A critical review of behavioral issues related to malaria control in sub-Saharan Africa:: what contributions have social scientists made?

• Published in: Social Science & Medicine Vol. 59; no. 3; pp. 501 - 523
• Main Authors: Williams, Holly Ann, Jones, Caroline O.H
• Format: Book Review Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2004; Elsevier
• Series: Social Science & Medicine
• Subjects: Advocacy; Africa South of the Sahara; Antimalarials - therapeutic use; Behavioural aspects; Biological and medical sciences; Blood Diseases; Control; Health; Health Behavior; Health Care Utilization; Helpseeking; Human protozoal diseases; Humans; Infectious diseases; Literature; Malaria; Malaria - prevention & control; Malaria control; Malaria Social science Treatment seeking Malaria control Sub-Saharan Africa; Medical Research; Medical sciences; Medical treatment; Medicine; Miscellaneous; Parasitic diseases; Patient Acceptance of Health Care; Prevention and actions; Protozoal diseases; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research Applications; Self Care; Social Medicine - organization & administration; Social science; Social Science Research; Social sciences; Social sciences research; Social scientists; Sociocultural Factors; Socioeconomic Factors; Sub Saharan Africa; SubSaharan Africa; Treatment seeking; Tropical medicine; Sub-Saharan Africa; Africa; Africa South of the Sahara; Malaria; Treatment seeking; Social science; Malaria control; Sub-Saharan Africa; Human; Protozoal disease; Social sciences; Parasitosis; Review; Infection; Treatment; Surveillance; Behavior; Social aspect; Bibliographic review; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2003.11.010

In 1996, Social Science & Medicine published a review of treatment seeking for malaria (McCombie, 1996). Since that time, a significant amount of socio-behavioral research on the home management of malaria has been undertaken. In addition, recent initiatives such as Roll Back Malaria have emphasized the importance of social science inputs to malaria research and control. However, there has been a growing feeling that the potential contributions that social science could and should be making to malaria research and control have yet to be fully realized. To address these issues, this paper critically reviews and synthesizes the literature (published, unpublished and technical reports) pertaining to the home management of illness episodes of malaria in sub-Saharan Africa from 1996 to the end of 2000, and draws conclusions about the use of social science in malaria research and control. The results suggest that while we have amassed increasing quantities of descriptive data on treatment seeking behavior, we still have little understanding of the rationale of drug use from the patient perspective and, perhaps more importantly, barely any information on the rationale of provider behaviors. However, the results underline the dynamic and iterative nature of treatment seeking with multiple sources of care frequently being employed during a single illness episode; and highlight the importance in decision making of gender, socio-economic and cultural position of individuals within households and communities. Furthermore, the impact of political, structural and environmental factors on treatment seeking behaviors is starting to be recognised. Programs to address these issues may be beyond single sector (malaria control programme) interventions, but social science practice in malaria control needs to reflect a realistic appraisal of the complexities that govern human behavior and include critical appraisal and proposals for practical action. Major concerns arising from the review were the lack of evidence of ‘social scientist’ involvement (particularly few from endemic countries) in much of the published research; and concerns with methodological rigor. To increase the effective use of social science, we should focus on a new orientation for field research (including increased methodological rigor), address the gaps in research knowledge, strengthen the relationship between research, policy and practice; and concentrate on capacity strengthening and advocacy.