title: The evil circle of poverty: a qualitative study of malaria and disability.
abstract: BACKGROUND
  This article discusses the link between disability and malaria in a poor rural setting. Global malaria programmes and rehabilitation programmes are organized as vertical and separate programmes, and as such they focus on prevention, cure and control, and disability respectively. When looking at specific conditions and illnesses, the impairing long-term consequences of illness incidents during childhood are not questioned.
  
  
  METHODS
  The study design was ethnographic with an open, exploratory approach. Data were collected in Mangochi District in Malawi through qualitative in-depth interviews and participant observation.
  
  
  RESULTS
  Despite a local-based health service system, people living in poor rural areas are confronted with a multitude of barriers when accessing malaria prevention and treatment. Lack of skilled health personnel and equipment add to the general burden of poverty: insufficient knowledge about health care, problems connected to accessing the health facility in time, insufficient initiatives to prevent malaria attacks, and a general lack of attention to the long term disabling effects of a malaria attack.
  
  
  CONCLUSIONS
  This study points to the importance of building malaria programmes, research and statistics that take into consideration the consequences of permanent impairment after a malaria attack, as well as the context of poverty in which they often occur. In order to do so, one needs to develop methods for detecting people whose disabilities are a direct result of not having received health services after a malaria episode. This may be done through qualitative approaches in local communities and should also be supplemented by suitable surveys in order to estimate the problem on a larger scale.
authors.affiliation: Institute of Health and Society, Department of General Practice and Community Medicine, Section for Medical Anthropology, University of Oslo, P.O. Box 1130 Blindern, N-0318 Oslo, Norway.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Ingstad
authors.forename: Alister C
authors.initials: AC
authors.lastname: Munthali
authors.forename: Stine H
authors.initials: SH
authors.lastname: Braathen
authors.forename: Lisbet
authors.initials: L
authors.lastname: Grut
mesh_terms: D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008288:Malaria / Q000150:complications* / Q000453:epidemiology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011203:Poverty; D011247:Pregnancy; D012424:Rural Population