Malaria in Africa, and in particular, Tanzania

Malaria, a disease that has been mentioned several times throughout this course, can be effectively cured by medication, but it still remains prevalent in Sub-Saharan Africa, where it kills 3,000 African children a day.  This parasitic disease is transmitted by mosquitoes. Once inside the body, the parasite destroys red blood cells and can clog cerebral arteries.  Without treatment, the initial flu-like symptoms from infection can progress to life-threatening illness.

Malaria is a major public health issue in the poor countries of Africa, where it is tied to poverty in a grim cycle: the disease is a consequence of poverty, and at the same time further impoverishes the communities it affects.  By preventing infected people from working, causing immeasurable human suffering from the loss of loved ones, leaving children with lasting neurological damage, requiring costly medication, and negatively impacting the economic decisions of households and entire nations, malaria has a devastating effect wherever it strikes.  The governments of the countries where malaria has a high incidence are generally poor to begin with, and this lack of funding for treatment and prevention is a major barrier to controlling the disease.  People with HIV or AIDS, which are also a major health concern in Africa, are particularly vulnerable to malaria.  As malaria is such a large-scale global health problem, multiple health organizations like WHO and the World Bank, as well as the UN, donor governments, and various charitable organizations are focused on addressing it.

One medical anthropologist studying malaria in Africa is Dr. Vinay Kamat, a professor at the University of British Columbia who has focused his research on how recent changes in malaria medication and control strategies are affecting those afflicted with the disease.  In a 2009 study, he researched how the Tanzanian government implemented new treatment guidelines that included the large-scale deployment of an artemether/lumefantrine-based combination therapy (ACT) medication commonly known as ALu.  This medication is regarded as an effective treatment and a “key weapon” against malaria, but its high cost is unsustainable in the long-term for Tanzania without a significant donor.  Dr. Kamat studied the public’s perspective on ALu as public health facilities began distributing it within the new policy.  He found that the majority of mothers of children with malaria do not rush to the hospital within the initial onset of the disease; rather they rely on store-bought fever medications.  Despite this, once at a health care facility, the mothers were satisfied with the efficacy of ALu, as well as its affordability due to the government subsidy.  This study prompted further questioning of how to encourage early treatment of malaria, to avoid the delay between the onset of symptoms and proper treatment.

Sources:

Bio of Vinay Kamat: http://www.anth.ubc.ca/people/anthropology-faculty/vinay-kamat.html

Kamat’s study in Tanzania: http://www.malariajournal.com/content/9/1/61

Basic facts on malaria: http://www.who.int/malaria/en/

http://www.earth.columbia.edu/articles/view/41

 

 

4 thoughts on “Malaria in Africa, and in particular, Tanzania

  1. Based on the information from the links provided and the summary I would say that the anthropologist could be using a combination of the critical and ethnomedical approaches. Critical medical anthropology supposedly deals with the political economy of health including how policy impacts health and the delivery of health services, and the research was dealing with a new drug being deployed and the reception and perceived effectiveness. I included the ethnomedical approach because while it tends to deal looking at a culture’s traditional means healthcare, one of the ways it was defined as in the class included studying health seeking behavior and comparison of health systems. One of the things Dr. Vinay Kamat’s research did was it determined what the people thought of this new drug, ALu, compared to the old one. It also found that even though it they liked it better they still waited awhile before seeking it out. The methods he used to get this information included participant observation, focus group discussions, interviews with a random sample of 110 mothers of children less than five years of age, who were diagnosed with malaria and prescribed ALu as well as observations done in two village dispensaries.

    I think applying anthropology helped to better understand people’s reactions when it comes to trying to introduce new medications or forms of treatment. They figured out not only that the medication seemed to work better, and that it was preferred by the people there, but it showed that there is a problem in getting people to seek out the medicine early. They could focus their attention on figuring out why people wait to get proper treatment, and ways they can try to fix it.

    http://www.malariajournal.com/content/9/1/61

  2. In his research, I found that Dr. Kamat utilized the critical approach, ethnomedical approach, ecological approach, and biological approach in his anthropological research. He used the biological approach in the sense that he looked at individual choice as well as effectiveness of the drug. In using an ecological approach he looked at the political economy of Tanzania in relation to drug distribution. Because ALu medication was expensive, the Tanzanian government found it difficult to distribute despite its effectiveness. The lack of medical donations in the country makes it impossible to sustain this medicine as the primary Malarial treatment. Dr. Kamat uses the ethnomedical approach in his analysis of how mothers of children react to the disease, a “health seeking behavior.” For his critical approach, Dr. Kamat considered how pharmaceuticals are being used in Tanzania, by the government in distribution, as well as by the people who receive them.

    Using anthropology in this global health problem has resulted in a better understanding of why Malaria is not being controlled in underdeveloped nations. Because Tanzania does not have an economy that can support countrywide treatment of Malaria, many people do not receive treatment. This also is due to the reaction of citizens to the onset of Malaria in them or their children, seeking the wrong medication before going to doctors for correct treatment.

  3. After reading your blog post and looking at your links I have come to the conclusion that Dr. Kamat uses a number of approaches such as critical, ethnomedical, and biological. Dr. Kamat uses critical in that he looked at how the policies in place and the political economy in Tanzania would affect the delivery and distribution of the new drug. Dr. Kamat used the biological approach in order to see how the drug affected each person who took it, studied the results and also the personal choices of each person. I believe that this seems like the most straightforward approach when distributing a new drug because you must see how it reacts with individuals before you can distribute it widely. Lastly, Dr. Kamat used the ethnomedical approach which is used when looking for a health seeking behavior and comparing health systems. He studied how women and their children reacted to the medicine and what people thought of this new malaria drug. What he found was that most people were understandably hesitant about it even if they did like it more. Often times people waited a bit before seeking the drug out for themselves.
    Applying anthropologic approaches and theories can help discover why there are regions of the world that are still falling ill to certain diseases and illnesses. As an example, studying why people in Tanzania are still contracting malaria would be helpful. Using the critical approach and ecological approach to see why certain policies may prevent people from getting the drug and also why the cost of the drug may also prevent a wide spread availability of it.

  4. After reading your post, and the links provided, I believe this anthropologist, Dr. Kamat, did a good job of utilizing the multiple approaches to medical anthropology. He used some more than others, but all seem present to some extent. Ethnomedical, is probably the most useful & important of the approaches here. It was used to look at the surrounding culture, and how outsiders (biomedicine or the bug nets for example) could help, or do so better. Another major approach used, Biological, displays the use, & results of drugs/medications on people, as well as their choices towards it. The Ecological approach, was used to look at political & cultural ecologies in relation to malaria & to its treatment. Similarly the Critical approach looked at the political economy, and the distribution of medication. The Experiential approach is even present, being utilized by looking at patients (& caretakers) perceptions of treatment when received. Also present, the Applied approach, which enables everything to be put to use through the interactions of anthropological approaches, and scientific & government agencies. In my opinion its necessary to use all of these to look at a problem like this. It’s the best possible way to understand what is going on and possibly help find a cure.
    Anthropology enables a better understanding of why illnesses and diseases, such as Malaria, are still tormenting some areas of the world, while nearly nonexistent in others. This better understanding also extends to how to better help those less fortunate areas/countries, such as Tanzania. For example, as stated in the post as well as lecture, the bed nets to keep out malaria transporting mosquitoes were a failure because it wasn’t understood what they were for. However, also stated in the post is the fact that they have since been a huge help. One can only assume, anthropologists talked to the people, either helped to explain why they are so important or found a compromise for the people & aid workers to agree upon.

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