Utilisation of local knowledge in household adaptation to malaria endemicity in the Okavango Delta, Botswana

Abstract

Malaria is a persistent health challenge in developing countries. The African continent is the most affected, with nearly 90% of malaria related mortality in the world. In Botswana, malaria is endemic in the northern region where the Okavango Delta is situated. This wetland ecosystem and its biodiversity is a major source of livelihoods for rural communities along its fringes. However, it also provides a suitable habitat for breeding anopheles mosquito, the malaria vector. Contriving malaria is a socio-ecological phenomenon that cannot be addressed solely through national level biomedical interventions. Local knowledge, perceptions, beliefs and adaptation strategies are also key aspects that can enhance biomedical malaria prevention efficacy. This study assessed utilisation of local knowledge on the prevention and adaptation strategies to malaria endemicity, in the Okavango Delta, Botswana. The study engages a critical appraisal of the Health Service Utilisation framework Andersen and Newman and a conceptual framework of Utilisation of local knowledge in adaptation to malaria endemicity to guide this study. Data in this study is from a retrospective cohort of 79 households that reported malaria cases/incidences during the first community level household survey, which was conducted from October -November 2015. Data were also collected from 16 key informants’ interviews and two focus group discussions (FGDs). Data collected through participatory rural appraisal methods using tools such as seasonal calendars and livelihoods rankings were also used. Inferential and descriptive statistics were applied as in data analysis. Households observed that malaria occurs mostly during the rainy season, flooding season and throughout the year. Overall, households local knowledge included burning dry elephant and cow dung, and a combination of these with Insecticide Treated Nets (ITN) to repel mosquitoes. Specific combinations included, ITN with herbs, ITN with elephant dung ITN with cow dung and peppermint tree (schimus molle) leaves were also observed as the most effective. Households practiced several livelihood activities; gathering grass/reeds at the river, rain fed farming, harvesting water lily. Chances of mosquito bites were reported to be very high during subsistence fishing, commercial fishing and molapo arable farming. Adaptive strategies against malaria included application of knowledge received from community education information workshops, modifications of housing structures and timing activities by restricting movement at certain times of the day. Households have positive perceptions about health institutions utilization of local knowledge prevention/treatment on malaria. Concerns were raised with regard to collaboration between traditional healers and health institutions and the timing of Indoor Residual Spraying (IRS). The households in the Delta could benefit more from their local knowledge of malaria prevention, provided the Ministry of Health embarks on investigating and improving upon the measures which actually do repel mosquitoes. Exposure to malaria transmission was very high for livelihoods activities, which take place by or at the river compared to others. The positive perceptions towards health institutions practice could catalyse the malaria eliminating progress in Botswana. Although environmental health education is crucial for capacity building against malaria endemicity, improved housing structural adaptation could be enhanced by assisting people to install gauzes on eaves.