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“We have this, with my husband, we live in harmony”: exploring the gendered decision-making matrix for malaria prevention and treatment in Nampula Province, Mozambique
Malaria Journal ( IF 3 ) Pub Date : 2020-03-30 , DOI: 10.1186/s12936-020-03198-5
Zoe Jane-Lara Hildon , Maria Escorcio-Ymayo , Rose Zulliger , Rosario Arias de Aramburú , Nan Lewicky , Hunter Harig , Jose Braz Chidassicua , Carol Underwood , Liliana Pinto , Maria Elena Figueroa

Conceptualizing gender dynamics and ways of bridging entrenched gender roles will contribute to better health promotion, policy and planning. Such processes are explored in relation to malaria in Mozambique. A multi-method, qualitative study using focus group discussions (FGDs) and in-depth interviews (IDIs) explored the perspectives of community members, leaders and stakeholders on malaria. The study was conducted in Nampula Province, in an intervention district for the Tchova Tchova Stop Malaria (TTSM) gender-sensitive community dialogues, and in a non-intervention district. Participants (n = 106) took part in six FGDs and five IDIs in each district. Those exposed to TTSM commonly stated that the programme influenced more equalitarian gender roles, attitudes and uptake of protective malaria-related practices. These positive changes occurred within the context of an observed, gendered decision-making matrix, which aligns inward- or outward-facing decisions with malaria prevention or treatment. Decisions more dependent on male or elder sanctioning at community level are outward-facing decisions, while decisions falling within women’s domain at household level are inward-facing decisions. Related to prevention, using bed nets was largely an inward-facing prevention decision for women, who were generally tasked with hanging, washing and making nets usable. Net purchase and appropriation for malaria prevention (rather than for instance for fishing) was men’s prerogative. Regular net use was associated with sleeping together more regularly, bringing couples closer. Attending antenatal care to access intermittent preventive treatment during pregnancy was often an outward-facing prevention decision, under the purview of older, influential women and ultimately needing sanctioning by men. With respect to seeking care for malaria symptoms, women typically sought help from traditional healers first. This inward-facing treatment decision was within their control, in contrast to the frequently transport-dependent, outward-facing decision to attend a health facility. Sharing decisions was described as a feature of a “harmonious household,” something that was said to be encouraged by the TTSM intervention and that was both lived and aspirational. TTSM community dialogues helped communication on both interpersonal (couple) and community levels, ultimately encouraging malaria-related behaviours. Leveraging ways of bringing men and women together to share decision making will improve malaria intervention success.

中文翻译:

“与丈夫一起,我们拥有和谐的生活”:探索莫桑比克楠普拉省预防和治疗疟疾的性别决策矩阵

概念化性别动态以及弥合根深蒂固的性别角色的方法将有助于更好的健康促进,政策和计划。在莫桑比克探索了与疟疾有关的此类过程。使用焦点小组讨论(FGD)和深入访谈(IDI)进行的多方法,定性研究探索了社区成员,领导人和利益相关者对疟疾的观点。这项研究是在楠普拉省,在Tchova Tchova Stop Malaria(TTSM)对性别问题敏感的社区对话的干预区以及在非干预区进行的。参与者(n = 106)参加了每个地区的六个FGD和五个IDI。接触过TTSM的人通常表示,该计划影响了更平等的性别角色,态度以及与保护性疟疾有关的习俗的采用。这些积极的变化发生在观察到的性别决策矩阵的背景下,该矩阵使向内或向外的决策与疟疾的预防或治疗相一致。在社区一级更依赖于男性或老年人制裁的决策是面向外的决策,而在家庭一级属于女性领域的决策是面向内的决策。与预防有关,使用蚊帐在很大程度上是面向女性的预防决定,这些妇女通常负责悬挂,清洗和使蚊帐可用。预防疟疾的净购买和拨款(而不是用于捕鱼)是男人的特权。经常性的净使用与更规律的睡在一起有关,使夫妻之间的距离更近。在有影响力的老年妇女的权限范围内,在怀孕期间接受产前保健以获得间歇性预防治疗通常是一个外向的预防决定,最终需要男性的批准。关于寻求疟疾症状的护理,女性通常首先寻求传统治疗师的帮助。与经常依赖运输的朝外决定参加卫生保健机构相反,这一向内治疗决定在他们的控制之内。共享决策被描述为“和谐家庭”的一个特征,这被TTSM的干预所鼓舞,既生动又令人向往。TTSM社区对话有助于人际(夫妇)和社区层面的交流,最终鼓励了与疟疾有关的行为。
更新日期:2020-04-22
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