Man and his parasites: Integration of biomedical and social approaches to transmission and control

The significance of sociocultural and behavioural factors in the transmission and control of parasitic infections has been underestimated. Explanations for this neglect include the failure of communication between biomedics and social scientists and reliance on control measures such as mass chemotherapeutic and anti-vector programmes which do not involve the participation of the community at risk. The need for an integrated approach to both the impact of parasitic infections and their control is now being recognised. Given their very high prevalence and the background socio-economic and other factors which exacerbate the problem, parasites of the subtropical countries will be the main emphasis of this discussion. The paper will illustrate a number of methodologies employed to look at the relationship between sociocultural and parasitic infections rather than provide a catalogue of interesting and yet isolated examples of human risk behaviours. These methodologies will include assessments of both individual risk factors and a broader framework to include larger social groupings including 'outsiders' involved in control programmes. Finally, the importance of this type of emphasis within control strategies will be discussed and a concluding section on research priorities and recommendations will be presented.