When eating mangoes becomes the cause of malaria!

By Frederick Womakuyu

Despite enormous efforts by health professionals, educators and Government, malaria remains the single most significant health threat to Ugandans. Why is this the case?
A team of medical students from Makerere University believe they have the answer: the professionals who are leading the fight against malaria aren’t listening to the voices of the people who are affected by the disease. As a result, programmes to educate people about malaria prevention don’t take account of what people know and they therefore fail to teach people what they need to know.
“In Uganda, the main problem is not lack of information,” said Nixon Nyonzima, from Makerere University. The problem, he said, is that “we don’t package information so that the man on the street can understand it.”
In June and July last year, the students spent six weeks in Mifumi Village, Tororo, eastern Uganda, listening carefully to what people told them about malaria. After learning what the people of the village knew, the students then designed an educational program designed to fill gaps in the people’s knowledge. The students, who presented their preliminary findings in a video conference with the U.S National Library of Medicine (NLM) and Fogarty International Centre, are currently studying the impact of their efforts.
Meeting villagers in their homes and in public settings, the students learned that villagers’ ideas about malaria are neither correct nor incorrect.
While listening to the people, a response like, “Mangoes cause malaria in this village. When I eat mangoes I get sick,” was common—an indicator that people had not received correct information on how malaria is got.
But the researchers learnt that in their perceptions, the locals were not far from the truth, because during the rainy season when mangoes are plenty, malaria cases increase. “This is when mosquitoes breed around the bushes, broken bottles, containers and swamps. And when people exposed to these places get bitten by mosquitoes , they attribute malaria sickness to mangoes,” said William Lubega, one of the researchers.
Another response from the locals was: “Malaria is caused by witchcraft or bad spirits. When I got malaria, I found out that my neighbour was responsible for it. And when he was sent away from the village, I got cured,” one local said.
But the researchers found out that when malaria attacks villagers, they don’t seek medical advice due to ignorance. “The pain may go away after some time even when someone hasn’t visited a health centre. But the germ remains in the body and the person will succumb to the disease again,” said Lubega. “So when they have a quarrel with a neighbour they attribute it to them. Like in this case it was a coincidence that the pain reduced for a short time when the neighbour was sent away from the village, but the disease resurfaced later. When we treated him, he became okay, showing that he had shunned medical help. But the neighbour was innocent.”
The researchers also discovered that there was a link between malaria and diarrhoea in this village. There was no protected water source in the area. The people shared wells with animals and lacked basic knowledge about personal hygiene. As a result, many had suffered from malaria and diarrhoea and yet attributed their illness to witchcraft.
Another problem encountered was misuse of anti-malaria drugs. According to Brian Sseruyombya, a pharmacist with the project, the people had tried various drugs and had given up visiting health centres because it had made no difference. “The majority had not completed the doses,” he said. “And some used over the counter-drugs especially Panadol that merely reduced pain and people had also resorted to sharing the tablets with their immediate family members because everyone couldn’t afford his or her own.”
The researchers attributed all these problems to lack of basic education, and cultural beliefs. “Looking at Mifumi village, people are so poor and ill educated. They sleep near swamps, broken bottles and their personal hygiene in homes was so appaling. So I looked at the best way of how we can send the message effectively to the people,” said Julia Royal, head of International Program, NLM, who led the team.
The researchers created tutorials on malaria with the faculty of medicine and a team of Ugandan doctors, artists and translators. The faculty members worked with an artistic team to create locally meaningful text and illustrations for the tutorials. “We moved from one homestead to another both through group and individual approach, educating people about malaria,” said Nyonzima
In order to make the people understand the messages, the community had to be a partner in all this. “They had to be included at all levels. Education was passed to them and the team had to stay with the community in their homes to address their concerns.” Lubega said.
“We set up a community-based education service, which enabled us educate communities and allowed the communities to pose questions. It was done on both radio and through physical contact. The group targeted individuals in various villages in conjunction with local councils where education in local languages about malaria was imparted to them,” said group member Nelson Igaba.
Another approach the researchers used was passing on messages on malaria through school children. “Children are the best mode through which health education can be passed. Most are able to read and write due to the Universal Primary Program. Therefore we taught children in homes and schools about the causes, signs, and symptoms of malaria,” said Deborah Kisige, another student.
“After a few days we noticed a difference. People started making toilet covers from wood, slashed bushes around their compounds and separated human water sources from those of the animals,” said Igaba.
“They abandoned their belief of malaria caused by mangoes and demons,” said Thomas Kiggundu. “They abandoned it and sought medical care from professionals.”
The students’ work is very timely. Statistics show that in Uganda, malaria is a serious health problem and currently poses the most significant threat to the health of the population. Malaria accounts for 25-40% of all outpatients’ visits at health centres, 20% of hospital admissions, 9-14% of in-patient deaths, and kills 3-5% of the people who get it. Each year, malaria kills about 100,000 people in Uganda, nearly a quarter of whom are children aged five and below.