[Contribution of social anthropology to malaria control]

Most countries with endemic malaria have implemented national control programs. However there has been practically no change in the burden caused by malaria in zones of highest transmission, especially in Africa. Development of forms resistant to antimalarial agents suggests that adaptation of the treatment to the disease has not been adequately monitored, that insecticide-impregnated bednets and screens have not been used sufficiently, and that the vertical approach to these problems has destabilized a fragile health care system. Application of social anthropology could help to resolve these problems. The five main areas in which social anthropology could make a positive contribution can be summarized as follows: (1) improving mutual understanding between the population and heath care providers by describing popular systems for interpreting the disease; (2) describing available care services and popular healing practices as a means of understanding the reasoning underlying access to care; (3) analysing the implications of recommended preventive measures for social behavior (e.g. "bed manners") that must take into account the modalities of appropriation of the proposed innovations; (4) improving the relationship between care givers and patients by evaluating local moral perceptions; and (5) reducing the adverse effects of oververticalization of control programs by promoting opportunities for synthesis with projects initiated by community groups and local officials. By undertaking work on these problem areas, preliminary and permanent pluridisciplinary teams could improve the current situation.