Qualitative Study on Malaria Prevention and Control in Oromia and Amhara Regional States in Ethiopia

This 118-page report shares information from a formative study to better understand the knowledge, attitudes, and practices of community members in Ethiopia towards malaria prevention, particularly related to promoting the well being of mothers and children. According to the report, linking malaria control with, and promoting, use of HIV-related prevention of mother to child translation (PMTCT) and antenatal care (ANC) is one possible intervention area. The study was initiated by C-Change, in order to inform the design of an effective communication strategy to help increase ANC attendance by pregnant women.

From the executive summary

Most community members have correct knowledge about causes, symptoms, mode of transmission, and prevention methods of malaria. Some common misconceptions include transmission via utensils and eating certain food items. People have some idea about the different kinds of malaria presentations and their severity, though they don’t commonly describe them correctly. Almost all informants commonly hold positive attitude towards the use of insecticide treated nets (ITNs), but ITNs are not consistently used by all members of the household mainly due to the inadequacy of the ITN. Inappropriate use and misuse of ITN is common.

The report suggests that some of the misconceptions described might modify the way people respond to malaria prevention and control, and there is the need to clear these misconceptions by giving clear and repeated messages. Malaria related messages should focus on causes, means of transmission, and the definite possibility of cure. Distribution of ITN should also consider the size of family. Since health workers and health extension workers (HEWs) are the main and preferred source of information they should be one of the key audiences for effective communication strategy with appropriate and updated information on malaria prevention in general. Providing adequate information on how to use ITN properly to all involved in its distribution and use is essential.

Indoor Residual Spraying (IRS) is highly preferred in some areas of the study because of its added effect on other household bugs. Fear of side effects and aesthetic reasons are barriers to its application. Spraying should be accompanied with proper messages that emphasize the need to prioritise avoiding unnecessary suffering and death of children and family members - give value to life.

The report adds that health workers and health extension workers are the most commonly mentioned and trusted sources of information followed by community meetings indicating preference to direct face-to-face communication channels. Radio is the most accessible and preferable compared to other forms of mass media. Community members also mentioned that they get health messages through their children and recommended to have regular education programmes in schools. People should be aware of the consequences of delaying malaria treatment and get very clear messages about the need for prompt treatment seeking from the nearest health facility, and that malaria treatment is provided freely at the local public health facilities. Messages should clearly indicate the dosage and the need to fully take the drug as prescribed by health workers.

The findings suggest that education should also incorporate the linkage between HIV and malaria. The ANC service is largely perceived as beneficial with little knowledge of the timing of initial visit and frequency of ANC. Developing and providing appropriate messages to the whole community members including the traditional healer is very important. Stigma and discrimination, fear of being HIV positive, and fear of notifying one's status to the spouse, are all barriers to PMTCT services and require more communication not only with women but with spouses, close family members, and the community members.

The report also states that effective communication strategies must be developed using local languages and need to be properly piloted before large scale use. Print media can be potentially effective as a means of conveying clear messages to grassroots level communicators and educators and to provide illustrations of desired actions, skills, practices, and behaviours.