Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies

We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention.The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39).These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis.Each year, malaria accounts for up to 1 million deaths worldwide, mostly in children under five [1]. In 2002, there were as many as 500 million episodes of clinical Plasmodium falciparum malaria infection, and more than two thirds of these cases were in Africa [2]. More recently, malaria related morbidity and mortality have been significantly worsened by the emergence of widespread drug-resistance [3].During the past decade, numerous large-scale initiatives have been undertaken with the goal of reducing or eradicating the burden of malaria in the developing world. These include among others the Glob