poverty in these communities [ 26 , 39 ]. Poor housing, engagement in outdoor activities, and outdoor sleeping habits are also common among rural and tribal communities and all these associated with malaria transmission in tribal areas [ 26 , 40 , 41 ].…”

Utilization of complementary and traditional medicine practitioners among older adults in India: results of a national survey in 2016-2017

“…The prevalence using AYUSH and THP for malaria was about 1.2%, similarly to the biomedical sector (1.2%). In a qualitative study in the district of Gadchiroli, Maharashtra state in India, widespread misconceptions about malaria and treatment by unquali ed traditional healers delayed effective treatment seeking [41]. The higher utilization of AYUSH and/or THP for fever or pyrexia of unknown cause, chronic pain in joints, arthritis, rheumatism or osteoporosis, generalized pain (stomach, headache, migraine, or other nonspeci c pain) than allopathic health care services, may emphasise their role in the provision of both acute and chronic care services.…”