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Deviance and resistance: Malaria elimination in the greater Mekong subregion

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  • Lyttleton, Chris

Abstract

Malaria elimination rather than control is increasingly globally endorsed, requiring new approaches wherein success is not measured by timely treatment of presenting cases but eradicating all presence of infection. This shift has gained urgency as resistance to artemisinin-combination therapies spreads in the Greater Mekong Sub-region (GMS) posing a threat to global health security. In the GMS, endemic malaria persists in forested border areas and elimination will require calibrated approaches to remove remaining pockets of residual infection. A new public health strategy called ‘positive deviance’ is being used to improve health promotion and community outreach in some of these zones. However, outbreaks sparked by alternative understandings of appropriate behaviour expose the unpredictable nature of ‘border malaria’ and difficulties eradication faces. Using a recent spike in infections allegedly linked to luxury timber trade in Thai borderlands, this article suggests that opportunities for market engagement can cause people to see ‘deviance’ as a means to material advancement in ways that increase disease vulnerability. A malaria outbreak in Ubon Ratchathani was investigated during two-week field-visit in November 2014 as part of longer project researching border malaria in Thai provinces. Qualitative data were collected in four villages in Ubon's three most-affected districts. Discussions with villagers focused primarily on changing livelihoods, experience with malaria, and rosewood cutting. Informants included ten men and two women who had recently overnighted in the nearby forest. Data from health officials and villagers are used to frame Ubon's rise in malaria transmission within moral and behavioural responses to expanding commodity supply-chains. The article argues that elimination strategies in the GMS must contend with volatile outbreaks among border populations wherein ‘infectiousness’ and ‘resistance’ are not simply pathogen characteristics but also behavioural dimensions born of insistent market aspirations.

Suggested Citation

  • Lyttleton, Chris, 2016. "Deviance and resistance: Malaria elimination in the greater Mekong subregion," Social Science & Medicine, Elsevier, vol. 150(C), pages 144-152.
    • Handle: RePEc:eee:socmed:v:150:y:2016:i:c:p:144-152
    DOI: 10.1016/j.socscimed.2015.12.033
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    2. Randall M. Packard, 2009. "“Roll Back Malaria, Roll in Development”? Reassessing the Economic Burden of Malaria," Population and Development Review, The Population Council, Inc., vol. 35(1), pages 53-87, March.
    3. Stratton, Leeanne & O'Neill, Marie S. & Kruk, Margaret E. & Bell, Michelle L., 2008. "The persistent problem of malaria: Addressing the fundamental causes of a global killer," Social Science & Medicine, Elsevier, vol. 67(5), pages 854-862, September.
    4. Jeffrey Sachs & Pia Malaney, 2002. "The economic and social burden of malaria," Nature, Nature, vol. 415(6872), pages 680-685, February.
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    2. Kinley Wangdi & Ayodhia Pitaloka Pasaribu & Archie C.A. Clements, 2021. "Addressing hard‐to‐reach populations for achieving malaria elimination in the Asia Pacific Malaria Elimination Network countries," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 8(2), pages 176-188, May.

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