Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Abstract

AbstractIntroductionThe Indonesian roadmap to malaria elimination in 2009 indicated that the nation is progressing towards achieve malaria elimination by 2030. Currently, most of the districts in the Western part of Indonesia have eliminated malaria, however, none of the districts in East Nusa Tenggara Province (ENTP) have met set targets. This study aims to investigate the status of malaria awareness of rural adults in the ENTP.MethodsA cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria endemic settings (MES) in ENTP. 1495 participants recruited by multi-stage sampling method were interviewed using a validated questionnaire, after obtaining informed consent. A malaria awareness index was developed based on ten questions. Logistic regression method was applied to investigate the significance of associations of malaria awareness with the three malaria endemic settings.ResultsParticipants were between the age of 18 and 89 years old, 51.4% were female and 45.5% had completed primary education. Malaria awareness index was very low (48.8%, 95% confidence interval (CI): 45.2 – 52.4). Malaria awareness of rural adults residing in low endemic settings was three times higher compared to those were living in high endemic settings (Odds ratio (OR): 3.11, 95% CI: 2.40 – 4.03, p < 0.001) and the basic malaria knowledge for participants living in low malaria endemic setting was almost five times higher than that of in high endemic setting (OR: 4.66, 95% CI: 3.50 – 6.20, p < 0.001). Of total participants, 81.3% (95% CI: 79.1 – 83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6 – 77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours when suffering with malaria was poor, 37.9% (95% CI: 33.9 – 41.9), 59.1% (95% CI: 55.9 – 62.3), and 46.0% (95% CI: 42.3 – 49.7) respectively. The poor level of awareness was statistically significantly different amongst three MES, the level of awareness was the lowest in the high endemic setting.ConclusionMalaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap to malaria elimination. Results indicate public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention packages to address local malaria awareness.