Malaria Knowledge and Long-Lasting Insecticidal Net Use in Rural Communities of Central Côte d'Ivoire

Published by the Malaria Journal, this article shares findings of a study to determine factors influencing the use of long-lasting insecticidal nets (LLINs) in three rural communities of Côte d'Ivoire, two of which benefited from recent interventions. According to the article, the study not only confirmed that education and socioeconomic position (SEP) play important roles in the prevention and control of malaria and promotion of health in general, but pointed at the basic essential knowledge and the key behavioural elements that should guide education and learning processes among the poorer segments of the population. In turn, such knowledge may change behaviour and lead to an increased utilisation of LLINs.

Three villages were chosen for this study: Bozi, N'Dakonankro, and Yoho, all located in central Côte d'Ivoire. In 2008, Bozi and Yoho received free LLINs from the national malaria control programme resulting in an increase of LLINs coverage from zero to 35.2% in Bozi and from zero to 10.2% in Yoho. N'Dankonankro did not benefit from this malaria control intervention. In July 2009, the heads of randomly selected households were interviewed using a pre-tested questionnaire. Males usually head a household; in case they were absent, the wife of the head of household or another adult household member was interviewed instead.

Most respondents knew about malaria, and this was significantly associated to SEP. The main malaria symptoms identified by respondents were dark yellow urine, followed by fever or hot body, yellow eyes, and vomiting, whereas only about 1% of households mentioned convulsion. Yellow eyes and dark yellow urine are signs of jaundice, which is common in cases of severe Plasmodium falciparum malaria. A significant and positive association between fever or hot body, anaemia, yellow eyes and convulsion with SEP was found. Approximately 80% of N'Dakonankro households identified fever, yellow eyes, and dark yellow urine as symptoms of malaria, whereas approximately 60% of households in Bozi and 30% in Yoho gave similar responses. Respondents reported mosquitoes, the sun, and fever as main cause of malaria in children; however, a positive association with SEP was only found for mosquitoes, tiredness, and dirty water.

Treatment practice was significantly associated with SEP; households from the wealthiest group mentioned more often the use of modern (pharmaceutical or drugs purchased from local street markets) medicine as first-line home treatment, whereas the poorest mentioned the use of any form of traditional medicine. If the first-line treatment failed, the wealthier groups preferred to visit the hospital, whereas the less wealthy groups preferred to visit a traditional healer or not to take any action.

LLINs knowledge was high. Information about LLINs was mainly given in hospital and broadcast through television and radio. The poorest were more likely to report having received the information from friends, but the least poor mentioned having received the information through media, i.e., television and radio. At the village level, half of the heads of households in Bozi and N'Dakonankro reported to have been informed on LLINs primarily through hospitals, whereas in Yoho only 30% of the household heads reported hospitals as the main source of information. Television and neighbours played an important role in conveying malaria-related information in N'Dakonankro, compared to Bozi and Yoho.

From the findings, the article suggests that a clear relationship was found between SEP and reported malaria symptoms, treatment behaviour, and measures taken against mosquitoes. It was found that the education attainment of the household heads and whether children are present in a household are associated with LLINs utilisation. More than two thirds of the household heads (69.9%) mentioned mosquitoes as the main cause of malaria in children, but mosquitoes were more frequently mentioned by wealthier households, suggesting better access to health information and education.

In conclusion, the article states that the study in rural parts of central Côte d'Ivoire confirm results from other settings by reiterating that education and SEP play important roles in the control of malaria and the promotion of health in general. In particular, the findings of this study suggest that there is a need that the current form of single or intermittent health education campaigns needs to be replaced with continuous learning processes that transmit and reinforce the knowledge of malaria transmission, the importance of prompt diagnosis and effective treatment, and its prevention in order to increase equitable access to quality health care within a systemic approach to develop and strengthen health systems.