Wait a minute - maybe we are being too sensitive to cultural differences here. Do we just accept the culture of sub-Sarahran Africa as equally valid to our own in this case? Do we just accept that Africans don't like using bed nets and so we must discount that approach and look for alternative ways to combat malaria?

Let's not pussy-foot around the issue. The LA Times article mentions that some African people think that mangoes cause malaria - in this case the African view is wrong and the Western view is right. Perhaps it is also wrong to hold the view that (a) malaria is no more harmful than the flu; and (b) having ventilation is preferable to a bed net.

I realise that changing people's attitudes is difficult, particularly when the message is delivered by white people who have such a poor historical record in Africa. But malaria causes a quarter of childhood deaths in sub-Saharan Africa [1] and insecticide-treated bed nets are 90-95+% effective, even when they have small holes [2].

I'm not saying that Western culture is always right - or even right when it comes to malaria. Lets just be careful to avoid automatically excluding other cultural viewpoints from criticism.

[1] http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

[2] http://www.againstmalaria.com/faq_bednets.aspx

The question here, I imagine, is not primarily one of the validity of the various viewpoints. Rather, it is commentary that someone solving the problem of malaria has to accept the reality of the sub-Saharan African viewpoint as a starting point for their approach.

Foundationally, the local populations aren't clamouring for a solution, so they are much less likely to accept inconvenience as a by-product of a solution.

We know rhinovirus and flu kill scores of elderly people in nursing homes, but continue to avoid the minor inconvenience of meticulous hygiene before visiting our geriatric loved ones.

In risk communication, we might say "the audience will be hostile toward our rhetoric". Put another way, the target population will require careful encouragement to changing their viewpoint, while being presented with a solution that does not operate from a confrontational approach.

Any solution that does not consider the local populations' viewpoints will likely fail.

"the overwhelming majority of cases go away on their own" go away for most africans because they are more likely to carry the sickle cell trait which provides defence against malaria.