A total of 261 questionnaires were completed, with no refusals, and 100% of the questions were answered. Females accounted for approximately 82% (213/261) of the total study population. The ages of the participants ranged from 18 to 95 years, with a mean, median and standard deviation of 44.1, 40 and ± 18.1 respectively. Most of the study participants were mothers (70.1%, 183/261). The majority of respondents, 71.6% (187/261) were unemployed (casual workers and pensioners) and more than three quarters of them 79.3% (207/261) had at least primary school level education. In addition, 1.9% (5/261) of the participants reported that they had malaria (tested by Rapid Diagnostic tests) within the previous 3 months. One focus group discussion was conducted after the individual interviews and constituted of men and women aged between 21 and 79 years old. Table 1 (See additional file 1) represents the demographics of the study participants.
Malaria knowledge
Participants’ knowledge on the transmission of malaria.
Of the 261 participants, all (100%; 261) had heard about malaria, with about 95% (247/261) correctly associating malaria with mosquito bites. However, a small number of the participants had no knowledge about malaria transmission at all and this proportion differed significantly across the villages; Masetoni (5.8%), Tshamulavhu (1.5%), Tshihothi (12.2%) (P = 0.01). When asked about their general view of malaria, the majority of study participants (93.1%; 243/261) who had heard about malaria further demonstrated appropriate knowledge of malaria by recognizing it as a problem, stating that it is dangerous, that it can kill if not treated early, it’s a terrible or frightening illness; or by directly stating that it is a problem. However, only 1.9% (5/261) and 3.1% (8/261) of the study participants mentioned malaria signs and symptoms; and prevention methods, respectively. Although majority of study participants recognize malaria as a health problem in the community, only 2% (5/261) recognized the proximity of Kruger National Park to the study area as an important risk factor for the transmission of malaria. Of note, 97% (253/261) of participants who believe that malaria is dangerous and kills or see it as a health problem have been resident in the study area for at least 5 years. TABLE 2 (See additional file 2) shows the details on the knowledge and perception on malaria transmission of study participants.
TABLE 2: Reported knowledge and perception on malaria transmission; and its occurrence in Ha-Lambani area by village
Village name
|
Masetoni
n= 86
|
Tshihothi n= 41
|
Tshamulavhu
n= 134
|
Total n= 261
|
p value
|
1.1 Have you heard of malaria?
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
(α= 0.05)
|
Yes
|
86(100)
|
41(100)
|
134(100)
|
261(100)
|
-
|
No
|
0(0)
|
0(0)
|
0(0)
|
0(0)
|
-
|
1.2. Knowledge of malaria transmission
|
|
|
|
|
|
Mosquito bites
|
80(93)
|
36(87.8)
|
131(97.8)
|
247(94.6)
|
P=0.03
|
Don’t know
|
5(5.8)
|
5(12.2)
|
2(1.5)
|
12(4.6)
|
P=0.01
|
Other transmissionc
|
1(1.2)
|
0(0)
|
1(0
|
2(0.80
|
-
|
1.3. What is your general view of malaria?
|
|
|
|
|
|
It kills, dangerous, a lot or problematic
|
80(93)
|
39(95.1)
|
124(92.5)
|
243(93.1)
|
P=0.84
|
Mentions malaria symptom(s)
|
1(1.2)
|
0(0)
|
4(3)
|
5(1.9)
|
-
|
Mentions prevention method(s)
|
2(2.3)
|
1(2.4)
|
5(3.7)
|
8(3.1)
|
P=0.82
|
No comment
|
3(3.5)
|
1(2.4)
|
1(0.7)
|
5(1.9)
|
P=0.34
|
1.4. What can you say about its occurrence in the Ha-Lambani area in years
|
|
|
|
|
|
It kills, dangerous, a lot or problematic
|
75(87.2)
|
40(97.6)
|
131(97.8)
|
246(94.30
|
P=0.00
|
Mentions malaria symptom(s)
|
3(3.5)
|
0(0)
|
0(0)
|
3(1.1)
|
--
|
Mentions prevention method(s)
|
7(8.1)
|
0(0)
|
3(2.2)
|
10(3.8)
|
--
|
Othersd
|
1(1.2)
|
1(2.4)
|
0(0)
|
2(0.80
|
--
|
1.5. Length of stay in Ha-Lambani area in years
|
|
|
|
|
|
≤4
|
3(3.5)
|
1(2.4)
|
4(3)
|
8(3.1)
|
P=0.95
|
≥5
|
83(96.5)
|
40(97.6)
|
130(97.)
|
253(96.9)
|
P=0.95
|
1.6 Relating malaria to Kruger National Park
|
|
|
|
|
|
Yes
|
3(3.5)
|
0(0)
|
2(1.5)
|
5(1.9)
|
-
|
No
|
83(96.50
|
41(100)
|
132(98.5)
|
256(98.1)
|
-
|
Total
|
86(100)
|
41(100)
|
134(100)
|
261
|
|
Otherc transmission routes included drinking bad water and otherd perceptions of malaria in the Ha-Lambani village specifically included refusing to use the same alcohol cup as a person with malaria and no comment. Chi-square test for differences in prevalence across villages.
The study participants gave a wide range of sources of malaria information (Table 3). However, clinics (health centers) (84.7%; 221/261) were the most prominent sources. Family was also an information source in some villages, but not others (P = 0.03), while other sources were not commonly reported in any of the villages (Indoor residual Spraying (IRS) team, television, home-based care workers, neighbors or newspapers, P = 0.85). Additionally, friends were the least common source of malaria information (1.1%; 3/261).
Table 3
Reported sources of malaria information by village
Village name | Masetoni n = 86 | Tshihothi n = 41 | Tshamulavhu n = 134 | Total n = 261 | p value |
Source of malaria knowledge | n (%) | n (%) | n (%) | n (%) | α = 0.05 |
Radio | 0(0) | 3(7.3) | 3(2.2) | 6(2.3) | - |
School | 3(3.5) | 0(0) | 3(2.2) | 6(2.30 | - |
Clinic | 78(90.7) | 32(78.0) | 111(82.8) | 221(84.7) | P = 0.13 |
Friends | 1(1.2) | 0(0) | 2(1.5) | 3(1.10 | - |
Family | 1(1.2) | 5(12.2) | 12(9) | 18(6.9) | P = 0.03 |
Other sourcese | 3(3.5) | 1(2.4) | 3(2.20 | 7(2.7) | P = 0.85 |
Total | 86(100) | 41(100) | 134(100) | 261(100) | - |
Other sourcese of malaria information included Indoor residual Spraying team, television, home-based care workers, neighbors or newspaper. Chi-square test for differences in prevalence across villages.
Participants knowledge on malaria symptoms and treatment.
Malaria signs and symptoms such as headache, vomiting and diarrhea were the most frequently reported. However, participants also mentioned sweating, loss of appetite, fever and chills; and to a lesser extent fatigue, loss of weight, joint pains and others. One participant (0.4%, 1/261) did not know of any symptoms of malaria (FIGURE 2). Overall, about 99.2% (259/261) correctly identified at least one of the three most common symptoms of malaria (headache, chills and fever 1). However, only 21% (56/261) of the participants were able to correctly identify all 3 of these most common symptoms of malaria.
3.1.3 Participants knowledge on malaria treatment
The participants’ knowledge of malaria treatment was low, with only one participant mentioning quinine as a drug to treat malaria. However, a majority of the participants knew that effective treatments for malaria are available (98.08%; 256/261) and 83.5% (218/261) mentioned tablets/pills as medication for malaria treatment. Only 1.5% (4/261) of the respondents had no knowledge of any form of malaria treatment (TABLE 4).
TABLE 4: Reported knowledge of malaria treatment of participants by village
Village name | Masetoni n = 86 | Tshihothi n = 41 | Tshamulavhu n = 134 | Total n = 261 |
What do you know about malaria treatment? | n (%) | n (%) | n (%) | n (%) |
Pills | 77(89.5) | 31(75.6) | 110(88.8) | 218(83.5.) |
Quinine | 0(0) | 0(0) | 1(0.74) | 1(0.74) |
Clinic | 7(8.1) | 3(7.3) | 4(3) | 14(5.4) |
Drip (intravenous) | 0(0) | 1(2.4) | 1(0.7) | 2(0.8) |
Pills and/ medicine | 1(1.2) | 2(4.9) | 3(2.2) | 6(2.3) |
Pills and drips | 1(1.2 | 0(0) | 2(1.5) | 3(1.1) |
pills, drips(intravenous) | 0(0) | 2(4.9) | 3(2.2) | 5(1.9) |
Hospital | 0(0) | 1(2.4) | 0(0) | 1(0.4) |
Otherf | 6(7) | 0(0) | 1(0.7) | 7(2.7) |
None | 2(2.3) | 1(2.4) | 1(0.7) | 4(1.5) |
Total | 86(100) | 41(100) | 134(100) | 261(100) |
Otherf reported treatment options included mentioning that it works, those with malaria should adhere to it and that it is helpful.
Attitudes and practices towards Malaria.
Treatment seeking behavior of participants.
A total of 97.7% (255/261) of the participants had a positive attitude regarding seeking treatment by stating that they would take their child to clinic if they had symptoms such as fever. However, a small proportion (3%; 3/261) reported that they would either use Panado (paracetamol), pray or talk to their pastor (Table 5).
Table 5
Reported treatment seeking behavior of participants by Village
Treatment seeking behavior (when seeking child care e.g. when a child has fever) | Masetoni n = 86 | Tshihothi n = 41 | Tshamulavhu n = 134 | Total n = 261 |
n (%) | n (%) | n (%) | n (%) |
Consult at the clinic | 84(97.7) | 41(100) | 130(97) | 255(97.7) |
Give him Panado | 0(0) | 0(0) | 1(0.7) | 1(0.4) |
Praying, talk to the pastor then clinic | 0(0) | 0(0) | 2(1.5) | 2(0.8) |
Othersg | 2(2.3) | 0(0) | 1(0.7) | 3(1.1) |
Otherg steps to take when seeking childcare included calling the ambulance, giving the child boiled lemon leaves to drink and breastfeeding the child more.
Participants knowledge and practices on malaria prevention.
Most of the study participants were aware of malaria prevention measures (81.9%; 214/261). However, the rest of the study participants either did not know or mentioned an incorrect malaria prevention measure(s) such as using clean water, eating clean food and drinking soft drink. Amongst other prevention measures, wearing long-sleeved clothes (39.1%, 102/261) proved to be the most prominent in the study population; this was followed by using bednets (23.8%, 62/261) and these proportions differed across villages (Masetoni (48.8%), Tshamulavhu (44%), Tshihothi (2.4%; p = 0.00); Masetoni (27.9%), Tshamulavhu (26.1%), Tshihothi (7.3%, p = 0.03) respectively.
Also, most (85.4%; 223/261) of the study participants correctly reported removal of stagnant water and removal of used cow dung (for decorations), proper disposal of empty cans or keeping their compound clean as ways to prevent mosquito breeding. Many of these proportions differed significantly across villages (p = 0.00, p = 0.00, p = 0.00, p = 0.23, respectively) (TABLE 6: See additional file 3). Removal of stagnant water or covering water bodies was the most frequently reported measure to prevent mosquito breeding (47.9%; 125/261), however, some participants either did not know or mentioned incorrect mosquito breeding prevention measures. A high proportion of participants (98%; 256/261) reported that they adhere to the above-mentioned malaria prevention measures while the rest of the participants (2%, 5/261) either did so sometimes or did not adhere to any measure at all. Of note, 96.9% (253/261) of the study participants reported not to have slept under a bednet the previous night.
Participants’ reasons for participating in the study.
The study participants had different reasons for participating in the current study (FIGURE 3). Majority of the participants reported the need to know their health status followed by recognizing malaria studies as important or helpful to the community as reasons for participating. Also, the rest of the participants mentioned reasons such as malaria is a problem, they have suffered from malaria or to be more informed about malaria. To a lesser extent, participants mentioned that they will not need to travel long distances to get to the clinic to get tested for malaria
Knowledge of malaria transmission, symptoms, treatment and prevention stratified by gender, age, educational level and total household income.
Female participants had more knowledge on malaria transmission (77.4%, 151/195) compared to males 27.6% (44/195). Knowledge on malaria transmission knowledge was insignificantly higher for participants with secondary school education than other levels (p = 0.51) and significantly comparable (P = 0.05) for participants who were 30 years of age and below compared to those above 30 years. Participants who had resided in the village for 5 years and more had greater knowledge of malaria transmission compared to participants who stayed less than 5 years (p = 0.06).
The study participants’ knowledge on malaria symptoms was significantly higher for females than males (P = 0.00); and significantly lower for participants aged 30 and below compared to those above 30 years (P = 0.02). Moreover, the participants’ knowledge on malaria treatment and prevention was significantly higher for females than males (P = 0.00), (P = 0.00) respectively. Total household income was not associated with participants knowledge on malaria transmission, symptoms, treatment or prevention (TABLE 7: see additional file 4).
TABLE 6: Reported knowledge on malaria prevention and practices of participants by village.
Village name
|
Masetoni n=86
|
Tshihothi n=41
|
Tshamulavhu n=134
|
Total n=261
|
p value
|
Characteristic
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
α= 0.05
|
2.3. Knowledge of malaria prevention
|
|
|
|
|
|
Using bednets
|
24(27.9)
|
3(7.3)
|
35(26.1)
|
62(23.8)
|
P=0.03
|
Burning cow dung/ Musuzungwane plant leaves (Lippia javanica)
|
10(11.6)
|
5(12.2)
|
28(20.9)
|
43(16.5)
|
P=0.14
|
Removal of dirty or stagnant water
|
13(15.1)
|
0(0)
|
9(6.7)
|
22(8.4)
|
|
Removal of used cow dung
|
0(0)
|
0(0)
|
(2.2)3
|
3(1.1)
|
|
Wearing long sleeved clothes
|
42(48.8)
|
1(2.4)
|
59(44)
|
102(39.1)
|
P=0.00
|
using mosquito repellants
|
5(5.8)
|
3(7.3)
|
5(3.7)
|
13(5)
|
P=0.59
|
Using mosquito coils
|
5(5.8)
|
1(2.4)
|
12(9)
|
18(6.9)
|
P=0.32
|
Burying empty cans
|
7(8.1)
|
1(2.4)
|
5(3.7)
|
13(5)
|
P=0.24
|
Keeping cleanliness
|
10(11.6)
|
1(2.4)
|
13(9.7)
|
24(9.2)
|
P=0.23
|
Allow IRS workers to spray your house
|
8(9.3)
|
3(7.3)
|
8(6)
|
19(7.3)
|
P=0.27
|
Closing windows
|
8(9.3)
|
4(9.8)
|
4(3)
|
16(6.1)
|
P=0.09
|
Clinic/ treatment
|
1(1.2)
|
2(4.9)
|
3(2.2)
|
6(2.3)
|
P=0.42
|
Don’t know
|
0(0)
|
3(7.3)
|
1(0.7)
|
4(1.5)
|
--
|
Otherh
|
1(1.2)
|
1(2.4)
|
6(4.5)
|
8(3.1)
|
P=0.37
|
3.1. Knowledge of preventing mosquito breeding
|
|
|
|
|
|
Removal of dirty, stagnant water or covering water holes
|
47(54.7)
|
1(2.4)
|
77(57.5)
|
125(47.9)
|
P=0.00
|
Removal of used cow dung
|
10(11.6)
|
27(65.9)
|
25(18.7)
|
62(23.8)
|
P=0.00
|
Proper tin disposal
|
29(33.7)
|
1(2.4)
|
20(14.9)
|
50(19.2)
|
P=0.00
|
Clean compound
|
8(9.3)
|
8(19.5)
|
25(18.7)
|
33(12.6)
|
P=0.14
|
Don’t know
|
3(3.5)
|
1(2.4)
|
5(3.7)
|
9(3.4)
|
P=0.92
|
Incorrect measuresi
|
14(16.3)
|
10(24.4)
|
5(3.7)
|
29(11.1)
|
P=0.00
|
3.2. Adherence to preventative measures
|
|
|
|
|
|
Yes
|
85(98.8)
|
41(100)
|
130(97)
|
256(98)
|
-
|
No
|
0(0)
|
0
|
1(0.7)
|
1(0)
|
-
|
Sometimes
|
1(1.2)
|
0
|
3(2.2)
|
4(2)
|
-
|
3.1. Did you sleep under a bednet last night?
|
|
|
|
|
|
Yes
|
2(2.3)
|
0
|
6(4.5)
|
8(3.1)
|
-
|
No
|
84(97.7)
|
41(100)
|
128(95.5)
|
253(96.9)
|
-
|
Percentage total exceed 100 because of multiple responses. Otherh prevention measures included the use of clean water, fans, clean food, drinking stoney soft drink to prevent malaria. Incorrect prevention measuresi included the use of bednets, closing windows, shaking off curtains, wearing long sleeved clothes, burning mosquito coils or using mosquito repellants. Chi-square test for differences in prevalence across villages.
TABLE 7: Knowledge of malaria stratified by gender, age, educational level and total household income
Characteristic
|
Total n=261
|
Knowledge on malaria
|
P value
|
Knowledge on malaria transmission
|
P value
|
Knowledge on malaria Symptoms
|
P value
|
Knowledge on malaria treatment
|
P value
|
Knowledge on malaria prevention
|
P value
|
Gender
|
Male
|
48(18.39)
|
48(18.39)
|
P=0. 76
|
44(22.6)
|
P=0.00
|
94(36.6)
|
P=0.00
|
73(28.40
|
P=0.00
|
74(28.8)
|
P=0.00
|
|
Female
|
213(81.61)
|
213(81.61)
|
P=0. 76
|
151(77.4)
|
P=0.00
|
163(63.4)
|
P=0.00
|
184(71.6)
|
P=0.00
|
183(71.2)
|
P=0.00
|
Total
|
|
261
|
261
|
|
195
|
|
257
|
|
257
|
|
257
|
|
Age
|
≤30
|
69(26.4)
|
69(26.44)
|
P=0.02
|
66(26.5)
|
P=0.05
|
75(29.2)
|
P=0.02
|
67(26.1)
|
P=0.166
|
68(26.5)
|
P=0.31
|
|
31-50
|
103(39.5)
|
103(39.46)
|
P=0.38
|
100(40.2)
|
P=0.12
|
95(36.96)
|
P=0.12
|
98(38.1)
|
P=0.10
|
102(39.7)
|
P=0.16
|
|
>50
|
89(34.1)
|
89(34.1)
|
P=0.35
|
83(33.3)
|
P=0.73
|
87(33.85)
|
P=0.53
|
92(35.8)
|
P=0.33
|
87(33.9)
|
P=0.73
|
Total
|
|
261
|
261
|
|
249
|
|
257
|
|
257
|
|
257
|
|
Educational level
|
No formal education
|
54(20.7)
|
54(20.7)
|
P=0.71
|
47(18.9)
|
P=0.37
|
54(21.7)
|
P=0.06
|
53(20.62)
|
P=0.54
|
52(20.3)
|
p=0.61
|
|
Primary
|
67(25.7)
|
67(25.7)
|
P=0.11
|
67(26.9)
|
P=0.13
|
59(23.7)
|
P=0.13
|
66(25.68)
|
P=0.29
|
64(25)
|
p=0.17
|
|
secondary
|
132(50.6)
|
132(50.6)
|
P=0.00
|
116(46.6)
|
P=0.51
|
125(50.2)
|
P=0.09
|
132(51.36)
|
P=0.79
|
130(50.8)
|
P=0.18080
|
|
Tertiary
|
8(3.1)
|
8(3.10
|
P=0.95
|
19(7.6)
|
P=0.06
|
11(4.4)
|
P=0.19
|
6(2.33)
|
P=1.109
|
10(3.91)
|
P=0.85
|
Total
|
|
261
|
261
|
|
249
|
|
249
|
|
257
|
|
256
|
|
Total household income
|
<3000
|
250(95.8)
|
250(95.8)
|
P=0.29
|
239(94.1)
|
P=0.07
|
244(94.9)
|
P=0.21
|
246(95.7)
|
P=0.83
|
248(96.5)
|
-
|
|
3000-10000
|
8(3.1)
|
8(3.1)
|
P=0.19
|
12(4.7)
|
P=0.03
|
8(3.1)
|
P=0.16
|
7(2.7)
|
P=1.10
|
6
|
-
|
|
>10000
|
3(1.1)
|
3(1.1)
|
-
|
3(1.2)
|
-
|
5(1.9)
|
-
|
4(1.6)
|
-
|
3(2.3)
|
-
|
Total
|
|
261
|
261
|
|
254
|
|
257
|
|
257
|
|
257
|
|
Length of stay in Ha-Lambani area in years
|
<4
|
8(3.07)
|
8(3.07)
|
P=0.60
|
8(4.52)
|
p=0.00
|
9(3.46)
|
P=0.92
|
9(3.5)
|
P=0.75
|
13(5)
|
P=0.30
|
|
≥5
|
253(96.93)
|
253(96.93)
|
P=0.60
|
169(95.5)
|
P=0.00
|
251(96.54)
|
P=0.92
|
251(97.67)
|
P=0.75
|
247(95)
|
P=0.30
|
|
|
261
|
261
|
|
177
|
|
260
|
|
260
|
|
260
|
|
Outcome of the focus group discussion.
Overall, the focus group discussion concurred with the questionnaires, however, with a few ideas added.
Knowledge of malaria transmission.
The study participants had heard of malaria and correctly associated it with mosquito bites as the mode of transmission. Others mentioned the close proximity of the village to Kruger National Park as a risk factor of malaria. When asked of their general knowledge or view of malaria, many mentioned that poor practice of malaria prevention measures such as uncleanliness, sleeping with open windows at night, poor disposal of empty cans and diapers, leaving small water dams unattended attracts mosquitoes resulting in malaria; malaria symptoms such as headache, vomiting and body weakness leading to inability to walk; as well as malaria transmission briefly described in the quotes below:
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“What I know or think about malaria is that it is caused by mosquitoes. Theses mosquitoes come after biting animals that we have in our very own Kruger National Park that we live next to. This is how malaria comes about. When the mosquito bites us as humans whether asleep or awake, it vomits the blood from the animals. That blood from the animals has poison, which is now introduced to the human body. That poison affects your body and results in you not feeling well. You may start feeling cold, get a headache or start vomiting. That’s the little that I know.”
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“Once a malaria mosquito bites, it can bite a lot of people in that same household.”
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“Sleeping with open windows at night makes one to be bitten by mosquitoes carrying the malaria parasite”.
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“Also, in this generation, you will find a bucket with diapers in the house, if it doesn’t get full or pop from the bottom or something, it will never be removed or emptied! It will only be emptied once the smell becomes unbearable.”
The participants mentioned the local health clinic, school, family, Indoor residual Spraying (IRS) team and firsthand experience as the source of malaria information, with more emphasis on the local health clinic. Additionally, in the past, the IRS team would also give medication to those showing malaria symptoms immediately. Participants originally knew malaria as “Mudinyane” which would easily go away once you vomit sometimes, even without taking medication.
Knowledge of malaria symptoms.
The symptoms of malaria were clearly recognized by focus group participants. Additionally, deafness and sleepiness/exhaustion emerged. Although headache was mentioned in the questionairres, it was however further described in the quote below:
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“It aches differently from other headaches; you feel it on the forehead and you cannot even walk because of it.’’
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“It will ache as pins and needles mainly on the forehead, you will feel like your eyes cannot look up.”
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“On your feet, your knees tremble, you cannot walk long distances without resting and feeling like you are losing your breath.”
Knowledge and practice of malaria prevention measures.
Additionally, prevention measures described were using Bunganyunu plant” (Lippia javanica) which is kept in the room for a short while before sleeping. The smell is reported to drive away mosquitoes. Lastly, in addition to burning cow dung, burning tissue or egg holder cardboard of which, the smoke drives away the mosquitoes was also mentioned. Regarding bednet usage, only one participant owned a bednet and used it while the rest of the participants did not use bed-nets due to the reasons expressed in the quote below:
We would like to use the bednets but we don’t have them. We cannot afford it, we can’t use one for everyone in the house, it’s expensive to buy for everyone in the house.” If the government can consider us and give us, we would gladly use it.
Most of the study participants correctly reported removal of stagnant water or removal of used cow dung (commonly used for soil-based floor decorations), proper disposal of empty cans and diapers or keeping their compound clean as ways to prevent mosquito breeding with removal of stagnant water or covering water bodies with soil as the most frequently reported measure to prevent mosquito breeding. This is supported by the quote below:
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“Getting rid of cow dung around the compound, once we do that the mosquito will be ashamed to even come to a clean place.”
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“If there are small water dams around the house, I need to fill them with soil so that water is not stagnant.”
In addition, adding bleach (Jik) or salt grains in water drums to keep away mosquitoes emerged as methods to prevent mosquito breeding which were not mentioned from the individual questionnaires.
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“Another is to use bleach in rain water we collected into water drums, to keep that water clean.”
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“If it rained for example, and I collect water into water drums, I add a granule of salt into the water so that mosquitoes won’t enter and breed.”
Knowledge of malaria treatment and; treatment seeking behavior.
Focus group participants knew that effective treatments for malaria are available. They further described malaria medication in the following quotations:
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“Medication for malaria is a malaria drip (intravenous) containing a colorless water like liquid, pills (which are yellow in color of which the dosage is in hours) and malaria injections”.
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“There’s another medication, I just do not know what it is called, it is a drip. They inject you; it is effective. They absorb it from a small bottle using an injection and inject it into the drip. You will not even take an hour before you become conscious again. It is very effective.’’
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“The yellow pills are bitter, and they (health workers) recommend that we take them with milk, so they can work faster.”
These yellow pills are actually artemether-lumefantrine. In addition, participants mentioned that in the past, malaria medication would be distributed as pills (white in color) in the community by malaria IRS workers so that they can use them once malaria symptoms show. These are actually chloroquine or Sulphadoxine-Pyrimethmine (SP) used in the 1990s for malaria treatment in South Africa) 18. However, this was later discontinued because girls started using them to terminate pregnancies.
The participants had a positive treatment seeking behavior by stating that they would take their child to the clinic if they had symptoms such as fever. This supported by the quote below:
I would take the child to the clinic to be tested for malaria.