Gender-related factors affecting community malaria-related perceptions and practices in Migori County, Kenya

(2025) 24:196 Ngutu et al. Malaria Journal https://doi.org/10.1186/s12936-025-05336-3 Malaria Journal Open Access RESEARCH Gender‑related factors affecting community malaria‑related perceptions and practices in Migori County, Kenya Mariah Ngutu1,2*, Dalmas O. Omia2, Tonny Onyango Ngage2, Cynthia Akinyi Oduor2, Nelson O. Ouko2, Balentine Oingo2, Iscar Oluoch3, Simon Kariuki4, Jeremiah Chikovore5, Washington Onyango‑Ouma2 and Salome A. Bukachi2,6 Abstract Background Malaria poses a significant global public health challenge yet there remains limited information on the influence of gender dynamics on malaria programmes despite the well-known gender-specific differentials in the prevalence, transmission and exposure to malaria. The 2024 World Malaria Report indicates that the burden of malaria and the challenges in addressing it remain severe in sub-Saharan Africa (SSA), with eleven countries including Kenya bearing almost two-thirds of the global disease burden. Kenya remains heavily affected, with around 70% of the population at risk. The aim of this paper is to explore how gender-related factors influence malaria healthcareseeking perceptions and practices in Migori County, a malaria endemic area in Western Kenya. Methods The study employed a qualitative research design to gain in-depth insights into local perceptions and practices regarding malaria. Thirty-one in-depth interviews, four gender-stratified focus group discussions, six key informant interviews, and five process mapping exercises. Participants were purposively selected to ensure diversity and data thematically with both inductive and deductive approaches applied to generate themes. Results The results of the study are in three main themes; gender-related similarities and differences in malaria healthcare-seeking perceptions; gender differentials in malaria prevention and treatment practices and the gendered dimensions of malaria healthcare-seeking information. Participants were generally aware of malaria, although there were noticeable gaps in their understanding regarding transmission and prevention. Gender related factors including gender dimensions (gender roles and relations); social stratifiers (level of education, gender identity, occupation) and cultural dynamics (beliefs- religion and traditional superstitions) influenced the perceptions of risk and vulnerability. Decision-making was reported as shared in relation to type of treatment and access to care. Conclusion The study of community’s perceptions reveals that malaria healthcare-seeking, knowledge, attitudes and practices and the perceptions of risk and vulnerability are influenced by gender roles and relations and intersections among socio-demographic factors, beliefs including religion and traditional superstitions, and occupation. Gender disparities in knowledge and healthcare-seeking behaviours illuminated in this study underscore the need for gender-sensitive public health interventions, inclusive health policies and integration of pluralistic health care systems to improve public health outcomes. Keywords Malaria, Gender, Intersectionality, Health seeking behaviour, Perceptions, Risks, Vulnerability *Correspondence: Mariah Ngutu Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Ngutu et al. Malaria Journal (2025) 24:196 Background Sub-Saharan Africa (SSA) continues to shoulder the heaviest burden of malaria with 95% of malaria cases in 2021. In 2021 96% of all deaths with 80% among children under 5 years was recorded in SSAs [1, 2]. Malaria, a vector-borne disease is susceptible to inherent phases of change triggered by climate, changes in human land use and the effectiveness and coverage of initiatives and measures that focus on the parasite and vector [2–4]. The disease spreads across zones with diverse risk and intervention profiles determined by altitude, rainfall patterns, and temperature, and malaria prevalence [1, 3–5]. There has been marked progress in reducing the global malaria burden over the last two decades and four countries have eliminated it. However, progress has plateaued with data from 2022 indicating that milestones set out in the World Health Organization (WHO) Global Technical Strategy for Malaria (GTS) for the year 2020 were missed by a wide margin [2, 4, 5]. Malaria thrives in and exacerbates poverty by directly endangering health [6, 7]. Malaria costs lives and deepens inequalities, disproportionately affecting the most vulnerable groups such as pregnant women, infants, children under 5 years, refugees, migrants, internally displaced people, and indigenous people [6–8]. Women, men, young people and children at different times assume roles as patients, caregivers and healthcare providers, and experience differentiated vulnerabilities to, and impacts from malaria [7–9]. Recurring infections often strike families multiple times in a year, during which women are impacted as patients or caregivers to sick family members and children. In resource-limited settings this direct and indirect burden on families affects livelihoods, creating a vicious cycle of inequity [6–9]. Kenya’s population is vulnerable to malaria with 70% at risk, with thirteen million individuals living in endemic regions and an additional nineteen million in highland epidemic-prone and seasonal transmission zones [3, 10, 11]. Interventions to control malaria in Kenya have been integrated with key strategies focused on prevention and case management at community level [10, 11]. These strategies combined with messages about social behavioural changes, increase community uptake and utilization [3, 10–13]. Despite these efforts, the families and communities at greatest risk are among the hardest-toreach populations, living in remote, rural areas with poor access to health services as is the case of Migori County, western Kenya [10, 13]. Malaria prevalence and incidence is more than two times higher i (...truncated)