Women's knowledge and perceptions of malaria and use of malaria vector control interventions in Kersa, Eastern Ethiopia

Understanding psychosocial determinants of malaria behaviours in low-transmission settings: a scoping review

BACKGROUND

Recent estimates show progress toward malaria elimination is slowing in many settings, underscoring the need for tailored approaches to fight the disease. In addition to essential structural changes, human behaviour plays an important role in elimination. Engagement in malaria behaviours depends in part on psychosocial determinants such as knowledge, perceived risk, and community norms. Understanding the state of research on psychosocial determinants in low malaria transmission settings is important to augment social and behaviour change practice. This review synthesizes research on psychosocial factors and malaria behaviours in low-transmission settings.

METHODS

A systematic search of peer-reviewed literature and supplemental manual search of grey literature was conducted using key terms and eligibility criteria defined a priori. Publications from 2000-2020 in the English language were identified, screened, and analysed using inductive methods to determine the relationship between the measured psychosocial factors and malaria behaviours.

RESULTS

Screening of 961 publications yielded 96 for inclusion. Nineteen articles collected data among subpopulations that are at increased risk of malaria exposure in low-transmission settings. Purposive and cluster randomized sampling were common sampling approaches. Quantitative, qualitative, and mixed-methods study designs were used. Knowledge, attitudes, and perceived risk were commonly measured psychosocial factors. Perceived response-efficacy, perceived self-efficacy, and community norms were rarely measured. Results indicate positive associations between malaria knowledge and attitudes, and preventive and care-seeking behaviour. Studies generally report high rates of correct knowledge, although it is comparatively lower among studies of high-risk groups. There does not appear to be sufficient extant evidence to determine the relationship between other psychosocial variables and behaviour.

CONCLUSIONS

The review highlights the need to deploy more consistent, comprehensive measures of psychosocial factors and the importance of reaching subpopulations at higher risk of transmission in low transmission contexts. Malaria-related knowledge is generally high, even in settings of low transmission. Programmes and research should work to better understand the psychosocial factors that have been positively associated with prevention and care-seeking behaviours, such as norms, perceived response efficacy, perceived self-efficacy, and interpersonal communication. These factors are not necessarily distinct from that which research has shown are important in settings of high malaria transmission. However, the importance of each factor and application to malaria behaviour change programming in low-transmission settings is an area in need of further research. Existing instruments and approaches are available to support more systematic collection of psychosocial determinants and improved sampling approaches and should be applied more widely. Finally, while human behaviour is critical, health systems strengthening, and structural interventions are essential to achieve malaria elimination goals.

House-wall modification after indoor residual spraying in Shashogo district, southern Ethiopia

BACKGROUND

Indoor residual spraying has been a key national malaria prevention and control strategy in Ethiopia. However, there is a gap in monitoring and evaluation of house-wall modification after indoor residual spraying before the end of residual lifespan. This study has determined the prevalence of house-wall modification after indoor residual spraying and identified the associated factors in Shashogo district, southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from April to May 2022. Data were collected from 640 randomly selected households using a pre-tested questionnaire and an observational checklist. The binary logistic regression models were used to identify factors associated with house-wall modification after indoor residual spraying before the end of the potency period.

RESULTS

The prevalence of house-wall modification after indoor residual spraying was found to be 30.4% (95% CI 27.4-34.2%). Educational status of could not read and write [AOR = 1.76, 95% CI (1.16, 2.68)], monthly income of more than birr 3000 [AOR = 3.27, 95% CI (1.78, 6.01)], low level of knowledge about indoor residual spraying [AOR = 3.81, 95% CI (2.39, 6.06)], lack of information within two weeks before spraying [AOR = 2.23, 95% CI (1.44, 3.46)], absence of supervision after spraying [AOR = 1.79, 95% CI (1.14, 2.81)], absence of stagnant water near house [AOR = 3.36, 95% CI (2.13, 5.39)], and thatched roof [AOR = 1.82, 95% CI (1.04, 3.16)] were factors significantly associated with house-wall modification after indoor residual spraying.

CONCLUSION

This study has revealed that the prevalence of house-wall modification after indoor residual spraying before the end of the residual lifespan in the study area was higher compared to other studies in developing countries. Therefore, special emphasis should be given to providing community education about indoor residual spraying, conducting regular supervision before and after residual spraying, enforcing some legislative strategies for modifying the house-wall before six months after spraying, and improving environmental and housing conditions.

Altering of the sprayed wall after indoor residual spraying and associated factors among households in Boricha district, Sidama regional state, Ethiopia, 2019: community-based cross-sectional study

BACKGROUND

Indoor residual spraying (IRS) has been the main tool used to control malaria. Reducing the life span and the density of the vector mosquitoes are direct effects of IRS towards restricting malaria transmission. Residents must not wash or re-plaster walls after the spray application for at least 6 months to fight against malaria with IRS. This study sought to assess the alteration of the sprayed wall after the IRS operation and associated factors among households in the Boricha district.

METHODS

Community-based cross-sectional study was conducted among 608 households selected using multi-stage sampling. A structured interviewer-administered questionnaire was used to collect data. Data were analysed by SPSS version 25. Both bivariable and multivariable logistic regression analysis was done. Finally, the strength of the association was measured based on AOR with 95% CI and statistical significance was declared at a p-value less than 0.05.

RESULT

From the total of 608 sprayed houses included in the study, 37.3% (95% CI: 33.41% - 41.15%) were found to have altered sprayed walls. The highest class of wealth index category (AOR = 2.50; 95% CI: 1.19, 5.16), low level of comprehensive knowledge about IRS (AOR = 6.08; 95% CI: 3.37, 10.94), did not get information within 2 weeks before spray (AOR = 2.09; 95% CI: 1.43, 3.05), absence of supervision after the spray operation (AOR = 1.77; 95% CI: 1.27, 2.73) and walking distance to nearest health facility (AOR = 2.39; 95% CI: 1.63, 3.35) remained significant factors of altering of the sprayed wall after IRS.

CONCLUSION

The prevalence of alteration was relatively high. The highest socio-economic status, poor knowledge about indoor residual spraying, lack of information about IRS within two weeks before spray, absence of supervision after IRS, and walking distance of more than 30 min to reach the nearest health post were the factors affecting the alteration status of the sprayed wall. Future efforts to focus on successive awareness creation activities should be done before and after IRS operation to the community by concerned bodies.

The Need for Strengthening Health Information Dissemination Toward Indoor Residual Spraying for Malaria Prevention in Malarious Area of Ethiopia

Introduction

Malaria remains prevalent in developing countries. This is particularly true among the community who are prone but do not apply malaria prevention and controlling strategies. In one of the malarious areas of Ethiopia (Shewa Robit), the acceptance level of indoor residual spraying (IRS) is indicated to be low as per guidelines. However, factors determining communities' acceptance of IRS are not well-investigated. Hence, this study was designed to identify the determinants for the acceptance of IRS in order to indicate priorities for malaria prevention and control.

Methods

A community-based cross-sectional study design was used among 649 households in Shewa Robit town, from February to March 2021. Households were selected from five IRS-targeted kebeles. Data were collected using structured questionnaire. A multivariable logistic regression model was used to identify the independent factors associated with the acceptance of IRS.

Results

The response rate in this study was 98%. The proportion of community who accepted the IRS for malaria prevention was 56.5% [95% confidence interval (CI): 52.7–60.2%]. Being male [adjusted odds ratio (AOR) = 2.21, 95% CI: 1.32–3.72], having good knowledge (AOR = 2.25, 95% CI: 1.33–3.84), did not paint/re-plaster the wall after spraying (AOR = 3.99, 95% CI: 2.36–6.76), did not perceive any side effects after spraying (AOR = 1.82, 95% CI: 1.11–2.99), effectiveness of previous IRS (AOR = 2.99, 95% CI: 1.85–4.84), non-utilization of long-lasting insecticide-treated net (LLIN) (AOR = 0.52, 95% CI: 0.33–0.84), and spraying the house at the right season (AOR: 2.14, 95% CI: 1.11–4.13) were determinant factors for the acceptance of IRS.

Conclusions

To increase the acceptance level of IRS among the communities, health interventions and services should focus on the awareness creation toward the effectiveness of IRS, proper spraying time/season, and side effects of IRS. Therefore, strengthening health information dissemination could help promote the acceptance of IRS.

Acceptability and associated factors of indoor residual spraying for malaria control by households in Luangwa district of Zambia: A multilevel analysis

The global burden of malaria has increased from 227 million cases in 2019 to 247 million cases in 2020. Indoor residual spraying (IRS) remains one of the most effective control strategies for malaria. The current study sought to measure the acceptability level and associated factors of indoor residual spraying. A cross sectional study was conducted from October to November 2020 in sixteen urban and rural communities of Luangwa district using a cluster sampling method, Multilevel analysis was used to account for the hierarchical structure of the data. The acceptability level of indoor residual spraying among household heads was relatively high at 87%. Individuals who felt the timing was not appropriate were associated with decreased odds of accepting IRS (AOR = 0.55, 95% CI: 0.20-0.86). Positive attitude was associated with increased odds of accepting IRS (AOR = 29.34, 95% CI: 11.14-77.30). High acceptability level was associated with unemployment (AOR = 1.92, 95% CI: 1.07-3.44). There were no associations found between acceptability levels and community-level factors such as information, education, communication dissemination, awareness achieved through door-to-door sensitization, and public address system. Acceptability level of indoor residual spraying was relatively high among households of Luangwa District suggesting that the interventions are more acceptable which is essential in reaching malaria elimination by 2030. Finding that community factors known to influence acceptability such as information, education and communication as well as awareness were not important to influencing acceptability suggests need for reinforcing messages related to indoor residual spraying and redefining the community sensitization approaches to make indoor residual spraying more acceptable.

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.

Parents' perception on cause of malaria and their malaria prevention experience among school-aged children in Kutcha district, Southern Ethiopia; qualitative study

INTRODUCTION

School-aged children become a highly vulnerable group for malaria, yet they are less likely to use malaria prevention interventions. Previous studies exploring perception on cause of malaria mainly focused on pregnant mothers or parents of children under age five years. Exploring parent's perception on cause of malaria and their experiences on the prevention of malaria and associated challenges among school-aged children is important to develop a malaria prevention education package for school-aged children to reduce malaria and malaria related morbidities among school-aged children.

METHODS

A descriptive qualitative study is conducted in Kutcha district by recruiting 19 parents of school-aged children for semi-structured interviews, 6 key informants and 6 focus group discussion which consists of parents, health development army and health extension workers. A semi-structured interview guide is used to guide the interview process. The collected data is analyzed thematically with a focus on the three major areas of concern: perceived cause of malaria, experience of malaria prevention and challenges of bed net use for prevention of malaria.

RESULTS

Five causes of malaria were identified, namely hunger, mosquito bite, exposure to hot sunshine, poor sanitation and hygiene and eating some sweet foods and unripe maize. Participants perceived that eating sweet foods and unripe maize lead to enlargement of the spleen that ends in malaria while poor hygiene and sanitation leads to either development of the ova of mosquito and the landing of the housefly to contaminate food for consumption. The experiences of malaria prevention were largely influenced by their perceived cause of malaria. The malaria prevention measures undertaken by parents were vectors control measures, homemade herbal remedies and restricting children from eating sweet foods. The challenges of malaria prevention by using bed nets were related to a negative attitude, sleeping behaviors of children; use of bed nets for unintended purposes, shortage of bed nets and delays in the distribution of bed nets.

CONCLUSION

There were misconceptions about the cause of malaria and associated experiences of malaria prevention. Control of malaria among school-aged children need health education targeting the challenges and correcting identified misconceptions by parents in Kutcha district and in other similar settings.

An exploratory study of the acceptability of indoor residual spraying for malaria control in upper western Ghana

Background

Despite the implementation of the World Health Organisation’s recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low. This study explores the facilitators and barriers to the acceptability and community uptake of indoor residual spraying in a highly endemic region of Ghana.

Methods

The health belief model (HBM) and realist evaluation framework were used to inform the study. A qualitative enquiry was conducted between April to October 2016. Data were collected through focus group discussions and semi-structured interviews with program stakeholders including community members, AngloGold Ashanti malaria control (AGA Mal) spray operators, and AGA Mal officials.

Results

A total of 101 people participated in the study. Considerable barriers to community acceptance of indoor residual spraying (IRS) were found, including, dislike of spray insecticides, inadequate information, religious and cultural beliefs, perceived low efficacy of IRS, difficulties with packing, unprofessional conduct of IRS spray operators, and other operational barriers to spraying. Facilitators of IRS uptake included a perceived effectiveness of IRS in preventing malaria and reducing mosquito bites, incidental benefits, respect for authority, training and capacity building, and sensitization activities.

Conclusion

The numerous barriers to indoor residual spraying acceptance and implications show that acceptance levels could be improved. However, measures are required to address householders’ concerns and streamline operational barriers to increase community uptake of indoor residual spraying.

Coverage of indoor residual spraying for malaria control and factors associated with its acceptability in Nasarawa State, North-Central Nigeria

Introduction

Indoor residual spraying (IRS) is among the major vector control strategies recommended for endemic populations by the World Health Organization (WHO). The success of IRS requires high coverage which is dependent on its acceptability. In Nigeria, IRS pilots have been ongoing and rejection has been a major setback to its coverage. We assessed coverage of IRS and determined factors associated with its acceptability in Nasarawa Eggon district, Nasarawa state, Nigeria

Methods

A cross-sectional survey involving 409 households selected using multi-stage sampling was carried out. Trained data collectors administered pre-tested structured questionnaire to collect data on socio-demographic characteristics of household heads or their representatives, their perceptions on IRS and factors associated with IRS acceptability. Descriptive, bivariate and multivariate analyses were done at 5% level of significance.

Results

Majority of respondents were male (79.7%) and married (82.6%), and their mean age was 36.4 ± 13.3 years. Coverage of IRS was 99.3%. However, only 82.6% of those who previously accepted IRS were willing to accept it in again. Factors independently associated with acceptability were perceived effectiveness of IRS (aOR = 21.8; 95%CI = 6.9-68.8) and lower household cost of malaria prevention after IRS (aOR = 5.0; 95%CI = 1.1-21.8)

Conclusion

IRS coverage in the communities studied met WHO minimum standard of 85%. However, for similar results to be achieved in future, acceptability must be promoted by providing information on its effectiveness and its ability to reduce household cost of malaria prevention.

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.

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.

HDSS Profile: The Kersa Health and Demographic Surveillance System

Kersa HDSS was established in 12 sub-districts of Kersa district, Eastern Hararge, Oromia Region, Ethiopia. The site is principally rural with two small towns (Kersa and Weter). The baseline census was conducted in 2007 and since then has been updated every 6 months, with registration of demographic and health events. Data are entered into the HRS-2 relational database. At baseline a total of 10 085 houses, 10 522 households and 50 830 people were registered. The sex ratio and number of persons per household were 1.0 and 5.1, respectively. At the end of 2013, the population was 60 694. Up to the end of 2013, 12 571 births and 3143 deaths were registered, respectively. Over 85% of births and deaths occurred at home. The annual net population growth ranges from 0.06 to 1.6. The majority of the population in Kersa are not working age group; hence the dependency ratio in most of the years is below 1. The total fertility rate ranges from 4.0 to 5.3. A reduction in neonatal, infant and under-five mortalities was observed. For all deaths, verbal autopsies were done. Tuberculosis is the leading cause of death among adults and malnutrition is the leading cause of death among children aged under 5 years. Kersa HDSS is ready to collaborate with interested researchers on health and demographic issues. For further details please visit: [ http://www.haramaya.edu.et/research/projects/kds-hrc/ ].

Knowledge and practices on malaria prevention in two rural communities in Wakiso District, Uganda

BACKGROUND

Malaria is the leading cause of morbidity and mortality in Uganda particularly among children under 5 years of age.

OBJECTIVES

The study assessed the knowledge and practices on malaria prevention in 2 rural communities in Wakiso District, Uganda with emphasis on the various prevention methods.

METHODS

The study was a cross-sectional survey carried out among 376 households using both quantitative and qualitative methods. Log-binomial regression, chi square and Spearman's rank order correlation were used to test for associations.

RESULTS

The majority of participants (64.6%) had low knowledge on malaria prevention methods, with untreated mosquito nets (81.7%), mosquito coils (36.9%) and insecticide treated nets (29.6%) being the most known methods. Knowledge on malaria prevention methods was associated with age (χ2 = 32.1; p < 0.01), employment status (χ2 = 18.1; p < 0.01), education (χ2 = 20.3; p = 0.01), income (χ2 = 14.5; p = 0.01) and having heard a malaria message in the previous 12 months (χ2 = 92.3; p < 0.01). Households that had at least one mosquito net were 45.5% and net ownership increased with household income. Only 0.5% of the houses had undergone indoor residual spraying in the previous 12 months, while 2.1% had complete mosquito proofing in windows and ventilators to prevent mosquito entry.

CONCLUSION

There is potential to improve practices on malaria prevention by targeting other methods beyond mosquito nets such as installing proofing in windows and ventilators. The integrated approach to malaria prevention which advocates the use of several malaria prevention methods in a holistic manner should be explored for this purpose.