The role of community education and involvement in malaria control

To advance in the battle against malaria, not only de we need new tools and techniques but also better ways of applying all available tools and techniques in unison to attain the strongest synergistic power possible under various local conditions. Integrated Vector Management (IVM) has been a hot topic for some time now, yet it is far from reaching its full potential in many malaria endemic areas. A lot of the attention off IVM has been focused on the combined use and improvement of the tools and techniques available to formal malaria vector control programmes that that is backed by technical and financial resources. With a lot of focus on big interventions and new products, small, basic and less glamorous interventions are often neglected.

The role and importance of community involvement is often over-looked and under-utilised in control programmes. Many malaria programmes focus on providing the communities with vector control interventions in the form of indoor spraying and / or bed-nets, and these interventions are provided to the community free of charge and without expecting any action on the part of the community apart from allowing spraymen into their homes and removing some furniture and foodstuff from their dwellings. Malaria awareness campaigns are often restricted to providing information at health posts and through the media (television, radio and printed press) however these media are not readily available to all people in rural areas and to people with low levels of education. These campaigns are also usually aimed at informing people about vector control activities, and to motivate people to make use of the provided control measures, with little focus on actions that individual community members can take to not only help themselves, but to help the overall effectiveness of the local malaria control interventions.

These practices often results in a culture of dependency, where the affected people in rural areas are in most part dependent on the formal control programmes to provide all protection against the vector mosquitoes. In many cases the perception of the local people is that they don’t have the resources or knowledge to actively participate in malaria control. However, when visiting these villages, one often sees a variety of risks that can be easily rectified by local inhabitants with little or no resources. One good example is the many small puddles of standing water often encountered in and around rural villages in the rainy season. These can easily be filled in by nearby householders or even children at no cost, and often without the need for any tools at all. These puddles are often not perceived as a thread by local inhabitants, yet hundreds and thousands of vector mosquitoes can hatch from them, not only increasing the malaria risk, but also contributing to the nuisance factor. Another simple example is the inappropriate use of bednets . . . a million bednets won’t make a difference if a large percentage of the nets are used inappropriately.

The lack of accurate knowledge at community level also results in problems such as negativity towards certain insecticides and increasing refusal to indoor spraying, which in turns affects coverage rates and thus the protective value of IRS programmes. It is not only vector control activities that are affected, for instance, with Malaria rapid tests resembling HIV rapid tests, uninformed individuals may be sceptical of “getting tested”. Fear of the unknown and poorly understood can severely hamper the effectiveness of good control measures.

As the age-old saying goes...”Knowledge is Power” and to get the community motivated and involved will require educating the communities to such an extent that they will not solely be reliant on formal programmes to protect themselves from mosquito borne diseases, but will actively participate in anti-malaria activities, contributing towards true integration of all resources. By educating the communities in areas plagued by malaria, and getting them actively involved, we can increase the global “Army” fighting against malaria by millions.