"Before we used to get sick all the time": perceptions of malaria and use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.</p> <p>Methods</p> <p>Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.</p> <p>Results</p> <p>Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.</p> <p>Conclusions</p> <p>Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.</p

Poor people in rich countries : the roles of global governance

Connections between global governance and poverty are usually made in relation to what are loosely called ‘poor countries’ of the ‘global south’. However, global governance also significantly shapes dynamics of impoverishment in ‘rich countries’ of the ‘global north’. These impacts become the more apparent when global governance is understood to involve not only well-known intergovernmental agencies such as the United Nations and the World Trade Organisation, but also additional institutional forms such as transgovernmental networks and private regulatory mechanisms. This broad complex of global governance has often exacerbated poverty in the global north: e.g., through neglect of the issue; through marginalisation of the people affected; and through the promotion of neoliberal policy frames. At the same time, global governance has in other ways also promoted poverty alleviation in ‘high-income countries’: e.g., with rules that work in their structural favour; with policy learning; with rights discourses; and with some promotion of global-scale social democracy. Thus the challenge for efforts to reduce poverty in the global north is, on the one hand, to counter the negative implications of global governance and, on the other hand, to nurture the positive forces. Global coalitions of anti-poverty campaigners – in particular across north-south lines – could especially serve these politics