Background

One component of the baseline study conducted in December 1999, was a Knowledge, Attitudes and Practices (KAP) survey assessing community perceptions concerning malaria.

Environmental factors and behavioral patterns of vectors and human populations combine to provide favorable conditions for malaria transmission. While much is known about vector biology and behavior and the malaria parasites, the importance of human behavior in malaria transmission has been largely overlooked.  This failure to consider community attitudes and beliefs about malaria has contributed to the inability of programs to achieve sustainable control. An intimate knowledge of community attitudes, knowledge and behavior can form the basis of appropriate health education messages. 

Two structured questionnaires were used for data collection, one in KwaZulu-Natal and Swaziland, and a more comprehensive one in Mocambique. Both questionnaires covered important socio-demographic characteristics, malaria knowledge, treatment-seeking behavior and compliance with Malaria Control Programme activities.  Four teams consisting of 25 health personnel, malaria control specialists and scientists conducted the interviews over ten consecutive days.

Results

The level of formal education in this study populations was low. The majority of the people in rural areas of KwaZulu-Natal, Swaziland and Mocambique have limited formal education. Literacy level is an important determinant of health status and is closely linked with poverty. The low educational level in the areas may hamper the dissemination of information about malaria and its control.

Most respondents in KwaZulu-Natal  mentioned mosquitoes as the cause of malaria. In contrast, roughly half of Mocambican and Swaziland interviewees indicated mosquito bites as the source of malaria while the majority of the remainder either did not reply or did not know how malaria was contracted.  Female respondents from all three areas were less likely to record that mosquitoes caused malaria.

Ongoing awareness initiatives are required in Mocambique to increase community knowledge about malaria. It has been widely acknowledged that women play an important role in education and therefore special efforts need to be made to ensure that they are well informed, particularly given the limited formal education. Radio may prove a useful medium for communicating key health messages, as most respondents in this study had a radio at home.  

In the Mocambican survey, roughly one quarter of respondents reported using Baygon, bednets or mosquito coils as ways to avoid malaria. The remainder of methods mentioned included improved hygiene, traditional medicine or burning rubbish as effective ways to prevent the disease.

The possession of a radio and proportion of cement and painted structures were used as indicators of socio-economic status. KwaZulu-Natal scored high in both categories.  In comparison, in Mocambique, a radio was owned by a minority of the interviewees, and cement and painted structures only accounted for 10% of all structures. The number of cement and painted structures are also a major determinant of the suitability of homes for DDT spraying.

The resultant stain left by DDT on the surface is often a negative factor affecting compliance of house-owners who tend to repaint thereafter. Replastering of sprayed wall surfaces compromises the success of the spraying program. Health education is required to improve the community's understanding of the function of the indoor residual insecticide spraying.

Although the majority of people in the areas seek treatment for malaria from clinics and hospitals, a significant proportion of the community seek treatment elsewhere. There is, therefore, a need to reinforce the importance of early diagnosis and treatment of malaria.