Malaria risk behaviours, socio-cultural practices and rural livelihoods in southern Tanzania: Implications for bednet usage
Malaria risk behaviours, socio-cultural practices and rural livelihoods in southern Tanzania: Implications for bednet usage
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DOI：
10.1016/j.socscimed.2010.11.009
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发表时间：
2011-02-01
影响因子：
5.4
通讯作者：
Makungu, Christina
中科院分区：
文献类型：
--
作者：
Dunn, Christine E.;Le Mare, Ann;Makungu, Christina
大多数减少疟疾风险的策略都牢固地植根于生物医学实践和公共卫生观点。 “控制”疟疾的国家和国际计划的特点是促进公共卫生干预措施，重点针对疾病媒介疟疾蚊子，特别是通过在室内喷洒杀虫剂，以及使用经过杀虫剂处理的蚊帐（ITN）。有令人信服的证据证明驱虫蚊帐在降低疟疾发病率方面的有效性，控制计划强调了“扩大”蚊帐覆盖范围的概念。此前许多关于人们“遵守”蚊帐计划的研究往往侧重于对蚊帐使用情况进行量化，并根据家庭或个人指标（如财富、年龄、性别或教育水平）或气候因素（如季节和温度）得出“不遵守”的解释。然而，疟疾风险行为也植根于当地生计的更广泛方面以及社会文化信仰和实践，这些信仰和实践与蚊帐的使用和最重要的是不使用蚊帐相互作用。本文利用来自坦桑尼亚农村两个村庄的参与者的深入、一对一半结构化访谈、焦点小组和参与方法（制图和图表）获得的经验数据，探讨这些做法和脆弱性的性质及其对疟疾暴露风险的潜在影响。参与者包括男女农牧民以及村“官员”。通过征求当地人对疟疾相关行为的理解，我们探讨了疟疾风险在人们的日常生活中是如何产生的，以及导致不使用蚊帐的环境和决策。我们的研究结果揭示了改变睡眠模式以应对生计需求和社会文化习俗和事件的重要性。这些安排不利于公共卫生政策所要求的一致和持续使用蚊帐。我们特别展示了农业实践的空间和时间维度的重要性以及冲突在获得共享土地方面的作用；生计活动对学龄儿童疟疾风险的影响；葬礼等“特殊”社会文化活动期间的危险行为；黎明和黄昏前后的例行户外活动以及这些活动的性别特征。 (C) 2010 Elsevier Ltd. 保留所有权利。
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 sociocultural 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. (C) 2010 Elsevier Ltd. All rights reserved.