The New Vision (Kampala) reported on a project by A team of medical students from Makerere University that identified important communication problems in our attempts to control malaria. As long as health communication programs “don’t take account of what people know”, the students suggest, we will actually “fail to teach people what they need to know.”
People have plenty of information, it seems, but they not understand or believe it all. In contrast, when interviewing villagers the students heard ideas like, “Mangoes cause malaria in this village. When I eat mangoes I get sick.” Another villager suggested that, “Malaria is caused by witchcraft or bad spirits. When I got malaria, I found out that my neighbor was responsible for it. And when he was sent away from the village, I got cured.” Such beliefs make health communication about using nets to prevent the disease sound strange.
Our experiences in Nigeria have shown that people can say in response to a questionnaire that mosquitoes cause malaria when in fact they hold multiple beliefs like malaria is caused be eating too much (red) palm oil, working too hard, being exposed too long to the hot sun, and dust, among others. If this is the case, it is hard to imagine a rural agricultural population preventing malaria by avoiding work and sun, and hence they usually take prophylactic herbal mixtures to hold the disease at bay.
When one understands local beliefs, one can frame plausible connections and solutions when communicating with villagers. One should always show respect and not criticize people because of their malaria thoughts. The students from Makerere realized that mangoes are more common in the rainy season when mosquitoes are also more common and suggested this link as a communication bridge with the villagers. We have used this process as a major approach in training village health workers to enable them to translate western ideas into locally acceptable information.
Money spent on fancy health communication materials will not go far to changing behavior unless there are people on the ground who can communicate directly and respectfully with local populations in terms they understand.