Abstract
BackgroundThe focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services.MethodsA qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed.ResultsThe 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services.ConclusionApart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate the community perceptions and practices on malaria management. The current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. Promoting active community involvement and ownership in malaria control and management through strengthening community based organizations would be relevant. Further, timely availability of drugs and commodities at the community level can improve their confidence in the public health system.
Highlights
The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches
This study aimed at generating evidence on the existing community perceptions, practices and their determinants on malaria control and management to complement the ongoing community-based malaria control programme
Local illness concepts This study found that the community had adopted the biomedical-equivalent term of malaria, known as ‘meleria’ to describe a broad range of illnesses
Summary
The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. Appropriate community awareness and practice are inevitable for the effectiveness of such efforts In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. The study assessed community perceptions and practice on malaria and similar febrile illnesses This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services. Strengthening the availability of effective and affordable care has been a key strategy of all malaria-endemic countries [1]. These supply-side strategies were sub-optimally effective, as there was not adequate synergy between the service delivery and the community responses to it [1]. In the context of a community-based approach, the understanding of community perceptions and practices are crucial for the policy makers to embed the disease control interventions into the socio-cultural dimensions of the community for effective adoption of healthy practices
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