Abstract
BackgroundIn 2005, the Ministry of Health in Ethiopia launched a major effort to distribute over 20 million long-lasting insecticidal nets, provide universal access to artemisinin-based combination therapy (ACTs), and train 30,000 village-based health extension workers.Methods and FindingsA cross-sectional, nationally representative Malaria Indicator Survey was conducted during the malaria transmission season in 2007. Multivariate logistic regression analyses were performed to assess the effect of women's malaria knowledge on household ITN ownership and women's ITN use. In addition, we investigated the effect of mothers' malaria knowledge on their children under 5 years of age's (U5) ITN use and their access to fever treatment on behalf of their child U5. Malaria knowledge was based on a composite index about the causes, symptoms, danger signs and prevention of malaria. Approximately 67% of women (n = 5,949) and mothers of children U5 (n = 3,447) reported some knowledge of malaria. Women's knowledge of malaria was significantly associated with household ITN ownership (adjusted Odds Ratio [aOR] = 2.1; 95% confidence interval [CI] 1.6–2.7) and with increased ITN use for themselves (aOR = 1.8; 95% CI 1.3–2.5). Knowledge of malaria amongst mothers of children U5 was associated with ITN use for their children U5 (aOR = 1.6; 95% CI 1.1–2.4), but not significantly associated with their children U5 seeking care for a fever. School attendance was a significant factor in women's ITN use (aOR = 2.0; 95% CI 1.1–3.9), their children U5′s ITN use (aOR = 4.4; 95% CI 1.6–12.1), and their children U5 having sought treatment for a fever (aOR = 6.5; 95% CI 1.9–22.9).ConclusionsAlong with mass free distribution of ITNs and universal access to ACTs, delivery of targeted malaria educational information to women could improve ITN ownership and use. Efforts to control malaria could be influenced by progress towards broader goals of improving access to education, especially for women.
Highlights
Malaria is a leading cause of morbidity and mortality in Ethiopia [1]
Fewer (15.0%) mothers of children U5 lived in households of the highest wealth quintiles compared to all women (20.1%), while more (57.4%) mothers of children U5 lived in households that owned at least one insecticide-treated nets (ITNs)
5,023/6,657 (73.8%) women had heard of malaria, only 2,953 (43.6%) stated that fever was a symptom, 2,233 (34.6%) mentioned mosquitoes as the cause, 2,296 (31.5%) reported that nets or ITNs could prevent malaria, and 2,731 (39.7%) named at least one danger sign of malaria
Summary
Malaria is a leading cause of morbidity and mortality in Ethiopia [1]. In 2007–2008, malaria was the top cause of outpatient visits and admissions with 12% of all visits and 10% of admissions [2]. Malaria transmission intensity varies throughout Ethiopia and is mainly determined by its diverse eco-climatic conditions. Climatic factors such as temperature, rainfall, and humidity vary greatly, partly as a function of altitude. Areas below 2,000 m elevation are considered at risk for malaria and are targeted to receive malaria interventions. This encompasses approximately 75% of the country’s landmass and 68% of the population [3]. In 2005, the Ministry of Health in Ethiopia launched a major effort to distribute over 20 million long-lasting insecticidal nets, provide universal access to artemisinin-based combination therapy (ACTs), and train 30,000 village-based health extension workers
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