The Role of Social Capital in Malaria Control in Nyabondo, Western Kenya

By 2015, target 8 of the United Nations Millennium Development Goal number six aimed to have halted and began to reverse the incidence of malaria and other major diseases. One of the strategies through which this target was expected to be achieved is to increase the proportion of the population in malaria risk areas who use effective malaria prevention and treatment measures. Malaria is one of the most common vector-borne diseases widespread in tropical and subtropical regions, including parts of the America, Asia, and Africa. Over half of all malaria cases are known to occur in five African countries, including Kenya. Geographically, 70% of the country is prone to epidemics, putting about 20 million Kenyans at constant risk, and killing an estimated 26,000 children every year. In addition to the human cost, the economic burden of the disease is huge. The force of transmission of malaria infection requires an interaction between a human host, a malaria parasite, an Anopheles vector, and a physical, biological and socioeconomic environment, all of which prevail in Nyabondo. Consequently, the plateau was hit by many serious outbreaks of malaria; in response to which the Swiss BioVision Foundation launched an Integrated Vector Management Malaria Project in 2004. Having achieved active community involvement and participation, and benefitted from the support of the relevant authorities and stakeholders, the outcome of this project, unlike other malaria control implementation efforts, has been touted as highly positive. Considering its role in fostering trust and social cohesion, which facilitates social participation, cooperation and collective action, it was perceived that social capital might have played a role in the success of the malaria control project in rural Nyabondo. However, it was yet to be proven if social capital did play any significant role in the success achieved and, if yes, the exact mechanisms through which it contributed to the success of the project. It is against this backdrop that this research was undertaken to explore the role played by social capital in malaria case management. Specifically, it sought to: evaluate the influence of social networks on the propensity of individuals to manage malaria cases through the formal health care system; assess the effects of social trust on the choice of malaria treatment services patronised by malaria treatment seekers; evaluate the influence of social norms on the choice of malaria treatment services utilised to manage malaria cases. To achieve the study objectives, an amalgamation of cross-sectional, retrospective and exploratory research designs was utilized. A case study approach was employed to take advantage of both quantitative and qualitative research strategies. Quantitatively, the special survey technique for researching social capital was utilized, while the qualitative methodologies embraced document analysis and the application of qualitative methodologies to the statistical survey. The World Bank’s Social Capital Assessment Tool, the Position Generator, the Resource Generator and the Name Generator were utilised for measurement in order to take advantage of the complementarities offered by these tools. Field data was analysed using SPSS and R statistical software. A multilevel generalized linear modelling routine was utilized to explore both individual and contextual influences of social capital. The results of data analysis revealed that: an individual’s choice of which health care services to utilise for the management of malaria cases is influenced by members of his/her social networks; social trust plays important roles in the utilisation of formal health services for malaria case management; the motivation to comply with the norms of family and friendship networks also has major influences on how individuals manage malaria cases; generally, the roles played by the different forms of social capital are relative and contingent in nature. This implies that social networks, trust and norms can have both positive and/or negative influences on the use of recommended health services for malaria treatment; depending on their nature. By these findings, it is recommended that program planners incorporate a social capital dimension in the design of up-scaling strategies for malaria control interventions. This generates a need for awareness to be created among malaria control program implementers on how specific contextual conditions affect the building, harnessing and mobilizing of social capital. It is also important that officials of public health facilities strive to build appropriate social capital with their target clients.