Epidemiology of Malaria in East Nusa Tenggara Province in Indonesia: Protocol for a Cross-sectional Study

Abstract

Background Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. Objective The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. Methods A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. Results Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. Conclusions The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030. International Registered Report Identifier (IRRID) DERR1-10.2196/23545

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

“…The sample size was based on the prevalence of malaria in ENTP of 1.99% in 2018 estimated by the Indonesian basic health research, which is called Riskesdas [10]. Sample size calculation was described comprehensively in the previous publication of the authors [33]. Overall, the sample size was sufficiently large enough to detect a minimum 5% difference in the proportion of malaria awareness amongst high, moderate, and low malaria endemic settings (Statistical power > 90%, p=0.05).…”

“…Furthermore, the translation version of the questionnaire was demonstrated upon 30 participants before finalising the questionnaire. On the first part of the questionnaire, we collected data on the socio-demographic variables of participants and the second part is questions used to investigate the understanding of general malaria knowledge of participants as shown in the questionnaire that has been published on the previous publication of the authors [33].…”

Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

“…This number was obtained after considering the prevalence of malaria in ENTP, the intra-class coefficient correlation for malaria prevention study in Indonesia, design effect, and participation rate of participants. The complete sample size calculation was presented previously [39].…”

“…A multi-stage random cluster sampling was conducted to obtain data from 49 clusters in the rural village of ENTP Indonesia. The description of sampling procedure was described previously [39]. Three districts were selected based on their malaria-endemic settings (MES), which were East Manggarai, Belu, and East Sumba district, representing as low, moderate, and high MES [40].…”

“…These data were used to construct the social-economic status of participants. The comprehensive questionnaire has been published by the authors previously [39]. Three main questions as indicated in Table 1 were asked to participants to capture their understanding on malaria treatment-seeking behaviour.…”