Results from a Knowledge, Attitudes, and Practices Survey in Two Malaria Transmission Foci of Santo Domingo, Dominican Republic

Abstract

Metropolitan Santo Domingo has accounted for a majority of reported malaria cases in the Dominican Republic in recent years. To inform malaria control and elimination efforts, a cross-sectional survey of malaria knowledge, attitudes, and practices collected 489 adult household-level questionnaires across 20 neighborhoods in the city’s two main transmission foci, Los Tres Brazos (n = 286) and La Ciénaga (n = 203), in December 2020. Overall, most residents (69%) were aware of the problem of malaria in Santo Domingo, but less than half knew that mosquitos transmit the disease (46%) or took any correct preventative measure (45%). More residents of Los Tres Brazos, where malaria incidence is higher than in La Ciénaga, said that they had never been visited by active surveillance teams (80% versus 66%, respectively; P = 0.001), did not link mosquitos with malaria transmission (59% versus 48%, P = 0.013), and did not know medication can cure malaria (42% versus 27%, P = 0.005). Fewer residents of Los Tres Brazos said that malaria was a problem in their neighborhoods (43% versus 49%, P = 0.021) and fewer had mosquito bed nets in their homes (42% versus 60%, P < 0.001). The majority (75%) of questionnaire respondents in both foci did not have enough mosquito nets for all household residents. These findings demonstrate gaps in malaria knowledge and community-based interventions and highlight the need to improve community engagement for malaria elimination in affected areas of Santo Domingo.

The Importance of Local Context in National Malaria Elimination Efforts

“…20,21 In this low-transmission urban setting, limited surveillance and people's perception that malaria is not an important health concern also may have amplified the outbreak. 5 Malaria in urban settings is taking on new meaning, as nearly three-quarters of the world's population will be living in urban settings by 2050, including more than half of those living in malaria-endemic countries. 4 Analytic tools aimed at identifying and quantifying urban transmission 22,23 should be used to enhance surveillance and community-based interventions that are tailored to urban settings.…”

“…In this issue of the Journal , Keys and colleagues 5 report on people’s knowledge, attitudes, and practices (KAP) concerning malaria after a recent outbreak in urban Santo Domingo, capital of the Dominican Republic (DR). The island of Hispaniola (DR and Haiti) represents the last stronghold of malaria in the Caribbean.…”

“…Keys et al. 5 found that more than two-thirds of residents recognized malaria as a local health problem, yet fewer than half knew that transmission is by mosquitoes or could name any effective prevention. Although people’s malaria knowledge was positively associated with local incidence, more than one-third could not name any correct malaria symptom or did not know how malaria was diagnosed.…”

“…The reasons for this sudden urban malaria resurgence are enigmatic but may include increasing human density, rural-to-urban movement, inadequate surveillance, treatment and prevention, and suitable conditions for mosquito vectors. 5 Anopheles albimanus is probably the principle vector, 5 , 7 – 9 and it is well established in urban settings of DR and the region. 10 – 13 Although urbanization has been associated with decreased malaria in some contexts, 14 , 15 many diverse environmental conditions and social elements influence transmission risk in each specific urban setting.…”

“… 20 , 21 In this low-transmission urban setting, limited surveillance and people’s perception that malaria is not an important health concern also may have amplified the outbreak. 5 …”