Knowledge And Attitude Toward The Prevention Of Malaria In The Community
Approximately, out of 3.4 billion people worldwide who are exposed to malaria annually, 1.2 billion are mainly children 0-5 years, and pregnant women. (who,2013). Malaria is the leading cause of morbidity and mortality in Nigeria. An elaborate understanding of the knowledge and attitude toward the prevention of malaria in the community. This study investigated the knowledge and attitude toward the prevention of malaria in the community in relation to malaria prevention and control among households in Lokoja, Kogi State. A community based, cross sectional study was carried out where a stratified random sampling with proportional allocation was used to select 370 representative households. A questionnaire was used to collect information on demographics, knowledge and attitudes towards malaria and its prevention and treatment habits. The data was described using frequency and contingency tables. Chi-square tests are used to test for associations between demographics variables, prevention and control. The results showed that resident of rural Lokoja were knowledgeable on malaria, its transmission, its symptoms, how to seek treatment and prevent malaria. However, their attitudes towards malaria and their treatment seeking behaviours varied. Demographic factors like age and education level played a role in their malaria prevention habits. Younger people slept under mosquito nets more frequently than older people, and those with secondary school education slept more under mosquito nets than those with primary education only (Cramer’s V = 0.313 and 0.706 respectively). Campaign interventions could consider information of importance of early diagnosis, completion of prescribed drugs and possibly personalities and myths surrounding malaria in the locality.
1.1 Background of the Study
Malaria continues to be the leading killer-disease in Nigeria, despite countrywide efforts to eradicate the disease. The disease claimed more than 46,000 lives in 2013. While the disease is easily preventable, curable and treatable, it remains a big health threat to many communities in Nigeria[Bärring, L. .
The ailments have proved to be serious threats to the economy. Nearly all Nigerian households experience the burden caused by malarial illness [Imbhale, S. S. et al 2011]. The economic effects of malaria infection can be tremendous and include direct costs for treatment and prevention, as well as indirect costs such as lost productivity from morbidity and mortality; time spent seeking treatment, and diversion of household resources. All these affect the country economy, leading to increased poverty [Leighton, C. et al .
The Nigeria government, through the Ministry of Health (MoH) is committed to the control and prevention of Malaria and subsequently developed a strategy document titled “President’s Malaria Initiative Nigeria- Malaria Operation Plan FY 2013.”The National Malaria Strategy National Malaria Strategy (NMS) document outlined several intervention measures which includes: management of malarial illness, vector control by use of Insecticide-Treated Mosquito Nets (ITNs) and other methods, such as indoor spraying; control of malaria in pregnancy; and epidemic prevention and control. Although progress has been made and Malaria has been on a slow but steady decline [Njoroge, F. K 2009 ], one of the gaps identified in the NMS is insufficient advocacy and social mobilization which can be enhanced through Behavior Change Communication (BCC) strategy.
Malaria is a mosquito born protozoan infection of humans and other animals caused by parasitic protozoa of genus Plasmodium (WHO, 2015). Approximately, out of 3.4 billion people worldwide who are exposed annually, 1.2 billion are mainly children 0-5 years, and pregnant women. (WHO, 2013) By 2009, malaria was one of devastating diseases killing more than 1 million people annually where pregnant women, children, and immune-compromised individuals had the highest morbidity and mortality, and Africa bearing the heaviest burden (Julianna and Nawal, 2009). Children and Pregnant women are 3 times more likely to suffer from severely as a result of malarial infection compared to their counterparts. In malaria endemic areas, it is estimated that at least 25% of children under 5 years are infected with malaria, with the highest risk of infection and morbidity in neonates and infants. This being because, in high transmission areas, partial immunity is acquired at childhood. However, if this is does not happen, there is rapid progression of disease to severity and death among children being enhanced 2 by severe anemia, hypoglycemia, cerebral malaria which are more commonly seen among children under five than their adult counterparts (WHO, 2014). There are five species of malaria parasites which infect humans namely: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and P. knowlesi (WHO, 2013). Of these, P. falciparum is the most virulent malaria parasite in Uganda (Bauer, 2015). Among children, WHO recommended Insecticide-treated nets to be provided as early as possible to all households living in malaria endemic areas, epidemic and disaster situations and according to perceived need in the locality and be used throughout pregnancy to mothers, and postpartum to neonates and children (WHO, 2014).
1.2 Statement of the Problem
Malaria is endemic in over 95% areas of the country. According to a recent report from the World Health Organization (WHO), Uganda has the world’s highest malaria incidence, with a rate of 478 cases per 1000 population per year (Bauer 2015). The pattern of malaria parasites transmission is largely a function of the Anopheles mosquito breeding ecology (Greenwood et al., 2008) and the proximity of human dwelling places to vector breeding sites among others (Onyido et al., 2009a). An. gambiae s. l., the principal transmitter of malaria in Nigeria is closely associated with sunlit water collections close to human dwellings. On the contrary, An. funestus which is another important malaria vector in Nigeria tends to breed more in cool, clear, shaded, permanent water bodies relatively undisturbed by man in rural areas (Onyido et al., 2009b). Though Anopheles species are known to be ground pool breeders, a large number of them have been observed in clean collections of water in gutters and domestic containers (Mafiana et al., 1998; Aigbodion and Odiachi, 2003). Anopheles mosquitoes have also been found to breed in clear water of suitable pH, temperature and nutrient composition (Okorie, 1978). They can also be found in fresh or salt water marshes, mangrove swamps, rice fields and grassy ditches as well as the edge of streams and rivers
Malaria is the leading cause of morbidity and mortality in Uganda and is responsible for up to 40% of all outpatient visits, 25% of all hospital admissions and 14% of all hospital deaths. The overall malaria-specific mortality is estimated to be between 70,000 and 100,000 child deaths annually in Uganda, a death toll that far exceeds that of HIV/AIDS (Bauer, 2015). This study investigated the understanding of households on malaria transmission, their recognition of signs and symptoms, and their treatment seeking behaviours, household preventive measures and practices as well as the cultural context within which all of this occurs
1.3 Objective of the Study
To investigate knowledge and attitude toward the prevention of malaria in the community
1.4 Specific Objectives
The specific objectives are to;
- Describe the social-demographic characteristics of the community.
- Assess the knowledge and attitude of community about malaria transmission, prevention and control
- Assess the treatment seeking behavior of the local community for malaria like illness
- Identify relationships between knowledge, attitudes and practices, socio-economic and demographic variables in relation to malaria prevention and control
1.5 Significance of the Study
This study adds to the growing body of knowledge needed for malaria programming for Kogi State and the MoH NMCP by providing strategic information to compliment facility-based malaria data sources. The survey provided community data on key malaria indicators including mosquito net ownership and use. To effectively mobilize the community, we need to know what information they have about malaria and their attitudes and practices towards malaria in order to tailor messages that suit their needs. In particular, findings from this study will enable NMCP design more effective BCC strategies.
1.6 Definition of Terms
There are a number of operational definitions that frame and helped guide this research. These include:
Knowledge of Malaria:
The ability of a person to have correct understanding of malaria in terms of causative agent, mode of transmission, signs and symptoms, treatment and prevention.
Attitudes Towards Malaria Prevention:
Beliefs of susceptibility, seriousness and threat of malaria.
Practice of Malaria Prevention:
Routine activities and actions of individual or group for prevention of malaria. These include the use of insecticide treated mosquito nets, using insecticides to spray and control/clear mosquito breeding places.
Refers to a group of people living in a particular area and having shared values, cultural patterns, and social problems.
Refers to the whole process of recognition of the causes, symptoms and transmission of malaria and seeking health care for it treatment promptly.
This is the process that requires eradicating the carrier mosquito or reducing man-vector contact so as to cut in the life-cycle of the parasite.
Prevalence of Malaria:
This means the proportion of individuals in a defined population that have malaria during a specified period of time (period prevalence).
1.7 Organization of the Study
The first chapter contains the study’s introductory section, which includes the study background, the research problem statement, the objective study, and the scope of the study. The second chapter is a critical review of other literatures pertinent to the study and its objectives, as well as the theoretical framework of the study. The third chapter goes over the study’s data collection, sampling, and data analysis methods. The fourth chapter examines the research findings, including how they relate to previous findings. The fifth chapter includes a summary of the findings, a conclusion, and recommendations based on the objectives of the study.
Conclusion and Recommendations
5.2.1 The Social-Demographic Characteristics of the Community
The study established that majority of the respondents were male aged between 31 and 40years. Most of the household heads had studied to upper primary, and had household sizes of between four and five people. Many are farmers living in rural areas, without a regular source of income. They lived in mud and clay houses with mabatiroof and were prone to frequent mosquito bites. Most respondents owned electronic equipment like radios which they used to get information on malaria symptoms, prevention and treatment.
5.2.2 Knowledge and Attitude of Community About Malaria Transmission, Prevention and Control
The study established that the respondents are well aware of malaria as a disease. They were aware that malaria is transmitted through mosquito bites and it can kill if not treated early. They understood that mosquitoes bite both day and night. They gave the common signs of malaria as sweating, loss of energy and high temperature. They said that sleeping in bed nets can reduce and control malaria, in addition to spraying insecticide. The respondents agreed that using mosquito nets can guard the family against malaria. They clarified that their children under five years and mothers sleep under bed nets. The main medium through which they got this information was the radio.
The study established that the attitude of respondents towards malaria are; they agreed that malaria is a serious and life threatening disease, that anyone can get malaria, sleeping under mosquito net one way of prevention from malaria, one cannot recover spontaneously from malaria without any treatment, one is at a greater risk of getting malaria if they work and sleep overnight in the garden or forest, it is dangerous when malaria medicine is not taken completely, they can buy anti-malaria drugs from the shop/pharmacy to treat themselves, agreed that it’s important to have your blood tested if you suspect signs of malaria, one should seek for advice or treatment when they get malaria and it is very important to check for an expiry date of the drug before taking it.
5.2.3 Treatment Seeking Behaviour of the Local Community for Malaria Like Illness
The respondents said that they would visit health centres to get treatment for Malaria. They also would self-administer Malaria tablets in case they did not visit the health facilities.
In addition, they mentioned that they would occasionally visit community health worker to learn more on the prevention and control of Malaria. Since most of them had radios, they preferred other relevant information be communicated through the popular local stations.
5.2.4 Relationships Between Knowledge, Attitudes and Practices, Socio-Economic and Demographic Variables in Relation to Malaria Prevention and Control
Despite all respondents having a good grasp of malaria, its prevention and treatment, many are still not sleeping under bed nets. This study could not exhaustively establish as to why. Some proposed reasons are their economic status since many are poor and other pressing needs will have higher priorities than mosquito nets. Figure 4.1 showed that 47.6% do not own bed nets.
The respondents whose scores on understanding malaria were strong (level 4) did not seek medical attention from a health centre but opted to self-diagnose and self-treat themselves through the available pharmacies. Again this study could not exhaustively explain this behaviour. Other socio-economic factors could have played a role in this.
Finally, there was a clear relationship between age and prevention habits of sleeping under mosquito nets. The oder respondents tend to not sleep under mosquito nets while the younger respondents did. In addition, schooling affected the rate of respondents sleeping under the mosquito nets. A higher education level increased the chances for households to sleep under a mosquito net. Most respondents with secondary education owned mosquito nets (88.2%), unlike their counterparts with no secondary education (16.8%).
The study aimed at assessing community knowledge and practices in relation to malaria prevention and control to inform the design of more effective strategic/behaviour change communication (BCC) interventions. In general, most people had good knowledge about malaria prevention and control. Majority of respondents were aware of malaria, its transmission, common signs and recognized malaria as a threat to their lives in the community. Despite this (good knowledge and fair attitudes), practices towards malaria prevention and control were average. The respondents were at risk given their socio-economic characteristics. Many lived in mud houses, had dropped out of primary school and were not employed. Most would not buy the mosquito nets but managed nearby bushes and pools of water to control mosquito population. Interventions may be geared towards social and behaviour change to target increase in uptake of mosquito nets. The interventions should also consider empowerment of the Lokoja rural folks to encourage them to seek proper testing and prescription use.
Based on the findings in the study, the following recommendations should be considered as an effort to improving preventive and control behaviour against malaria among the residents of Lokoja:
Although knowledge about malaria prevention and control was generally good, it did not translate into good practice behaviour. Therefore public education is necessary to address the few but highly negative impact knowledge gaps highlighted in the study. For instance, some resident thought that there are people who can never fall sick from malaria such as children above 5 years and adults.
The residents were cognisant of risks associated with malaria. However, they were lax towards its prevention and control. This may be due to individual personalities and myths surrounding the disease and its preventive mechanisms. Some said they were afraid of suffocating while sleeping under a mosquito bed net.
Some believed that malaria usually heals automatically after a given period of time, hence increasing the risk of mortality as a result of malaria. There is need for educative communication on seeking proper treatment for malaria. Such information can cover the importance of seeking proper diagnosis early, as opposed to buying painkillers from nearby drug shops only go to health centre when symptoms persist. In addition information on dangers related to sharing medication or stopping prescribed medication mid-way may need to be developed. This information can best be delivered through campaign on malaria targeting Lokoja community.
Communication about malaria prevention and control should employ a combination of channels from radio, posters at health centres and other community locations.
5.4.1 Recommendations for Future Research
This study focused on understanding the people’s knowledge and attitude towards malaria, and basic treatment seeking behavior. Further studies can be conducted to adequately understand the myths surrounding malaria that affect their treatment seeking behavior.
A study to check the proportion of drugs that have expired can be conducted to inform the government on risks for the rural farmer succumbing to death because of them. This is especially so since the respondents stated that some do not bother checking on the date of expiry hence putting themselves at risk of even death.
Finally, a study on how the economic well being of the rural residence affect their treatment seeking behavior can be conducted. Understanding the threshold of economic empowerment rural population of Lokoja needs to increase their treatment seeking behavior might be of importance to the government. This will help in recommending the scale of campaign the government should invest in.
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