Knowledge, Attitudes, and Practices about Malaria and Its Control in Rural Northwest Tanzania

Prevalence and drivers of malaria infection among asymptomatic and symptomatic community members in five regions with varying transmission intensity in mainland Tanzania

BACKGROUND

Despite implementation of effective interventions in the past two decades, malaria is still a major public health problem in Tanzania. This study assessed the prevalence and drivers of malaria infections among symptomatic and asymptomatic members of selected communities from five regions with varying endemicity in mainland Tanzania.

METHODS

A cross-sectional community survey was conducted in five districts, including one district/region in Kagera, Kigoma, Njombe, Ruvuma and Tanga from July to August 2023. Participants aged ≥ 6 months were recruited and tested using rapid diagnostic tests (RDTs). Demographic, anthropometric, clinical, parasitological, type of house, and socio-economic status (SES) data were captured using structured questionnaires. Associations between parasite prevalence and potential drivers were determined by logistic regression, and the results were presented as crude (cOR) and adjusted odds ratios (aOR), with 95% confidence intervals (CIs).

RESULTS

Among 10,228 individuals tested, 3515 (34.4%) had positive results by RDTs. The prevalence of malaria varied from 21.6% in Tanga to 44.4% in Kagera, and from 14.4% to 68.5% among the different villages (P < 0.001). The odds of malaria infections were higher in males (aOR = 1.32, 95% CI 1.19-1.48, P < 0.001), under-fives (aOR = 2.02, 95% CI 1.74-2.40, P < 0.001), schoolchildren [aged 5-9 years (aOR = 3.23, 95% CI 1.19-1.48, P < 0.001) and 10-14 years (aOR = 3.53, 95% CI 3.03-4.11, P < 0.001)], and non-bednet users (aOR = 1.49, 95% CI 1.29-1.72, P < 0.001). Individuals from households with low SES (aOR = 1.40, 95% CI 1.16-1.69, P < 0.001), or living in houses with open windows (aOR = 1.24, 95% CI 1.06-1.45, P < 0.001) and/or holes on the walls (aOR = 1.43, 95% CI 1.14-1.81, P < 0.001) also had higher odds.

CONCLUSIONS

Malaria prevalence varied widely across regions and villages, and the odds of infections were higher in males, schoolchildren, non-bednet users, and individuals with low SES or living in houses with open windows and/or holes on the walls. The identified vulnerable groups and hotspots should be targeted with specific interventions to reduce the disease burden and support the ongoing malaria elimination efforts in Tanzania.

Impact of mass media campaigns on knowledge of malaria prevention measures among pregnant mothers in Uganda: a propensity score-matched analysis

BACKGROUND

Uganda grapples with a considerable malaria burden, reporting prevalence rates of over 33% in some regions. To address this, the Uganda Ministry of Health employs audiovisual platforms for disseminating malaria prevention messages. However, the impact of these messages on pregnant women's knowledge of malaria prevention remains insufficiently explored. This paper therefore emphasizes the influence of audiovisual messages on the knowledge of malaria prevention measures among pregnant women in Uganda.

METHODS

Secondary data obtained from the Uganda Malaria Indicator Survey (MIS) 2018-2019 was used for this analysis. Women aged 15-49 were included in the study. A total of 8868 women were selected using a two-stage sample design. The two stages of selection included clusters and households. Women who were currently pregnant were included in the study, resulting in a weighted sample of 721 women. Propensity score-matched analysis was used to evaluate the impact of access to malaria messages on knowledge of prevention measures.

RESULTS

The study revealed that 39% [95% CI 34.0-44.2] of pregnant women were exposed to malaria messages before the survey. Those exposed had a 17.2% higher knowledge [ATT = 0.172; 95% CI 0.035-0.310] of using mosquito nets for prevention compared to those unexposed. Among women exposed, radios accounted for most form of access to mass media campaigns [64.8, 95% CI 57.0-71.8] followed by interpersonal communication [45.0, 95% CI 37.6-52.6], community health workers [38.8, 95% CI 29.6-48.8], community events [21.4, 95% CI 15.8-28.3], and social mobilization [18.3, 95% CI 12.7-25.8].

CONCLUSION

Results highlight the importance of radios in spreading important malaria prevention messages to pregnant women. Being exposed to these messages is linked to increased awareness and knowledge about the proper use of insecticide-treated bed nets (ITNs) for preventing malaria. This finding underscores the importance of evaluating different channels for mass media campaigns to ensure the effective delivery of information about malaria prevention to the intended audiences.

Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study

BACKGROUND

Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi.

METHODS

The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility.

RESULTS

The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges.

CONCLUSION

Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention's fidelity, feasibility, and sustainability.

Community knowledge, attitude, practices and beliefs associated with persistence of malaria transmission in North-western and Southern regions of Tanzania

BACKGROUND

Despite significant decline in the past two decades, malaria is still a major public health concern in Tanzania; with over 93% of the population still at risk. Community knowledge, attitudes and practices (KAP), and beliefs are key in enhancing uptake and utilization of malaria control interventions, but there is a lack of information on their contribution to effective control of the disease. This study was undertaken to determine KAP and beliefs of community members and service providers on malaria, and how they might be associated with increased risk and persistence of the disease burden in North-western and Southern regions of Tanzania.

METHODS

This was an exploratory study that used qualitative methods including 16 in-depth interviews (IDI) and 32 focus group discussions (FGDs) to collect data from health service providers and community members, respectively. The study was conducted from September to October 2017 and covered 16 villages within eight districts from four regions of mainland Tanzania (Geita, Kigoma, Mtwara and Ruvuma) with persistently high malaria transmission for more than two decades.

RESULTS

Most of the participants had good knowledge of malaria and how it is transmitted but some FGD participants did not know the actual cause of malaria, and thought that it is caused by bathing and drinking un-boiled water, or consuming contaminated food that has malaria parasites without warming it. Reported barriers to malaria prevention and control (by FGD and IDI participants) included shortage of qualified health workers, inefficient health financing, low care-seeking behaviour, consulting traditional healers, use of local herbs to treat malaria, poverty, increased breeding sites by socio-economic activities and misconceptions related to the use of bed nets and indoor residual spraying (IRS). Among the misconceptions, some participants believed that bed nets provided for free by the government came with bedbugs while others reported that free bed nets caused impotence among men.

CONCLUSION

Despite good knowledge of malaria, several risk factors, such as socio-economic and behavioural issues, and misconceptions related to the use of bed nets and IRS were reported. Other key factors included unavailability or limited access to health services, poor health financing and economic activities that potentially contributed to persistence of malaria burden in these regions. Relevant policies and targeted malaria interventions, focusing on understanding socio-cultural factors, should be implemented to reduce and finally eliminate the disease in the study regions and others with persistent transmission.

Assessing the population's correct knowledge of malaria in Malaysia: a vital component for malaria elimination certification

BACKGROUND

Malaria remains a public health problem in Malaysia despite a decline in the number of cases in recent years. Public knowledge of malaria is essential to achieving and maintaining malaria elimination. Therefore, this survey assessed the prevalence of people who had ever heard of malaria, had correct knowledge of malaria transmission, symptoms, risk activities, and prevention measures in the Malaysian population, and identified the associated factors involved.

METHODS

The data were obtained from the National Health and Morbidity Survey (NHMS) which was conducted from September to October 2020. A cross-sectional survey with five structured questionnaires using the method of computer-assisted telephone interviews (CATI) was used to collect data. The socio-demographic characteristics such as age, gender, ethnicity, nationality, marital status, educational level, and occupation were recorded. Data were analysed using STATA SE Version 16. Associations between variables were tested using chi-square and logistic regression, with the level of statistical significance set at p < 0.05.

RESULTS

Out of 3085 respondents who participated in this survey, 2491 had ever heard of malaria with a prevalence of 76.1% (95% CI 70.5, 80.9). The prevalence of correct knowledge of malaria transmission was 53.9% (95% CI 50.2, 57.7), symptoms 24.1% (95% CI 21.2, 27.2), risk activities 34.0% (95% CI 29.3, 39.1) and prevention measures 59.7% (95% CI 55.5, 63.7). Multivariate analysis showed that age, ethnicity, and educational level were significantly associated with correct malaria transmission and risk activities. In addition, age and educational level were significantly associated with correct malaria symptoms. Subsequently, only the variable ethnicity showed a significant association with the correct malaria prevention measures.

CONCLUSION

In general, the prevalence of ever heard of malaria was considered high since the survey was performed based on a non-specific malaria population. However, the prevalence of correct knowledge of malaria symptoms and risk activities were considered low. It is concluded that educational level is one of the major factors associated with correct malaria knowledge, along with age and ethnicity. Therefore, based on these findings, targeted intervention and innovation should be planned by malaria programme managers to sustain malaria elimination in Malaysia.

Determination of knowledge, attitude, and practice of Chinese and local people toward malaria prevention in Kano State, Nigeria

To date, malaria is still a major public health issue in the world. Africa remains the most affected continent with the highest number of malaria cases and deaths. Since more than one thousand Chinese citizens are living in Nigeria, an examination of their knowledge, attitude, and practice compared with those of the local people may be essential for malaria prevention. This study adopted cross-sectional research. A total of 137 Chinese people and 299 local people residing in Kano State, Nigeria constituted the study subjects. A questionnaire was used for the collection of data on socio-demography and predictors of attitudes. The Cronbach alpha statistic was used to analyze these data. Insecticide spraying, mosquito repellents, and wearing protective clothing at night are the malaria preventive measures by both the local and Chinese people living in Kano state, Nigeria. However, there is a significant difference (P<0.05) between the two groups, with the duration of stay in Nigeria, the use of mosquitoes, attitude, and practices playing impactful roles among the Chinese people. Hence, Chinese people demonstrated better knowledge and control of malaria transmission and prevention than the local people living in Kano State. In conclusion, attitudes and practices toward malaria diseases are the major causes of the high rate of malaria in Nigeria, particularly in Kano State.

Malaria knowledge, attitude, and practice among communities involved in a seasonal malaria chemoprevention study in Nanyumbu and Masasi districts, Tanzania

Background

Utilization of malaria interventions is influenced by, among other things, the level of knowledge and attitude that the community has toward the infection as well as the available interventions. This study assessed malaria knowledge, attitudes, and practices on malaria infection and interventions in Masasi and Nanyumbu districts, Tanzania.

Methods

A community-based cross-sectional survey was conducted between August and September 2020, among the heads of households having at least one under-five child. Information on knowledge, attitudes, and practices on malaria infection and interventions was gathered from the heads of the households using a structured questionnaire. The knowledge level was classified into low, moderate, and high. Attitudes were classified into positive and negative, whereas the practices were classified into good and poor. Children aged between 3 and 59 months were screened for malaria infection using a malaria rapid diagnostic test (mRDT). The proportion of the households' heads with high level of knowledge was the primary outcome. Proportions were compared using Chi-square or fisher's test, and logistic regression analysis was used as appropriate.

Results

A total of 1,556 household heads were interviewed, 1,167 (75.00%) were male, and according to marital status, 1,067 (68.57%) were couples. All the household heads had some knowledge of malaria, but 47.33% (736/1,555) and 13.83% (215/1,555) of them had moderate and high knowledge, respectively. The level of knowledge on malaria was significantly influenced by gender [adjusted odds ratio (aOR) = 0.72, 95.00% confidence interval (CI) = 0.56-0.94, p = 0.017], level of education (aOR = 1.50, 95.00% CI = 1.04-2.16, p = 0.03), and the occupation of the household head (aOR = 1.90, 95.00% CI = 1.22-2.96, p = 0.004). Majority of the households [83.87% (1,305/1,556)] had bed nets hanging on the sleeping spaces. Of the household heads possessing bed nets, 85.10% (514/604), 79.62% (586/736), and 95.35% (205/215) of them had a low, moderate, and high level of knowledge on malaria infection, respectively (trend x ² = 31.53, p < 0.001). The majority [95.04% (1,474/1,551)] of the household heads perceived sleeping under the bed net to be beneficial. Furthermore, 15.56% (94/604), 14.67% (108/736), and 7.44% (16/215) of the household heads with low, moderate, and high knowledge, respectively, had children with malaria infection (trend x ² = 9.172, p = 0.01).

Conclusion

The study population had a good level of knowledge about malaria infection, and a good attitude toward malaria interventions, and the majority of them were using bed nets.

Quality and Integrated Service Delivery: A Cross-Sectional Study of the Effects of Malaria and Antenatal Service Quality on Malaria Intervention Use in Sub-Saharan Africa

Using regionally linked facility and household surveys, we measured the quality of integrated antenatal care and malaria in pregnancy services in Kenya, Namibia, Senegal, and Tanzania. We examined country heterogeneities for the association of integrated antenatal and malaria service quality scores with insecticide-treated bed net (ITN) use in pregnant women and children under-five and intermittent preventive treatment in pregnancy (IPTp-2) uptake. Malaria in pregnancy service quality was low overall. Our findings suggest modest, positive associations between malaria in pregnancy quality and ITN use and IPTp-2 uptake across pooled models and for most studied countries, with evidence of heterogeneity in the strength of associations and relevant confounding factors. Antenatal care quality generally was not associated with the study outcomes, although a positive interaction with malaria in pregnancy quality was present for pooled ITN use models. The improved quality of malaria services delivered during formal antenatal care can help address low coverage and usage rates of preventive malaria interventions in pregnancy and childhood. Study findings may be used to target quality improvement efforts at the sub-national level. Study methods may be adapted to identify low-performing facilities for intervention and adaption to other areas of care, such as HIV/AIDS, child immunizations, and postnatal care.

Sero-prevalence of malaria and the knowledge, attitudes and practices relating to the prevention of malaria among indigenous people living in the central forest spine in Peninsular Malaysia: a mixed-methods study

BACKGROUND

Malaria is still a major public health threat in some parts of the world. Many countries are targeting to achieve malaria free status country. This study aimed to determine the sero-prevalence of malaria and the knowledge, attitudes and practices relating to the prevention of malaria among the indigenous adults living in the central forest spine in Peninsular Malaysia.

METHODS

A mixed method study was conducted in indigenous settlements in 2020. Blood film for malaria parasite (BFMP) was used to diagnose malaria in this study. A structured questionnaire was used to collect data from the participants. For the qualitative data, in-depth interviews were conducted and data was collected until data saturation was reached. Multiple linear regression was used to determine the predictors after adjusting for confounders. A p-value of < 0.05 is considered as statistically significant. Meaningful statements from the in-depth interviews were assigned to the relevant codes using NVivo version 12 software.

RESULTS

A total of 284 indigenous people participated in the study. The prevalence of malaria in this study was 0%. Those in the middle age group between 25 and 41 years and tested positive for malaria previously were significantly more likely to have better knowledge and attitude scores. Significant correlations were also observed between knowledge-attitude and knowledge-practice. For the qualitative results, most of the respondents were unsure of monkey malaria, but all were aware of human malaria.

CONCLUSION

The present study highlighted the absence of malaria in the study population and relatively good knowledge, attitudes and practices relating to the prevention of malaria.

Participatory approaches for raising awareness among subsistence farmers in Tanzania about the spread of insecticide resistance in malaria vectors and the possible link to improper agricultural pesticide use

Background

Insecticide resistance is a key barrier to long-term malaria control, and it may be exacerbated by poor agricultural pesticide use. Current practices, however, do not link public health and agricultural pesticide use. This study investigated the perspectives of farmers and other stakeholders regarding the integration of agricultural and public health measures to address resistance. Additionally, the feasibility of participatory workshops to increase the farmers’ understanding and participation in pesticide stewardship was assessed.

Methods

Four themes were investigated: pesticide awareness, practices, and opinions of; insecticide resistance in malaria vectors; the effectiveness of current malaria prevention tools; and the links between agricultural and public health pesticide usage. Participatory workshops and field training were held with entomologists, farmers, and agricultural specialists, focusing on agro-ecosystem practices related to pest control; and local farmers were involved in live-testing for insecticides resistance of local Anopheles mosquitoes.

Results

Most farmers (94%) considered pesticides effective, and nearly half of them (n = 198, 46.4%) could identify and name crop pests and diseases, mostly using local names. Three quarters were unaware of mosquito larvae in their fields, and only 7% considered their fields as potential sources of mosquitoes. Two thirds were uninformed of any effects that agricultural pesticides may have on mosquitoes, and three quarters had never heard of resistance in malaria mosquitoes. Experts from various sectors acknowledged that agricultural pesticides might impact malaria control through increasing resistance. They did, however, emphasize the importance of crop protection and advocated for the use of pesticides sparingly and non-chemical approaches. Farmers learnt how to discriminate between malaria vectors and non-vectors, identify agricultural pests and diseases, choose and use pesticides effectively, and conduct resistance tests during the participatory workshops.

Conclusion

This study emphasizes the significance of enhancing subsistence farmers’ awareness of mosquito ecology as well as merging public health and agricultural pest management measures. Participatory techniques have the potential to raise stakeholder awareness and engagement, resulting in more effective resistance management.

Population knowledge, attitudes and practices towards malaria prevention in the locality of Makenene, Centre-Cameroon

Background

To contribute to the mission of the National Malaria Control Programme (NMCP) and guide future interventions in Cameroon in general, and in Makenene in particular, this study assessed the knowledge, attitudes and practices of the population of Makenene towards the fight against malaria.

Methods

Using a semi-structured questionnaire, a descriptive cross-sectional household community survey was carried out in randomly selected households in Makenene, a locality situated between forest and savannah ecotypes.

Results

Out of the 413 households surveyed, all (100%) claimed to have heard of malaria with over 94% (n = 391) associating disease transmission with mosquito bites. The main mosquito control tools used in the area were mosquito nets (92.25%). The majority of participants had good knowledge (55.93%; n = 231), good practices (71.67%, n = 296) but moderate attitudes (47.94%; n = 198) towards malaria control and fight. Good knowledge and practices were recorded mostly in educated persons including public servants and students. Good attitudes were adopted mostly by public servants and students of secondary and higher levels of education.

Conclusion

In Makenene, the population exhibits good knowledge and practices towards malaria and its control. However, despite high LLINs ownership and use, people still complain about malaria in the area. Control tools should be monitored, repaired or replaced when necessary to support the achievement of the NMCP mission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04253-z.

Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis

Background

Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.

Methods

A situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014.

Results

Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.

Conclusions

Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04244-0.

A Cross-Sectional Survey on the Malaria Control and Prevention Knowledge, Attitudes, and Practices of Caregivers of Children Under-5 in the Western Area of Sierra Leone

(1) Background: Children under 5 years of age are the most vulnerable to malaria infection, and they suffer serious complications. Sierra Leone is one of the countries with the highest malaria burden in the world. This study aimed to assess the knowledge, attitudes, and practices (KAPs) toward malaria control and prevention among caregivers of children under 5 in the Western Area of Sierra Leone. (2) Methods: A cross-sectional survey was conducted among caregivers of children under-5 visiting the out-patient department of six selected hospitals/community health centers. Data were collected via questionnaire interviews with 350 caregivers. (3) Results: A total of 97.1% of the respondents were women and the majority of them were young mothers; 46.3% of respondents were unemployed; and 27.1% received no education. Only 1.4% accessed malaria related information from the internet/social media. This KAPs survey indicated that a misconception of the cause, transmission, and clinical symptoms of malaria; unawareness of its lethality and its severity; and inappropriate prevention and treatment behaviors, such as self-medicating, were still in existence among some caregivers. However, a positive correlation in knowledge−attitudes (rs = 0.13, p < 0.05) and in attitudes−practices (rs = 0.45, p < 0.001) was revealed. The caregivers, being mothers and having at least a secondary education, demonstrated positive attitudes and practices. Meanwhile, more urban caregivers (79.8%) followed a complete malaria treatment course of artemisinin-based combination therapies than the rural (63.3%), but in view of insecticide treated net use, more rural caregivers presented positive attitudes (85.3%) and practices (70.1%) than the urban (69.9%, 52.0%). (4) Conclusions: For better protection of children under-5 against lethal malaria, it is essential to provide better guidance at the community level for their caregivers, especially young mothers, in order to reduce some misconceptions and inappropriate behaviors. An increase in education and employment opportunities for women, establishment of an accessible community-based malaria counselling service, and construction of an effective communication channel are also needed.

Knowledge, Attitude, and Practice towards Malaria among People Attending Mekaneeyesus Primary Hospital, South Gondar, Northwestern Ethiopia: A Cross-Sectional Study

BACKGROUND

Malaria is one of the most severe public health problems worldwide. It is a leading cause of suffering, death, and socioeconomic problem, especially in many developing countries like Ethiopia. To introduce appropriate preventive and control measures, assessment of community's levels of knowledge, attitude, and preventative practices regarding malaria is crucial. This study was aimed at assessing the knowledge, attitude, and practice (KAP) towards malaria and its preventive and control methods among people attending Mekaneeyesus primary hospital, South Gondar, northwestern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted from September 2017 to April 2018. A structured questionnaire was administered to collect data on sociodemographic characteristics and KAP of 390 randomly selected individuals. The data collecting tool was pretested before commencing the actual data collection. The data were analyzed using the SPSS version 21 software. P values less than 0.05 were considered statistically significant.

RESULTS

The overall prevalence rate of malaria in the study area was 8.5%. Nearly two-third of the participants had good knowledge (63.1%) and positive attitude (62.6%) scores towards malaria while only half of the participants had (50.8%) good practice score towards malaria prevention and control measures. Sex, age category, family monthly income, residence, and occupational and educational status of the participants were significantly associated with knowledge and practice scores (P < 0.05). The odds of malaria were 26.93 (CI = 3.67-197.47, P = 0.001) and 13.09 (CI = 0.93-183.47, P = 0.036) times higher among individuals who had poor knowledge and poor practice towards malaria, respectively, as compared to individuals who were knowledgeable and had good practice score towards malaria.

CONCLUSION

The overall knowledge score, attitude, and practice level of respondents towards malaria was relatively good. However, significant proportion of the participants still have misconception about the cause, sign and symptoms, modes of transmission, and practices towards prevention methods of malaria. Thus, health education which is aimed at raising community's awareness about the disease is necessary to address the gaps identified by this study.

Malaria infection and anemia status in under-five children from Southern Tanzania where seasonal malaria chemoprevention is being implemented

BACKGROUND

Malaria and anemia remain major public health challenges in Tanzania. Household socioeconomic factors are known to influence these conditions. However, it is not clear how these factors influence malaria transmission and anemia in Masasi and Nanyumbu Districts. This study presents findings on malaria and anemia situation in under-five children and its influencing socioeconomic factors in Masasi and Nanyumbu Districts, surveyed as part of an ongoing seasonal malaria chemoprevention operational study.

METHODS

A community-based cross-sectional survey was conducted between August and September 2020. Finger-prick blood samples collected from children aged 3-59 months were used to test for malaria infection using malaria rapid diagnostic test (mRDT), thick smears for determination of asexual and sexual parasitemia, and thin smear for parasite speciation. Hemoglobin concentration was measured using a HemoCue spectrophotometer. A structured questionnaire was used to collect household socioeconomic information from parents/caregivers of screened children. The prevalence of malaria was the primary outcome. Chi-square tests, t-tests, and logistic regression models were used appropriately.

RESULTS

Overall mRDT-based malaria prevalence was 15.9% (373/2340), and was significantly higher in Nanyumbu (23.7% (167/705) than Masasi District (12.6% (206/1635), p<0.001. Location (Nanyumbu), no formal education, household number of people, household number of under-fives, not having a bed net, thatched roof, open/partially open eave, sand/soil floor, and low socioeconomic status were major risks for malaria infection. Some 53.9% (1196/2218) children had anemia, and the majority were in Nanyumbu (63.5% (458/705), p<0.001. Location (Nanyumbu), mRDT positive, not owning a bed net, not sleeping under bed net, open/partially open eave, thatched window, sex of the child, and age of the child were major risk factors for anemia.

CONCLUSION

Prevalence of malaria and anemia was high and was strongly associated with household socioeconomic factors. Improving household socioeconomic status is expected to reduce the prevalence of the conditions in the area.

Prevalence of Malaria and Associated Knowledge, Attitude, and Practice among Suspected Patients in Bahir Dar Zuria District, Northwest Ethiopia

BACKGROUND

Control and prevention activities have brought substantial decline of malaria incidence in the last two decades in Ethiopia. However, lack of local data on the disease transmission and community knowledge, attitude, and practice about malaria are thought to reverse the trend of malaria in certain areas. Therefore, assessment of the prevalence and community awareness towards malaria plays pivotal role for the success of malaria control and prevention.

OBJECTIVE

To assess malaria prevalence and knowledge, attitude, and practice about malaria among febrile patients in Bahir Dar Zuria district, Northwest Ethiopia.

METHODS

A facility based crosssectional study was conducted from January to March 2020 among 149 febrile patients attending selected health centers in Bahir Dar Zuria district. Data about knowledge, attitude, and practice about malaria were collected using semistructured questionnaire. Blood sample from each participant was tested for Plasmodium species through malaria rapid diagnostic tests and blood film microscopy. Data were analyzed using statistical software for social sciences version 20.

RESULTS

Among 149 participants, 22 (14.8%) were positive for Plasmodium infection at least by one diagnostic methods. Prevalence of P. falciparum and P. vivax was 3.4% and 10.1%, respectively, while that of mixed infection was 1.3%. From the total study participants, 29.5% have good knowledge, 77.2% have positive attitude, and 34.9% have good practice towards malaria. Statistically significant associations were observed on knowledge with age group (X 2 = 10.377, P = 0.035), educational level (X 2 = 15.075, P = 0.001), family size (X 2 = 7.601, P = 0.022), attitude level and practice level. Participants with family size < 5 were 6.841 (95% CI: 2.570-18.206, P ≤ 0.001) times more likely to have negative attitude as compared to those with family size ≥ 5.

CONCLUSIONS

Prevalence of malaria in the study area was relatively high. Study participants had encouraging attitude; however, their knowledge and practice towards malaria were poor. Therefore, the existing malaria control activities should be supplemented with continuous health educations, aware the community, and ensure participation in the control and prevention activities.

Malaria prevention knowledge, attitudes, and practices in Zambezia Province, Mozambique

Background

In Mozambique, socio-economic and cultural factors influence the wide adoption of disease preventive measures that are relevant for malaria control strategies to promote early recognition of disease, prompt seeking of medical care, sleeping under insecticide-treated nets (ITNs), and taking intermittent preventive treatment for pregnant women. However, there is a critical information gap regarding previous and ongoing malaria social and behavioural change (SBC) interventions. The aim of this study is to assess the knowledge, attitudes, practices of beneficiaries of SBC interventions.

Methods

A descriptive cross-sectional survey was undertaken in 2018 in two rural districts of Zambezia Province, Mozambique. A structured questionnaire was administered to 773 randomly selected households. Respondents were the adult heads of the households. Descriptive statistics were done.

Results

The main results show that 96.4% of respondents recalled hearing about malaria in the previous 6 months, 90.0% had knowledge of malaria prevention, and 70.0% of preventive measures. Of the 97.7% respondents that had received ITNs through a mass ITN distribution campaign, 81.7% had slept under an ITN the night before the survey. In terms of source of health information, 70.5% mentioned the role of community volunteers in dissemination of malaria prevention messages, 76.1% of respondents considered worship places (churches and mosques) to be the main places where they heard key malaria prevention messages, and 79.1% asserted that community dialogue sessions helped them better understand how to prevent malaria.

Conclusions

Results show that volunteers/activists/teachers played an important role in dissemination of key malaria prevention messages, which brought the following successes: community actors are recognized and people have knowledge of malaria transmission, signs and symptoms, preventive measures, and where to get treatment. There is, however, room for improvement on SBC messaging regarding some malaria symptoms (anaemia and convulsions) and operational research is needed to ascertain the drivers of malaria prevalence and inform the SBC approach.

Community knowledge, attitudes and practices towards malaria in Ha-Lambani, Limpopo Province, South Africa: a cross-sectional household survey

BACKGROUND

Malaria remains a global health concern and is endemic in Limpopo, Mpumalanga and KwaZulu Natal Provinces of South Africa, which aims to eliminate malaria by 2025. Community engagement plays a significant role in improving the acceptability and effectiveness of programmes aimed at reducing malaria transmission. The success of such intervention efforts depends on the knowledge, attitudes and practices (KAP) of the community, and understanding the KAP of community residents may support malaria control efforts in the locality. In this context, a cross-sectional household survey to assess community KAP on malaria transmission and prevention in the Ha-Lambani village, Vhembe District, Limpopo Province was conducted.

METHODS

Data were collected between November 2018 and May 2019 by questionnaire of 261 consenting adults (213 females and 48 males, aged between 18 and 95 years) selected from different households. Also, a focus group discussion among 13 randomly selected participants was conducted. Pearson's Chi Square test was used to determine statistical differences by village.

RESULTS

Study participants (100%, 261/261) were aware of the presence of malaria in their community and 95% associated it with mosquito bites. The local health clinic was the most prominent source of malaria information (85%). Only 22% correctly identified headache, chills and fever as the three most common symptoms of malaria. The majority of participants (98%) knew that effective medication for malaria is available and had a positive treatment-seeking behaviour. Knowledge of malaria prevention measures was high (82%); contrarily, 97% of respondents did not sleep under a bed net the previous night. The focus group data concurred with these results and also revealed that poor bed net use resulted from lack of access to bed nets because community residents could not afford them.

CONCLUSIONS

The study demonstrates that participants have appropriate knowledge about malaria transmission and a positive treatment-seeking behaviour. However, economic barriers are responsible for the inadequate use of bed nets. Therefore, distribution of bed nets to the community should be considered to improve practice of malaria prevention measures. Furthermore, knowledge of signs and symptoms and appropriate malaria treatment was limited, and initiatives to improve awareness on these topics should be continued.

Role of vector control in fighting against malaria: Evidence from Ethiopian health-related indicators

BACKGROUND

Due to a high burden imposed on public health from malaria disease in Sub-Saharan Africa, the vector control strategy is a significant concern. Despite the implementation of malaria control interventions in Ethiopia, it remains a major public health problem. Moreover, none of the prior researches was conducted in this title specifically. Therefore, this study investigates the impact of vector control interventions on malaria based on panel data of 10 malaria endemic-regions from 2000 to 2018.

METHODS

A reflexive analysis study based on before-and-after assessment was used to evaluate the impact of vector control interventions on malaria with a difference-in-difference approach, representing Period I for before and Period II for after strategic intervention. The random-effect model was also employed to explore the direct relationship between the study variables. The data exported to Stata version 13.0 for analysis.

RESULTS

The study results suggest that the negative relationship between intervention strategy and malaria cases reported in comparison with its counterfactual, showing the increase in malaria cases during Period II comparing to Period I. The study explores a remarkable achievement on the decline in mean malaria-related death in all regions after the implementation of the strategy. Furthermore, a significant relationship between indoor residual spraying, insecticide-treated mosquito nets, and malaria was demonstrated within the strategic periods.

CONCLUSION

Better results achieved in Period I on mean malaria cases. The results of Period II showed a decline in mean malaria related-death, which was encouraging. The study calls for a supplementary strategy to align with the existing program. The study demonstrates the need for extra efforts on the implementation of the programme and progress about malaria.

Evaluation of malaria preventive measures among adult patients attending the Bamendjou and Foumbot district hospitals of the West Region of Cameroon

BACKGROUND

Although a significant decrease in entomological and epidemiological indicators was reported in Cameroon since the introduction of insecticide-treated bed nets, malaria prevalence remains high also in some parts of the West Region of Cameroon. This study was designed to evaluate malaria preventive measures among patients attending the Bamendjou and Foumbot District hospitals of the West Region of Cameroon.

METHODS

This was a cross-sectional study carried out within a period of 3 months, from January to March 2020. Data was obtained using a structured questionnaire and laboratory analysis. The CareStart™ Pf Malaria HRP2 qualitative rapid diagnostic test was used for malaria diagnosis. The questionnaire was designed to collect information on respondent's socio-demographic characteristics, and the use of malaria preventive measures. Data were analysed using descriptive statistics, regression analysis, and Chi-square (and Fisher's exact) test.

RESULTS

A total of 170 study participants were recruited in Foumbot and 197 in Bamendjou. Malaria was significantly (P < 0.0001) more prevalent in Foumbot (47.06%) than in Bamendjou (19.8%). In Foumbot, non-use of insect repellent spray (P = 0.0214), insect repellent body cream (P = 0.0009), mosquito spray (P = 0.0001) and not draining stagnant water (P = 0.0004) predisposed to higher risk of malaria. In Bamendjou, non-use of insect repellent spray (P = 0.0012), long-lasting insecticidal bed nets (P = 0.0001), window and door nets (P = 0.0286), predisposed to a higher risk of malaria.

CONCLUSIONS

Malaria prevalence was high among the study participants especially in Foumbot. An adequate follow-up to ensure effective execution of the recently launched third phase of LLINs distribution campaign in Cameroon is recommended. Additionally, integrated vector management is required to ensure effective control of malaria transmission in Foumbot and Bamendjou.

Malaria in children and women of childbearing age: infection prevalence, knowledge and use of malaria prevention tools in the province of Nyanga, Gabon

Background

There is little information on the social perception of malaria and the use of preventative measures in Gabon, especially in rural areas. Adequate knowledge of malaria prevention and control can help in reducing the burden of malaria among vulnerable groups, particularly pregnant women and children under 5 years old living in malaria-endemic settings. This study was designed to assess the prevalence of malaria and the knowledge and attitude towards this disease in households in Nyanga Province.

Methods

A cross-sectional study was conducted to assess malaria knowledge, prevention practices and prevalence of the malaria infection in five departments of Nyanga Province. Plasmodial infection was diagnosed in children  ≤ 5 years of age and women aged 15-49 years using rapid diagnostic tests. A questionnaire was administered randomly to women aged 15–49 years and to the parents or guardians of children aged ≤ 5 years in 535 households during a 2-week period in March 2018. Overall, the respondents’ socio-demographic characteristics, knowledge of malaria, malaria prevention practices and malaria prevalence were evaluated and compared across the five departments.

Results

Data from a total of 1,307 participants were included in this study, including 631 women of childbearing age (61 of them pregnant) and 676 children. Practically the entire (97.7%) interviewed population had heard about malaria and attributed the cause of malaria to a mosquito bite (95.7%). This survey revealed that the reported rate of reported bed-net use was 73.3%. The study observed an average malaria parasite prevalence of 13.9%. All departmental capitals of Nyanga Province had a significant level of malaria infection except for Mayumba where no plasmodial infection was found.

Conclusion

High malaria prevalence is found in the departmental capital cities of Nyanga Province. This study reveals that respondents have a high knowledge of the malaria symptoms, its mode of transmission and preventive measures. Despite this high level of knowledge of the disease and its preventive measures, the incidence of malaria remains relatively high in this rural community highlighting the need for other types of interventions.

Community perception of malaria in a vulnerable municipality in the Colombian Pacific

Background

Malaria primarily affects populations living in poor socioeconomic conditions, with limited access to basic services, deteriorating environmental conditions, and barriers to accessing health services. Control programmes are designed without participation from the communities involved, ignoring local knowledge and sociopolitical and cultural dynamics surrounding their main health problems, which implies imposing decontextualized control measures that reduce coverage and the impact of interventions. The objective of this study was to determine the community perception of malaria in the municipality of Olaya Herrera in the Colombian Pacific.

Methods

A 41-question survey on knowledge, attitudes, and practices (KAP) related to malaria, the perception of actions by the Department of Health, and access to the health services network was conducted.

Results

A total of 134 adults were surveyed, in whose households a total of 671 people lived. According to the survey data, about 80% of the household members included teenagers and children, out of which 61% had malaria at one time, and for 75.3%, this disease is a persistent problem. In spite of this, 57.2% of people who fell ill due to malaria were never visited by health personnel for a follow up. This population claimed that responsibility for who should prevent the disease is shared between each person and the Department of Health. However, personal actions were focused on using mosquito nets, ignoring other important practices to prevent bites. Despite campaigns by the Department of Health, 11.9% of respondents did not know how malaria was transmitted, and 8.96% thought it was transmitted through water. Also, 43.5% said that the Department of Health did not do any work to control malaria and 16% did not know if any action was taken.

Conclusions

In spite of the knowledge about malaria and the efforts of the Department of Health to prevent it, the community actions do not seem to be consistent with this knowledge, as the number of cases of malaria is still high in the area.

Knowledge of malaria prevention and control methods and associated factors among rural households in west Belessa district, north west Ethiopia, 2019

Background

In Ethiopia malaria is one of the top ten leading causes of morbidity and mortality. Community knowledge of prevention and control methods had been proven to play an important role in the implementation of effective and sustainable interventions against malaria. This information is limited in the study area. This study aimed to assess knowledge of malaria prevention and control methods and its associated factors among households in West Belessa district, 2019.

Methods

Community-based cross-sectional mixed quantitative and qualitative study was conducted from April to June 2019 in West Belessa district, North West Ethiopia. Multistage sampling was used to select an estimated 770 sample size. A structured questionnaire was used for the quantitative component and semi-structured questionnaire for the qualitative component. Quantitative data were collected by interviewing and qualitative data using focus group discussion (FGD). Quantitative data was coded and entered using Epi info software version 7 then exported to SPSS version 20 for analysis. The binary logistic regression model was fitted to identify the associated factors. Odds Ratio (OR) with 95% Confidence Interval (CI) was used to assess the strength of association. The qualitative data was transcribed manually using the thematic approach.

Result

A total of 770 subjects were included in this study with a 99.5% response rate. Of the total respondents, 75.6% had good knowledge of malaria prevention methods. LLINs and IRS were mentioned by 84.7 and 83.7% respectively. Poorest wealth quintiles [AOR = 0.40, 95% CI: 0.23, 0.73], poor wealth quintiles [AOR = 0.38, 95% CI: 0.21, 0.70], and medium wealth quintiles [AOR = 0.41, 95% CI: 0.22, 0.76], living in Menti Kebele [AOR = 3.07, 95% CI 1.85, 5.08], living in Abay tera kebele [AOR = 2.00, 95% CI 1.21, 3.29] were significantly associated with good knowledge. About all of the focused group discussion (FGD) participants agreed that malaria is a preventable disease and mentioned some of the preventive methods.

Conclusion

Overall there was relatively high knowledge of malaria prevention and control methods. LLINs and IRS were known malaria prevention methods in West Belessa. Wealth index and respondents living kebele are predictors for knowledge of malaria prevention.

Knowledge, attitudes and perceptions regarding malaria: a cross-sectional study in pregnant women attending antenatal care in the New-Bell district hospital, Douala, Cameroon

Introduction

malaria remains a major public health problem in Cameroon. For a successful malaria control, there is a need to evaluate the level of awareness, attitude and perception of people living in malaria endemic areas such as the swampy littoral region of Cameroon.

Methods

this was a descriptive cross-sectional study targeting pregnant women attending ANC in the New-Bell District Hospital. Data was collected with a semi-structured questionnaire on demographic characteristics as well as knowledge, attitudes and practices regarding malaria.

Results

two hundred and six pregnant women were enrolled in the study, all of them had heard on malaria in the past, with hospitals and television been the most known information dissemination channels. Only 60.2% of them own and used a LLINs with only 51.6% of owners treating the net.

Conclusion

respondents with no education had poor knowledge on malaria. There is a need to improve education on malaria with active participation of women and improve malaria surveillance that will lead to malaria eradication.

Knowledge, Attitude, and Practices towards Malaria among Employees from Enterprises in the Town of Douala, Cameroon

BACKGROUND

Malaria remains a public health issue in the world especially in resource-limited countries, where it has a negative impact on their economy. There is a body of recent reports outlining the crucial role of enterprises in control of malaria. The present study aimed at determining the knowledge, attitudes, and practices (KAP) towards malaria among employees from enterprises in the town of Douala, Cameroon.

METHODS

A cross-sectional descriptive study took place between February 2015 and June 2017 in 14 enterprises of Douala. A pretested structured questionnaire was used to document sociodemographic parameters and KAP of employees.

RESULTS

A total of 2705 employees, mainly consisted of males (83.1%), were included in the study. The mean age of respondents was 37.33 ± 9.78 years (range 19-87). Over 90% of respondents knew at least one sign/symptom (94.1%) and associated malaria transmission with mosquito bites (91%). Artemether-Lumefantrine (36.2%), under commercial name "Coartem," was the most cited antimalarial drug. Nearly 98.2% considered malaria as a dangerous disease. Misconceptions on malaria transmission, causative agent, prevention, and treatment were recorded. More than 77% of employees declared to use mosquito bed nets to prevent malaria. About 63% employees declared going to the hospital when they were feel having malaria while 12.9% were seeking care through street drugs. Educational level, socioprofessional category, area of residence, and enterprise were significantly associated with the level of knowledge on malaria transmission, causative agent, and preventive and treatment practices.

CONCLUSION

This study showed a good level of knowledge, attitudes, and practices of employees even though some misconceptions and bad behaviors are still present especially in people with a low level of education. Hence, there is a need to develop strategies for sensitization especially in this fraction of employees. In addition, enterprises could be an interesting approach in order to control malaria in Cameroon.

Assessment of community knowledge, practice, and determinants of malaria case households in the rural area of Raya Azebo district, Northern Ethiopia, 2017

Background

In Ethiopia malaria is one of the leading causes of outpatient visits and admission. Still, it remains a major cause of morbidity and mortality in the study area. Therefore, this study was aimed to assess the knowledge, practice, and determinant of malaria case households in rural areas of Raya Azebo district, Northern Ethiopia.

Method

A community-based cross-sectional survey was conducted in the selected villages of Raya Azebo district from January to June 2017. A multi-stage random sampling method was employed to select a total of 422 study households. Data was collected using a semi-structured questionnaire. The household head was interviewed face to face. Logistic regression analysis was used to determine the determinant of malaria cases households.

Result

A total of 412 (97.6) of the respondents had ever heard about malaria. About 63% of households recognized the causes of malaria to be a mosquito bite. Around 173 (41%) of the study households had been treated for malaria within a year of data collection. This study also revealed that the presence of mosquito breeding sites near to home, bed bug infestation, outdoor sleep due to bed bugs and household with poor bed net practicing were significantly associated with malaria case households.

Conclusion

Although the overall knowledge on malaria transmission, symptoms, and the preventive measure was relatively good, the rate of household insecticide-treated net coverage and utilization were reported low in the area. Therefore, the distribution of adequate bed net with community-based education is a key intervention to promote household insecticide-treated net utilization. In addition, an effective bed bug management strategy is necessary to overcome the outdoor sleeping habit of the community in the area.

Knowledge, attitude and practice towards malaria among symptomatic patients attending Tumbi Referral Hospital: A cross-sectional study

Background

Despite significant improvement in prevention and control over the past decades malaria remains a significant public health concern in Tanzania with 93% of the population being at risk. To prevent malaria infection and promote malaria free zones, understanding the community’s knowledge, attitudes, and practices toward malaria control are essential. This study therefore aimed at determining the levels of understanding, and attitudes, as well as socio-cultural aspects of malaria prevention and treatment-seeking behaviours among suspected malaria patients.

Methods

This study was a hospital based cross-sectional study, in which patients attending Tumbi Referral Hospital with symptoms and signs that warrant inclusion of suspicion of malaria, were recruited. We used a pre-tested semi-structured questionnaire to collect participants’ demographic characteristics, as well as information on their knowledge, attitudes, and practices towards malaria infection. Data were analysed using Stata Version 12.1.

Results

We enrolled a total of 295 respondents of which 179 (60.68%) were females. Participants’ ages ranged from 1–91 years, with a mean of 31.4 years. Seventy-nine (26.8%) patients reported having malaria in the previous 28 days, with 57 (72.2%) being laboratory confirmed. Only 52 (65.8%) individuals reported taking prescribed medications for malaria. A total of 277 (93.90%) were aware of malaria, and 264 (95.31%) knew that it is transmitted by mosquito. Nearly all participants (263, 94.95%), identified sleeping under bed nets to be protective against malaria. About half of the respondents either agreed 63 (22.74%) or strongly agreed 62 (22.38%) that malaria can be transmitted like the common cold. Self-reported mosquito net use was 88.09% (244).

Conclusion

Despite the endemicity of malaria in our study site, patients had adequate knowledge, encouraging attitudes, and good practices related to malaria prevention and control.

Malaria Perceptions among Medicine Vendors in Buea Community: An Assessment of Knowledge of Malaria and Conditions of Antimalarial Drug Dispensing

Background:

Lack of knowledge of rational use of antimalarial drugs among medicine vendors is a serious problem, notably in areas of intense transmission. These misunderstandings increase the risks of resistance and adverse drug reactions. This study aimed to assess knowledge of malaria and environments wherein medicine vendors dispense antimalarials in the Buea community.

Methods:

Administration of a community-based cross-sectional survey of a random sample of 140 medicine vendors living within the Buea community occurred between March and June 2017. The survey sought to obtain information from medicine vendors on their general knowledge of malaria as well as their dispensing practices. Statistically significant findings were associated with p ≤ .05.

Results:

The majority of participants were aware that use of insecticide – treated bed nets (ITNs) and maintenance of a clean environment equate to effective malaria prevention efforts. Alternatively, only one-third of participants correctly attributed the causative organism of malaria to being protozoan. Participants employed within drugstore settings had less knowledge of malaria than their hospital/community counterparts did. A directly proportional relationship existed between the amount of experience that participants had in their respective disciplines with an increased knowledge of malaria overall.

Conclusion:

These findings reveal fluctuating knowledge of malaria among study participants. Reported antimalarial dispensing practices also warrants room for improvement. Routine monitoring and evaluation to prevent emergence of resistant strains to current efficacious antimalarials remains paramount.

Socioeconomic determinants of community knowledge and practice in relation to malaria in high- and low-transmission areas of central India

This study was undertaken with an aim of exploring community knowledge and treatment practices related to malaria and their determinants in high- and low-transmission areas of central India. A community-based cross-sectional study was carried out between August 2015 and January 2016 in two high- and two low-malaria-endemic districts of central India. A total of 1470 respondents were interviewed using a pre-tested structured interview schedule. Respondents residing in high-transmission areas with higher literacy levels, and of higher socioeconomic status, were found to practise more modern preventive measures than those living in low-transmission areas with low literacy levels and who were economically poor. Level of literacy, socioeconomic status and area (district) of residence were found to be the main factors affecting people's knowledge of malaria aetiology and clinical features, and prevention and treatment practices, in this community in central India.

The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi

BACKGROUND

Malaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions.

METHODS

This paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes.

RESULTS

Using education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members' attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours.

CONCLUSION

The HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs' motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers' motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.

Knowledge, attitudes and practices about malaria in Cabo Verde: a country in the pre-elimination context

Background

Malaria in Cape Verde is unstable, with a sporadic and seasonal transmission of low endemicity. In this sense, the community perceptions regarding malaria transmission, their attitudes and practices against the disease are very important to understand and to better develop the best strategical policies to achieve malaria elimination goal. This study aim to assess the knowledge, attitudes and practices (KAP) of Cape Verdean population about malaria, a country in the elimination step of disease.

Methods

A cross-sectional malaria KAP Survey was performed at the household level. A structured open questionnaire was developed and applied to residents of randomly selected households from 5 islands and 15 municipalities in Cape Verde. Correlation analyses were performed using a logistic regression model to determine the factors that are associated with the complete knowledge of the population about malaria.

Results

A total of 1953 fully completed questionnaires were analysed, with majority of questionnaires administered in Santiago island (68.3%), mainly in the capital city of Praia, 38.43%. About 88% of the population knew the correct form of transmission, 96% had knowledge that the entire population is at risk of malaria and identified the main symptoms. Regarding the attitudes, 58% seek treatment atthe nearest health structure upon the apparition of the symptoms, 64% in the first 24 h and 88% within the first 48 h. More than 97% have heard about mosquito nets but only 19% used it. In practice, 53% use coils, 45% rely on household sprays and 43% have benefited from IRS. About 90% received information about malaria from media, mainly the TV and the radio (83 and 43%, respectively). In summary, 54% of the population has complete knowledge of the disease.

Conclusion

The population of Cape Verde has a high level of knowledge about malaria, including its transmission, main symptoms and preventive and control measures. However, some gaps and misunderstandings have been noticed and contribute to the insufficient community involvement in actions against malaria. Therefore, is necessary to increase the knowledge of the population, leading to their full ownership and participation in community actions to contribute to the malaria elimination in the country.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7130-5) contains supplementary material, which is available to authorized users.

Assessment of the knowledge of the modes of transmission and prevention of malaria among pregnant women attending antenatal clinic at the Nkwen Health Center Bamenda, Cameroon

Introduction

Malaria is a life threatening disease caused by the Plasmodium parasite, transmitted through the bites of infected female anopheles' mosquitoes. According to the latest WHO data published in 2017, malaria deaths in Cameroon reached 9.161 deaths accounting for 4.14% of total deaths. The age adjusted death rate is 29.11 per 100,000 and Cameroon is ranked the 30th in the world with a high prevalence of malaria. The aim of this study was therefore, to access the knowledge of the modes of transmission and prevention of malaria among pregnant women attending Antenatal Clinic (ANC) at the Nkwen Health Center, Bamenda.

Methods

This was a cross-sectional hospital based survey study. The researchers recruited 51 eligible women in the Nkwen Health Centre and used a validated and pre-tested questionnaires to collect data. Collected data were entered into Excel and analysed using descriptive statistics and the results presented in tables and figures.

Results

Sixty four percent of the women have basic knowledge about the mode of malaria transmission. Thirty six percent of the women had little knowledge about malaria transmission modes and the possible dangers of the disease.

Conclusion

Slightly above 50% of pregnant women have basic knowledge on the modes of malaria transmission. Lack of knowledge regarding the modes of malaria transmission can be one of the reasons why there is still quite a high level of malaria prevalence among pregnant women attending ANC at the Nkwen Health Center, Bamenda. There is therefore, a need to educate women on malaria transmission modes.

Malaria prevention in the city of Yaoundé: knowledge and practices of urban dwellers

Background

Malaria prevention in Cameroon mainly relies on the use of ITNs. Although several free distribution campaigns of treated nets have been conducted across the country, bed net usage remains very low. A household survey was conducted to assess knowledge of the population and practices affecting treated net usage in the city of Yaoundé.

Methods

A community-based descriptive cross-sectional survey was conducted in January 2017 in 32 districts of the city of Yaoundé. Parents (household head, spouse or an elder representative) who consented to the study, were interviewed using a structured pre-tested questionnaire. Interviews were conducted in French or English. A questionnaire consisting of 22 questions was administered to know (i) people’s knowledge and attitude on preventive measures; and, (ii) attitudes concerning the treatment of malaria and estimated amount spent for malaria prevention and treatment.

Results

A total of 1643 household heads were interviewed. Over 94% of people interviewed associated malaria transmission to mosquito bites. The main methods used against mosquito bites were: treated bed nets (94%; n = 1526) and insecticide spray or coils (32.2%; n = 523). The majority of people interviewed reported using bed nets mainly to prevent from mosquito bites (84.4%, n = 1257), rather than for malaria prevention (47.3%). Knowledge and attitude analysis revealed that people with university or secondary level of education have better knowledge of malaria, prevention and treatment measures compared to those with the primary level (OR = 7.03; P < 0.001). Also, wealthy households were more aware of good practices concerning malaria prevention and treatment compared to poor ones. In the majority of districts of Yaoundé, over 50% of people interviewed per district, had good knowledge of malaria and prevention measures but less than 50% applied good practices concerning malaria treatment and prevention. The amount spent annually by a household for vector control was CFAF 11,589 ± 1133 (US$21.87 ± 2.14) and CFAF 66,403 ± 4012 (US$125.29 ± 7.57) for malaria treatment.

Conclusion

The study indicated that, despite good knowledge of malaria and prevention measures, few people apply good practices. More sensitization needs to be done to improve adherence to good practices concerning malaria prevention and treatment.

Electronic supplementary material

The online version of this article (10.1186/s12936-019-2799-6) contains supplementary material, which is available to authorized users.

Reproductive-Age Women's Knowledge and Care Seeking for Malaria Prevention and Control in Ghana: Analysis of the 2016 Malaria Indicator Survey

INTRODUCTION

Malaria is a major cause of morbidity and mortality worldwide, requiring individual and environmental level controls to prevent its adverse morbidity effects. This study examined reproductive-aged women's knowledge and care-seeking practices for malaria prevention and control in Ghana.

METHODS

The 2016 Ghana Malaria Indicator Survey data for reproductive-age women was analysed (n=5,150). Multilevel mixed-effects logistic regression model was used to determine factors associated with reproductive-aged women's knowledge and care-seeking practices for malaria.

RESULTS

62.3%, 81.3%, and 64.6% knowledge levels on causes, signs/symptoms, and prevention of malaria were found, respectively, among respondents. Age, wealth and educational status, religion, region, and place of residence (rural) were found to significantly influence respondents' knowledge of causes, signs/symptoms, and care-seeking practices for malaria. A 15% differential among Insecticide Treated Nets (ITNs) awareness and use was found. Increasing age (≥35 years) was associated with increasing knowledge of malaria. Regional variations were observed to significantly influence knowledge of malaria treatment.

CONCLUSION

Though ownership of ITNs and knowledge of malaria prevention were high, it did not necessarily translate into use of ITNs. Thus, there is a need to intensify education on the importance and the role of ITNs use in the prevention of malaria.

The Challenges and Knowledge Gaps in Malaria Therapy: A Stakeholder Approach to Improving Oral Quinine Use in the Treatment of Childhood Malaria in Ghana

Background

The study was undertaken to elicit the knowledge, views, and perceptions of key stakeholders on malaria, its bioburden, and treatment options, in order to ascertain the knowledge gabs and challenges, especially in the use of oral quinine in childhood malaria.

Methods

A cross-sectional survey was conducted using a well-structured Likert Scale and self-administered questionnaire. The principal site of the study was a government-run children's hospital located in the Ashiedu Keteke Sub-Metro of Accra. The study population included health workers, parents, and guardians or care givers. The participants were 300, purposively selected, and consisted of both men (41%) and women (59%) who were twenty years and above, whether employed (42%), self-employed (37%), or unemployed (21%).

Results

Majority of the participants (78%) demonstrated above average knowledge of malaria. However, their awareness of the causes, modes of transmission, signs, and symptoms as well as preventive mechanisms of malaria did not result in low incidence of malaria. About 77% of the respondents agreed they would seek treatment within 24 hours once signs and symptoms are detected. Though close to 50% undertook home treatment of malaria, majority eventually sought treatment at hospital or clinic. Above 92% of respondents knew that quinine is used to treat malaria and agreed its bitter taste greatly affects compliance, especially in children. Consequently, 95% of the respondents would be glad if its bitter taste is masked.

Conclusion

The study demonstrated the availability of substantial knowledge of the devastating effects of malaria, especially in children. Therefore, there is the need to ensure the availability and utilization of effective paediatric formulations in the fight against malaria. From this study, fast dissolving oral thin film with a good mouth feel, would be the formulation of choice for quinine.

The impact of industrial activities on vector-borne disease transmission

Industrial activities have produced profound changes in the natural environment, including the mass removal of trees, fragmentation of habitats, and creation of larval mosquito breeding sites, that have allowed the vectors of disease pathogens to thrive. We conducted a review of the literature to assess the impact of industrial activities on vector-borne disease transmission. Our study shows that industrial activities may be coupled with significant changes to human demographics that can potentially increase contact between pathogens, vectors and hosts, and produce a shift of parasites and susceptible populations between low and high disease endemic areas. Indeed, where vector-borne diseases and industrial activities intersect, large numbers of potentially immunologically naïve people may be exposed to infection and lack the knowledge and means to protect themselves from infection. Such areas are typically associated with inadequate access to quality health care, thus allowing industrial development and production sites to become important foci of transmission. The altered local vector ecologies, and the changes in disease dynamics that changes affect, create challenges for under-resourced health care and vector-control systems.

Outdoor malaria transmission risks and social life: a qualitative study in South-Eastern Tanzania

BACKGROUND

Behaviour changes in mosquitoes from indoor to outdoor biting result in continuing risk of malaria from outdoor activities, including routine household activities and occasional social and cultural practices and gatherings. This study aimed to identify the range of social and cultural gatherings conducted outdoors and their associated risks for mosquito bites.

METHODS

A cross-sectional study was conducted in four villages in the Kilombero Valley from November 2015 to March 2016. Observations, focus group discussions, and key informant interviews were conducted. The recorded data were transcribed and translated from Swahili to English. Thematic content analysis was used to identify perspectives on the importance of various social and cultural gatherings that incidentally expose people to mosquito bites and malaria infection.

RESULTS

Religious, cultural and social gatherings involving the wider community are conducted outdoors at night till dawn. Celebrations include life course events, religious and cultural ceremonies, such as Holy Communion, weddings, gatherings at Easter and Christmas, male circumcision, and rituals conducted to please the gods and to remember the dead. These celebrations, at which there is minimal use of interventions to prevent bites, contribute to individual satisfaction and social capital, helping to maintain a cohesive society. Bed net use while sleeping outdoors during mourning is unacceptable, and there is minimal use of other interventions, such as topical repellents. Long sleeve clothes are used for protection from mosquito bites but provide less protection.

CONCLUSION

Gatherings and celebrations expose people to mosquito bites. Approaches to prevent risks of mosquito bites and disease management need to take into account social, cultural and environmental factors. Area specific interventions may be expensive, yet may be the best approach to reduce risk of infection as endemic countries work towards elimination. Focusing on single interventions will not yield the best outcomes for malaria prevention as social contexts and vector behaviour vary.

Knowledge, attitudes and practices of malaria transmission and preventive measures in Woreta town, Northwest Ethiopia

OBJECTIVE

Despite a high public health burden of malaria in endemic regions of Ethiopia, there are limitations on the availability of data concerning public awareness about the disease and its preventive measures. The present study aimed in producing base line data on the community knowledge, attitudes and practices towards malaria transmission and its preventive measures in Woreta town, northwest Ethiopia. A community based two-stage random cluster study was conducted from May to July 2013. Household heads were interviewed to assess their awareness about malaria and its control measures.

RESULTS

About 78.5% (113/144) of the respondents rated bite of infected mosquito as a way of malaria transmission. The majority of participants, 126 (87.5%) stated one or more symptoms of malaria. About 95.8% (138/144) of the respondents indicated that malaria is preventable and curable disease. Only about 25% (36/144) of the study participants practiced frequent and proper use of insecticide treated bed nets (ITNs). Draining logged water was a highly rated, 83 (57.6%), practice of environmental management of malaria.

Equal Opportunity, Equal Work: Increasing Women's Participation in the U.S. President's Malaria Initiative Africa Indoor Residual Spraying Project

BACKGROUND

One of the primary control measures for malaria transmission is indoor residual spraying (IRS). Historically, few women have worked in IRS programs, despite the income-generating potential. Increasing women's roles in IRS requires understanding the barriers to women's participation and implementing measures to address them. The U.S. President's Malaria Initiative (PMI) Africa Indoor Residual Spraying (AIRS) Project is the largest implementer of IRS globally. To address gender inequity in IRS operations, PMI AIRS assessed the barriers to the participation of women and developed and implemented policies to address these barriers.

METHODS

The PMI AIRS Project initially identified barriers through a series of informal assessments with key stakeholders. PMI AIRS then implemented a series of gender-guided policies, starting in 2015, in Benin, Ethiopia, Ghana, Mali, Madagascar, Mozambique, Rwanda, Senegal, Zambia, and Zimbabwe. The policies included adapting physical work environments to ensure privacy for women; ensuring the safety of women in the workplace; guaranteeing safety and job security of women during pregnancy; and encouraging qualified women to apply for supervisory positions. The project collected routine programmatic data on staff, spray quality, and spray efficiency; data from 2012 through the end of 2015 were analyzed (up through 1 year after implementation of the gender policies). In addition, PMI AIRS conducted surveys in 2015, 2016, and 2017 before and after the spray campaigns in 4 countries to determine changes in gender norms among spray operators through questions about decision making and agency.

RESULTS

The PMI AIRS Project increased women's employment with the program. Specifically, women's employment increased overall from 23% in 2012 to 29% in 2015, with a 2015 range from 16% (Mali) to 40% (Madagascar). Growth among supervisor roles was even stronger, with the percentage of women in supervisory roles increasing from 17% in 2012 to 46% in 2015, with a 2015 range from 9% (Mali) to 50% (Madagascar). While the data showed that in most countries women sprayed fewer houses per day than men in 2015, the differences were not meaningful, ranging from 0.1 to 1.2 households per day. Gender norms shifted toward more egalitarian views in 2 of the 4 countries with survey data.

CONCLUSION

Preliminary results suggest the PMI AIRS Project gender policies are increasing the engagement of women in all aspects of spray operations, especially in supervisory roles. Expansion of these policies to all countries implementing IRS and to malaria control implementation more broadly is recommended.

Factors affecting prevention and control of malaria among endemic areas of Gurage zone: an implication for malaria elimination in South Ethiopia, 2017

Background

Globally malaria remains one of the most severe public health problems resulting in massive morbidity particularly in developing countries. Ethiopia as one of the sub-Saharan country it is highly endemic to malaria. It was noted that early detection and prompt treatment of malaria cases, selective vector control and epidemic prevention and control are the major strategies for malaria prevention and control; So far, a lot have been done and remarkable improvements were seen. However, in what extent the prevention strategy was running in the community and what factors are hindering the prevention strategy at community level was not well known in Ethiopia. Therefore this study aimed to assess measures taken to prevent malaria and associated factors among households in Gurage zone, south Ethiopia.

Methods

Community based cross- sectional study was conducted in Gurage zone, southern Ethiopia. A total of 817 randomly selected households were included in the study. After checking for completeness the data was entered in to Epi info 7 and analyzed through SPSS (Statistical Package for Social Sciences) version 21. Descriptive summary was computed and presented by tables, graphs and figures. After checking for assumptions Bivariate analysis was run to look for the association between dependent and explanatory variables; and using variables which have p-value ≤0.25 binary logistic regression was fitted. Association was presented in Odds ratio with 95% confidence interval and significance determined at P-value less than 0.05. Goodness of fit of the final model checked by Hosmer and Lemshow test.

Results

Overall 496 (62%) of households practiced good measure of malaria prevention and control. Educated households (AOR = 2.15 (95% CI [1.21–4.67]), higher wealth index (AOR = 3.3 (95% CI [2.3–6.2]), iron corrugated house owners (AOR = 2.7 (95% CI [1.7–3.5]), who received ITN from HC (AOR = 3.6 (95% CI [1.7–4.5] and involved in malaria prevention campaign AOR = 2.6, (95% CI [1.8–3.6]) were independently and significantly determined the practice of malaria prevention measures.

Conclusion

The practice of malaria prevention measures were at acceptable and comparable level to other national findings and standards. Further strengthening of the program is important.

Household knowledge and practices concerning malaria and indoor residual spraying in an endemic area earmarked for malaria elimination in Iran

Background

Indoor residual spraying of insecticide (IRS) is a key intervention for reducing the burden of malaria infection. Effectiveness and success of this strategy are to a considerable extent dependent on knowledge and practice of the target community regarding the IRS. Iran has entered the malaria elimination phase, and IRS has been considered as the main strategy for malaria vector control. Therefore, this study was conducted to determine the household knowledge and practices about malaria and IRS in Bashagard County, one of the malaria-endemic areas in the southeast of Iran.

Methods

A community-based cross-sectional survey was conducted among 420 households in Bashagard County. The participants who were selected using a two-stage randomized cluster sampling procedure were subjected to a tested structured questionnaire. During the survey, direct observations were made concerning the use of IRS as well as housing conditions. The data were coded and analysed using SPSS version 19.

Results

Knowledge levels about malaria as a disease and the mosquito as its vector were high and of equal magnitude (85.5% and 85.4%, respectively), while knowledge levels of IRS were even higher (91.6%). The main source of households’ information about malaria and IRS was primarily community health workers (73.3%). Despite positive perceptions towards IRS only 26.7% of respondents had sprayed their houses which is lower than the WHO targeted coverage of 80%. Respiratory disorders and headache (33.3%), food contamination (24.9%), discolouring of inner house walls (17.7%), difficulty in furniture’s movement (13.8%), and unpleasant odour (10.4%) were the main reasons for IRS refusal.

Conclusion

There is a discrepancy between knowledge about symptoms and the transmission route of malaria and control practices related to IRS use. Therefore, IRS campaigns accompanied with education for behaviour change should be considered to ensure householders’ participation and cooperation in the IRS programme. Moreover, continuous evaluation and monitoring of IRS as well as conducting more surveys on knowledge, attitude, and practices are recommended to improve malaria control measures and to identify indicators for effective, successful, and sustainable malaria elimination programme.

Caretakers' understanding of malaria, use of insecticide treated net and care seeking-behavior for febrile illness of their children in Ethiopia

BACKGROUND

Local understandings of malaria and use of preventive measures-are critical factors in sustained control of malaria. This study assessed caretakers' knowledge on malaria, use of Long Lasting Insecticide Treated Nets (LLINs) and care-seeking behavior for their children's illness in different malaria transmission settings of Ethiopia.

METHODS

Data were collected from 709 caretakers of children of 2-9 years of age during in 2016. A standard questionnaire was used to assess caretakers' perceptions of malaria, use of LLIN and care seeking behavior for febrile illness of children aged 2-9 years.

RESULTS

The caretakers recognized malaria mostly by chills (70.4%, 499/709), fever (45.7%, 324/709) and headache (39.8%, 282/709). Overall, only 66.4% (471) of the caretakers knew that mosquito bite caused malaria and that it was quite heterogeneous by localities (ranging from 26.1% to 89.4%) and altitude (p < 0.05). Majority, 72.2% (512), of the caretakers knew that sleeping under LLIN could prevent malaria. Overall knowledge on malaria (mean = 51.2%) was very low with significant variations by localities, altitude and levels of malaria transmission, being low in high altitude and low in transmission areas (p < 0.05). Four hundred ninety-one (69.3%, 491/709) of the children slept under LLIN in the previous night. Of malaria related knowledge items, only knowledge of LLIN was associated with net use; non-use of LLN was higher among caretakers who did not know the role of LLIN (AOR = 0.47, 95%CI: 0.28-0.77, p = 0.003). Of course, attributing causation of malaria to stagnant water discouraged use of net (p = 0.021). Of febrile children (n = 122), only 50 (41.0%) sought care with only 17 (34.0%) seeking the care promptly. There was no significant link between knowledge of malaria and care seeking behavior (p > 0.05). However, knowledge of malaria had some level of influence on treatment source preference where caretakers with greater knowledge preferred pharmacy as source of care.

CONCLUSIONS

The findings demonstrated that caretakers' understanding of malaria was unsatisfactory with marked heterogeneity by localities. The present evidence suggests that knowledge is not sufficient enough to drive LLIN use and care seeking. Yet, context-specific health education interventions are important besides ensuring access to necessary preventive tools.

Knowledge of prevention, cause, symptom and practices of malaria among women in Burkina Faso

BACKGROUND

Malaria remains a major public health issue in most southern African countries as the disease remains hyper endemic. Burkina Faso continues to face challenges in the treatment of malaria, as the utilization of preventive measures remains low on a national scale. While it has been acknowledged that understanding women's health-seeking behaviours, perception of malaria and its preventive measures will aid in the control of malaria, there is paucity of information on Knowledge, Attitudes and Practices among women in the reproductive age of 15-49 years in Burkina Faso. This study investigated women's knowledge of malaria, attitudes towards malaria, and practices of malaria control in order to create a synergy between community efforts and governmental/non-governmental malaria control interventions in Burkina Faso.

METHODS

The analysis used data from the 2014 Burkina Faso Malaria Indicator Survey (MIS). In total 8111 women aged between 15-49 years were included in the present study. We assessed women's knowledge about 1) preventive measures, 2) causes and 3) symptoms of malaria, as well as malaria prevention practices for their children and during pregnancy. The socio-demographic characteristics were considered for Age, Religion, Education, Wealth index, Number of household members, Sex of household head, Household possession of radio, TV and Received antenatal care. Data were analyzed using STATA, version 14. Associations between variables were tested using a Chi-square and logistic regression, with the level of statistical significance set at 95%.

RESULTS

A preponderant proportion of respondents were aged 15-29 years (mean age was 28.63±9.41). About three-quarters of the respondents had no formal education. An estimated two-third of the participants were of Islamic faith, while access to media and behavioural communication were generally poor. The level of knowledge was 53% for rural women and 68.2% for urban dwellers. In sum, there was 56.1% level of accurate knowledge of malaria among women in Burkina Faso. In the multivariable logistic regression, women in rural location had 40% reduction in the odds of having accurate knowledge of malaria when compared to urban women (aOR = 0.60; 95%CI: 0.52-0.68). The educational level was a key factor in the knowledge of malaria. The odds of having accurate knowledge of malaria increased as the educational level increased, hence, women with secondary and higher education had 29% and 93% increase in the odds of having accurate knowledge of malaria when compared to the women without formal education. Results indicate that antenatal care (ANC) services were major sources of information on malaria. Women who reportedly received ANC were 3.9 times more likely to have accurate knowledge of malaria when compared to those who did not utilize skilled ANC services (aOR = 3.90; 95%CI = 3.34-4.56).

CONCLUSION

The overall knowledge of malaria prevention practices among a large proportion of women was found to be low, which implies that the knowledge about the prevention of malaria should be improved upon by both urban and rural dwellers. There is need for concerted behavioural communication intervention to improve the knowledge of malaria especially for rural dwellers regarding malaria prevention measures, causes and symptoms. Consistent efforts at providing relevant information by health organizations are needed to reduce and control incidences of malaria in the general public.

Knowledge, attitude, and practices about tsetse control among communities neighbouring Serengeti National Park, Tanzania

Tsetse flies are vectors of blood parasite of the genus Trypanosoma, which causes African trypanosomiasis to both human beings and animals. Large losses due to nagana have been reported; and this indicates the importance of tsetse control to avoid estimated losses. This study assessed the knowledge of tsetse and control practices, attitude towards control practices against tsetse, and the actual control practices used by the local communities in Serengeti District near the Serengeti National Park (SENAPA). Data for this study were collected using various methods. An interview schedule was administered to 70 randomly selected households, 12 focus group discussions with men and women farmers, and four key informant interviews with technical staff were held. The data were analysed using largely descriptive statistics and content analysis method. The farmers had inadequate knowledge of tsetse such that they confused them with other similar flies. On the other hand, they demonstrated knowledge of tsetse control measures, and these included some, which were not among those recommended by the extension staff. While the attitude towards control methods was positive most of the farmers did not use the recommended methods largely due to the cost associated with them. This suggests that the positive attitude towards a recommendation by itself is not sufficient to influence its use. Besides, poor management of dipping facilities for tsetse control and inadequate supervision by district staff impacted on the quality of services offered. Thus enabling local community members to have clear knowledge of tsetse flies is an important starting point for mobilizing them to take appropriate control measures against tsetse. Also, district authorities need to take an active role in monitoring the performance of the dipping facilities in the district by taking up appropriate measures to ensure quality control of services offered. Moreover, there is need for the district authorities and the central government to address the challenges which privatization of veterinary services posed to animal health and the wellbeing of people who depend on livestock for their livelihood.

Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo

In zones of violent conflict in the tropics, social disruption leads to elevated child mortality, of which malaria is the leading cause. Understanding the social determinants of malaria transmission may be helpful to optimize malaria control efforts. We conducted a cross-sectional study of healthy children aged 2 months to 5 years attending well-child and/or immunization visits in the Democratic Republic of Congo (DRC). Six hundred and forty-seven children were tested for malaria antigenemia by rapid diagnostic test and the accompanying parent or legal guardian simultaneously completed a survey questionnaire related to demographics, socioeconomic status, maternal education, as well as bednet use and recent febrile illness. We examined the associations between variables using multivariable logistic regression analysis, chi-squared statistic, Fisher's exact test, and Spearman's rank correlation, as appropriate. One hundred and twenty-three out of the 647 (19%) children in the study tested positive for malaria. Higher levels of maternal education were associated with a lower risk of malaria in their children. The prevalence of malaria in children of mothers with no education, primary school, and beyond primary was 41/138 (30%), 41/241 (17%), and 39/262 (15%), respectively (p = 0.001). In a multivariable logistic regression model adjusting for the effect of a child's age and study site, the following remained significant predictors of malaria antigenemia: maternal education, number of children under five per household, and HIV serostatus. Higher maternal education, through several putative causal pathways, was associated with lower malaria prevalence among children in the DRC. Our findings suggest that maternal education might be an effective 'social vaccine' against malaria in the DRC and globally.

Caregivers' Malaria Knowledge, Beliefs and Attitudes, and Related Factors in the Bata District, Equatorial Guinea

Objectives

Adequate community knowledge about malaria is crucial in order to improve prevention by reducing exposure to the disease. Malaria is a major cause of morbidity and mortality among children of less than five years of age in Equatorial Guinea. However, information concerning the accuracy of community knowledge is insufficient. This study aimed at assessing the depth of caregivers’ knowledge of malaria, their beliefs and attitudes about this disease, and their socioeconomic determinants in the Bata district of Equatorial Guinea.

Methodology

A cross-sectional study was conducted in the district of Bata, involving 440 houses selected from 18 rural villages and 26 urban neighbourhoods. A combined "Malaria Knowledge Score" was generated based on caregivers’ knowledge about transmission, symptoms, prevention, the treatment of children, and best place to seek treatment. Multivariate logistic regressions analyses were performed to assess those factors that are associated with knowledge about malaria.

Results

A total of 428 caregivers were interviewed; 255 (59.6%) and 173 (40.4%) lived in urban and rural areas respectively. Significant differences between rural and urban households were observed in caregivers’ malaria knowledges and beliefs. Almost 42% of urban and 65% of rural caregivers were unaware as to how malaria is transmitted (OR = 2.69; 95% CI: 1.78–4.05). Together with rurality, the factors most significantly associated with the Malaria Knowledge were the level of education of the caregiver and the socioeconomic status of the household.

Conclusions

Improvements in educational programs are needed to empower the most vulnerable households such that they can pro-actively implement malaria control measures. This could be achieved by a comprehensive communication strategy aimed at changing individual and community behaviours, and delivered by suitably trained community health workers and indoor residual spraying personnel.

Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda

BACKGROUND

Active community participation in malaria control is key to achieving malaria pre-elimination in Rwanda. This paper describes development, implementation and evaluation of a community-based malaria elimination project in Ruhuha sector, Bugesera district, Eastern province of Rwanda.

METHODS

Guided by an intervention mapping approach, a needs assessment was conducted using household and entomological surveys and focus group interviews. Data related to behavioural, epidemiological, entomological and economical aspects were collected. Desired behavioural and environmental outcomes were identified concurrently with behavioural and environmental determinants. Theoretical methods and their practical applications were enumerated to guide programme development and implementation. An operational plan including the scope and sequence as well as programme materials was developed. Two project components were subsequently implemented following community trainings: (1) community malaria action teams (CMATs) were initiated in mid-2014 as platforms to deliver malaria preventive messages at village level, and (2) a mosquito larval source control programme using biological substances was deployed for a duration of 6 months, implemented from January to July 2015. Process and outcome evaluation has been conducted for both programme components to inform future scale up.

RESULTS

The project highlighted malaria patterns in the area and underpinned behavioural and environmental factors contributing to malaria transmission. Active involvement of the community in collaboration with CMATs contributed to health literacy, particularly increasing ability to make knowledgeable decisions in regards to malaria prevention and control. A follow up survey conducted six months following the establishment of CMATs reported a reduction of presumed malaria cases at the end of 2014. The changes were related to an increase in the acceptance and use of available preventive measures, such as indoor residual spraying and increase in community-based health insurance membership, also considered as a predictor of prompt and adequate care. The innovative larval source control intervention contributed to reduction in mosquito density and nuisance bites, increased knowledge and skills for malaria control as well as programme ownership.

CONCLUSION

This community-based programme demonstrated the feasibility and effectiveness of active community participation in malaria control activities, which largely contributed to community empowerment and reduction of presumed malaria in the area. Further studies should explore how gains may be sustained to achieve the goal of malaria pre-elimination.

Community knowledge and the role of health extension workers on integrated diseases among households in East Hararghe Zone, Ethiopia

Background

Ethiopia constitutes approximately 1% of the world’s population but it contributes to 7% of the world’s HIV/AIDS cases. Malaria is the most important disease of humans in terms of mortality, morbidity, and long-term effects upon quality of life, especially in Ethiopia. Despite the ongoing efforts and progress in fighting HIV/AIDS and malaria, these diseases remain the leading cause of morbidity and mortality in the country. In this study, we assessed community knowledge and the role of health extension workers on integrated diseases among households in East Hararghe Zone, Ethiopia.

Methods

A community-based multistage stratified cross-sectional study was conducted from February to March 2014 among six woredas of the East Hararghe Zone, Ethiopia. The data were collected from 2,319 households using structured questionnaires. A total of 12 well trained data collectors conducted a face-to-face interview with the head female of each household. The data entered on Epi-Data version 3 were then exported for analysis on STATA version 11.

Results

Multivariable logistic regression showed that among the 1,967 (92.7%) study participants who scored above the mean value in regard to the overall knowledge of HIV/AIDS, study participants who could read/write (adjusted odd ratios [AOR] =2.54, 95% confidence interval [CI]: 1.15–5.61, P=0.021) and worked as a daily laborer (AOR =0.40, 95% CI: 0.17–0.91, P=0.029) were significantly associated with comprehensive knowledge about HIV/AIDS. Meanwhile, out of the 2,172 eligible study participants for the malaria interview, 934 (43%) scored above the mean in regard to the overall knowledge about malaria. Rural residents (AOR =0.27, 95% CI: 0.17–0.44, P<0.005), >45 years of age (AOR =1.44, 95% CI: 1.04–1.99, P=0.030), and single marital status (AOR =3.81, 95% CI: 1.97–7.37, P<0.005) were significantly associated with comprehensive knowledge about malaria.

Conclusion

Based on the findings of this study, health extension workers’ number of monthly regular visits of each household was high, with the overall knowledge of study participants regarding malaria was unsatisfactory, unlike the overall knowledge of study participants regarding HIV/AIDS, which is very high.