Indigenous knowledge systems and malaria prevention in Zimbabwe: a market basket analysis

(2025) 24:322 Chapoterera et al. Malaria Journal https://doi.org/10.1186/s12936-025-05543-y Malaria Journal Open Access RESEARCH Indigenous knowledge systems and malaria prevention in Zimbabwe: a market basket analysis Byron Chapoterera1*, Anesu Marume2, Nicholas Midzi3 and Keshena Naidoo1 Abstract Background Malaria remains a major public health challenge in Zimbabwe, reporting the highest prevalence in Manicaland Province, where indigenous health practices and religious beliefs influence healthcare-seeking behaviours. Understanding the interplay between biomedical and traditional approaches is essential for designing culturally sensitive malaria control strategies. The study explored malaria prevention practices and the role of indigenous knowledge systems, including traditional and spiritual health practices, among adults in Manicaland Province, Zimbabwe. Methods A cross-sectional study was conducted among 480 adults aged 18 years and above, recruited through stratified random sampling. Data were collected using structured questionnaires administered in faceto-face interviews. Variables included sociodemographic characteristics, recent malaria experiences, use of indigenous and biomedical malaria prevention methods, and visits to health facilities, traditional healers, or church prophets. Descriptive statistics were computed, and association rule mining (ARM) using the Apriori algorithm in R was employed to identify frequent co-occurring behaviours and health-seeking patterns. Results Participants were predominantly female (69.0%) and within the 25–44 age range (57.5%). A majority reported employment (60.0%) and low household income (47.9%). In the previous three months, 36.7% of respondents and 54.0% of families had experienced malaria. Primary sources of indigenous knowledge included older people (27.7%), informal discussions (7.7%), and observations (5.6%). Association rule mining revealed strong linkages between visits to church prophets and avoidance of traditional healers, as well as notable patterns involving use of cow dung, health facility visits, and indigenous practices. For instance, individuals who visited prophets were highly likely not to have visited traditional healers (support = 0.66, confidence = 0.91, lift = 1.08). Conclusion Health-seeking behaviour for malaria in Manicaland Province is influenced by complex interactions between spiritual, traditional, and biomedical systems. Indigenous knowledge plays a significant role in malaria prevention and treatment. Public health programmes should integrate culturally informed strategies that respect local belief systems while promoting effective malaria control interventions. Keywords Malaria prevention, Indigenous knowledge, Traditional medicine, Association rule mining, Zimbabwe, Health-seeking behaviour *Correspondence: Byron Chapoterera 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/. Chapoterera et al. Malaria Journal (2025) 24:322 Background Malaria remains a persistent global health challenge, particularly in sub-Saharan Africa (SSA), where the disease is endemic and continues to cause high morbidity and mortality [1]. In 2023, an estimated 263 million malaria cases were reported globally, an increase of nearly 11 million cases compared to 2022 [2, 3]. While there was a gradual decline in malaria incidence globally between 2015 and 2022, the incidence and mortality rates remain well above the targets set by the Sustainable Development Goals [4]. Traditional knowledge systems and practices shape health-seeking behaviours related to malaria, and in some instances, pose challenges to the adoption of biomedical prevention and treatment strategies. Malaria prevention and control strategies being conducted in Zimbabwe are largely focused on vector control, which includes indoor residual spraying, longlasting insecticidal nets (LLINs) [5, 6]. Additional strategies involve case management, prophylaxis, especially for vulnerable populations such as pregnant women and visitors to malaria-endemic areas, social and behaviour change, disease and vector surveillance [7, 8]. Indigenous Knowledge Systems (IKS) refer to the local knowledge, beliefs, practices, and skills that are developed and sustained by indigenous and local communities over generations, often through direct interaction with their environment [9, 10]. These systems are deeply rooted in cultural traditions, languages, and worldviews and represent an underexplored yet potentially valuable resource [11]. Communities in malaria-prone regions utilise traditional healing practices, locally grown medicinal plants, and community-based approaches to prevent and treat malaria [12]. A growing body of evidence suggests that sociocultural and environmental factors play a critical role in influencing malaria-related behaviours. Although widely practised across SSA, these indigenous approaches are often poorly documented, and their interaction with formal health systems remains insufficiently understood [13]. IKS are of significant importance in the fight against malaria as primary healthcare systems are struggling to adapt to changes in malaria transmission patterns linked to climate change [14]. The formal health systems remains insufficiently understood [13]. Extreme weather events and global warming associated with climate change have altered rainfall patterns, temperature, and humidity, which in turn affect mosquito breeding sites and malaria transmission cycles. Recent data from 2022 show a concerning resurgence, with the highest number of malaria cases recorded since 2004. Predictive models that account for environmental factors and health interventions suggest that, in the absence of intensified efforts, annual malaria cases could increase by 25% to 30% by the 2050s. Existing health Page 2 of 10 systems, which are already dealing with a critical shortage of trained healthcare workers, are un (...truncated)