Barriers to the Effective Treatment and Prevention of Malaria in Africa: A Systematic Review of Qualitative Studies

Background:In Africa, an estimated 300-500 million cases of malaria occur each year resulting inapproximately 1 million deaths. More than 90% of these are in children under 5 years of age. Toidentify commonly held beliefs about malaria that might present barriers to its successful treatmentand prevention, we conducted a systematic review of qualitative studies examining beliefs andpractices concerning malaria in sub-Saharan African countries.Methods:We searched Medline and Scopus (1966-2009) and identified 39 studies that employedqualitative methods (focus groups and interviews) to examine the knowledge, attitudes, andpractices of people living in African countries where malaria is endemic. Data were extractedrelating to study characteristics, and themes pertaining to barriers to malaria treatment andprevention.Results:The majority of studies were conducted in rural areas, and focused mostly or entirely onchildren. Major barriers to prevention reported included a lack of understanding of the cause andtransmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use ofineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malariatreatment, including concerns about the safety and efficacy of conventional medicines (15/39),logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment ofchildhood malaria identified included the belief that a child with convulsions could die if given aninjection or taken to hospital (10/39).Conclusion:These findings suggest that large-scale malaria prevention and treatment programsmust account for the social and cultural contexts in which they are deployed. Further quantitativeresearch should be undertaken to more precisely measure the impact of the themes uncovered bythis exploratory analysis.