Gender barriers that hold back anti-malaria efforts

Dar/Kigoma. Scientists say the fact that the female Anopheles mosquito is the one known for transmitting malaria parasites does not mean her biting discriminates men, women or children.

Yet, when it comes to gender differences, the challenges in malaria prevention go deeper and further to affect the poor, rural and marginalised women, indicating that development, gender equality and health outcomes are intrinsically linked.

Campaigners and researchers say there is a pressing need to invest more in research on how to curb gender barriers that are holding back the efforts to eliminate malaria in Tanzania.

Real life stories and situations of women’s dilemmas on malaria prevention and men’s work culture speak volumes of the gaps that must be bridged as the country seeks to achieve the targets of eliminating the disease by 2030.

In Nyamoli Village, Kasulu District in Kigoma Region, Flora Alfred, 33, says she only sleeps under an Insect-Treated Net (ITN) when she is pregnant. In the region, 76 per cent of each of the households owns at least one treated bed net, according to the Tanzania Malaria Indicator Survey 2017 (TMIS 2017).

“When I was pregnant, I went to a clinic and told that throughout the pregnancy I must use a mosquito net to prevent malaria. But after delivery, I don’t use it anymore. After all, my husband does not like using nets.

“In all this period that I am not pregnant. I have given the net to my children,’’ she says as she points out the challenges she faces in dealing with mosquitoes.

“Our kitchen is not inside the house. So, I have to go out to cook in the evening, some times in the night. That’s when the mosquitoes are flying around. It’s difficult to avoid them, they bite me,’’ says Flora. Her story represents the bigger challenge in Kigoma, a region where the prevalence of malaria stands at 24 per cent, surpassing all other regions in Tanzania, says the (TMIS 2017).

More than 93 per cent of the Tanzanian population remains at risk of malaria but in recent years, the (TMIS-2017) reported that the prevalence rate of malaria dropped from 14.4 per cent in 2015 to 7.3 per cent in 2017.

The Tanzania National Malaria Movement (Tanam) calls for investment in interventions that will bridge the remaining gaps if the country is to achieve the targets of eliminating malaria.

For decades, Ms Beatrice Minja, 64, has been engaging communities on malaria prevention across the country through Tanam. She believes that gender roles and human rights issues that contribute to the malaria burden are yet to be addressed fully.

“In my experience, there is high malaria prevalence in some parts of the country, where there are community barriers. If there is child abuse or domestic violence, you will not see the use of bed nets. Imagine when children are forced to sleep outside as a result of gender-based violence. If we don’t address these community gaps, the war against malaria will be difficult to win.

“We need, as a country, to start focusing on behavioural change communication and addressing gender and human rights barriers that impede malaria efforts,’’ recommends Ms Minja, the Tanam CEO.

The World Health Organization (WHO) has previously stated that in some societies, men have a greater occupational risk of contracting malaria than women if they work in mines, fields or forests at peak biting times, or migrate for work to areas of high malaria endemicity.

In its report: Gender, Health and Malaria, the WHO said 12 years ago that a woman who cooks evening meals outdoors or wakes up before sunrise to prepare the household for the day is increasingly exposed to the risk of being bitten by mosquitoes.

Some women, especially in rural parts of the country are likely to avoid sleeping under Insecticide Treated Nets (ITNS) nets because of social pressures.

And, pregnant women and children are biologically more vulnerable to malaria, yet, there are increasing socio-economic and cultural issues determining access to prevention and treatment services for the disease in children, men and women.

Legal and Human Rights Center (LHRC) executive director Anna Henga believes that domestic violence may prevent women from accessing health services, including malaria services.

“All Lake Zone regions are the top 14 regions in terms of malaria prevalence, so there could be some connection [because these are the same areas where Gender-based Violence is high,’’ she explains, stressing on the need for more research.

Ms Henga says gender and malaria are issues of concern—and health is a common factor for both.

“We cannot say with certainty that where the rate of GBV is high, Malaria prevalence is also high, but it is something we could look into,” she explains. On the other hand, routine activities are exposing men to malaria parasites because they keep moving from place to place, stay away—outdoors—from their homes for longer periods during the night time.

Men also go out to drink alcohol and increase the risk of being bitten by mosquitoes because of staying outdoors late into the night.

Further, men are also likely to engage in security jobs, protecting crops, hunting, and fishing which keep them outdoors throughout the night. Studies in other African countries, such as Ghana have pointed out how family decisions determine health seeking behaviour of women.

In some families, women have to ask for permission from their husbands to be able to seek for treatment of malaria.

According to the World Malaria Report 2018, there were about 219 million cases of malaria in 2017 globally and about two million more cases than that of 2016.

As the disease continues to threaten lives in most parts of Africa, campaigners are proposing that more research should be carried out on the barriers for men and women in accessing prevention and treatment interventions for the mosquito-borne disease.

Emphasis is on exploring the cultural contexts to ascertain preferences for prevention and treatment as well as access to financial resources.

Additional Reporting by Herieth Makwetta