Malaria

The acceptable disease in Tanzania

What are the social consequences of labelling mild fevers as malaria in Africa? Research in northern Tanzania highlights the social and cultural factors that influence women's experiences and attitudes to malaria and its diagnosis.

While the diagnosis of a disease is biomedical, the labelling of an illness involves social processes including the cultural norms regarding the accepted 'sick role' for a disease. If being tested for malaria is performing a social, as well as a clinical function, then changing the behaviour of both patient and provider requires an understanding of the symbolism of malaria diagnosis.

In sub-Saharan Africa, malaria is often perceived as a common illness, producing minimal disruption. Treating the tolerable signs and symptoms is considered the responsibility of the individual or family. Even among children, uncomplicated malaria is seen as a mild everyday illness.

Unlike AIDS or tuberculosis, people with malaria do not suffer social sanctions or emotional trauma from stigmatisation. In Tanzania, malaria is being used to hide stigmatising situations. Although associated with poverty, malaria seems to be an acceptable label because it is not directly infectious and is 'invisible'.

A study in the Kilimanjaro and Mawenzi regions of Tanzania found that women:

• recognise the biomedical model of malaria and describe a broad range of 'malaria' illnesses, based on previous experiences, which cause different symptoms and affect different parts of the body
• who are sure they have malaria but had negative tests, visit a second health facility for a repeat test. This is either because they believe the malaria could be 'hiding' or because they are looking for confirmation that they have malaria rather than a more serious illness
• use the term 'malaria', even when they do not feel sick, to conceal other problems such as menstruation, early signs of pregnancy, gynaecological problems, and to avoid sex with their spouses.

Women use malaria as an excuse to avoid duties, but at the same time a diagnosis of malaria is reassuring when women are feeling sick. As a consequence, women are prepared to spend money on unnecessary malaria tests and treatment.

Practitioners and policymakers need to consider how the term 'malaria' is perceived and used because:

• inappropriate malaria diagnosis can generate significant costs
• wrong diagnosis may lead to inappropriate treatment and/or result in the real illness being overlooked
• the willingness to adopt malaria as a label may reflect unmet social, rather than medical, needs.

The social construction of malaria calls for further investigation - especially given the costs of over diagnosis and overuse of antimalarial drugs.

Rose Mwangi
Joint Malaria Programme, KCMC, Moshi, PO Box 2228, Tanzania
T + 255 272753714
F +255 272753982
mwangirose2000@yahoo.co.uk

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