Local Perspectives on Malaria, Fever Case Management and Bed Net Use in Madagascar

The country's unique epidemiological profile features five different patterns of malaria transmission, influenced by seasonality, transmission duration, and outbreak propensity. The National Malaria Control Program implements various interventions, including Intermittent Preventive Treatment, Long Lasting Insecticidal Nets distributions, Indoor Residual Spraying campaigns, and fever case management with systematic diagnostic testing. Local perspectives on malaria in Madagascar differ significantly from biomedical understandings. The Malagasy population uses local terms such as "tazo" and "tazomahery" to describe malaria-related symptoms, rather than the biomedical term "tazomoka." These terms are not associated with mosquito-borne illness, and each symptom requires specific health recourse. The usual fever management strategies involve self-medication or recourse to traditional and biomedical caregivers. The use of Long Lasting Insecticidal Nets (LLINs) encounters obstacles in Madagascar, despite evidence of their effectiveness in preventing malaria-related morbidity and mortality. Several qualitative studies have identified underlying factors for the use of bed nets, including access to information, discomfort, design of bed nets, practical and technical difficulties, costs, education, local illness perceptions, organizational obstacles, nights away from home, and perception of mosquito density. Health seeking behavior in Madagascar is influenced by perceptions of the seriousness of a disease, among other factors. In cases of simple fever or uncomplicated malaria, fast, close, and cheap solutions are preferred, often involving self-medication based on industrial pharmaceutical drugs or traditional remedies. When the disease takes a serious nature, there is a "special appeal" to health care practitioners or traditional healers. The study aimed to explore local perspectives on malaria and its impact on fever case management and bed net use in Madagascar. The qualitative component of a nationwide survey on malaria, conducted in 2012-2013, analyzed the social representation of malaria and the malaria prevention modalities used by populations in four endemic areas. The study found that local perceptions of malaria present a holistic vision of the disease, including various social and cultural dimensions, rather than reflecting a universal understanding. The consideration of this "holistic vision" and other socio-cultural aspects surrounding the understanding of malaria is essential in implementing successful control intervention strategies.