Cast the net wide: Assessing the root causes of malaria transmission through the knowledge, attitude and practice of treated inpatients in rural western Uganda

Abstract

Introduction Despite significant progress malaria entails a significant public health concern in western Uganda. This qualitative cross-sectional study explores the knowledge, attitude and practice pertaining to malaria in rural Uganda. Methods With ethical approval from the management committee fifty patients were recruited between March-May 2018 at Kagando Hospital, western Uganda. Those with evidence of malaria transmission were recruited, at random prior to discharge, from the medical, paediatric (parents) and maternity wards. Participants were consented and briefed by a translator prior to answering a standardised semi-structured questionnaire. Answers were anonymised before being tabulated and analysed electronically. Results Participants were commonly, primary-school educated, subsistence farmers (56%). Knowledge of symptoms, mosquito breeding sites and feeding habits was generally good, yet dichotomous causes of malaria were common (mosquito n=43 and“unsafe drinking water” n=25). Malaria was “normal” to 40% of respondents and 92% acknowledge that it “kills”. Ten-percent accessed herbalists and 74% self-medicated with 30% admitting to not completing the treatment. Eighty-two percent of patients received governmental net donation but household use was variable and often infrequent. Indoor residual spraying (IRS) was practiced by two participants with just 30% aware of it. Stagnant water was present in 46% of communities without any knowledge of community spraying. Conclusions Participants demonstrated reasonable knowledge on vector/disease characteristics and treatment. Net access was within governmental target level but household practice was highly variable. Notably there was almost no IRS and no targeted spraying. A more integrated approach to vector control could represent an appealing strategy.