parts of the world are finding that available control measures are either too expensive, not efficacious, or efficacious only under certain conditions. Obtaining high rates of acceptance and use of such interventions, especially those that are marginally efficacious, is crucial to the success of control efforts. Human behavior and social organization—one side of malaria's host-vector-parasite triangle—are clearly vital determinants for the success of control programs. Unfortunately, we do not know enough about how humans respond to malaria to be able to build strong multidisciplinary control programs.

Historically, social scientists have had little or no role in the design and evaluation of malaria control programs. In modern malaria control programs, there is a clear need for applied social science research and the participation of social scientists. The choice of control methods appropriate for a specific community or region requires an understanding of how factors such as deforestation and the movement of populations from one region to another affect the local epidemiology of malaria. Many of these factors have their roots in social and economic change.

It is the behavior of individuals and groups that determines how or whether efforts to prevent or treat malaria will be successful. To attain high rates of acceptance or use of a given control method, attention must be paid to a number of important considerations: (1) local perceptions of malaria and its causes, (2) the manner in which people decide whether a given treatment or preventive measure is efficacious, (3) patterns of treatment-seeking behavior during episodes of malaria, and (4) the role that the community as a whole plays in planning, implementing, and evaluating the control program.

Social science research has often been criticized as anecdotal, unfocused on practical outcomes, and overly academic. These characterizations have little validity today. New research approaches to the social sciences that focus on participatory activities and multidisciplinary problem solving, combined with the adoption of formal and survey research methodologies, have narrowed the gap between the social and natural sciences.

Factors Favoring Malaria Transmission

The constancy of endemic malaria in certain parts of the world, and the resurgence of the disease in areas where eradication efforts were undertaken, are in large measure due to the interplay of broad social, cultural, and economic factors. Three such factors—agricultural development, population movement, and urbanization—are particularly important determinants of patterns of malaria transmission.



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