The Bamako initiative and its relevance to malaria control in Bar Chando Sub-Location, Bondo Division, Siaya District, Kenya

Abstract

This study attempted to examine the relevance of the Bamako Initiative (B.I.) approach to malaria control in Bar Chando sub-location, Bondo division. The general objective of the study was to describe the differences inknowledge,perceptions and the use of the B.1. services among men and women. Specifically, the study set out to determine the perceived socio-economic costs and benefits which influenced the use of the malaria control services. It also aimed at describing the people's perceptions of the risks and control of malaria as well as the current ethnomedical malaria control practices employed. Standardized questionnaires with both open-and closed-ended questions were used in data collection. More data were acquired through unstructured interviews and direct non-participant observation. The data were analyzed through qualitative and quantitative techniques which included inferences from verbatim reports, simple frequencies and cross-tabulations. Interpretations were based on the ecological theory and the health belief model. The findings indicated that there were no major differences between men and women regarding their knowledge, perceptions and use of the B.1. services. However, very few people used the B.1.services and instead relied more on local shops and other sources of medical care. The major reason for the under-utilization of the 8.1. services, especially bednets, was the local people's low income. Also a majority of the people did not have confidence in the services provided by volunteer community health workers (CHWs) as well as the fact that there were no referral systems and specialist supervision to support the B.1.malaria control efforts. The study also revealed that the

local people were more likely to depend on the widely available traditional malaria control resources. The study population generally had a high knowledge of the risks of malaria but they lacked a complete grasp of how malaria is caused and transmitted. It is recommended here that feasible income-generating projects be set up to help in sustaining the B.1.programme. Locally acceptable ways, such as the merry-goround and hire purchase arrangements, should be encouraged to help the poor pay for the health services more easily. There should be increased malaria control education activities as well as awareness campaigns about the B.1. services. It might also be helpful to train the CHWs in the management of malaria and other diseases. The efforts should be supported by a referral system and regular supervision. Finally, scientific studies should be carried out on the efficacy of the traditional malaria medicines and mosquito repellents. If some of the traditional remedies are found to be efficient, they should be made available to the local people.