End Malaria for All
By Brittany Iskarpatyoti, MPH
On World Malaria Day 2015, MEASURE Evaluation called for a global commitment from public health workers to address gender in anti-malaria programming and policies and build up data systems to measure and respond to gender inequities in malaria outcomes. Two years later, gender’s role in malaria programs and outcomes continues to be overlooked or understated.
Neglecting the role that gender plays undermines efforts to reach crucial international milestones and improvements in international health. This year’s theme—"End malaria for good"—reflects the vision of a malaria-free world—an ambitious goal in a time of uncertainty around funding and aid commitments. It is imperative, now more than ever, to be strategic about targets and scale-up and understand the structural barriers that may prevent people from receiving prevention tools, diagnosis, and treatment.
Some might argue that malaria is gender-blind, but gender influences individuals’ exposure to malaria-carrying mosquitoes. For example, traditional gender roles may involve men working in the fields at dusk or women gathering water early in the morning, exposing them to peak mosquito-biting times.1-3 Socially marginalized populations, such as sex workers and people who are lesbian, gay, bisexual, transgender, and queer, may be more vulnerable, because they are more likely than others to be homeless and sleep outside and less likely to seek health services, owing to stigma related to gender and sexual identity expectations.4 Along borders and in hard-to-reach areas that have more focal transmission, mobile and migrant populations often sleep outside without protection and therefore drive transmission. Here, men are more at risk than women, as they are more typically in these settings.5 Gender norms can also influence use of protective measures to reduce exposure; men, particularly adolescent boys, may be less likely to sleep under insecticide-treated bed nets (ITN).6
Though men may be more vulnerable than women to exposure, women may be more vulnerable than men to the consequences of malaria.7 Gender dynamics can influence who within a household can decide if and when to access healthcare or seek out and use prevention measures.8 Women may be more likely to invest in malaria-prevention measures—but many lack the financial and decision-making power to do so.9 For biological and social reasons, women, particularly pregnant women, and children are at the greatest risk of contracting malaria both in high and low malaria-endemic areas.10-13
These patterns could be evident in the data that programs collect and use for decision making, but only if data systems and indicators are gender-sensitive to allow for this type of analysis. A significant barrier to gender-responsive malaria programming is the availability and use of sex-disaggregated data. A recent review of malaria data in Kenya found that while sex-disaggregated data were available in multiple non-routine data sources, such as Malaria Indicator Surveys and Demographic and Health Surveys, routine data from health facilities are summarized and entered into the district health information system as aggregated population data.14 This fact eliminates the possibility for crucial sex-disaggregated analysis, which in turn impacts the ability of program managers, decision makers, and policymakers to make strategic decisions. Beyond sex-specific data, there has been little effort to look at the gender dynamics surrounding malaria including household decision making, power dynamics, and control of resources to access and use malaria prevention and treatment.
MEASURE Evaluation, a project led by the Carolina Population Center at the University of North Carolina at Chapel Hill and funded by the U.S. Agency for International Development (USAID), is playing a key role to develop policy and guidelines and to strengthen data systems to measure progress and detect gender-related inequities in access to malaria prevention and treatment. A new brief, The Importance of Gender in Malaria Data, explores the importance of gender in monitoring and evaluation activities and suggests indicators that can reveal and explain gender gaps in malaria outcomes. By creating a dialogue and shared understanding of these issues, program officers, data advisors, and decision makers can better integrate gender in data and strategic programming.
A focus on gender equity in anti-malaria programming and policies will be fundamental to controlling, eliminating, and eradicating the disease. If we are really to “End Malaria for Good” we need to end malaria for ALL.
For more information
Brittany Iskarpatyoti is a gender research advisor at MEASURE Evaluation. For information on the project’s malaria work, see https://www.measureevaluation.org/our-work/malaria
Reprinted with permission from Science Speaks.
1. Reuben, R. (1993). Women and malaria—special risks and appropriate control strategy. Social Science & Medicine, 37(4), 473–480. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8211259
2. Vlassoff, C., & Manderson, L. (1998). Incorporating gender in the anthropology of infectious diseases. Tropical medicine & International Health, 3(12), 1011–1019. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9892287
3. Cotter, C., Sturrock, H. J., Hsiang, M. S., Liu, J. Phillips, A. A., Hwang, J., . . . Feachem, R. G. A. (2013). The changing epidemiology of malaria elimination: New strategies for new challenges. The Lancet, 382(9895), 900–911. Retrieved from http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(13)60310-4/abstract
4. Walters, V. & Gaillard, J. (2014). Disaster risk at the margins: Homelessness, vulnerability and hazards. Habitat International, 44, 211–219. Retrieved from http://www.sciencedirect.com/science/article/pii/ S0197397514000824
5. Guyant, P., Canavati, S. E., Chea, N., Ly, P., Whittaker, M. A., Roca-Feltrer, A., & Yeung, S. (2015). Malaria and the mobile and migrant population in Cambodia: A population movement framework to inform strategies for malaria control and elimination. Malaria journal, 14(1), 1. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26088924
6. Garley, A. E., Ivanovich, E., Eckert, E., Negroustoueva, S., & Ye, Y. (2013). Gender differences in the use of insecticidetreated nets after a universal free distribution campaign in Kano State, Nigeria: Post-campaign survey results. Malaria Journal, 12(1), 1–7. Retrieved from https://www.ncbi.nlm. nih.gov/pubmed/23574987
7. Bates, I., Fenton, C., Gruber, J., Lalloo, D., Medina Lara, A. Squire, S. B., . . . Tolhurst, R. (2004). Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part 1: Determinants operating at individual and household level. The Lancet Infectious Diseases, 4(5), 267–277. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/15120343
8. Tolhurst, R., & Nyonator, F. K. (2006). Looking within the household: Gender roles and responses to malaria in Ghana. Transactions of The Royal Society of Tropical Medicine and Hygiene, 100(4), 321–326. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16214194
9. Lampietti, J. A., Poulos, C., Cropper, M. L., Mitiku, H., & Whittington, D. (1999). Gender and preferences for malaria prevention in Tigray, Ethiopia. Policy report on gender and development working paper series, No. 3. World Bank. Retrieved from http://siteresources.worldbank.org/ INTGENDER/Resources/wp3.pdf
10. Steketee, R. W., Nahlen, B. L., Parise, M. E., & Menendez, C. (2001). The burden of malaria in pregnancy in malariaendemic areas. The American Journal of Tropical Medicine and Hygiene, 64(1), 28–35. Retrieved from http://www. ajtmh.org/content/64/1_suppl/28.abstract
11. Duffy, P. E. & Fried, M. (2005). Malaria in the pregnant woman. In Sullivan, D. J. & Krishna, S. (Eds.) Malaria: Drugs, Disease and Post-Genomic Biology (pp.169– 200). Berlin & Heidelberg, Germany: Springer-Verlag 169–200. Retrieved from http://link.springer.com/ book/10.1007%2F3-540-29088-5
12. Mbonye, A. K., Neema, S., & Magnussen, P. (2006). Preventing malaria in pregnancy: A study of perceptions and policy implications in Mukono district, Uganda. Health Policy and Planning, 21(1), 17–26. London, England: Oxford Academic. Retrieved from https://academic.oup. com/heapol/article/21/1/17/746912/Preventingmalaria-in-pregnancy-a-study-of
13. Okonofua, F. E., Feyisetan, B. J., Davies-Adetugbo, A., & Sanusi, Y. O. (1992). Influence of socioeconomic factors on the treatment and prevention of malaria in pregnant and non-pregnant adolescent girls in Nigeria. The Journal of Tropical Medicine and Hygiene, 95(5), 309–15. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1404551
14. Ministry of Health. Gender and malaria in Kenya. Retrieved from http://www.cpc.unc.edu/measure/pima/malaria/gender-and-malaria-in-kenya
