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

Abstract

IntroductionThe Indonesian roadmap to malaria elimination in 2009 indicated that the country 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. Fourteen hundred and ninety-five participants from high, moderate, and low malaria endemic settings (MES) in ENTP were interviewed using a semi-structure questionnaire. A malaria awareness index was developed based on ten questions. Chi-square test was applied to investigate the significance of associations of malaria awareness with the three malaria endemic settings.ResultsParticipants were between 18 and 89 years old, 51.4% were female and 45.5% had completed primary education. Malaria awareness index was 48.8% with the highest in low MES 64.8%, followed by the moderate MES 44.4% and the high MES 37.2% (p<0.001). Of total participants, 81.3% were aware that malaria could be prevented and 75.1% knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, seeking treatment within 24 hours when suffering with malaria, and mosquito bites as the transmission mode of malaria was poor, 37.9%, 46.0%, and 59.1% 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 action plan. 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.

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

“…Furthermore, this study has provided strong evidence that rural adults with a low level of education are the most vulnerable groups having a poor understanding of AMTSB. Considering of poor malaria awareness and the low level of education of the rural population in the ENTP [28,34,72] special attention of the local authority should be focused on this vulnerable group to improve their awareness of AMTSB.…”

“…Another study covering a Tetun community in Timor islands indicated the prevalence of community members applying various local medicinal plants to treat malaria [32]. One study representing the rural population in the province level indicated that more than half of the population delayed in seeking malaria treatment [34]. However, factors associated with this poor understanding of AMTSB of rural communities have not been investigated yet.…”

“…Limited investigations into malaria treatment-seeking behaviour had been conducted in the ENTP [21,[31][32][33][34]. One study drawing on a small sample at the sub-district level indicated that most participants sought care at health facilities after four days of the onset of symptoms [31].…”

“…The ethnicities comprised Manggarai, Sumba, Timor, and other ethnicities. The SES of participants was classified as high, moderate, and low as indicated in the previous publication of the authors[34].Data AnalysisParticipant's characteristics including gender, age group, education level, main occupation, ethnicity, the nearest health service, and the distance to the nearest health service were analysed by descriptive statistics. The proportion of participants based on the first, second, and third outcome variables were tabulated based on the socio-demographic and environmental variables of participants.…”

Ethnic Variation and its Association with Malaria Awareness: A Cross-sectional Study in the East Nusa Tenggara Province (Indonesia)

“…In an Indonesian context, a country with 145 ethnic groups [20], some studies were conducted at a village level to evaluate the association between malaria awareness and socio-demographic factors [21,22]. One population-based study in a rural community in Indonesia reported a low level of malaria awareness [23], however the diversity of ethnicity in rural community and their association with malaria awareness were not investigated yet. To date, there have been no studies investigating factors associated with malaria awareness in different ethnic groups of rural population in Indonesia.…”