A1260944306MCcJH

1
Introductory Study of Womens Roles in Holistic
Management of Malaria in an Isolated,
Traditional Subsistence Farming Village in
Mali Author Pauline E. Powers-Peprah Mentor
Florence V. Dunkel Departments Cell Biology and
Neuroscience Plant Sciences and Plant Pathology
ABSTRACT In Mali, an estimated two million
malaria cases occur annually causing 50 of
children deaths. Sanambele, an isolated
subsistence farming village in Mali, identified
malaria as their primary health concern. Village
women were concerned 40 more than the men. Bed
nets / medication were challenging for them to
obtain. Village women expressed need for more
effective malaria prevention / management.
Because of their stronger response in identifying
malaria as a problem and role as caretakers of
at-most-risk group (children 0-5 yrs), women
appear to be key players in the fight against
malaria. This project explored factors such as
general malaria knowledge and current treatments,
social infrastructure, efficacy of existing
programs, village hierarchy, women specific
roles, spiritual and personal beliefs. We tested
the hypothesis that older village children/
teenagers would be ideal group for focus.
However, because of their respected position, we
found elder women are stronger candidates for
training in malaria prevention and care amongst
the village. Ongoing research entails ethical
obligations of developed countries in
contributing to malaria prevention in
resource-poor countries, and creating a manual
based upon a village survey, that may benefit
Sanambele.

• Discussion
• Hypothesis that young women should be focus
  because of their roles as caretakers and mothers
  of children was rejected. Whole community must
  be involved.
• Current malaria prevention focus is bednets /
  preventative medicine for pregnant women.
  Peer-refereed literature/interviews indicate
  malaria is a community disease, and must be
  fought as a community (Tiono, 2008 Bellamy,
  2004 Bennett, et al., 2008 Bove Valeggia,
  2009 Editorial, 2008 Francke Lalou, 2009
  Fraser-Hurt Lyimo, 1998 Mathanga Bowie,
  2007 Pincock, 2008 Wakabi, 2008).
• Those more removed than mothers from at risk
  group must be encouraged / educated on importance
  of malaria eradication,connection of child deaths
  and sickness with village productivity (Killeen,
  2007).
• Bed net / preventative medicine distribution
  programs are beneficial, but not final solution
  to malaria eradication (Fraser-Hurt Lyimo,
  1998), (Launiala Kulmala, 2006) (Muller, et
  al., 2008) (MALI Malaria cases decrease, 2004).
  
• Interviews / articles suggest bednets are most
  likely used for parents, not children (Muller,
  2008 Ba 2008 Lampietti, 1999).
• Bednet program neither well advertised nor
  adhered to (IRIN Africa-West Africa- Mali-
  Beating Malaria achievable this year gov't says,
  2007). Village interviews indicated
  government-promised free medicines / bednets did
  not arrive.
• Women do not attend clinics usually until second
  / third trimester, or until children are very
  sick (Brentlinger, et al., 2007 Muller, et al.,
  2008 Rosato, et al., 2006 Parise, 2003).
  Complete course of preventative medicine is
  important in addition to bed net coverage for
  health baby delivery (Brentlinger, 2007)
• Other forms of prevention must be incorporated
  with Roll Back Malaria initiatives (Hommerich et
  al, 2007, Malaria Journal), larvae management,
  sanitation, bednets, repellants, preventative
  medicine (Hommerich et al, 2007, Malaria
  Journal).
• Education is essential for malaria eradication
  )(Bellamy, 2004). Few promote breaking
  transmission by bednet covering those with the
  fever (Dunkel 2008). Mothers need to be reminded
  of moments to act in covering children with nets
  and how fast to seek medical aid (Boller et al,
  2003, Bulletin of the WHO Adeneye, 2007, World
  Health Population).
• Government programs are not reliable.. Villagers
  need to be encouraged to be self-sufficient.
  Women especially need to be encouraged /
  supported in entrepreneurial endeavors since they
  likely to pay for medicine / bed nets (Castle,
  1993).
• Pay special attention to older village mothers /
  grandmothers in malaria education. Since they
  hold a revered position as a village elder,
  education attempts must keep the specialness of
  their position in consideration. Traditional
  spiritual beliefs influence older womens health
  decisions (Launiala Kulmala, 2006 Omorodion,
  1993 Bâ, 1972).
• Older mothers wait longer than younger mothers to
  seek help for sick children (Castle, 1993)
  (Boller et al, 2003, Bulletin of the WHO
  Adeneye, 2007, World Health and Population), and
  were not as familiar with government programs or
  policy changes.
• Grandmothers make financial decisions to pay for
  medical care for sick children (Castle, 1993
  Dunkel et al. in review, 2007 Whitworth, et al.,
  2008 Anya Raine, 2008).

SURVEY INSTRUMENT
See attached
LITERATURE CITED
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607-615. Launiala, A., Kulmala, T. (2006). The
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a/2004/march/malaria.htm Mathanga, D., Bowie,
C. (2007). Malaria control in Malawi are the
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Allegri, M., Becher, H., Tiendrebogo, J.,
Beiersmann, C., Ye, M., et al. (2008).
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Mwansambo, C. W., Kazembe, P. N., Phiri, T.,
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(2008). Research collaboration boosts women's
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• General Knowledge Questions
• Have you had Malaria?
• What was it like?
• Who took care of you?
• Were you given medicine?
• Where did it come from?
• What other treatments are there for Malaria?
• What do you know about Malaria?
• Bednet Questions
• Did you use bednets?
• Do you know how to use bednets?
• Are bednets practical for use in your village as
  malaria management?
• Who has bednets in your community?
• How are they distributed?
• How many people can use one bed net? Is this
  reasonable?
• Would bednets fully manage malaria?
• Are there other factors necessary in management?
• DDT Questions

Discussion The focus of prevention of malaria
seems to be on bednets and preventative medicine
for pregnant women. However, it is evident from
the articles reviewed, as well as the interviews
conducted that malaria is a community disease,
and must be fought as a community (Alfred B
Tiono, 2008), (Bellamy, 2004), (Bennett, et al.,
2008), (Bove Valeggia, 2009), (Editorial,
2008), (Francke Lalou, 2009), (Fraser-Hurt
Lyimo, 1998), (Mathanga Bowie, 2007), (Pincock,
2008), (Wakabi, 2008). The original hypothesis
that young women should be the focus because of
their roles as caretakers and mothers of children
was rejected based upon the interviews. The
whole community must be involved. Those who are
somewhat more removed than the mothers from the
most at risk group must be encouraged and
educated upon the importance of malaria
eradication and the connection of child deaths
and sickness with the overall productivity of the
village (Killeen, 2007). The bed net and
preventative medicine distribution programs seem
to be beneficial, yet are not a final solution to
eradication of malaria (Fraser-Hurt Lyimo,
1998), (Launiala Kulmala, 2006) (Muller, et
al., 2008) (MALI Malaria cases decrease, 2004).
Several challenges within the program exist.
First of all, as revealed through an interview
with Professor Sidy Ba, as well as article
review, the bednets are most likely to be used
for the parents, not the children (Muller, 2008)
(Lampietti, 1999). Secondly, the program appears
to be neither well advertised nor adhered to. As
stated previously, Mali initiated the program in
2007, yet there was only one article that
discussed it in the article review and search
(IRIN Africa-West Africa- Mali- Beating Malaria
achievable this year gov't says, 2007).
Additionally, the midwife in Sanambele did not
seem to have awareness of the program since she
stated she desperately needed medicine and
bednets for the areas children during this
years rainy season. Another important factor is
that in other countries where similar programs
have been initiated, women do not attend clinics
usually until their second or third trimester, or
until children are very sick (Brentlinger, et
al., 2007) (Muller, et al., 2008) (Rosato, et
al., 2006). This means that women are not
receiving bednets during their first trimester,
where medicine is deleterious. Women also are
inconsistently returning to the clinics for their
second and third rounds of preventative medicine.
The women who do return were found to have
concerns regarding the effect of preventative
medicine on their fetus (Parise, 2003). The
complete course of preventative medicine was
shown to be important in addition to bed net
coverage for delivery of healthy babies
(Brentlinger, 2007) Other forms of prevention
must be incorporated with Roll Back Malaria
initiatives. Prevention has been stressed as
most important factor by articles interviews
(Hommerich et al, 2007, Malaria Journal). Forms
of prevention include larvae management,
sanitation, bednets, repellants, and preventative
medicine in the sense of neonatal care although
caution should be used since a substantial
increase in the proportion of resistant parasites
has been observed within weeks after preventive
SP treatment Meanwhile alternative options to SP
in intermittent prevention medicine should
urgently be evaluated (Hommerich et al, 2007,
Malaria Journal). Education is essential for
malaria eradication. It is very important to
continue reminding the villagers of what they
have already learned, and for outside groups to
continue to reach the whole village as a
community with new education (Bellamy, 2004).
Mothers need to be reminded of key moments to act
in covering children with nets older mothers
were identified as waiting longer than younger
mothers in seeking medical help for sick children
(Boller et al, 2003, Bulletin of the WHO), and
were not as familiar with government programs or
policy changes (Adeneye, 2007, World Health
Population). As discussed previously, government
programs are not reliable, and it is important
for the villagers not to be waiting for them to
help. All those interviewed identified
government management and allocation of resources
as an area of improvement. The villagers need to
be encouraged and provided with self-sufficiency.
Women especially need to be encouraged and
supported in their entrepreneurial endeavors
since they are the ones who allocate their
resources and would be likely to pay for medicine
and bed nets (Castle, 1993). Special attention
should be paid to older village mothers and
grandmothers regarding malaria education. Since
they hold a revered position as a village elder,
education attempts must keep the specialness of
their position in consideration. Additionally,
it is the grandmothers who are likely to be
interacting with the healthy children since the
mothers would be going about daily
responsibilities in the village and fields.
Traditional spiritual beliefs are more likely to
influence older mothers and grandmothers
decisions in health care for the children as well
(Launiala Kulmala, 2006) (Omorodion, 1993) (Bâ,
1972). Older mothers were identified as waiting
longer than younger mothers in seeking medical
help for sick children (Castle, 1993) (Boller et
al, 2003, Bulletin of the WHO) up to 24-48 hours
or more, relying on their wealth of experience in
child care. (Adeneye, 2007, World Health and
Population), and were not as familiar with
government programs or policy changes (Adeneye,
2007, World Health Population). In households
where the mothers and grandmothers are living
together, it may be the grandmother who is making
the financial decisions to pay for medical care
for sick children (Castle, 1993). They may also
choose traditional medicine, although strengths,
timing of administration, as well as timing of
harvesting are all areas that need further
investigation (Dunkel et al. in review, 2007)
(Whitworth, et al., 2008) (Anya Raine, 2008).