Community knowledge, attitude and practice about malaria in a low endemic setting of Shewa Robit Town, northeastern Ethiopia

BMC Public Health Community knowledge, attitude and practice about malaria in a low endemic setting of Shewa Robit Town, northeastern Ethiopia Andargie Abate 1 Abraham Degarege 0 Berhanu Erko 0 0 Aklilu Lemma Institute of Pathobiology, Addis Ababa University , P.O. Box 1176, Addis Ababa , Ethiopia 1 Somali Regional State Health Office , P.O. Box 238, Jijga , Ethiopia Background: Since malaria is one of the foremost public health problems in Ethiopia, assessment of situation of the disease, and communities' knowledge and perceptions about malaria is necesary to institute appropriate preventive and control measures. Thus, the aim of this study was to assess malaria prevalence and knowledge, attitude and practice (KAP) about the disease among ShewaRobit Town community, northeastern Ethiopia. Methods: A community-based cross-sectional study was conducted in Shewa Robit Town from October to November 2011. A multi-stage random sampling technique was used to select the study participants. A total of 425 individuals were examined for malaria using thin and thick Giemsa stained blood film, and 284 of the participants were interviewed to assess their KAP about malaria. Logistic regression analysis was used to assess predictor factors for malaria prevalence. Results: All respondents had ever heard of malaria. Most of the respondents (85.2%) attributed the cause of malaria to mosquito bite. However, some of the respondents (>20%) mentioned lack of personal hygiene, exposure to cold weather, hunger, chewing maize stalk, body contact with malaria patient and flies as the causes of malaria. Sleeping under mosquito nets, draining stagnant water and indoor residual spraying were the most frequently mentioned malaria preventive measures perceived and practiced by the respondents. Among 425 individuals examined for malaria, only 2.8% were positive for Plasmodium parasites. Living in houses made of wall without hole, sprayed with insecticide within the last 12 hours and located at a distance of greater than 500 meters from potential mosquito breeding sites as well as knowing and using of mosquito net were significant predictors of low malaria prevalence among the study participants. Conclusions: A high level of knowledge about the cause, transmission and preventive methods of malaria was detected among the community in Shewa Robit Town. However, a considerable proportion had misconception about the cause and transmission of malaria suggesting the necessity of health education to raise the community's awareness about the disease. Malaria prevalence; Knowledge; Attitude; Practice; Shewa Robit; Ethiopia - Background Malaria remains a major global public health and development challenge. It caused 216 million cases and 655,000 deaths worldwide in 2010, of which 81% of the cases and 91% of the deaths were from sub-Saharan Africa [1]. In Ethiopia, malaria also remains one of the most public health problems despite considerable effort made to control it [2-4]. Approximately 75% of the land mass where 68% of the total population lives is malarious [2]. The Federal democratic Republic of Ethiopia Ministry of Health estimated that there are more than 5 million clinical cases and thousands of deaths due to malaria each year [2]. However, the epidemiological pattern of the disease varies from place to place and even from time to time [5-7]. About 1 million confirmed clinical cases and 1,581 deaths were officially reported due to malaria in 2010 [1]. Due to availability of favorable conditions for the vector to develop and multiply, malaria tends to predominantly occur in rural areas [5,8,9]. However, studies documented increased malaria transmission in urban areas [10-13]. This could be associated with the rapid growth of cities coinciding with lack of proper sanitation, poor housing and poor drainage of surface water that facilitate human-mosquito interaction and subsequent malaria transmission [10-13]. Additionally, weak health services, increased migration of people from malarious rural areas to urban areas, limited tradition of indoor residual insecticide spraying (IRS) and bed net use, increased number of man-made mosquito breeding sites, and unplanned irrigation schemes and water collection reservoirs my hasten the spread of the disease in Ethiopian urban settings [5,13]. In view of the increasing urbanization in the country, there is a need to assess the risk of plasmodial infection. This provides baseline information to integrate malaria control activities with urban planning. This study assessed malaria prevalence and community KAP about the disease in Shewa Robit Town, northeastern Ethiopia. Methods Study area and population A community-based cross-sectional study was conducted in Shewa Robit Town, northeastern Ethiopia, from October to November 2011. The town is located at 225 Km northeast of Addis Ababa, in the Amhara Regional State at an elevation of about 1,280 meters above sea level. The town lies at a longitude and latitude of 10060N39590E and10.1N39.983E, respectively. It is divided into 9 kebeles (lowest administrative unit) and several villages (sub units of kebeles). The town has a total population of 42,208 and 10,048 households, with the average of 4.5 family size. There are 10 governmental health centers, eleven private clinics and pharmacies. Malaria is one of the top ten diseases in the town and reported throughout the year [14]. Individuals eligible for the parasitological survey were all family members living in the 4 kebeles of Shewa Robit Town. However, only family members older than 18 years, who gave blood samples for malaria diagnosis, and volunteered for interview were included in the KAP survey about malaria. Relatives who joined familly members during the parasitological survey and mentally sick people were excluded from the KAP study. Family members who were not present at home during the study period and children who were younger than 18 years were also excluded from the KAP study. Sample size and sampling procedure The sample size for the study was calculated using the formula (n = (z/2)2 p (1-p)/ d2) for estimating a single population proportion at 95% confidence interval (CI) (Z/2 = 1.96), 5% margin of error, design effect of 2, 15% non-response rates [15]. Based on a report of 14% prevalence of plasmodial infection among febrile individuals visiting a health center in the study area for medical attention [14], and an average family size of 4.5, a total of 426 individuals were selected for the parasitological survey from 94 households. The sample size for parasitological survey was calculated as n = [(1.96)2 (0.14) (0.86)/(0.05)2] = 185; total n = (1,85 2) + (1,85 2 0.15) = 370 + 56 = 4,26; and 426/4.5 = 95. Assuming an average of three individuals older than 18 years from each household, a total of 284 individuals were randomly selected from the 426 individuals for the KAP study. A multi-stage cluster random sampling technique with kebeles as t (...truncated)