Relationship Between Care-givers' Misconceptions and Non-use of ITNs by Under-five Nigerian Children

Published in the Malaria Journal, this article explores misconceptions about malaria causes and prevention as determinants of ownership and use of insecticide-treated nets (ITNs). While ITNs have shown to be cost-effective in the prevention of malaria, the number of people actually using these nets remains generally low. The researchers found that misconceptions about causes and prevention of malaria by caregivers adversely influence the use ITN by under-five children, and suggest that appropriate communication strategies should correct these misconceptions.

According to the article, several national surveys have shown persistently low levels of ownership and use of insecticide-treated nets. The proportion of Nigerian households that owned at least one ITN was 2.2% in 2003 and 8% in 2008 while the proportion of under-five children that used ITN during the same periods were 1.2% and 5.5% respectively. Poor perception and knowledge of malaria control is among the factors likely to influence use of ITNs. In southeastern Nigeria, excessive heat was thought to be responsible for malaria. Among the perceived causes of malaria in south-western Nigeria were over-work, sunlight, excessive sex and noise, as well as witchcraft. Such erroneous perception of malaria as "ordinary fever" that is caused by "too much work" or "too much sun" have been reported across a wide range of cultural sub-groups in Nigeria, and believed to significantly influence treatment-seeking behaviour and attitude to preventive measure.

Structured questionnaires based on thematic areas were administered by trained interviewers to 7,223 care-givers of under-five children selected from all the six geo-political zones of Nigeria. On the knowledge of causes of malaria, more than three-quarters of the caregivers knew that mosquito bites could cause malaria, yet only about 25% mentioned sleeping under ITNs as a means of preventing malaria. Using insecticide sprays every night was the most commonly mentioned method of preventing malaria (40%). A significant positive association was observed with caregivers who have higher level of education most likely to own and use a net compared with caregivers with no education.

A respondent was considered to hold a misconception if he/she mentioned what is not a known cause of malaria or what is not a known means of preventing malaria. For instance, misconceptions mentioned included: not resting enough or lack of sleep, drinking too much alcohol/beer, witchcraft/juju, eating too much palm/ground nut oil, and working too hard/stresses. The study found that caregivers with misconceptions about prevention of malaria are about 20% less likely to own and use a net, while caregivers with some misconception about causes are about 25% less likely to own and use a net. The findings of this survey suggest that misconceptions about the cause of malaria, its prevention, and control by care-givers have the potential to adversely influence the utilisation of insecticide treated nets by the children.

Another observation in this study is that while misconceptions about the cause and prevention of malaria was significantly associated with non-use of ITNs, researchers observed no association between knowledge of symptoms or risk of malaria and the use of ITNs. Findings from a similar study from another West African country showed no significant association between knowledge and the use of ITNs suggesting that relationship between knowledge and health action may be influenced by other biosocial factors.

The article points out that people in different societies hold a variety of beliefs about the cause and transmission of malaria that vary according to cultural, educational, and economic factors, and have direct consequences for both preventive and treatment-seeking behaviour as well as for other activities to control malaria. Failure to implement appropriate communication strategies to specifically address misconceptions would result in their persistence with potential adverse consequences on the utilisation of ITNs and other malaria control services. The protective efficacy of ITN against malaria infections is no longer in doubt. The programmatic implication from this finding is that behaviour change communication messages should address issues on misconception about causes of malaria and modes of its prevention.