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Community participation for malaria elimination in tafea province, vanuatu: part ii. social and cultural aspects of treatment-seeking behaviour

Anna Tynan1*, Jo-An Atkinson1, Hilson Toaliu3, George Taleo4, Lisa Fitzgerald15, Maxine Whittaker1, Ian Riley1, Mark Schubert5 and Andrew Vallely12

Author Affiliations

1 Pacific Malaria Initiative Support Centre, School of Population Health, University of Queensland, (Herston Road), Brisbane, (4006), Australia

2 Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, (West Street) Sydney, (2010), Australia

3 Save the Children, Port Vila, Vanuatu

4 National Vector Borne Disease Control Programme, Ministry of Health, Port Vila, Vanuatu

5 Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, (Herston Road), Brisbane, (4006), Australia

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Malaria Journal 2011, 10:204  doi:10.1186/1475-2875-10-204

Published: 26 July 2011



Early diagnosis and prompt effective case management are important components of any malaria elimination strategy. Tafea Province, Vanuatu has a rich history of traditional practices and beliefs, which have been integrated with missionary efforts and the introduction of modern constructions of health. Gaining a detailed knowledge of community perceptions of malarial symptomatology and treatment-seeking behaviours is essential in guiding effective community participation strategies for malaria control and elimination.


An ethnographic study involving nine focus group discussions (FGD), 12 key informant interviews (KII) and seven participatory workshops were carried out on Tanna Island, Vanuatu. Villages in areas of high and low malaria transmission risk were selected. Four ni-Vanuatu research officers, including two from Tanna, were trained and employed to conduct the research. Data underwent thematic analysis to examine treatment-seeking behaviour and community perceptions of malaria.


Malaria was perceived to be a serious, but relatively new condition, and in most communities, identified as being apparent only after independence in 1980. Severe fever in the presence of other key symptoms triggered a diagnosis of malaria by individuals. Use of traditional or home practices was common: perceived vulnerability of patient and previous experience with malaria impacted on the time taken to seek treatment at a health facility. Barriers to health care access and reasons for delay in care-seeking included the availability of health worker and poor community infrastructure.


Due to programme success of achieving low malaria transmission, Tafea province has been identified for elimination of malaria by 2012 in the Government of Vanuatu Malaria Action Plans (MAP). An effective malaria elimination programme requires interactions between the community and its leaders, malaria workers and health providers for success in diagnosis and prompt treatment. As malaria becomes more uncommon, utilizing unique motivators for communities to seek early diagnosis and treatment is important, particularly as other health conditions that cause fevers become increasingly more common. The design of these interventions are dependent upon robust understanding of community perceptions of disease, and the evolving nature of these perceptions.