Socio-demographic characteristics
A total of 243 respondents were interviewed during the period between February and April 2020 (Table 1). They comprised of males (47%, 113/243) and females (53%, 130/243) females. Most of them were over thirty years old (167%, 162/243) and had primary education (60%, 146/243). The next majority was below the primary level of education (33%, 81/243). The most common occupation reported by respondents was crop farming (87%, 211/243). Most of the study households had children below 5 years (63%, 153/243) and/or 5-15 years old (74%, 181/243).
Table 1 Demographics of respondents and households from Changa, Mfumbwe and Mkuyuni village during the study period
Category
|
Changa
N = 103 n (%)
|
Mfumbwe
N = 68 n (%)
|
Mkuyuni
N = 72 n (%)
|
Total
N = 243 n (%)
|
Age of the respondents (years)
|
17-30
|
35 (34)
|
17 (25)
|
29 (40)
|
81 (33)
|
30+
|
68 (66)
|
51 (75)
|
43 (60)
|
162 (67)
|
Sex of the respondents
|
Male
|
44 (43)
|
38 (56)
|
31 (43)
|
113 (47)
|
Female
|
59 (57)
|
30 (44)
|
41 (57)
|
130 (53)
|
Level of education of the respondents
|
Below primary
|
43 (42)
|
20 (29)
|
18 (25)
|
81 (33)
|
Primary
|
57 (55)
|
45 (66)
|
44 (61)
|
146 (60)
|
Above primary
|
3 (3)
|
3 (4)
|
10 (14)
|
16 (7)
|
Occupation of the respondents
|
Farming
|
95 (92)
|
64 (94)
|
52 (72)
|
211 (87)
|
Livestock keeping
|
2 (2)
|
1 (1)
|
2 (3)
|
5 (2)
|
Employed
|
4 (4)
|
1 (1)
|
2 (3)
|
7 (3)
|
Business
|
2 (2)
|
2 (3)
|
16 (22)
|
20 (8)
|
Number of households with children
|
<5 years of age
|
63 (61)
|
50 (74)
|
40 (69)
|
153 (63)
|
5-15 years of age
|
73 (71)
|
57 (84)
|
51 (71)
|
181 (74)
|
Knowledge of malaria disease and interventions
When asked about the vector of malaria, 53% (129/243) of the respondents cited Anopheles mosquitoes. Eighty-five (n=85) of those cited explicitly that it was female Anopheles mosquitoes. The rest of the respondents (47%, 114/243) were aware that malaria is transmitted by mosquitoes but was not sure of the name of the mosquito. The most commonly reported mosquito breeding sites were water bodies (75%, 182/243) and rubbish (24%, 58). Interestingly, half of the respondents (50%, 121/243) knew that they could still get malaria if bitten during the day (morning or late evening). Concerning the age group(s) at high risk of malaria, a significant proportion of respondents were able to cite the under-five children (61%, 148/243). The rest of the respondents responded to either the adults (6%, 15/243) or both the under-five children and adults (30%, 74/243). When asked about the ways of controlling malaria, most respondents mentioned bed nets (64%, 156/243). Other reported measures were cleaning surroundings (19%, 47/243), spraying houses with chemicals (1%, 3/243), and a combination of measures (15%, 37/243). Windows (46%, 112/243) were the most commonly cited mosquito’s entry route. Other reported routes were eave opening (10%, 25/243) and opening on the walls (4%, 9/243). The next majority (37%, 91/243) cited more than one mosquito entry route. Most respondents (84%, 205/243) were aware that screening their windows would protect them from mosquitoes and malaria thereof. Furthermore, they affirmed that the risk of contracting malaria was much higher during the wet season. The results are summarized in Table 2.
Attitudes towards malaria interventions
When asked about the performance of bednets, 47% (113/243) of the respondents doubted that bednets can still reduce malaria. However, with an exception of 26% (29/113) of the respondents who said that mosquitoes can penetrate even intact nets, the rest (64%, 84/113) were not sure of the reason(s). Interestingly, most respondents (85%, 206/243) were aware and trusted that screening their windows reduces mosquitoes inside their houses and thereof malaria transmission.
Table 2 Respondent reported knowledge about malaria at Changa, Mfumbwe and Mkuyuni village during the study period
|
Changa
n (%)
|
Mfumbwe
n (%)
|
Mkuyuni
n (%)
|
Total
n (%)
|
Do you know the type of mosquito that transmits malaria?
|
Anopheles
|
18 (17)
|
14 (21)
|
13 (18)
|
45 (18)
|
Female Anopheles
|
43 (42)
|
18 (26)
|
23 (32)
|
84 (35)
|
Not sure
|
42 (41)
|
36 (53)
|
36 (50)
|
114 (47)
|
In which of these areas do mosquitoes breed?
|
Water bodies
|
67 (65)
|
52 (76)
|
63 (88)
|
182 (75)
|
Rubbish
|
33 (32)
|
16 (24)
|
9 (12)
|
58 (24)
|
Don’t know
|
3 (3)
|
0 (0)
|
0 (0)
|
3 (1)
|
Can you get malaria if bitten during the day?
|
Yes
|
50 (49)
|
31 (46)
|
40 (56)
|
121 (50)
|
No
|
35 (34)
|
37 (54)
|
32 (44)
|
104 (43)
|
Don’t know
|
18 (17)
|
0 (0)
|
0 (0)
|
18 (7)
|
Which of these groups have a high risk of getting malaria?
|
Children <5 years
|
49 (47)
|
38 (56)
|
61 (85)
|
148 (61)
|
Adults
|
9 (9)
|
5 (7)
|
1 (1)
|
15 (6)
|
Both groups
|
45 (44)
|
19 (28)
|
10 (14)
|
74 (30)
|
Don’t know
|
0 (0)
|
6 (9)
|
0 (0)
|
6 (3)
|
Can you name ways for controlling malaria?
|
Use of Insecticide-treated Nets (ITNs)
|
65 (63)
|
52 (76)
|
39 (54)
|
156 (64)
|
Cleaning surroundings
|
23 (22)
|
15 (22)
|
9 (13)
|
47 (19)
|
Spraying chemicals
|
1 (1)
|
1(2)
|
1 (1)
|
3 (1)
|
Multiple ways
|
14 (14)
|
0 (0)
|
23 (32)
|
37 (15)
|
Do you know the entry points of mosquitoes into the house?
|
Window openings
|
45 (44)
|
37 (55)
|
30 (42)
|
112 (46)
|
Eave opening
|
15 (14)
|
6 (9)
|
4 (6)
|
25 (10)
|
Wall openings
|
3 (3)
|
3 (4)
|
3 (4)
|
9 (4)
|
Multiple points
|
37 (36)
|
22 (32)
|
32 (44)
|
91 (37)
|
Don’t know
|
3 (3)
|
0 (0)
|
3 (4)
|
6 (3)
|
Does screening of windows prevent malaria?
|
Yes
|
81 (79)
|
62 (91)
|
62 (86)
|
205 (84)
|
No
|
22 (21)
|
6 (9)
|
10 (14)
|
38 (16)
|
In which season of do we experience a high risk of malaria transmission?
|
Dry season
|
10 (10)
|
18 (27)
|
4 (6)
|
32 (13)
|
Rain season
|
91 (88)
|
47 (69)
|
63 (87)
|
201 (83)
|
Don’t know
|
2 (2)
|
3 (4)
|
5 (7)
|
10 (4)
|
Practices related to malaria disease and interventions
Most of the respondents (70%, 170/243) reported confirming whether they had malaria or not by presenting themselves to health facilities for diagnosis. The rest (30%, 73/243) still relied on clinical symptoms. When asked whether they at times opted self-medication without a confirmatory diagnosis, 38% (92/243) of the respondents asserted to that. Interestingly, however, a vast majority (96%, 233/243) preferred using modern remedies and extremely few (4%, 10/243) still trusted herbal remedies. 18% (43/243) of the respondents had lost family members in the past due to malaria and are therefore still concerned about the disease. Some respondents reported up to 5 deaths of their family members and/or close relatives in the past. Insecticide-treated nets (ITNs) remain the most predominantly used malaria control measure in the study area. When asked about malaria control measures, 91% (221/243) of the respondents cited bednets. Indeed, 79% (192/243) owned at least one ITN and 76% (184/243) claimed to have slept under an ITN the previous night. Other cited malaria control measures included cleaning surroundings (6%, 14/243), spraying chemicals (1%, 3/243) and other means (2%, 5/243). The results are summarized in Table 3.
Table 3 Respondent reported practices related to malaria
|
Changa
n (%)
|
Mfumbwe
n (%)
|
Mkuyuni
n (%)
|
Total
n (%)
|
How do you often confirm that you have malaria?
|
Disease symptoms
|
35 (24)
|
15 (22)
|
23 (32)
|
73 (30)
|
Visit a health facility
|
68 (66)
|
53 (78)
|
49 (68)
|
170 (70)
|
Do you sometimes use anti-malarial drugs without confirmation from a health facility?
|
Yes
|
44 (43)
|
24 (35)
|
24 (33)
|
92 (38)
|
No
|
59 (57)
|
44 (65)
|
48 (67)
|
151 (62)
|
Do you sometimes treat malaria using traditional remedies?
|
Yes
|
7 (7)
|
7 (10)
|
3 (4)
|
17 (7)
|
No
|
96 (93)
|
61 (90)
|
69 (96)
|
226 (93)
|
Which local remedies do you often use to treat malaria?
|
Neem plant
|
7 (7)
|
4 (6)
|
1 (1)
|
12 (5)
|
Lime fruits
|
4 (4)
|
5 (7)
|
1 (1)
|
10 (4)
|
Others
|
3 (3)
|
2 (3)
|
1 (1)
|
6 (2)
|
What do you prefer between modern and traditional remedies?
|
Modern remedies
|
97 (94)
|
65 (96)
|
71 (99)
|
233 (96)
|
Traditional remedies
|
6 (6)
|
3 (4)
|
1 (1)
|
10 (4)
|
Have you lost any family member(s) due to malaria?
|
Yes
|
15 (15)
|
14 (21)
|
14 (19)
|
43 (18)
|
No
|
86 (83)
|
54 (79)
|
58 (81)
|
198 (81)
|
Not sure
|
2 (2)
|
0 (0)
|
0 (0)
|
2 (1)
|
How do you control malaria?
|
Use of ITNs
|
94 (91)
|
64 (94)
|
63 (87)
|
221 (91)
|
Cleaning surroundings
|
7 (7)
|
3 (5)
|
4 (6)
|
14 (6)
|
Spraying chemicals
|
1 (1)
|
1 (1)
|
1 (1)
|
3 (1)
|
Other means
|
1 (1)
|
0 (0)
|
4 (6)
|
5 (2)
|
Do you own a bednet(s)
|
Yes
|
72 (70)
|
60 (88)
|
60 (83)
|
192 (79)
|
No
|
31 (30)
|
8 (12)
|
12 (17)
|
51 (21)
|
Did you sleep under an ITN last night?
|
Yes
|
68 (66)
|
55 (81)
|
61 (85)
|
184 (76)
|
No
|
35 (34)
|
13 (19)
|
11 (15)
|
59 (24)
|
Do you sometimes spray your houses with chemicals?
|
Yes
|
12 (12)
|
3 (4)
|
17 (24)
|
32 (13)
|
No
|
91 (88)
|
65 (96)
|
55 (76)
|
211 (87)
|
How frequently do you spray?
|
Every other day
|
0 (0)
|
0 (0)
|
4 (6)
|
4 (2)
|
Every 3 months
|
3 (3)
|
1 (2)
|
5 (7)
|
9 (4)
|
Every 6 months
|
1 (1)
|
1 (2)
|
3 (4)
|
5 (2)
|
Variable
|
8 (8)
|
2 (3)
|
5 (7)
|
15 (6)
|
Demographic/household risk factors for malaria transmission
The night-time cooking still took place predominantly outdoors (77%, 187/243), more so during the dry season (62%, 116/187). Most respondents (54%, 101/187) reported finishing cooking normally on and after 20:00h. The rest (47%, 88/187) normally finished cooking around 19:00h. Most respondents reported going to bed around 20:00h (40%, 97/243) and ≥21:00h (45%, 109/243). When asked about gatherings and/or ceremonies taking place outdoors during night-time, most respondents (58%, 141/243) reported that they still take place and that people may spend more than three nights outdoors (51%, 121/243) oftentimes without any protection against malaria (61%, 89/243). About 39% (55/243) claimed to protect themselves against malaria during those events, but they could not substantiate how they achieved that. The results are summarized in Table 4.
Table 4 Demographic/household outdoor malaria transmission risk features documented across study villages during the study period
|
Changa
n (%)
|
Mfumbwe
n (%)
|
Mkuyuni
n (%)
|
Total
n (%)
|
Do you cook outside during night-time?
|
Yes
|
78 (76)
|
51 (75)
|
58 (81)
|
187 (77)
|
No
|
25 (24)
|
17 (25)
|
14 (19)
|
56 (23)
|
What time do you normally finish cooking?
|
Around 19:00h
|
33 (42)
|
20 (39)
|
35 (60)
|
88 (47)
|
Around 20:00h
|
5 (7)
|
12 (24)
|
11 (19)
|
28 (15)
|
≥21:00h
|
42 (54)
|
19 (37)
|
12 (21)
|
73 (39)
|
Do you also cook outside during wet season?
|
Yes
|
37 (47)
|
26 (51)
|
8 (14)
|
71 (38)
|
No
|
41 (52)
|
25 (49)
|
50 (86)
|
116 (62)
|
What time do you normally go to bed?
|
Around 19:00h
|
12 (12)
|
10 (15)
|
15 (21)
|
37 (15)
|
Around 20:00h
|
39 (38)
|
26 (38)
|
32 (44)
|
97 (40)
|
≥21:00h
|
52 (50)
|
32 (47)
|
25 (35)
|
109 (45)
|
Do you sometimes spend nights outdoors during ceremonies/events?
|
Yes
|
56 (54)
|
43 (63)
|
42 (58)
|
141 (58)
|
No
|
47 (36)
|
25 (37)
|
30 (42)
|
102 (42)
|
How many consecutive nights do people spend in one event?
|
1 night
|
35 (34)
|
26 (38)
|
15 (21)
|
76 (31)
|
2 nights
|
20 (19)
|
11 (16)
|
12 (17)
|
43 (18)
|
≥3 nights
|
48 (47)
|
31 (46)
|
45 (62)
|
124 (51)
|
Do you use any protection against mosquitoes in such events?
|
Yes
|
19 (34)
|
9 (21)
|
27 (64)
|
55 (39)
|
No
|
37 (66)
|
34 (79)
|
15 (36)
|
86 (61)
|