gender and malaria - World Health Organization

1 gender , Health GenderandHealthDespite prevention and control efforts, malaria remains a leading cause of morbidityand mortality worldwide. According to data for 2005, an estimated 1 million deathswere related to malaria . Most of these deaths occur in children in high-transmission areasand malaria accounts for approximately one in five of all childhood deaths in , the true burden of malaria is difficult to estimate as many people are treated athome and no proper postmortem diagnosis is made in the case of death. As a result, manymalaria cases go unreported.

2 (1) A gender approach contributes to both understanding andcombating malaria . gender norms and values that influ-ence the division of labour, leisure patterns, and sleepingarrangements may lead to different patterns of exposure tomosquitoes for men and women. There are also genderdimensions in the accessing of treatment and care formalaria, and in the use of preventative measures such asmosquito nets. A thorough understanding of the gender -related dynamics of treatment-seeking behaviour, as well asof decision-making, resource allocation and financialauthority within households is key to ensuring effectivemalaria control programmes.

3 Therefore, gender and malar-ia issues are increasingly being incorporated into malariacontrol strategies in order to improve their coverage andeffectiveness in different do we know?There are four main types of parasite that cause humanmalaria - Plasmodium vivax,P. malariae,P. ovaleandP. falciparummalaria is the most deadly,and is most common in sub-Saharan Africa, accountingin large part for the extremely high malaria -relatedmortality in this region. (2)Those at highest risk biologically are infants and youngchildren (from six months to five years), pregnant women, non-immune people (such as travellers, labour-ers and populations moving from low-transmission to high-transmission areas) and people living with evidence suggests that given equal exposure,adult men and women are equally vulnerable to malaria infection, except for pregnant women who are at greaterrisk of severe malaria in most endemic areas.

4 (3)Data on malaria is often not is a particular problem for pregnant womenThe rate of malaria infection is higher in pregnant women because of their decreased immunity. Studieshave shown that infection rates are highest in first andsecond parity women with lower rates in later pregnan-cies. (4, 5, 6)Pregnant women with malaria have an increased risk ofabortion, stillbirth, premature delivery and low-birth-weight infants. (3, 5, 6)P. falciparumis generally accepted as a leading cause ofanaemia in pregnant women. (7) It is estimated that anaemia causes as many as 10 000 maternal deaths eachyear.

5 (4) However, despite the dangerous impact of malaria on pregnant women and their infants, it is esti-mated that less than 5% of pregnant women have access to effective interventions. (5)Although P. v i v a xis a more common cause of malariathan P. falciparumin many parts of the tropics outside Africa, much less is know about its harmful effects on pregnancy. Available research indicates that althoughthe effects of P. vivaxinfection are less severe compared to P. falciparum,P. v i v a xmalaria during pregnancy is also associated with maternal anaemia and low birthweight.

6 (8)Women with dual HIV and malaria infection are at particular risk of severe anaemia and adverse birth out-comes. One study in Kenya found that HIV-seroposi-tive women with malaria were twice as likely to have anaemia than HIV-seronegative women with orwithout malaria . (9)June 2007andMalariaAdolescent girls are particularly vulnerable to many sub-Saharan African settings, adolescents are often parasitaemic and anaemic when they first becomepregnant. According to data from Malawi, bothnon-pregnant and pregnant adolescent girls hadsignificantly higher parasite rates than women over19 years of age.

7 (10)As adolescents often face difficulties in accessing healthservices, pregnant adolescent girls might not seektimely care for malaria . Participants in a study inUganda, for example,perceived pregnant adolescents asa group least likely to use antenatal care. (11) Although the study indicated that pregnant adolescents recog-nized the importance of seeking preventive care for malaria , there were several constraints that limitedaccess to services. These were mainly the stigmaassociated with adolescent pregnancy and the negativeattitude of Health workers.

8 Similar findings were alsoreported in a study in Nigeria. (12)Patterns of exposure often coincide with gender normsand behaviourIn some societies, men have a greater occupational risk of contracting malaria than women if they work in mines, fields or forests at peak biting times, or migrateto areas of high endemicity for work. (3) Women who get up before dawn to perform household chores mayalso be exposed to mosquitoes and consequently tomalaria infection. (13)In other societies, the activities of men and womenduring peak biting times may result in equal risks of infection.

9 For example, a study in Myanmar on activities that enhance human-vector contact revealed thatgender-specific patterns of both leisure and workactivities during peak biting periods by men and womenplaced them at equal risk of contracting malaria throughexposure to mosquitoes. (14)The division of labour as a result of gender roles mayplay a significant part in determining exposure tomosquitoes. However very few studies have beenconducted to specifically look at , in addition to leisure activities, sleepingarrangements may also affect malaria transmission.

10 Insome societies, men tend to sleep outdoors and this mayincrease their risk of exposure to mosquitoes. (15)Understanding how gendered patterns of behaviourinfluence exposure to mosquitoes can therefore assist indeveloping more-effective recommendations forpreventing malaria to Health care services for malaria can be affectedby gender issues, including gender inequalityWomen often have to ask for their husband's permis-sion to access treatment for themselves and/or theirchildren. (16) A study on gender roles and responses tomalaria in Ghana found that women who lacked eithershort-term or long-term economic support from malerelatives, or who disagreed with husbands or familyelders about seeking appropriate treatment, faceddifficulties in accessing Health care for children with malaria .