Erema po otjindjumba? Highlighting cultural models and knowledge gaps of malaria in rural Namibian pastoralists.

Abstract

Background: As Namibia attempts to eradicate locally transmitted cases of malaria, epidemiological strategies, interventions, and outreach require a sound understanding of indigenous knowledge and practice. Research describing local explanatory models of disease can be of value in these efforts by elucidating how disease is interpreted and treated. To understand how perceptions of malaria infection and treatment may influence health-seeking behaviour, cultural models of the disease were explored in two ethnic groups in rural northwest Namibia.

Methods: Mixed-sex focus groups of 4-8 individuals were conducted in the Kunene region of Namibia. All participants were either Himba or Herero and lived between 14 and 57 km of the regional town centre of Opuwo. Discussion prompts were designed to assess knowledge, beliefs, and norms about malaria, including causes, symptoms, treatment, and prevention.

Results: Focus groups reported universal difficulty in discrimination between malaria and respiratory infections, the former of which was often only diagnosed at the hospital. Some recognized mosquitoes as the source of malaria, particularly the more formally educated Herero, but all also reported other causes. Notably these causes, including dietary and temperature-based origins, were considered unavoidable. Himba and Herero believed that malaria was infectious person-to-person and incorrectly believed that malaria was most common during the wintertime. Both groups also relied on a number of traditional remedies to alleviate symptoms, which were used as primary treatment, with formal healthcare treatment typically only sought when the illness progressed.

Conclusions: These results highlight significant differences between local cultural models and biomedical ones that could be detrimental to malaria eradication efforts. Kunene pastoralists have limited understanding of the causes of malaria, and beliefs about environmental and dietary causes may undermine attempts at prevention. Seeking healthcare solutions to malaria was normative, but secondary to use of at home traditional remedies. These findings indicate public health outreach and information campaigns are needed, particularly in rural groups with less formal education.