SUPPLEMENT VOL. 43 N0. 3 2009 48 ACTA MEDICA PHILIPPINA Notions of Risk and Vulnerability to Malaria Nina T. Castillo-Carandang Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila ABSTRACT An estimated average of 150 to 200 Filipinos developed malaria daily in the late 1990s (Malaria Control Service, 1996 ). For the 10-year period from 1985 to 1995 an average of PhP 100 million had been spent annually at the national government level alone for programs against malaria. The primary investigator (NCC) spent ten months living in Barangay Mangingisda (an endemic rural village) in Puerto Princesa City, Palawan from June 1995 to April 1996. With the help of assistants and households who acted as epidemiologic sentinels in four high and four low prevalence puroks (hamlets), she interviewed residents to elicit their perceptions and beliefs, practices and decision-making patterns in relation to the perceived causation/etiology, mode of transmission, susceptibility, signs and symptoms, case finding, treatment and prevention of malaria. A Triangulated Approach for Health Social Science Research on Malaria, using both qualitative and quantitative methods (modified version of the Qualitative Contrasting Groups Design – QCGD formulated by Higginbotham and Proteous ) was employed. A combined medical anthropological and epidemiological approach to the study of fever and malaria, which included a review of the development of the malaria control program in the Philippines as a historical process, was used. The concept of habituation can be used to describe the situation of the residents in Barangay Mangingisda. Perceived risk and vulnerability to fever and malaria, and its treatment and prevention were influenced by interactive variables. Responses to fever and perceived malaria at the household and community levels must be viewed within the context of lay capacities and perceived vulnerabilities (pasma or humoral imbalance which renders one susceptible to illness, presence of semilya ng malaria or “seeds” of malaria”), folk perceptions of resistance (resistensiya) and the state of being malariado (present or past experience with malaria), coping, and prevention. People employed diverse means to ensure the continued viability of their households amidst the immediate threat of malaria during its acute phase as well as its long-term threat due to the chronicity of the disease. Key Words: malaria, risk, vulnerability, health social science. Introduction The ancient scourge of malaria has returned with a vengeance resulting in global morbidity (247 million clinical cases yearly of which 21 million occurs in Asia) and SPECIAL ARTICLE Corresponding author: Nina T. Castillo-Carandang, MA, MSc Department of Clinical Epidemiology, College of Medicine University of the Philippines Manila 547 Pedro Gil St., Ermita Manila 1000, Philippines Telephone: +632 5254098/ +632 522-8380 Email: nina.castillo@gmail.com mortality (881,000 deaths per year of which 36,000 deaths occur in Asia) levels which make the disease a major social and economic burden worldwide. Nearly nine out of 10 deaths (85%) occur in children under five years of age. Malaria poses a further threat to approximately 3 billion persons or 50 percent of the world’s population who reside in 109 malaria-endemic countries. c In 2008, 57 of 79 provinces in the Philippines were endemic for malaria (DOH 2008), and 12.5 million Filipinos (specially the indigenous cultural groups) were at risk for the disease. d Endemic areas are primarily rural, with a mountainous or hilly topography, and isolated or with socio-political conflict. Malaria is the 8 th leading cause of morbidity with an estimated prevalence of 27.6 cases per 100,000 population in 2006 e and 0.17 deaths per 100,000 population. In 2006, Presidential Proclamation no. 1168 declared the month of November of every year as malaria awareness month. This further underscored the fact that malaria is a life-threatening disease with serious socio- economic consequences for many Filipino citizens as well as for the Philippine government. At the time of the study (1996), the Malaria Control Service estimated that an average of 150 to 200 Filipinos develop malaria daily and that majority of those afflicted with malaria belong to the working group age of 15-45 years of age. An average of PhP 100 million was spent annually at the national government level alone for insecticides, drugs, and manpower for the 10-year period from 1985 to 1995. Malaria as disease and malaria as illness The World Health Organization f argues that malaria is not only a health problem per se. This is because the key determinants of malaria and solutions to the malaria problem are not directly within the control of the health sector alone. Other factors involved in the classified determinants of malaria into: (1) Very Important factors (climate change, lack of adequate housing, lack of multisector coordination, lack of surveillance system, unavailability of health services, failure to use prevention strategies, and lack of effective vaccine); (2) Important Factors (deforestation, irrigation projects and dams, illiteracy, low status of women, increased travel and migration); and (3) Minor, indirect or no factor (poor sanitation and hygiene, hunger and malnutrition, lack of prevention tools or strategies, lack of effective treatment). Malaria is both a disease, marked by symptoms such as fever and chills and confirmed by laboratory examinations such as blood smears for malarial parasites; and an illness,