Ovadje Lauretta, Nriagu Jerome
School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
Malar J. 2016 Oct 21;15(1):516. doi: 10.1186/s12936-016-1557-2.
Poor malaria knowledge can negatively impact malaria control programmes. This study evaluates knowledge distribution in the domains of causation, transmission, vulnerability, symptoms, and treatment of malaria. It assesses the association between a caregiver's knowledge about malaria and ownership and use of insecticide-treated nets (ITNs) by children.
Some 1939 caregivers of young children were recruited through a school-based survey in two Nigerian states. A 20-item, multi-dimensional survey instrument was developed and used to rank each caregiver's knowledge in five dimensions (cause, transmission, vulnerability, symptoms, treatment of malaria). Scores for each domain were used to create an aggregate knowledge score for each caregiver. The outcome measures were ITN ownership, and ITN use the night and week before the study. Regression models were used to evaluate the relationship between caregiver's knowledge (individual domains and aggregate score) and ownership and use of ITN after controlling for likely confounders.
The main predictor of ITN use was ITN ownership (r = 0.653; p < 0.001); however, ownership only explains 43 % of variance in net use. Total knowledge index for the study population was significantly associated with both ITN ownership (r = 0.122; p = 0.001) and use (r = 0.095; p = 0.014). The spectrum of caregiver's knowledge of malaria and its causes captured in the various domains was, however, found to be poor. Fifty percent of the respondents knew that malaria is transmitted by female mosquitoes and 65 % still believe that too much exposure to the sun is a risk factor for malaria. Knowledge of populations most vulnerable to malaria (83 %) and knowledge of malaria transmission (32 %) were the domains with the highest and lowest average correct answers.
There is a need to improve ITN coverage in Nigeria as ITN ownership was associated with ITN use. Additionally, treating knowledge as a multi-dimensional phenomenon revealed that a lot of misperceptions about malaria still exist. Distribution of ITNs through the public/private sector may need to be augmented with tailored behavioural change communication to dispel myths and improve the multi-dimensional knowledge of malaria in the local population.
疟疾知识匮乏会对疟疾防控项目产生负面影响。本研究评估了疟疾在病因、传播、易感性、症状及治疗等方面的知识分布情况。它还评估了儿童看护者对疟疾的知识与儿童杀虫剂处理蚊帐（ITN）的拥有及使用之间的关联。
通过在尼日利亚两个州开展的一项基于学校的调查，招募了约1939名幼儿看护者。开发了一份包含20个项目的多维度调查问卷，并用于在五个维度（疟疾病因、传播、易感性、症状、治疗）上对每位看护者的知识进行排名。每个领域的得分用于为每位看护者创建一个综合知识得分。结果指标为ITN的拥有情况，以及研究前一晚和一周内ITN的使用情况。在控制可能的混杂因素后，使用回归模型评估看护者的知识（各个领域及综合得分）与ITN的拥有及使用之间的关系。
ITN使用的主要预测因素是ITN的拥有情况（r = 0.653；p < 0.001）；然而，拥有情况仅解释了蚊帐使用差异的43%。研究人群的综合知识指数与ITN的拥有情况（r = 0.122；p = 0.001）和使用情况（r = 0.095；p = 0.014）均显著相关。然而，发现看护者对疟疾及其病因在各个领域的知识掌握情况较差。50%的受访者知道疟疾是由雌蚊传播的，65%的人仍然认为过度暴露在阳光下是疟疾的一个风险因素。对最易感染疟疾人群的知识（83%）和疟疾传播知识（32%）是平均正确答案比例最高和最低的领域。
由于ITN的拥有与使用相关，尼日利亚需要提高ITN的覆盖率。此外，将知识视为一种多维度现象表明，对疟疾仍存在许多误解。通过公共/私营部门分发ITN可能需要辅以针对性的行为改变宣传，以消除误解并提高当地人群对疟疾的多维度知识。
