Malaria in Zanzibar: A Study on Zanzibari Cultural Barriers to Malaria Prevention and Treatment

Despite the World Health Organization promotion of malaria prevention and control guidelines, an estimated 219 million cases of malaria occur worldwide each year. The majority of the 660,000 recorded malaria-related deaths occur in sub-Saharan Africa. Hence, this dissertation focuses on factors affecting malaria prevention and treatment in Zanzibar, Tanzania, one area in sub-Saharan Africa. It reviews current malaria interventions, observes cultural practices that may hinder malaria treatment and prevention, and reflects on current intervention improvement and policy action in Zanzibar.

The introduction sets the stage for malaria as a public health problem in sub-Saharan Africa. The first paper, an initial literature review (N = 36 studies identified), documents what is known about malaria intervention strategies in Zanzibar. Informed by this literature review, the second paper, a key informant study (N = 75 participants interviewed), is conducted to identify cultural barriers to malaria prevention and control. The third paper is a discussion of possible intervention adaptations in consideration of cultural barriers found through the key informant study.

More specifically, the literature review examined 36 peer-reviewed articles of malaria intervention activities in Zanzibar and found no studies on the potential cultural barriers to malaria programs. The key informant study (N = 75) was conducted, and demonstrated four commonly held cultural practices in relation to malaria (1) the use of natural drugs, (2) seeking the aid of traditional healers or witch doctors, (3) the belief in religious or spiritual thinking, and (4) poorly constructed knowledge or belief about malaria. Finally, the third paper examined Zanzibar?s most effective malaria initiative (PMI?President?s Malaria Initiative) and recommended adaptations that could help thwart the reemergence of malaria in Zanzibar.

Cultural practices are known to act as barriers, requiring a more comprehensive understanding of how and where cultural practices serve as barriers in specific regions. This dissertation contributes to knowledge about cultural barriers in malaria prevention and treatment not readily known in Zanzibar. A major conclusion is the importance of conducting community regional assessments on cultural practices in the effective promotion of malaria interventions in sub-Saharan Africa.