Abstract
BackgroundDespite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities.MethodsOne year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015–April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6–59 months and women aged 15–49 years and IPTp uptake (for women aged 15–49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models.ResultsA total of 2046 participants were included from 1328 households; 56.6% were women aged 15–49 years and 43.4% were children aged 6–59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35–0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years.ConclusionTo achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.
Highlights
Despite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities
Study design and setting This paper describes and analyses quantitative data collected during a rolling malaria indicator survey in rural Malawi. rMIS involves a sequence of cross-sectional
There were more women with no formal education in the study area compared to the 2014 Malawi Malaria Indicator Survey (MMIS) [13]
Summary
Despite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. The lack of equitable access (availability, affordability, and acceptability) [8] and coverage affect utilization of the interventions in poor and rural communities [9, 10]; poor communities have a disproportionately higher burden of malaria infection than wealthier communities [11]. While national-level surveys provide statistics on the access and utilization of malaria control interventions, these aggregated survey estimates may mask substantial variations in intervention coverage that exist in rural communities [14]
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