Date Published: July 3, 2017
Publisher: Public Library of Science
Author(s): Sanni Yaya, Ghose Bishwajit, Michael Ekholuenetale, Vaibhav Shah, Bernard Kadio, Ogochukwu Udenigwe, Luzia Helena Carvalho.
Malaria remains a major public health issue in most southern African countries as the disease remains hyper endemic. Burkina Faso continues to face challenges in the treatment of malaria, as the utilization of preventive measures remains low on a national scale. While it has been acknowledged that understanding women’s health-seeking behaviours, perception of malaria and its preventive measures will aid in the control of malaria, there is paucity of information on Knowledge, Attitudes and Practices among women in the reproductive age of 15–49 years in Burkina Faso. This study investigated women’s knowledge of malaria, attitudes towards malaria, and practices of malaria control in order to create a synergy between community efforts and governmental/non-governmental malaria control interventions in Burkina Faso.
The analysis used data from the 2014 Burkina Faso Malaria Indicator Survey (MIS). In total 8111 women aged between 15–49 years were included in the present study. We assessed women’s knowledge about 1) preventive measures, 2) causes and 3) symptoms of malaria, as well as malaria prevention practices for their children and during pregnancy. The socio-demographic characteristics were considered for Age, Religion, Education, Wealth index, Number of household members, Sex of household head, Household possession of radio, TV and Received antenatal care. Data were analyzed using STATA, version 14. Associations between variables were tested using a Chi-square and logistic regression, with the level of statistical significance set at 95%.
A preponderant proportion of respondents were aged 15–29 years (mean age was 28.63±9.41). About three-quarters of the respondents had no formal education. An estimated two-third of the participants were of Islamic faith, while access to media and behavioural communication were generally poor. The level of knowledge was 53% for rural women and 68.2% for urban dwellers. In sum, there was 56.1% level of accurate knowledge of malaria among women in Burkina Faso. In the multivariable logistic regression, women in rural location had 40% reduction in the odds of having accurate knowledge of malaria when compared to urban women (aOR = 0.60; 95%CI: 0.52–0.68). The educational level was a key factor in the knowledge of malaria. The odds of having accurate knowledge of malaria increased as the educational level increased, hence, women with secondary and higher education had 29% and 93% increase in the odds of having accurate knowledge of malaria when compared to the women without formal education. Results indicate that antenatal care (ANC) services were major sources of information on malaria. Women who reportedly received ANC were 3.9 times more likely to have accurate knowledge of malaria when compared to those who did not utilize skilled ANC services (aOR = 3.90; 95%CI = 3.34–4.56).
The overall knowledge of malaria prevention practices among a large proportion of women was found to be low, which implies that the knowledge about the prevention of malaria should be improved upon by both urban and rural dwellers. There is need for concerted behavioural communication intervention to improve the knowledge of malaria especially for rural dwellers regarding malaria prevention measures, causes and symptoms. Consistent efforts at providing relevant information by health organizations are needed to reduce and control incidences of malaria in the general public.
According to WHO estimates, 212 million global cases of malaria led to 429,000 global deaths in 2015 . The burden was highest in the Sub-Saharan African region where 90% of the malaria cases and 92% of the malaria deaths occurred. Children under 5 years accounted for two thirds of deaths in this region . The disease is severe in pregnant women and children under 5 years old [2,3]. Moreover, approximately 7 million cases of malaria leading to 15,000 deaths were reported in Burkina Faso in 2015 . Of the country’s 16.2 million population, 80% reside in rural areas . The effective treatment of malaria in rural populations in Sub-Saharan Africa is often impeded by poor housing quality, inadequate understanding of malaria causes and transmission, and preference for traditional treatments [5,6].
Before each interview, all participants gave informed consent to take part in the survey. The DHS Program maintains strict standards for ensuring data anonymity and protecting the privacy of all participants. ICF International ensures that the survey complies with the U.S. Department of Health and Human Services regulations for the protection of human subjects, whilst the host country ensures that the survey complies with local laws and norms. Further approval for this study was not required since the data is secondary and is available in the public domain. More details regarding DHS data and ethical standards are available at: http://goo.gl/ny8T6X.
Knowledge about Malaria was analysed across four domains: prevention, causes, symptoms and preventive practises pursued. In the domain of prevention, majority of the women (97.4) reported that sleeping under a mosquito net and most of the women (80%) reported that sleeping under an insecticide treated net is the best practice to prevent malaria. A small proportion of women affirmed that using other preventive measures like insecticide sprays, using creams, lotions or keeping the surrounding clean can help to prevent transmission of malaria. Overall it can be stated that the knowledge about prevention, causes and symptoms of malaria was slightly above average among the respondents. This finding is similar to findings from previous studies where knowledge about preventive measures was found to be relatively high [31, 32]. One study interestingly reported that although the knowledge of preventive measures was high, it does not translate into preventive practices . This was an important finding during our analysis and will be further discussed in detail along with the preventive practices pursued among women. The finding about better knowledge of preventive practices might be illustrative of a positive impact of behavioural communication techniques used toward malaria control.
The findings indicate that the general knowledge of malaria could be improved upon by both urban and rural dwellers. There were statistically significant differences observed between urban and rural areas in terms of the knowledge about the prevention, causes and symptoms of malaria with the urban areas faring better than the rural areas. Also, there were factors, such as level of education, place of residence, access to the media, ANC and religion, that were associated with the level of knowledge of malaria. Overall, it can be stated that there is limited knowledge of the best practices in malaria prevention and control. The knowledge of malaria must be improved and translated into good practices to enhance prevention and control. Several factors, such as education level, exposure to the media, ANC, religion and place of residence, need to be integrated into the current generalized communication strategies employed by the ministry of health to improve the prevention and control of malaria. There is need to conduct more evidence-based research on the role of socio-cultural practices among women toward malaria prevention and control.