Malaria, Sex and Gender

Women and men have different health and disease experiences according to an article this morning in the Baltimore Sun. The article stresses that, “A rapidly growing body of research shows men and women are biologically different in ways that have nothing to do with the obvious physical features and lots to do with which diseases strike and how successfully or not the body fights them off.”

Some of the highlighted examples include …

  • Women’s bodies have been shown to generate a stronger antibody response to the H1N1 vaccine than men’s
  • Autism is four times more common in males
  • Lupus and irritable bowel syndrome predominantly afflict females

The Sun article states that like many innovative thoughts and practices, “… for the most part, the idea that males and females are very different patients hasn’t made its way into the doctor’s office.” Fortunately the Society for Women’s Health Research is trying to address these issues.

We might ask, is there evidence that malaria affects men and women differently? Such differences may be biological – sex-related; while other differences may be social – gender-related.

Among travelers, Schlagenhauf and colleagues found that, “Women are proportionately less likely to have febrile illnesses (OR, 0.15; 95% CI, 0.10-0.21) [and] vector-borne diseases, such as malaria (OR, 0.46; 95% CI, 0.41-0.51).”  Munga and Gideon learned that a greater proportion of women in rural Tanzania reported malaria episodes compared to men, while the opposite was true in urban areas. They surmise that social or gender roles may actually increase the exposure to mosquitoes in each setting.

In Yemen El-Taiar and colleagues observed that women were less likely to associate malaria with mosquitoes and that “different beliefs and roles identified between men and women need to be taken into account in health promotion messages.” In many places women have less access to formal education than men.

atiamkpat-community-2-nets-sm.jpg“Some research suggests that gender may influence the use of ITNs within households, as different roles dictate different sleeping patterns for men and women,” as Toe and colleagues summarized from the literature. Ahmed et al. in Bangladesh observed a “gender divide in knowledge and health-seeking behaviour was observed disfavouring women,” with malaria-like symptoms.

Other studies have shown that pregnant women attract more malaria-bearing mosquitoes, a biological issue in Sudan and The Gambia. Intra-household gender issues have been found to influence equitable use of bednets.

We welcome readers to contribute other examples of the gender and human biological factors that may influence malaria and its control. The key lesson is that unless we plan for both sets of influences, our tools may not be fully effective or equitably utilized in order to achieve universal coverage and mortality reduction.

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