Pergamon 0277-9536(95)00292-8 Soc. Sci. Med. Vol. 42, No. 10, pp. 1433-1446, 1995 Copyright © 1996 ElsevierScienceLtd Printed in Great Britain. All rights reserved 0277-9536/95 $9.50 + 0.00 GENDER ASPECTS AND WOMEN'S PARTICIPATION IN THE CONTROL AND MANAGEMENT OF MALARIA IN CENTRAL SUDAN SAMIRA HAMID A/RAHMAN, AHMED A. MOHAMEDANI, EINAS MUBARAK MIRGANI and ADIL MAHGOUB IBRAHIM University of Gezira, Faculty of Medicine, Medani, P.O. Box 20, Sudan Abstract--This work was designed to study the contribution of women in central Sudan in the control and management of malaria with particular emphasis on gender-related aspects that define women's role and participation. The Blue Nile Health Project (BNHP 1980-1990) was launched in 1980 mainly for control of water associated diseases in central Sudan. The BNHP model was chosen to conduct this work. The study showed that women were actively involved in the implementation of the BNHP strategies as health instructors (murshidat) who constituted 75% of the staff of BNHP unit of health education, as members of village health committees (VHC) where they constituted 40% of the VHC members and also as recipients of the project services. All murshidat were interviewed whereas multistage random sampling for VHC members and recipient women in 40 villages was used to select a sample which was interviewed.The results showed that the murshidat and VHC women members played a major role in the motivation, organization and health education of local communities prior to campaigns of environmental sanitation and vector control. Household commitments and difficulties in communication with the public were the main gender-related factors that contributed negatively to women's activities. Cases of malaria have more considerable socio-economic impact than other common diseases, especially with regard to women's household commitments and work. Recipient women were more concerned with aspects of self protection, management of family cases of malaria and health education programmes. They were less involved in drying mosquito breeding sites and spraying activities of insecticides which had been reluctantly accepted because of allergy and bad odour. Although the majority of women considered antimalarials to be less harmful than effects of malaria itself on pregnancy, they did not realize the role of malaria chemoprophylaxis during pregnancy. This needs more health education. The study showed that the BNHP programme was very successful in recruiting women in control and management programmes. Therefore, health planners are urged to persuade the subordinated communities of women in many African countries like Sudan to play a more active role in the health programmes and welfare of their communities. Copyright © 1996 Elsevier Science Ltd Key words--gender, women's health, malaria, Sudan community health programmes, tropical diseases INTRODUCTION Malaria, in many tropical and subtropical countries, is still the most catastrophic and formidable health problem. The disease is estimated to affect 200- 250 m/year worldwide causing the death of > 2.5 m/ year, whereas 40% of the world population live at risk in areas of malaria [1, 2]. Approximately 80% of all malaria cases (i.e. > 150 m) and 90-95% of death cases worldwide were reported in Africa. At least 300-500 million malaria episodes are treated annually in sub-Saharan Africa [1, 3]. In fact, the disease is responsible for 15-20% of all hospital admissions [3, 4]. Malaria severely afflicts children, pregnant women and migratory populations because of their low immunity to this disease; an estimate of 67L000-1.6 m death cases among children in sub-Saharan Africa are attributed to malaria [5]. Moreover, malaria is a recognized cause of complications of pregnancy such as spontaneous abortion, premature delivery, intrauter- ine growth retardation and foetal death [6, 7]. In Sudan, the situation is rather daunting. An estimate of 1.0 m/year patients are admitted for treatment of malaria in major hospitals of the nothern states percent mortality was about 1.5% of the admitted cases [8]. Children presented with severe malaria constituted 10-20% of the total number of hospital emergency admissions; the relative mortality amongst Sudanese children varied between 1 and 7.5% [9]. Malaria is endemic in many parts of Sudan including the central region where a number of agricultural projects such as the Gezira, Kenana, and Rahad have been established (Fig. 1). It is this predominance of agriculture and the intensive use of irrigation that give rise to many water associated diseases (e.g. malaria and bilharzia) in the region. Efforts to control these diseases had continued for the last three decades, but the magnitude of the problem 1433