Sociodemographic characteristics
Of the total 1311 participants, the majority 901 (68.7%) were females and married couples 1034 (78.9%). The mean age was 37 ± 12.8 years, and the highest number of participants 483 (36.9%) was within the age range of 26-34 years. More than half (768(58.7%)) of the respondents had no formal education, and the majority (978(74.7%)) were farmers. Regarding house ownership, 1046 (79.8) had their own houses and the majority of the study participants (959 (73.2%) had two and more rooms with the majority 870 (66.4%) had one sleeping space (Table 1).
Variables
|
Category
|
Frequency
|
Percent
|
Sex
|
Female
|
901
|
68.7
|
Male
|
410
|
31.3
|
Age category
|
<25
|
273
|
20.8
|
26-34
|
483
|
36.9
|
35-44
|
278
|
21.2
|
>45
|
277
|
21.1
|
Marital Status
|
Divorced/Separated
|
79
|
6.0
|
Married
|
1034
|
78.9
|
Single
|
103
|
7.9
|
Windowed
|
95
|
7.2
|
Educational
|
Diploma and above
|
26
|
2.0
|
Grade 1-4
|
190
|
14.5
|
Grade 5-8
|
194
|
14.8
|
Grade 9-12
|
132
|
10.1
|
No Formal Education
|
768
|
58.7
|
Occupation
|
Employed
|
74
|
5.6
|
Unemployed
|
68
|
5.2
|
Daily Laborer
|
116
|
8.8
|
Trading
|
75
|
5.7
|
Farmer
|
978
|
74.7
|
Ownership house
|
My Own
|
1046
|
79.8
|
Rent House
|
265
|
20.2
|
Number of rooms
|
1
|
352
|
26.8
|
2
|
481
|
36.7
|
3
|
396
|
30.2
|
4
|
72
|
5.5
|
5
|
8
|
.6
|
6
|
2
|
.2
|
Number of sleeping space
|
1
|
870
|
66.4
|
2
|
352
|
26.8
|
3
|
68
|
5.2
|
4
|
21
|
1.6
|
Total
|
|
1311
|
100.0
|
Knowledge about malaria causes, symptoms, and prevention
Out of the 1311 study participants included in the study, 1243 (94.1%) reported that they had heard of malaria, and of those, 714 (61.9%) reported that malaria is transmitted by mosquito bites and however, some participants reported other factors as possible means of malaria transmission, 421 (32.1%) reported malaria is transmitted by mosquito and other including Cold or changing weather, drinking dirty water, eating immature sugarcane and hunger. Overall, 37 (2.8%) of the participants did not know how malaria is transmitted. The majority of the participants 1014 (77.3%) mentioned malaria is bitted during the night time and 25 (1.9%) of the participants did not know when the mosquito bites. The majority of the participants 946 (72.2%) mentioned malaria mosquito nets as an indoor preventive measure against malaria and 981 (74.8%) mentioned that avoiding stagnant water is the outdoor preventive method of malaria. Approximately, two-thirds (65.1%, n = 854) [95%CI: 62.6%–67.5%] of participants had good knowledge of the cause, signs and symptoms, place and time for health-seeking and preventive measures of malaria (Table 2).
Participants were mostly (46.4%) informed about malaria by health workers, specifically by health extension workers (HEWs) (23%) and health professionals working in health facilities (23.4%) (Figure 1).
Table 1: Knowledge of the study participants towards malaria in Andasa cluster, Northwest Ethiopia, 2023.
Variables
|
Category
|
Frequency
|
Percent
|
Have you ever heard of an illness called malaria?
|
Yes
|
1234
|
94.1
|
No
|
77
|
5.9
|
Malaria transmission
|
Mosquito bites
|
714
|
54.5
|
Mosquito and others
|
421
|
32.1
|
Cold or changing weather
|
32
|
2.4
|
Drinking dirty water
|
33
|
2.5
|
Eating immature sugarcane
|
40
|
3.1
|
Hunger
|
34
|
2.6
|
Don't know
|
37
|
2.8
|
When do mosquitoes mostly bite
|
Any time
|
241
|
18.4
|
During the daytime
|
31
|
2.4
|
During the nighttime
|
1014
|
77.3
|
I do not know
|
25
|
1.9
|
Indoor-preventing methods for malaria
|
Fumigation
|
104
|
7.9
|
Insecticide residual spray
|
174
|
13.3
|
Insecticide-treated bed net
|
946
|
72.2
|
Keep windows and doors closed in the evening
|
87
|
6.6
|
outdoor-preventing methods for malaria
|
Avoid stagnant water
|
981
|
74.9
|
Avoid weeds
|
239
|
18.2
|
Insecticide spray
|
91
|
6.9
|
When to seek treatment if feel sick?
|
Beyond 24 hours
|
512
|
41.6
|
Within 24 hours
|
728
|
58.4
|
Where do you seek treatment if you suspect malaria?
|
Health facility
|
1277
|
97.3
|
Holy water
|
1
|
0.1
|
Pharmacy/drugstore
|
25
|
1.9
|
Self-treatment
|
6
|
0.5
|
Traditional healers
|
2
|
0.2
|
Overall, Knowledge level
|
Good knowledge
|
854
|
65.1
|
Poor knowledge
|
457
|
34.9
|
|
Total
|
1311
|
100
|
Attitude towards malaria
Overall, 90.6% of the study participants believe that anyone can be infected with malaria and 95.2% perceived the disease as life-threatening (fatal). The majority of the participants 94.2%, perceived malaria as a preventable disease. Furthermore, 89.7% of participants indicated the necessity to be tested before malaria treatment initiation, and 94.8% perceived to visit health centers when they fell sick. However, 25.2% believed that malaria could be cured without medical treatment.
Considering the total score of attitudes nearly half of the participants (49.1 % (n = 644) [95% CI: 46.5–52.2%] had a positive attitude (Table 3).
Table 2: Attitudes of the study participants towards malaria in Andasa cluster, Northwest Ethiopia, 2023.
Variables
|
Strongly agree
|
agree
|
Undecided
|
disagree
|
Strongly disagree
|
Total
|
Anyone can be infected with malaria
|
20.8
|
69.8
|
2.6
|
4.7
|
2.1
|
100.0
|
Blood smear is necessary for malaria diagnosis
|
20.5
|
69.2
|
7.2
|
2.3
|
.8
|
100.0
|
Do you think the presence of mosquitoes bothers you
|
19.2
|
73.7
|
4.4
|
2.0
|
.7
|
100.0
|
I believe in visiting the health center/clinic when I feel sick
|
21.9
|
72.9
|
3.7
|
.8
|
.7
|
100.0
|
Do you think malaria is a preventable disease
|
22.6
|
71.6
|
4.0
|
1.2
|
.6
|
100.0
|
I think malaria is a serious and life-threatening (fatal) disease
|
68.8
|
26.4
|
3.2
|
.8
|
.8
|
100.0
|
I believe sleeping under a mosquito net during the night is one way to prevent myself from getting malaria
|
24.7
|
71.8
|
2.6
|
.3
|
.6
|
100.0
|
I think it is risky when malaria medicine is not taken properly and completely
|
23.7
|
69.9
|
4.2
|
1.1
|
1.1
|
100.0
|
I feel like I should visit the health centers to get my blood tested if I suspect malaria
|
20.7
|
72.2
|
4.4
|
2.2
|
.5
|
100.0
|
Recovering from malaria without getting any treatment is possible
|
3.6
|
21.6
|
4.2
|
40.8
|
29.8
|
100.0
|
Overall Attitude
|
Positive
|
644
|
49.1
|
|
|
|
Negative
|
667
|
50.1
|
|
|
|
Total
|
|
1311
|
100
|
|
|
|
Practice of malaria prevention
Forty-five percent (86.3%, n = 1132) of the study participants reported that their households owned bed nets. Seventy-seven percent of participants used the LLINs during the previous night of the data collection. The proportion of participants who reported using nets always was 54.3%, sometimes 37.8%, and never used were 7.9%). Forty-seven percent of their family members (46.8%) reported using LLINs always, 41.7% sometimes, and 11.5% never used them. The main reason for not using the LLINs was no malaria 48, (3.7%), feeling too hot when sleeping under a net 66 (5%,) and don’t have access to a bed net 87 (6.6%), and feeling suffocation 44 (3.4%). In the study, 86.3%, (n = 1132) of participants stated that their households owned bed nets and the majority (77%) of participants used the LLINs on the night before the data collection. The habit of LLIN usage among participants was as follows: 54.3% always used nets, 37.8% sometimes used nets, and 7.9% never used nets. Additionally, 46.8% of family members always used LLINs, 41.7% sometimes used them, and 11.5% never used them. The main reasons for not using the LLINs were: not having malaria (3.7%), feeling too hot under the net (5%), lack of access to a bed net (6.6%), and feeling suffocated (3.4%). The study found that 37.5% of participants and their families always visited health facilities when feeling ill, 56.6% did so sometimes, and 5.9% never did. In addition, 14.9% always drained stagnant water, 66.3% did so sometimes, and 18.8% never practiced this habit (Figure 2).
Considering the total score of practice nearly half of the participants (51.0 % (n = 669) [95% CI: 48.6–53.8%] had a good practice of malaria health seeking, prevention, and control of malaria. Considering the total score of practice nearly half of the participants (51.0 % (n = 669) [95% CI: 48.6–53.8%] had a good practice of malaria health seeking, prevention, and control of malaria
Prevalence of malaria
Overall, 29.3 % of the study participants (n = 385) reported experiencing fever episodes. Of those participants, 32 (8.3%) had been infected with malaria in the two weeks before the data collection. The prevalence of malaria in this study is 8.3%, 95% (5.7-11.2).
Factors associated with malaria knowledge, attitude, and practices and malaria infection
Determinants of Attitude Towards Malaria
In the bivariable logistic regression, sex, age, income, educational status, marital status, occupational status, radio listening and level of knowledge were the candidate variables for the next analysis. From the multivariable logistic regression model, only income and marital status were significantly associated with the level of attitude towards malaria.
Participants whose monthly income was between 2001 to 4000 Ethiopian Birr had five times the likelihood of having a favorable attitude towards malaria prevention, compared to those with a monthly income less than 2000 ETB [AOR = 4.99 (3.05-8.18)]. Similarly, those with a monthly income greater than 4000 ETB were three times more likely to have a positive attitude compared to participants with a monthly income less than 2000 ETB [AOR = 3.32 (2.04-5.39)]. On the other hand, single and widowed study participants were 2 and 1.72 times more likely to have a positive attitude towards malaria prevention, as compared to divorced participants [AOR= 2.10 (1.27-3.39)] and [AOR= 2.73 (1.43-5.22)] respectively.
On the other hand, single and widowed study participants were 2 and 2.73 times a positive attitude towards malaria prevention as compared to divorced participants [AOR= 2.10 (1.27-3.39)] and [AOR= 2.73 (1.43-5.22)] respectively (Tabel 3).
Table 3: Multivariate logistic regression of level of attitude in Andasa cluster, Northwest Ethiopia, 2023.
|
Attitude Level
|
COR
|
AOR (95% C.I)
|
Variables
|
Category
|
Poor
|
Good
|
Sex
|
Female
|
449
|
452
|
|
|
Male
|
218
|
192
|
0.87(0.69-1.105
|
0.86(0.67-1.12)
|
Age group
|
<25
|
105
|
105
|
1
|
1
|
26-34
|
194
|
211
|
1.08 (0.79-1.51)
|
1.15 (0.79- 1.66)
|
35-44
|
111
|
123
|
1.10(0.76-1.60)
|
1.19 (0.77-1.83)
|
>45
|
149
|
85
|
0.57(0.39-0.83)
|
0.66 (0.42-1.03)
|
Income status per month
|
<=2000 EBR
|
180
|
254
|
1.60
|
1
|
2001-4000 ETB
|
202
|
221
|
4.49 (2.80-7.21)
|
4.99 (3.05-8.18)
|
>4000 ETB
|
199
|
142
|
3.48 (2.17-5.59)
|
3.32 (2.04-539)
|
Marital
|
Divorced
|
42
|
37
|
1.65 (0.89-3.05)
|
1.71(0.89-3.29)
|
Married
|
519
|
515
|
1.86 (1.20-2.89)
|
2.10 (1.27-3.39)
|
Single
|
44
|
59
|
2.52 (1.42-4.47
|
2.73 (1.43-5.22)
|
Windowed
|
62
|
33
|
1
|
1
|
Occupation category
|
Employed
|
38
|
36
|
|
1
|
Unemployed
|
32
|
36
|
1.18 (0.61-2.29)
|
1.62 (0.78-3.34)
|
Daily laborer
|
61
|
55
|
0.95 (0.53-1.70)
|
0.98 (0.52-186)
|
Trading
|
37
|
38
|
1.08 (.57-2.06)
|
1.23 (0.63-2.43)
|
Farmer
|
499
|
479
|
1.10(0.63-1.62)
|
1.48 (0.87-2.51)
|
Knowledge level
|
Poor
|
241
|
216
|
|
|
Good
|
426
|
428
|
0.89 (0.71-1.12)
|
1.11(0.87-1.42)
|
Radio listening
|
No
|
528
|
443
|
|
1
|
Yes
|
126
|
193
|
2.49(1.00-6.17)
|
2.06 (0.79-5.39)
|
Educational
|
Diploma and above
|
12
|
14
|
|
1
|
Grade 1-4
|
100
|
90
|
0.77(0.34-1.75)
|
1.34 (0.56-3.19)
|
Grade 5-8
|
91
|
103
|
0.97(0.43-2.20
|
0.76 (0.54-1.08)
|
Grade 9-12
|
62
|
70
|
0.96(0.41-2.25)
|
0.93 (0.65-1.33)
|
No Formal Education
|
402
|
367
|
0.78(0.35-1.71)
|
1.00 (0.65-1.54)
|
Determinants of Malaria Prevention Practice
In the bivariable logistic regression analysis, variables such as sex, income, marital status, educational status, occupational status, level of LLINs ownership, level of knowledge, and attitude were considered for further analysis.
After conducting the multivariable logistic regression model, it was found that sex, income status, marital status, level of LLINs ownership, and level of attitude were significantly associated with malaria prevention practice. Female respondents were 1.38 times more likely to practice malaria prevention practice as compared to the male respondents [AOR=1.38, (1.06-1.80). Participants whose monthly income was between 2001 to 4000 Ethiopian Birr had 1.65 times the likelihood of having good practice towards malaria prevention, compared to those with a monthly income less than 2000 ETB [AOR = 1.65, (104-2.60)].
On the other hand, daily laborers, traders, and farmers were 2.64, 2.19, and 1.43 times having good habits on malaria prevention practices than the employed ones [AOR=2.64(1.34-5.21)], [AOR= 2.19(1.07-4.50)], [AOR= 1.43(0.82-2.48)] respectively.
LLIN ownership was significantly associated with malaria prevention practice. Participants who owned LLINs were 80% more likely to have good malaria prevention practices [AOR=0.20, (0.13-0.30)]. Similarly, the study participants who have positive attitudes toward malaria prevention were 65% more likely to use malaria prevention practices as compared to poor attitudes [AOR=0.35, (0.27-0.45)] (Tabel 4).
Table 4: Malaria prevention practice in Andasa cluster, Northwest, Ethiopia, 2023
Variables
|
Category
|
Practice Level
|
COR
|
AOR (95% C.I)
|
Poor
|
Good
|
Sex
|
Female
|
427
|
474
|
1
|
1
|
Male
|
215
|
195
|
1.22(.96-1.55)
|
1.38 (1.06-1.80)
|
Educational
|
Diploma and above
|
12
|
14
|
1.27(0.58-2.78)
|
0.97(0.39-2.44)
|
Grade 1-4
|
87
|
103
|
1.29(0.94-1.77)
|
1.35(0.95-1.93)
|
Grade 5-8
|
86
|
108
|
1.37(0.99-1.87)
|
1.33(0.94-1.91)
|
Grade 9-12
|
56
|
76
|
1.48(1.01-2.15)
|
1.44(0.95-2.20)
|
No Formal Education
|
401
|
368
|
1
|
1
|
Income cate
|
<=2000
|
240
|
194
|
1.32(0.86-2.01)
|
0.94(0.59-1.50)
|
2001-4000
|
195
|
228
|
1.90(1.24-2.91)
|
1.65 (104-2.60)
|
>4000
|
137
|
204
|
1
|
1
|
Marital
|
Married
|
486
|
548
|
1
|
1
|
Divorced
|
42
|
37
|
0.78 (0.49-1.23)
|
0.86(0.50-1.48)
|
Widowed
|
64
|
31
|
0.43(0.28-0.67)
|
0.67(0.40-1.11)
|
Single
|
50
|
53
|
0.94 (0.63-1.41)
|
1.05(0.64-1.71)
|
Occupation category
|
Employed
|
41
|
33
|
1
|
1
|
Unemployed
|
32
|
36
|
1.39 (0.72-2.70)
|
1.63(0.77-3.48)
|
Daily laborer
|
49
|
67
|
1.69(0.94-3.05)
|
2.64(1.34-5.21)
|
Trading
|
29
|
46
|
1.97(1.02-3.75)
|
2.19(1.07-4.50)
|
Farmer
|
491
|
487
|
1.23(0.76-1.98)
|
1.43(0.82-2.48)
|
ITN ownership
|
No
|
144
|
35
|
0.19 (0.13-0.28)
|
0.20(0.13-0.30)
|
Yes
|
498
|
634
|
1
|
1
|
Knowledge level
|
Poor
|
412
|
255
|
0.79(0.63-0.99)
|
0.86(0.67-1.10)
|
Good
|
230
|
414
|
1
|
1
|
Attitude level
|
Poor
|
241
|
216
|
0.34(0.27-0.43)
|
0.35(0.27-0.45)
|
Good
|
401
|
453
|
1
|
1
|