|Year : 2023 | Volume
| Issue : 1 | Page : 6
Knowledge and practice of malaria prevention among residents of Ratuwamai Municipality, Nepal
Rajesh Karki1, Niruta Bartoula2, Maheshor Kaphle3, Sanjaya Kumar Shah1
1 Department of Public Health, Yeti Health Science Academy, Purbanchal University, Kathmandu 44600, Nepal
2 Department of Nursing, Yeti Health Science Academy, Purbanchal University, Kathmandu 44600, Nepal
3 Department of Public Health, People's Dental College and Hospital, Tribhuvan University, Kathmandu 44600, Nepal
|Date of Submission||12-Feb-2023|
|Date of Decision||01-Mar-2023|
|Date of Acceptance||30-Mar-2023|
|Date of Web Publication||20-Apr-2023|
Department of Public Health, Yeti Health Science Academy, Purbanchal University, Kathmandu 44600
Source of Support: None, Conflict of Interest: None
Objective: To assess the level of knowledge and practice on malaria prevention among the residents of Ratuwamai Municipality in Nepal.
Methods: A community-based cross-sectional study was carried out on Ratuwamai Municipality of Ward No. 8 in Morang District, Nepal. A total of 352 respondents with an age range from 15 to 70 years were interviewed from October 9 to October 31, 2022. Statistically significant differences between two or more categorical groups were measured using independent sample t-test, one-way ANOVA test, and Kruskal-Wallis H test.
Result: Out of the total sample, 57.7% of the respondents were 24 to 50 years old with a mean age of (36.9±14.3) years. In the knowledge test, 82% of the responses were accurate. Though 98.6% of people had heard of malaria, only 48.3% said it was a communicable disease. In practice, 84.9% always cleaned the surrounding area and trimmed the bushes around the house; 75.9% used insecticide-treated bed nets or normal bed nets for sleeping; only 7.4% used mosquito repellent creams on exposed body parts while staying outdoors at night, working in fields, and sleeping.
Conclusions: The majority had knowledge about malaria, but more than half had poor practice. We advise concerned authorities to promote the behavior change communication strategy to encourage individuals to adopt healthy, beneficial, and good behavioral practices.
Keywords: Communicable; Knowledge; Malaria; Mosquito; Nepal
|How to cite this article:|
Karki R, Bartoula N, Kaphle M, Shah SK. Knowledge and practice of malaria prevention among residents of Ratuwamai Municipality, Nepal. One Health Bull 2023;3:6
|How to cite this URL:|
Karki R, Bartoula N, Kaphle M, Shah SK. Knowledge and practice of malaria prevention among residents of Ratuwamai Municipality, Nepal. One Health Bull [serial online] 2023 [cited 2023 May 31];3:6. Available from: http://www.johb.info/text.asp?2023/3/1/6/374224
| 1. Introduction|| |
Malaria is a major global cause of death and morbidity that is brought on by protozoan parasites of the genus Plasmodium. In the nations where it is still endemic, malaria continues to be a significant cause of sickness and death in both children and adults. Over 40% of the world’s population is at risk for malaria in over 100 different nations, making it the most common infectious illness in tropical and subtropical areas and a major global health concern. The number of malaria cases increased from 245 million in 2020 to 247 million in 2021, according to the most recent World Malaria Report. In South Asian nations, including Nepal, it is still a major public health problem. It is one of the 99 nations listed by the WHO as having malaria transmission. In Nepal, 70% of people reside in malaria-prone areas, and most of these high-risk areas are lowlands in the Terai, which border India in the south. Early detection, prompt treatment, and the use of preventative measures can all help to control the spread of malaria. Inadequate knowledge about mosquito bite prevention, treatment, and control measures can increase the number of cases of malaria. Therefore, it is essential to understand how the community perceives the cause, symptoms, and treatment of malaria. Despite this fact, very little research has been done on malaria prevalence, knowledge, practice, and attitudes among Nepalese residents,. Hence, the aim of this study was to identify the knowledge and practice regarding malaria prevention among residents in Ratuwamai, Morang.
| 2. Subjects and methods|| |
2.1. Study design, area and population
A community-based cross-sectional study was carried out in Ratuwamai Municipality, Ward No. 8 of Province 1, Nepal, from October 9 to October 31, 2022. People between the ages of 15 and 70 years old were involved in the study.
2.2. Sample size estimation and sampling technique
The sample size for the study was calculated using two different methods. First, we estimated the sample size for an infinite population (n= Z2 pq/e2), and then the final sample size was estimated using a finite population [n =(n ○)/(1+n ○/N)]. Assume adequate malaria prevention practice (p) = 66.1%, z=1.96 for a 95% confidence interval, and an acceptable sampling error (e) of 5%. For an infinite population, the sample size (n) was 344.32. There were (N) 4500 people in that ward, ranging from 15 to 60 years old. Now, the estimated sample size for a finite population was 319.85, and after adding a 10% non-response rate, the final sample size for the study was 352. The ward office provided the researchers with a voter list upon request. A random table was used to select the required sample.
2.3. Tools and technique of data collection
A questionnaire for measuring knowledge and practice was constructed by the researcher based on an earlier study conducted by Flatie et al.  and Erfani et al. The questionnaire was validated by reviewing the literature and consulting with experts in the field of public health. The English version of the questionnaire was translated into Nepali, and researchers were involved in data collection. A Pearson correlation coefficient was used to test the validity of the questionnaire. The obtained value for each item of the questionnaire was compared to the critical value. The item was determined to be valid if the observed value (P) was greater than the critical value and significant at the 0.05 level.
To test the reliability of the questionnaire, pre-testing was conducted. It was tested in 10% of the sample size at the same municipality’s ward number 7, and a few changes were made. The reliability was determined using Cronbach’s alpha (α= 0.806). The researcher visited each sample household and obtained information from the head of the family. If the head of the family was not available, eligible respondents from the same household were selected for the study. A selected household was followed up with at least twice in circumstances where the respondent wasn’t there during the first visit. Respondents who were unreachable even after a second attempt were excluded from the study, and the next household was included. All the data was collected using face-to-face interview techniques. Every completed questionnaire was examined daily for accuracy, completeness, and correctness.
2.3.1. Measurement of knowledge
Eighteen questions were prepared to assess the level of knowledge on malaria. A score was assigned to each question: true (3), no opinion (2), and false (1). The final total knowledge score was in the range of 18 to 54. Depending on each respondent’s score, knowledge was further divided into three categories: low knowledge (18–46), moderate knowledge (47–50), and high knowledge (51–54). The knowledge section of the questionnaire consisted of the following parts: general characteristics of disease, signs and symptoms, risk factors, prevention and control.
2.3.2. Measurement of practice
The Likert scale technique was used to determine the participants’ practices. According to respondents, Likert’s type scales had a scoring system that went from never (0) to sometimes (1) to always (2). Only for question No. 4, the score was reversed. Finally, practice was classified as “good” (score equal to or greater than the mean) or “poor” (score less than the mean) based on the observed score.
2.4. Data analysis
All data analysis was performed with SPSS version 26. The characteristics of the respondents were described using frequencies and percentages. To measure the level of knowledge and practice based on a score, means with standard deviations or frequency distributions were used. To compare the knowledge scores and practice scores among participants with different characteristics, the mean difference was used as an outcome and was analyzed using two-sided t-test or ANOVA test when appropriate. The Shapiro-Wilk test was used to analyze the normal distribution of the data to determine the selection of these statistics, and the Kruskal-Wallis H test was used if the normal distribution was violated. The Spearman’s correlation coefficient was used to measure the strength of the relationship between knowledge and practice of malaria prevention. P<0.05 were considered statistically significant.
2.5. Ethical approval
The concerned municipality has given its approval for the study. Ethical approval was obtained from the Institutional Review Committee of the Yeti Health Science Academy (Ref No. 2079-80-158). The purpose of the study was clearly explained, and written consent was obtained from the participants before data collection. None of the participants were forced to take part in our study or given any financial incentives.
| 3. Results|| |
3.1. Socio-demographic characteristics of the respondents
Of the total of 352 respondents, all of them participated in the study. The majority (57.7%, n=203) of the respondents were within the age range of 24-50 years, and the sampled population’s mean age was (36.9±14.3) years. Similarly, among the respondents, 60.8% (n=214) were female and 39.2% were male. Only 7.1% were unable to read and write, with the majority (33%, n=116) having completed a university degree. The respondents’ fields of occupation ranged from daily wage employees to business owners and farmers [Table 1].
3.2. Knowledge of malaria
In the knowledge test, 82% of the responses were accurate. However, only 48.3% and 44% of respondents, respectively, recognized that malaria was a communicable disease caused by a parasite [Table 2].
|Table 2: Respondents' knowledge of the causes, risk groups, risk factors, signs and symptoms, transmission of malaria, and preventive measures.|
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3.3. Practice towards malaria prevention
The majority of respondents (84.9%, n=299) and more than half (52.6%, n=185) always cleaned or trimmed the bushes and drain stagnant water around the house, respectively. Nearly half (46%, n=162) of respondents always screened doors and windows at night, and 41.8% (n=147) of respondents occasionally stayed outside in the evening. Although the majority (67.9%, n=239) always wore long sleeves when going out in the evening, in the forest, or working in the field, only 7.4% (n=26) used mosquito repellent creams on exposed body parts. More than half (55.1%, n=194) and 54% (n=190), respectively, sprayed insecticides in their homes, surrounding areas, and sheds, or used smoke or fumigant to combat mosquito bites. While the majority (75.9%, n=267) of the respondents always used insecticide-treated or normal bed nets, interestingly, 42.6% (n=150) of respondents never used mosquito coil while sleeping at night [Table 3].
According to our findings, the mean score for the 10 questions about the practice of malaria prevention was 13.56 (SD=3.12, range: 7–20). More than half of the participants (52.6%, n=185) had poor practices for preventing malaria. The 18 questions about knowledge of malaria had a mean score of 48.68 (SD = 4.63; range: 27–54). The majority of respondents (41.2%, n=145) had high knowledge of malaria, 31.8% (n=112) had moderate knowledge, and 27% (n=95) had low knowledge [Table 4].
|Table 4: Respondents' scores, level of knowledge, and level of practice on malaria.|
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3.4. Comparison of knowledge and practice between socio-demographic variables
An independent sample t-test was conducted to compare the knowledge and practice scores for males and females. There is no statistical significant difference in the knowledge score between sexes (male and female) (t=1.372, P=0.171). The male mean equals the female mean. Similarly, there was a statistically significant difference (t=-3.619, P<0.001) in the practice score, with the mean score for females (14.04±3.11) being higher than males (12.83±3.00) [Table 5]. Results of the ANOVA showed a statistically significant difference between age group (F=15.042, P<0.001; F=13.930, P< 0.001), Family income (F=50.544, P<0.001; F=26.015, P<0.001), and type of house (F=36.846, P<0.001; F=47.795, P<0.001) on knowledge and practice score [Table 5]. A Kruskal-Wallis H test revealed a statistically significant difference in knowledge and practice scores based on Ethnicity group [χ2(3) = 26.311, P<0.001; χ2(3) = 44.312, P<0.001], Religion[χ2(2) = 18.838, P<0.001; χ2(2) = 16.040, P<0.001], Educational level [χ2(4) = 157.782, P<0.001; χ2(4) = 116.112, P<0.001] and occupation [χ2(5) = 176.511, P<0.001; χ2(5) = 179.213, P<0.001] [Table 6].
|Table 5: Comparison of knowledge and practice score between selected variables using t-test and ANOVA test.|
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|Table 6: Comparison of knowledge and practice score between selected variables using Kruskal-Wallis H test.|
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3.5. Correlation between knowledge and practice regarding malaria prevention
There is significant relationship between knowledge and practice at the level of significant P<0.05, where r= 0.563, P<0.001. The relationship is considered to be moderately positive.
| 4. Discussion|| |
To our knowledge, this is the first study to assess how residents in Ratuwamai Municipality, Nepal, understand and practice malaria prevention. The majority (57.7%) of respondents in this study was between the ages of 24 and 50, was females (60.8%), and had a university education (33.0%). This is in line with earlier research done in Ethiopia and a study done in Ghana’s Ho Municipality, both of which found comparable results. In the knowledge test, 82% of the responses were accurate. This finding is higher than that of Northern Italy’s migrants  and the women of Burkina Faso, who had 73% and 56.1% correct knowledge of malaria, respectively.
In studies conducted in rural Mangalore, India, and south-western Saudi Arabia, 98.4% of respondents said they had heard of malaria. In South Africa, 93% of the respondents had heard about malaria. Similar to this, the current study found that 98.6% of respondents had heard of malaria. According to our research, 96.9% of respondents were aware that mosquito bites cause malaria, which was comparable with previous published literatures,. Also, a study conducted in Peninsular Malaysia revealed that around half of the aboriginal participants thought malaria was transmitted via mosquito bites.
People in the Rautuwamai municipality under study here showed a greater knowledge and practices toward malaria prevention compared to a study concerning knowledge and practices for malaria prevention among the community population of a different place in earlier studies. In Sudan, 75.8% of respondents identified fever with shivering as a symptom of malaria, while in our study, 83.2% of respondents correctly responded regarding malaria signs and symptoms. Furthermore, in a study conducted in Mozambique, 70% of respondents had knowledge regarding malaria preventive measures, whereas 98.3% in our study did. A study conducted by Khairy et al. reported that only 30.2% of respondents responded that it was a treatable disease, while in the current study, 85.8% had knowledge that it was a treatable and curable disease. The size of the samples and the location of the study may be the underlying causes of these inconsistencies.
In our study, 84.9% of participants regularly cleaned their surroundings and cut the bushes around their homes, and 75.9% used either regular bed nets or nets treated with insecticide, which is greater than in a prior study. Similarly, non-medical students at the University of Nigeria, Nsukka, reported that 42.3% of them slept under a treated mosquito net, despite the fact that more than half (53.5%) of the respondents had treated mosquito nets in their rooms. Additionally, one study in the South African province of KwaZulu-Natal reported that only nine (2%) of the 400 participants reported having bed nets. This variation could be due to differences in the sample size, respondents, and research area. Based on age, occupation, education, and income level, we found a statistically significant variation in knowledge scores. This is comparable to earlier published literature.
In our analysis, nearly half of the respondents (47.4%) had good practice, and 41.2% and 31.8% had high and moderate levels of knowledge, respectively. This is in line with previous findings,. However, the majority of participants in the study carried out in Cameroon had good knowledge (55.93%) and good habits (71.67%). This is better than what we found. Surprisingly, the majority of participants (64.6%) in a study of two remote communities in Uganda’s Wakiso District had little knowledge of malaria prevention measures. Overall, in our study, there was a good understanding of malaria, but this knowledge did not translate into behavior. This is comparable to earlier research,.
This is a community-based cross-sectional study conducted only in one selected ward. Generally, there are nine wards in the municipality of Nepal. So, due to the limited sample size and study area, the findings of the study may not be generalizable to a large population.
| 5. Conclusions|| |
The majority of respondents had knowledge about malaria, but of those, more than half were unaware that malaria is a communicable disease. In comparison to their knowledge, the practice of malaria prevention was poor. The most common preventive practices were cleaning bushes and surrounding areas, using a bed net, wearing long sleeves while working in the field, or going out in the evening or forest. We advise municipal offices and stakeholders to promote the behavior change communication strategy. Use of mass media, training, capacity-building, community open-air sessions, community participation, etc., will be effective. Behavior change communication strategy, along with other public health interventions, will be a helpful technique for individuals, groups, or communities to develop positive health behaviors and in the prevention of malaria.
Conflict of interest statement
The authors claim there is no conflict of interest.
The authors would like to acknowledge Mr. Puspa Bahadur Karki, Head of Ward No. 8 of Ratuwamai Municipality, for granting us the permission to conduct this study and Dr. Bijay Lal Pradhan for guidance during data analysis. We would like to express our gratitude to the IRC of the Yeti Health Science Academy for its ethical approval. We would also like to thank every respondent for their participation and valuable time.
The study received no extramural funding.
Karki R, the principal investigator of the study, thought about the particular study design. Bartoula N and Shah SK assisted and supervised data collection. Karki R and Bartoula N performed statistical analysis and prepared the first draft of the manuscript. Kaphle M and Shah SK helped in reviewing and editing the first draft manuscript. All the authors contributed to the literature review, writing the final version of the manuscript, and approving the final manuscript.
The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]