Growing evidence suggests that behaviour related to health is influenced by gender.   However the role of women and men in decisions to seek treatment for malaria has rarely been considered.  How does gender influence treatment-seeking behaviour for children with malaria?

Researchers from the Liverpool School of Tropical Medicine, UK and the Ghana Health Service designed a study to examine household gender roles and responses to malaria.  The research was conducted over 18 months between 2000 and 2002 in three districts of the Volta region of Ghana.

Communities in the study area describe malaria using a word that is most commonly translated into English as ‘fever’. Most people who participated in the study used herbal medicines or locally bought drugs as their first choice treatment for fever. A child with convulsions would most often be taken to the ‘elders’, who have some knowledge of traditional treatment. The majority of parents said they would seek prompt treatment at a clinic or hospital if the traditional treatment did not produce a cure.

Significant findings include:

• Women are increasingly taking on ‘male’ roles as providers as well as carers, while no corresponding change is occurring in men’s behaviour.
• In all communities it was seen as a man’s role to pay for medical treatment, but some women complained that they did not always do so.
• Single mothers were at a particular disadvantage because the fathers of their children did not feel a responsibility to provide for the children.
• Some men refused to pay for treatment that they did not agree to in advance, resulting in delays in seeking treatment if the man was away at the time of illness.
• Husband and in-laws could refuse to allow a mother to take a child to hospital if they did not agree on the type of treatment to be sought.
• A woman who seeks treatment in defiance of her husband may pay for it from her own resources, but risks blame if the treatment fails.

These findings reveal that where a woman disagrees with her husband or family elders over appropriate treatment, or lacks financial support from a male relative, formal treatment for her children may be delayed or not sought at all. It is important to understand a woman’s options and choices to pay for care and influence decision making in the family.

Implications for policy and practice include:

• Improving women’s access to income would strengthen their bargaining positions to influence what treatment is sought for children and when.
• More research is needed to understand how far women’s responsibility for children’s health care and health care payments threatens their ability to gain economic and social independence.
• The role of fathers and household elders in deciding what care is sought for a child suggests that they should be explicitly targeted in malaria education strategies.
• Women’s power to make decisions has been linked to improved health of both women and children. A better understanding is needed of what factors enable different groups of women to ‘dare to disagree’ with husbands or other family members.
• Approaches to managing malaria should include a gender perspective which takes account of how social and economic power of women and men can influence the household’s response to ill health.
• Health-seeking behaviour should be considered in the context of individual and household livelihoods, so that its socio-economic impacts are considered as well as its health outcomes.

Source(s):
‘Looking within the household: gender roles and responses to malaria in Ghana’, Transactions of the Royal Society of Tropical Medicine and Hygiene 100(4), pages 321-326, by Rachel Tolhurst and Frank K. Nyonator, 2005
HINARI subscribers can access the full-text article here. Full document.

Funded by: UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Disease (TDR); UK Department for International Development (DFID)

id21 Research Highlight: 21 July 2006

Further Information:
Rachel Tolhurst
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool L3 5QA
UK

Tel: +44 (0) 151 7053251
Fax: +44 (0) 151 7053364
Contact the contributor: r.j.tolhurst@liv.ac.uk

Liverpool School of Tropical Medicine (LSTM), UK

Ghana Health Service

Other related links:
'Mosquito nets challenge tradition in Tanzania'

'Malaria: the acceptable disease in Tanzania'

'Hitting malaria where it hurts: household and community responses in Africa'

'Gender and child health care seeking in Nepal'

'Gender perspectivees in malaria management', Malaria Knowledge Programme Policy Brief, Liverpool School of Tropical Medicine (PDF)

'Gender Differences in Treatment-seeking Behaviour during Common Childhood Illnesses in India: Does Maternal Education Matter?', Paper submitted to the 18th European Conference on Modern South Asian Studies, University of Lund, Sweden, by Saswata Ghosh, July 2004