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Barriers to Malaria Control among Marginalized Tribal Communities A Qualitative Study.doc

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Barriers to Malaria Control among Marginalized Tribal Communities A Qualitative Study

BarrierstoMalariaControlamongMarginalizedTribal Communities:AQualitativeStudy RadhikaSundararajan1,YogeshwarKalkonde2,CharutaGokhale2,P.GreggGreenough1,AbhayBang2* 1Brigham and Women’s Hospital, Boston, Massachusetts, United States of America, 2Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli,Maharashtra,India Abstract Background:Malariainfectionaccountsforoveronemilliondeathsworldwideannually.Indiahasthehighestnumberof malariadeathsoutsideAfrica,withhalfamongIndiantribalcommunities.Ourstudysoughttoidentifybarrierstomalaria controlwithintribalpopulationsinmalaria-endemicGadchirolidistrict,Maharashtra. Methods and Findings: This qualitative study was conducted via focus groups and interviews with 84 participants, and included tribal villagers, traditional healers, community health workers (CHWs), medical officers, and district officials. Questionsassessedknowledgeaboutmalaria,behaviorduringearlystagesofinfection,andexperienceswithprevention among tribal villagers and traditional healers. CHWs, medical officers, and district officials were asked about barriers to treating and preventing malaria among tribal populations. Data were inductively analyzed and assembled into broader explanation linking barriers to geographical, cultural and social factors. Findings indicate lack of knowledge regarding malariasymptomsandtransmission.Fevercasesinitiallypresenttotraditionalhealersorinformalproviderswhohavelittle knowledge of malaria or high-risk groups such as children and pregnant women. Tribal adherence with antimalarial medications is poor. Malaria prevention is inadequate, with low-density and inconsistent use of insecticide-treated nets (ITNs).Malariaeducationalmaterialsareculturallyinappropriate,relyingondominantlanguageliteracy.Remotevillagesand lackoftransportcomplicatesurveillancebyCHWs.Costsoftreatingmalariaoutsidethevillagearehigh. Conclusions:Geographic,cultural,andsocialfactorscreatebarrierstomalariacontrolamongtribalcommunitie