1
|
DeBoer KR, Vaz LM, Ondo Mfumu TA, Nlang JAM, Ondo L, Riloha Rivas M, Incardona S, Pollock J, von Fricken ME, Mba Eyono JN, Donfack OT, Guerra CA, García GA. Assessing IRS performance in a gender-integrated vector control programme on Bioko Island, Equatorial Guinea, 2010-2021. Malar J 2023; 22:323. [PMID: 37880774 PMCID: PMC10599007 DOI: 10.1186/s12936-023-04755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Indoor residual spraying (IRS) is a common vector control strategy in countries with high malaria burden. Historically, social norms have prevented women from working in IRS programmes. The Bioko Island Malaria Elimination Project has actively sought to reduce gender inequality in malaria control operations for many years by promoting women's participation in IRS. METHODS This study investigated the progress of female engagement and compared spray productivity by gender from 2010 to 2021, using inferential tests and multivariable regression. Spray productivity was measured by rooms sprayed by spray operator per day (RSOD), houses sprayed by spray operator per day (HSOD), and the daily productivity ratio (DPR), defined as the ratio of RSOD to HSOD, which standardized productivity by house size. RESULTS The percentage of women participating in IRS has increased over time. The difference in DPR comparing male and female spray operators was only statistically significant (p < 0.05) for two rounds, where the value was higher for women compared to men. Regression analyses showed marginal, significant differences in DPR between men and women, but beta coefficients were extremely small and thus not indicative of a measurable effect of gender on operational performance. CONCLUSIONS The quantitative analyses of spray productivity are counter to stigmatizing beliefs that women are less capable than male counterparts during IRS spray rounds. The findings from this research support the participation of women in IRS campaigns, and a renewed effort to implement equitable policies and practices that intentionally engage women in vector control activities.
Collapse
Affiliation(s)
| | | | - Teresa Ayingono Ondo Mfumu
- MCD Global Health, Malabo, Equatorial Guinea
- Ministry of Health and Social Welfare, National Malaria Control Programme, Malabo, Equatorial Guinea
| | | | - Lucas Ondo
- MCD Global Health, Malabo, Equatorial Guinea
| | - Matilde Riloha Rivas
- Ministry of Health and Social Welfare, National Malaria Control Programme, Malabo, Equatorial Guinea
| | | | | | - Michael E von Fricken
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | | | | | | | | |
Collapse
|
2
|
Shiras T, Tammaro M, Johns B, Stillman K, Belemvire A, Karera G, Hakizimana E, Gandaho T, Iwuchukwu N, Donner A. Expanding the Role of Women in Vector Control: Case Studies From Madagascar, Rwanda, and Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200508. [PMID: 37348949 DOI: 10.9745/ghsp-d-22-00508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Historically, vector control, including entomological monitoring, has been a field dominated by men. Each year, the U.S. President's Malaria Initiative (PMI) VectorLink project hires 50,000 to 70,000 seasonal workers across the countries in which it works to implement vector control activities, creating an economic opportunity for both men and women. Remaining barriers to women's employment in vector control include social and cultural norms regarding acceptability of formal employment for women, perceptions that women are not fit to serve as spray operators, and a historical context of male-dominated fields such as entomology. METHODS We use PMI VectorLink project data from Madagascar, Rwanda, and Zambia for 2019-2021 and key informant interviews with project staff in these countries to examine levels of female employment, effectiveness and efficiency of female versus male malaria spray operators, and strategies to expand the role of women in vector control. RESULTS The percentage of female seasonal employees ranges from 25% in Madagascar to 32% in Rwanda and 45% in Zambia. The percentage of women in leadership positions ranges from 32% in Madagascar and Rwanda to 38% in Zambia. Men and women are equally effective and efficient as spray operators. Best practices for recruiting and retaining women in vector control include engaging community leaders in recruitment, implementing affirmative action hiring policies, mentoring women to progress to leadership positions, and ensuring equitable, safe, and attractive workplaces. DISCUSSION As vector control programs transition away from donor funding and are increasingly government led, sustaining gains in female empowerment is critical. Country programs should work closely with national, regional, district, and local leaders to demonstrate the importance of hiring women in vector control-including leadership positions-and the impact on female economic empowerment, community well-being, and success of vector control programs.
Collapse
Affiliation(s)
| | | | - Benjamin Johns
- National Institutes of Health, Bethesda, MD, USA; Formerly of Abt Associates, Rockville, MD, USA
| | | | - Allison Belemvire
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, DC, USA
| | | | - Emmanuel Hakizimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | | | | |
Collapse
|
3
|
Mungall-Baldwin C. Women's participation in the prevention and control of dengue using environmental methods in the global south: a qualitative meta-synthesis. Int J Equity Health 2022; 21:140. [PMID: 36151547 PMCID: PMC9508726 DOI: 10.1186/s12939-022-01726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dengue, a mosquito-borne viral disease, causes significant mortality and morbidity in low- to middle-income countries. A body of research indicates that women can be effective in implementing vector borne disease control, but they still face inequitable opportunities for participation, leadership and decision-making in the execution of dengue prevention and vector control programmes. Yet implementing informal environmental management practices to prevent mosquito vector breeding forms part of their domestic household responsibilities. Understanding the enablers and barriers to women’s equitable roles with men in formal and informal disease prevention, and the benefits of their participation could help to increase their role and may be a contributing factor to reducing disease rates. The objective of this qualitative meta-synthesis was to synthesise evidence about women’s roles in dengue prevention and control in the global south and generate insights around the barriers, enablers, and benefits. Methods Eight databases were searched from inception to 7th December 2020. One investigator independently reviewed all titles and abstracts for relevant articles. Grey literature was searched using 34 websites of global health and international development organisations. Results A total of 18 articles representing qualitative research or the qualitative component of mixed methods studies from Latin American and Caribbean (n = 8), Asia (n = 9), and one international review were included in the meta-synthesis. Relevant scholarship from Africa was lacking. This meta-synthesis revealed five unique themes surrounding women’s participation, seven categories of barriers, six of enablers, four health, well-being and social benefits for individuals, and four for communities . Conclusion An analysis of the results confirmed that women’s participation in dengue prevention was not gender equitable, gender sensitive nor transformative although women are the primary human resource for household and community-based prevention. Women demonstrated specific qualities aiding successful implementation. Corrective action is urgently needed to shift unhelpful gender norms, and empower women into leadership and decision-making roles.
Collapse
Affiliation(s)
- Cathy Mungall-Baldwin
- Institute of Health and Wellbeing, University of Glasgow, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland, UK. .,School of Public Health and Community Medicine, University of New South Wales, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
4
|
Steege R, Taegtmeyer M, Ndima S, Give C, Sidat M, Ferrão C, Theobald S. Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique's community health workforce. HUMAN RESOURCES FOR HEALTH 2020; 18:37. [PMID: 32448359 PMCID: PMC7245854 DOI: 10.1186/s12960-020-00476-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/05/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mozambique's community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). The Government of Mozambique is aiming to increase the proportion of females to constitute 60% to improve maternal and child health outcomes. To understand the imbalance, this study explored the current recruitment processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience and retention of APEs in Maputo Province, Mozambique. METHODS We employed qualitative methods with APEs, APE supervisors, community leaders and a government official in two districts within Maputo Province. Interviews were recorded, transcribed and translated. A coding framework was developed in accordance with thematic analysis to synthesise the findings. FINDINGS In-depth interviews (n = 30), key informant interviews (n = 1) and focus group discussions (n = 3) captured experiences and perceptions of employment processes. Intra-household decision-making structures mean women may experience additional barriers to join the APE programme, often requiring their husband's consent. Training programmes outside of the community were viewed positively as an opportunity to build a cohort. However, women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income-generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with a higher salary. Age and geographic location were also important intersecting factors: younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain. CONCLUSION Gender norms, roles and power dynamics intersect with other axes of inequity such as marital status, age and geographic location to impact recruitment and retention of APEs in Maputo Province, Mozambique. Responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.
Collapse
Affiliation(s)
- Rosalind Steege
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Sozinho Ndima
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Celso Give
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Mohsin Sidat
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Clara Ferrão
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| |
Collapse
|
5
|
Dillip A, Mboma ZM, Greer G, Lorenz LM. 'To be honest, women do everything': understanding roles of men and women in net care and repair in Southern Tanzania. Malar J 2018; 17:459. [PMID: 30526608 PMCID: PMC6286524 DOI: 10.1186/s12936-018-2608-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Tanzania, the roles of men and women are classified based on the local cultural context. While men are usually the breadwinners, women are traditionally responsible for most domestic chores. Particularly for malaria prevention, studies in Africa have revealed women as being responsible for daily up-keep of the net. Using social role theory, this study explored the role of men and women in net care and repair and gender-related motivation and barriers to net care and repair in Tanzania. METHODS The study was conducted in the two villages of Ruangwa district in Lindi Region. The study applied qualitative approaches and carried out in-depth interviews and focus group discussions with men, women, women with children under the age of five, and village key informants. RESULTS Mosquito nets were valued by all participants as a protection measure against mosquitoes. Study findings indicate that net care and repair falls under a woman's daily household responsibilities. While men were said to assist in stitching damaged nets, washing dirty bed nets was regarded inappropriate for men and not traditionally accepted. Motivation for net care and repair was reported to come from both men and women; for a woman keeping the net clean defined a caring and responsible woman, while men indirectly promoted net washing when complaining about nets being dirty. Women reported that men could do everything that women do regarding net care and repair, but that it does not fit into societal norms. CONCLUSION With increased globalization in Tanzania, more women are becoming part of the workforce, which may limit their full commitment to net care and repair activities, leading to increased net damage, malaria incidences and higher costs for malaria treatment. The National Malaria Control Programme should consider incorporating research-informed gender-transformative messages into their behaviour change communication on mosquito nets and work closely with trusted Community Health Workers to inform communities about the importance of sharing responsibilities in net care and repair. It is acknowledged that changing people's behaviour and practices is a long process, which will require a deep cultural and political shift.
Collapse
Affiliation(s)
- Angel Dillip
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Zawadi Mageni Mboma
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - George Greer
- USAID/US President's Malaria Initiative Tanzania, Old Bagamoyo Road, Msasani, Dar es Salaam, Tanzania
| | - Lena M Lorenz
- Ifakara Health Institute, Kiko Avenue, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|