Community perception in a vulnerable municipality in the Colombian Pacific

Controlling malaria is costly and epidemics have a negative impact on the socioeconomic development (1) (2). Colombia is endemic for this disease and related to social and economic vulnerability faced by rural areas (3) (4). As a multicausal disease, new approaches to control it must integrate individual participation, community empowerment and institutional leadership (5). Because in Colombia the programs to control the disease have been characterized by a low community participation (6) (7), we need to approach the social construction of health and disease in the endemic population, their collective imagination, needs, and projects (8) (9). Therefore, this study aims to provide a community and institutional view on these elements in relation to the disease and the vector in a community with a long history of social segregation and poverty.
The great number of adolescents (55.73%), children (24.89%) and eldery (16.09%) in the community could affect the municipality’s economy, resulting in a small workforce or people forced to work from very early to very advanced ages.
Public services are absent or deficient, especially drinking water (33.58%), garbage (65.67%) and sewage disposal (8.21%). All those combine with inequality in the social structure, low-income, gender with inequalities for women and an ethnic group that marks a whole territory of inequality, where Afro-Colombian mixes with the high rurality full of oversight and poverty (10).
They know malaria is a disease transmitted by a mosquito and the responsibility to prevent it falls not only on government entities but also on individual and community level. They can identify signs and symptoms; this is in line with other studies in endemic settings from Colombia (11). Some of the field observations showed the lack of control measures and stagnant water, and the use of insecticides and mosquito nets as the most important control measures, being the same reported in other endemic countries (12) (13) (14).
To prevent malaria, the health system performs community education; the population accepts it and the level of knowledge is acceptable. However, such methods will not resolve problems regarding the environment which are breeding grounds for high-risk conditions for the population’s health. There is a health center with first level basic care focused on treatment and rehabilitation with few resources. Accessing levels of greater complexity is very difficult due to economic, geographic, and communication barriers, without dismissing the violent actors that are part of daily life.
The malaria control programs carried out by the government entities would be focused on effective interventions to address malaria specific risk factors. However, to ensure a health promoting environment in which these populations live and can then practice the appreciate a malaria prevention behaviours, probably a broader a primary care strategy involving a family and community approach is required.