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Two hundred primary level school children, aged between 7 and 18 years took part in a comparative pilot study of the effect of participatory school health education in Kisumu, Western Kenya in 1988. An experimental cohort of 100 pupils had participatory health education versus a passive control of another 100. An initial KAP survey revealed comparable sociological variables as well as morbidity statistics. No significant change occurred on the knowledge of the disease between the groups after 3 months. However, positive change in attitude here determined by positive antimalarial practices, was observed more frequently in the experimental group than in the control group. Efforts to environmental manipulation increased by 69% vs 1%, while parasite rates decreased by 32% vs an increase of 5%, respectively. Similarly there was a decrease in absenteeism of 25% vs an increase of 5% between the groups. Clinical malaria was reported less frequently in the experimental group than the control (26% against 8%). In conclusion, this pilot study suggests that participatory approach in effective health education to school children should be investigated further to determine its potential in the intersectoral malaria control strategy.
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PMID:The effect of participatory school health programme on the control of malaria. 150 11

Operational research studies of the immunization systems in Conakry, Guinea, conducted in 1988-89 following a series of mass campaigns, aided in the formulation of a comprehensive strategy for achieving high, sustained vaccination coverage. The first, an evaluation of service quality, found that only 30% of children who presented for treatment of diarrhea or malaria were screened by health center staff for their vaccination status; when injections were given, a sterile syringe and needle were used only half the time. In the second study, in-depth interviews with health workers revealed a lack of awareness of the importance of involving the community in immunization programs. In the third study, the focus group discussion technique was used to obtain users' perspectives on vaccination services. Mothers were supportive of vaccination, but lacked knowledge about the vaccination schedule and some complained about long waiting times, high costs of vaccines, a lack of rapport with health workers, and the occurrence of abscesses after vaccination. Finally, a KAP survey found that only 19% of eligible children had been completely vaccinated; an additional 19% had a sufficient number of contacts with the health center to be fully vaccinated, but had missed at least one opportunity. Factors associated with initial receipt of vaccine included higher socioeconomic status, hospital delivery, and the perception that vaccination was affordable, while the mother's educational level, employment status, and experience with the vaccination service were the key determinants of completion of the series. Taken together, these studies indicated a need for increased community involvement and efforts on the part of health personnel to reduce the number of missed opportunities for vaccination, especially in the curative sector.
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PMID:Application of multiple methods to study the immunization programme in an urban area of Guinea. 207 15

Malaria is still highly prevalent in many tropical countries and this disease can only survive in areas where mosquitoes and infected human populations are high. Relevant information on the species of mosquitoes, their habitats and their population are important in planning preventative strategies in the control of malaria, hence this study. Mosquito species and their habitats were investigated in both high and low density areas of Benin City, Edo State, Nigeria. The results showed that Culex pipiens fatigans, Aedes aegypti, Aedes albopictus, Anopheles gambiae and Culex trigripes were the commonest mosquitoes found in Benin City. Among the habitats studied, containers and gutters had the highest population of mosquitoes. The serious public health implications of these various species of mosquitoes is the possibility of outbreaks of infectious diseases like yellow fever, dengue, which some of these mosquitoes are known to transmit. Malaria, though endemic, is also important because of its associated high morbidity and mortality rates. This study provides some useful information on the habitats and species of mosquitoes found in Benin City. Follow-up studies are being carried out by the authors on quantitative studies on the population of these species of mosquitoes, the dissolved elements present in the different habitats that could promote or inhibit the breeding of mosquitoes, and KAP surveys on mosquitoes and malaria among the Benin populace. It is hoped that such comprehensive data would be very useful in planning effective preventative strategies in the control of malaria in Benin City.
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PMID:Towards malaria control in Nigeria: a qualitative study on the population of mosquitoes. 856 84

Chuk district hospital is centrally located in a rural malarious region in southern Cambodia. It was the site of a hospital-based evaluation (KAP assessment and in vivo i.v. quinine/oral tetracycline drug study) done to identify relevant issues for establishing a rational malaria control strategy. The KAP assessment identified the young, male forest worker as the highest risk group. Of 112 study patients, 73% were male and 82% reported various forest activities. The primary reason found for patient delay (8.9 days) in seeking hospital care was self-treatment at home (N = 102, 91%) with drugs purchased through private sellers (104/105). Using the 7-day WHO field test methodology, resistance rates were calculated (N = 22); S1/R1, 73%; R1, 9%; R2, 0%; R3, 18%. A modified version of the 7-day test was used to calculate its utility in this particular rural setting. It showed a negative predictive value of 93% and a positive predictive value of 71%. The case fatality rate for the study period was 2.7%. Information from this study, which correlates a confirmed malaria diagnosis with prior patient behavior and response to anti-malarial therapy, is intended for realizing the goals set forth by the national malaria control program.
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PMID:Identifying malaria control issues: a district hospital-based evaluation. 913 62

In 1994, six KAP studies were carried out in Cameroon to assess the importance of protective methods used by different population groups against culicine nuisance. The objective of these surveys was to evaluate the importance of the use of preventive measures by family against the parasite. The results show that in spite of a strongly resistant parasite in a hyperendemic malaria zone, the use of average protection remains very heterogeneous. Mosquito nets, identified as efficient protection, are used to varying degrees depending on the sites. In Douala, mosquito nets were found in 47% of households visited, with 65% of the inhabitants regularly using them. These figures rose to 75% and 82% respectively in a particularly exposed area of the city. In rural areas very few mosquito nets were identified with an average of one inhabitant per residence using them. The report of the study on the free distribution of mosquito nets and the reimpregnation of the nets six months later in Mbebe-Kikot village, showed that three years after the distribution of the nets, only 68% of the residences still had one mosquito net. In addition, only 9% of these nets were still in good condition. The results of these surveys showed that mosquito nets are more widely used in urban areas, with a higher number of inhabitants per household sleeping under them. They also showed that the free distribution of nets alone does not improve the protection of the population as they are not educated on the maintenance and care of the nets. So we can suggest to use different promotion and distribution strategies in urban area, where lot of people has got the experience of bed nets, and in rural area.
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PMID:[Knowledge, attitudes and practice of populations faced with culicidae nuisances: results of 6 surveys taken in Cameroon in 1994]. 950 73

Research projects for malaria control must involve communities to elicit strategies to be successful and programs to be sustainable. Therefore, knowledge, beliefs and practices of the population concerned must be taken into account in the design of interventions against malaria transmission. We conducted a KAP study in Buenaventura, a port on the Pacific Coast of Colombia where transmission was on the increase at the beginning of this decade. The purpose of the study was to help in the design and implementation of a primary health care approach for malaria control. Both qualitative and quantitative research methods were used. The focus group technique was applied in five urban and peri-urban communities and a cross sectional survey was conducted on a random sample of 1380 subjects with a structured interview on knowledge, practices and also on demographic and epidemiological aspects. The information obtained by the two methods was comparable on knowledge of symptoms, causes and ways of malaria transmission, and prevention practices like the use of bednets or provision of health services. We discuss the relevance of obtaining this information and analyze the elements that must be taken into account for communities to become more involved in malaria control strategies.
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PMID:Knowledge, beliefs and practices relevant for malaria control in an endemic urban area of the Colombian Pacific. 1045 16

An increasing proportion of malaria cases in Italy is observed in immigrants revisiting their country of origin, but little specific research work has been carried out in this field. All malaria cases occurring from 1990 to 1998 at the Reference Clinic for Infectious and Tropical Diseases in Brescia were prospectically evaluated to compare clinical outcome in migrant and non-immune cases. No difference was observed between parasitaemia at diagnosis and time to clearance of peripheral parasitaemia. Clinical presentation was milder in migrants than in non-immunes, with an OR for severe malaria of 0.27 (c.i. = 0.09-0.84) (p = 0.01). Fever clearance time was significantly shorter in migrants (3.0 days, SD = 1.2) than in non-immunes (4.3 days, SD = 1.7) (p < 0.001). Among immigrants, the proportion of severe cases was higher in residents since 2 years or less (12.5%) compared to residents since 2 to 5 years (3.3%) and residents since more than 5 years (0.9%) (p = 0.02). The proportion of malaria cases who had used chemoprophylaxis was significantly lower among immigrants (30/272, 11.0%) compared to non-immunes (41/74, 55.4%) (p < 0.001). In a population based malaria KAP analysis among 504 migrants from malaria endemic countries, correct knowledge of malaria risk was reported by 351 (69.5%). Of 170 subjects who reported at least one visit back to the home country, 30 (17.6%) had sought pre-travel advice, 24 (14.1%) had started chemoprophylaxis and 7 (4.1%) had completed it during the last visit. Of 140 migrants who failed to seek pre-travel advice, 73 (52%) were unaware of malaria risk, 56 (40%) did not know how to protect themselves, and 11 (8%) refused to use protective measures. Migrants account for a significant proportion of imported malaria cases in industrialised countries. Clinical presentation is milder compared to non-immune subjects. The proportion of migrants who adopt malaria protective measure while returning home is very low, due to both unawareness of risk and inappropriateness of medical advice.
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PMID:Malaria in migrants. 1069 66

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.
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PMID:An ecosystem approach to malaria control in an urban setting. 1142 79

The malaria disease burden is increasing in many countries despite the existence of effective preventative strategies and antimalarial drugs. An understanding of community perspectives and practices is one of the essential components of a successful malaria control program. This paper reports on a KAP (Knowledge, Attitudes and Practices) survey among the Raglai ethnic minority population in Ninh Thuan Province, Vietnam, which in 2003 had one of the country's highest confirmed rates of malaria. We found high levels of correct knowledge about malaria's transmission and symptoms, and self-reports of adequate bed net usage and appropriate health-seeking behavior. While the survey generated useful findings, an initial, qualitative investigation (eg, observation and focus group discussions) to explore the large numbers of potential influences on behavior and exposure risk would have provided a more robust underpinning for the design of survey questions. This would have strengthened its validity and generated additional information. The adoption of rigorous, multi-disciplinary research methods offers the best chance of contributing to the development of successful malaria control programs and effective policies.
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PMID:KAP surveys and malaria control in Vietnam: findings and cautions about community research. 1612 19

A current problem of malaria prevention programmes is that not enough attention is paid to understanding the local socio-cultural context prior to programme implementation. The aim of this study is to discover how Yao women in rural Malawi understand and explain malaria in pregnancy, how they perceive it and what type of knowledge they have on it. Women's knowledge of the adverse effects of malaria in pregnancy is also investigated. At first phase a total of 34 in-depth interviews were conducted. At second phase a KAP survey (n=248) was conducted for cross-validation of the qualitative information. The findings showed that there is neither a vernacular word for malaria nor malaria in pregnancy. Women used a local word, malungo, to refer to malaria. Malungo is an ambiguous disease term because of its multiple meanings which are used interchangeably to refer to many types of feverish illnesses of various causes, not only malaria. Most women did not perceive malungo during pregnancy as a serious illness. There were several other diseases from anaemia, STDs to cholera etc. that were perceived to be more dangerous than malungo. The local meaning of malungo also entailed an assumption that it is a common but fairly harmless illness. Women had limited knowledge of the adverse effects of malaria in pregnancy, the best-known adverse effect being miscarriage (28%, 52/189). A socio-cultural understanding of the implementation context is prerequisite for planning meaningful programmes for the pregnant women in rural Africa.
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PMID:The importance of understanding the local context: women's perceptions and knowledge concerning malaria in pregnancy in rural Malawi. 1664 81


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