KAP Survey Research Articles

The status of malaria before and after distribution of ITNs from 1999 to 2006 in two districts of Khammouanne Province, Lao P.D.R

In 1999, an insecticide-treated net (ITN) distribution project was started in several malaria-endemic villages in Lao P.D.R., namely Vientiane, Bolikhamxay and Khammouanne Provinces. After the completion of the project, it was found that the ITNs were effective for malaria control based on the analysis of the slide positivity rate for malaria parasites between 1999 and 2000 [6]. We conducted malariometric, entomological and KAP surveys in 2005-06 to confirm the status of malaria and to determine the effectiveness of ITNs in three different socioepidemiological areas (near city, rural and remote), represented by the Xebangfay and Boualapha districts, Khammouanne Province.A marked decrease in the annual malaria incidence and slide positivity rate was noted from 1999 to 2006 in the two districts. The malaria prevalence was significantly reduced in near city areas (5.6%-10.7% in 1999 to 0% in 2005-06) and rural areas (21.4%-50.9% in 1999 to 0%-1% in 2005-06). Twelve positive cases were recorded in remote areas (3.4 - 7.7% in 2006).The illiteracy rate was significantly higher among the respondents in the remote (83.9%) than among those in the near city (32.7%) and rural (54%) areas. In all areas, more than 50% of the villagers indicated that they were not aware of malaria. Similarly, about 60% of the respondents were found to have incorrect knowledge concerning malaria transmission. In remote, 40.9% of the respondents were aware of the methods to prevent malaria infection and 49.5% used mosquito nets throughout the year, rates significantly lower than the corresponding rates in near city and rural. The density of persons per net in remote (3.1-5.9) was considerably higher than that in near city (1.8-2.1) and rural (1.2-2.7). Malaria vector mosquitoes, such as An. minimus and An. nivipes were collected by human-baited adult collection, and cow-baited and CDC light traps. The results of the analysis suggested that the lower the number of persons per net the more effective the reduction of malaria morbidity in these areas. It is imperative that ITN distribution and health education regarding malaria be strengthened, especially in remote, but also in other areas.

The importance of understanding the local context: Women's perceptions and knowledge concerning malaria in pregnancy in rural Malawi

A current problem of malaria prevention programmes is that not enough attention is paid to understanding the local socio-cultural context prior to programme implementation. The aim of this study is to discover how Yao women in rural Malawi understand and explain malaria in pregnancy, how they perceive it and what type of knowledge they have on it. Women's knowledge of the adverse effects of malaria in pregnancy is also investigated. At first phase a total of 34 in-depth interviews were conducted. At second phase a KAP survey ( n = 248) was conducted for cross-validation of the qualitative information. The findings showed that there is neither a vernacular word for malaria nor malaria in pregnancy. Women used a local word, malungo, to refer to malaria. Malungo is an ambiguous disease term because of its multiple meanings which are used interchangeably to refer to many types of feverish illnesses of various causes, not only malaria. Most women did not perceive malungo during pregnancy as a serious illness. There were several other diseases from anaemia, STDs to cholera etc. that were perceived to be more dangerous than malungo. The local meaning of malungo also entailed an assumption that it is a common but fairly harmless illness. Women had limited knowledge of the adverse effects of malaria in pregnancy, the best-known adverse effect being miscarriage (28%, 52/189). A socio-cultural understanding of the implementation context is prerequisite for planning meaningful programmes for the pregnant women in rural Africa.

Dengue in Grenada.

Dengue fever is endemic in the country of Grenada and is grossly underreported as a source of morbidity. The goal of this study was to assess the status of dengue fever in a representative community in Grenada. Surveys were conducted in the Mont Tout/Grand Anse Valley area in the parish of St. George's from March to June 1996. The objectives of the survey were to: (1) to assess the knowledge, attitudes, and practices (KAP) of residents; (2) to determine the presence of larval and adult Aedes aegypti and their potential breeding sites; and (3) to identify the seroprevalence of specific immunoglobulin G (IgG) dengue antibodies in the local population. Out of the 102 respondents to the KAP survey, 100 of them (98%) reported never having had dengue fever. Of the 75 persons who agreed to have blood samples taken, 70 of them (93%) (95% confidence interval = 85.1%-97.8%) tested positive with the IgG enzyme-linked immunosorbent assay, indicating past exposure. In terms of water storage, 98 of 102 respondents (96%) stored fresh water in containers. The vector survey found 57 of the 102 households (56%) had Ae. aegypti larvae in water containers on their property, and 94 of 102 dwellings (92%) had adult Ae. aegypti mosquitoes indoors. Although many people were familiar with dengue fever and mosquitoes, the 1996 survey found that their knowledge of the important relationships among mosquitoes, human behavior, and disease transmission was incomplete. Since 1996, continued education efforts have been made in the public school system and with national public health campaigns, yet little effort has been specifically targeted towards our study community. These data suggest Grenada has a need for continued community education that addresses dengue fever transmission and Ae. aegypti reduction.

Knowledge and attitudes in the rural Western Cape towards pesticides in water sources

There is a need for pesticide water monitoring in South Africa and for community awareness with regard to chemical contamination of rural water sources. The results of two descriptive studies in the rural Western Cape are reported. One assessed water usage and the knowledge, attitudes and practices in relation to water of farm residents (229 participants from 60 farms) in the Slanghoek Valley, Hex River Valley and Grabouw (KAP) and the other (monitoring capacity survey), investigated water usage and the capacities of rural communities (63 farm residents from 16 farms in three local authorities and 8 environmental health officers (EHOs) from 7 local authorities) to conduct monitoring of pesticides in rural water sources. Most farm residents in both surveys identified protected sources such as groundwater from springs and boreholes (30 to 60%), and water from mountain dams (40 to 65%), as the most important sources for drinking and other domestic purposes. Many (> 40%), however, also reported farm dams. For use in the field (both drinking and other), potentially contaminated sources (river, subsurface drains, dams) were more frequently reported. Forty-eight percent of participants also reported swimming in farm dams. Other water sources reported included municipal, rain and canal water. In the monitoring capacity survey, 27 % reported using untapped water. About a third of respondents in the KAP survey reported living within 10 m of the nearest site of spraying and many used pesticides at home for pest control (41%) and in the garden (33%). While almost all participants (> 90%) in both surveys were aware that pesticides and polluted water could be harmful, many did not identify health effects (20%) especially chronic effects (91%) or reported no training (37%) in health effects. In all 7 districts surveyed in the monitoring capacity survey, water sources on farms are tested by EHOs. Only 3 (37%) respondents felt that there were enough persons conducting water monitoring in their area. Only 1 respondent reported that pesticides were monitored, and only in request to a complaint. Three state laboratories, that did not have the analytical capacity to conduct routine pesticide water monitoring at low (< 0.1 mg/l) detection limits, were identified as conducting water analyses. The study found that farm residents in the Western Cape are potentially exposed to pesticides through various environmental routes including water. This emphasises the need to monitor water for pesticides in the Western Cape, but in order to do this, human and laboratory resources and capacities to conduct routine pesticide water monitoring need to be increased.

Correlates of knowledge of prevention of sexually transmitted diseases among primary school pupils in Tanzania

In this paper we attempt to identify factors that determine knowledge on prevention of sexually transmitted diseases (STDs) among primary school pupils in Tanzania using data extracted from the Family Life Education KAP Survey conducted in 1999. The data used consist of a sample of 18,564 pupils (about 50% males and 50% females) from all the 20 regions of Tanzania mainland. There were significant differences between boys and girls as regards knowledge of family life education in general. Boys tended to be more knowledgeable than girls about many aspects of family life education. The findings show that only 40.1% of the respondents were able to identify all the three STDs given in the questionnaire namely gonorrhoea, syphilis and AIDS. As regards modes of HIV transmission only 37.5% had full knowledge of these, while 48.8% knew condom use and abstinence as methods of STD prevention. The bivariate analysis showed significant relationships between knowledge of condom use and abstinence as methods of STD prevention with knowledge of STDs, HIV transmission, education level of the respondents, residence and parents' education for both boys and girls. However, knowledge of STDs, HIV transmission and residence came out clearly in the logistic regression as predictors of knowledge of condom use as a method of STD prevention for both sexes. For males, mother's education was also a significant predictor of knowledge of condom use as a method of STD prevention. Furthermore, a significant predictor of knowledge of condom use for female respondents was found to be the respondent's educational level. On the other hand, predictors of knowledge of abstinence as a method of STD prevention were knowledge of STDs and HIV transmission.

An Assessment of the Availability and Utilization of Toilet Facilities at Alanamu Ward, Ilorin, Kwara State, Nigeria.

The study assessed the availability of toilet facilities in Alanamu Ward of Ilorin, the capital city of Kwara State of Nigeria. It also critically appraised the utilization of the toilets and factors affecting both availability and utilization. Heads of households or their representatives in 112 houses selected by systematic random sampling were interviewed. One hundred and ten of the questionnaires were found suitable for analysis. Results obtained showed that people in Alanamu use other methods beside the toilet for defaecation and excreta disposal. These other methods include refuse dumping sites, bush at backyard of houses, bowls and the surroundings. Factors such as accessibility, education, culture and socio-economy have strong influence on toilet availability and utilization in Alanamu. Recommendations were made in order to improve latrine conditions and excreta disposal generally. There is also an urgent need for further research, particularly, KAP survey of people on excreta disposal and its health implications. Sahel Med. J. Vol.5(4) 2002: 199-203

Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria.

To describe the current drug use practices at the institution, and gather baseline data, which can serve as a basis for designing an appropriate intervention to improve the drug use profile. A retrospective audit of in- and out-patient prescriptions, generated during the period January-March 1999. Indicators of drug use pattern include: average number of drugs prescribed per encounter (ANDPE), average number of antibiotics prescribed per encounter (ANAPE), % encounter with antibiotics (PEA), percent of antibiotic prescriptions based on microbial sensitivity test results (MCST). Additionally, a "knowledge, attitude and practice" (KAP) survey of prescribers and dispensers was performed. Indicators of prescribing and dispensing quality include: sources of drug/prescribing information, availability and use of the hospital formulary, knowledge of the prescribing process and the adequacy of the drug supply management system. A total of 9984 outpatient prescriptions and 127 in-patient case notes were audited. The total number of prescribers and dispensers surveyed were 88 and 13 respectively. The ANDPE was found to be 3.16 for out-patients and 9.7 for in-patients, ANAPE was 1.1 and 2.4 for out-patients and inpatients respectively. The PEA was 50.3% for out-patients and 96.7% for in-patients. Only 4.2% of in-patient antibiotic prescriptions were based on MCST and percent encounter with switches in antimicrobial therapy was 52.1% while the average number of switches per encounter was 1.35. In 18.5% of the in-patient encounters there was evidence of drug incompatibilities. The KAP survey revealed that prescribers and dispensers in the hospital rely on different sources for their drug information needs (MIMS vs Martindale Extrapharmacoepia). None of the prescribers surveyed was able to correctly enumerate all the 4 steps involved in the prescribing process, about 25% got at least 2 steps correctly, and only 9.1% of the dispensers surveyed could accurately define a hospital formulary. The drug supply management system was found to be inadequate. The survey revealed that appreciable gaps in knowledge with respect to rational drug use, still exists among these cadre of healthcare professionals. The foregoing suggests an urgent need for review of current policies and systems in the hospital with the view of enhancing the drug use practices of the health providers. Specifically it is recommended that there should be an intervention program involving concerted continuing education (to influence the KAP of the various cadre of healthcare providers) and the establishment of a hospital formulary/standard treatment guidelines.

A model of primary prevention of sexually transmitted diseases and HIV/AIDS in adolescents

To develop, apply, and evaluate an educational model for the primary prevention of sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) that was based on the sexual knowledge, attitudes, and practices (KAPs) of adolescents and on their perceptions and behaviors in this area, with the ultimate goal of helping develop educational tools to prevent infection with STDs and the human immunodeficiency virus (HIV). An STD/HIV/AIDS primary prevention model was applied with adolescent schoolchildren (12 to 15 years old) in the canton of Santo Domingo de los Colorados, Ecuador. Two groups with similar characteristics were formed: the experimental group, with 358 students, and the control group, with 288 students. Schools were selected according to inclusion criteria, and adolescents at each school were chosen at random. A discussion guide was applied with 16 focus groups, and the resulting information was used to prepare a KAP survey. After being validated, the KAP survey was applied to the experimental group and to the control group. A prevention education program geared to students and teachers was implemented with the experimental group. Eight months later a second KAP survey was done with the experimental group and the control group. The differences in KAPs before and after the intervention were evaluated using the chi-square test. There were no statistically significant differences between the two groups before the intervention, but afterwards the differences were statistically significant (P = 0.012), with an increase in the knowledge of sexuality and STDs/AIDS in the experimental group, even though the long-term behavior changes have not been evaluated. This study validated a multifactorial STD/AIDS prevention model adapted to the reality of adolescents, and it suggests the possibility of extrapolating this experience more broadly to contexts similar to those of this Ecuador population.

A Study on Knowledge, Attitude, Practice and Quality of Care in Family Planning at Dessie Zuria District.

Objective: To assess the knowledge, attitude and practice of Family Planning Programme of Dessie Zuria Woreda's female residents who are in childbearing age and to observe the quality of care in FP at health institution level. Method: The type of the study is cross-sectional study. We have conducted community based KAP survey in 1998 in Dessie Zuria Woreda. The Woreda's female residents were interviewed about Family planning and regarding quality care in Family Planning the health institution and health personnel were assessed . In the rural area, the peasant associations were selected by random sampling methods and the village by cluster sampling. In town the urban dweller associations were selected by random sampling. After calculating the sample size the desired number of study population was 1599 women. Concerning the quality of care assessment all the health institutions and all the health personnel who are conducting Family Planning programme in the woreda were included. Results: The most common source of information concerning FP in the urban area are Health personnel (64.6%), Mass media (14%) and similarly in the rural area, Health personnel contribute 80.3%. Among the study population 53.3% are not using Family Planning. It was observed that 75.2% of the rural and 36% of the urban are not using any means of contraceptive methods. When we compare the illiterate and those above six grades in relation to using Family planning service. Those above six grades are using the service 3.36 times more than illiterate ( P Conclusion: Expansion of service at community level with the support of CBDs, ensuring the availability of mix-contraceptive and conducting in-service training on FP is recommended. Key words: Family planning, Contraceptives, Information Education Communication, Counselling, Fertility. [J Ethiopia Med Pract. 2001:3(2):70–76 ]

An ecosystem approach to malaria control in an urban setting.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.

Knowledge, Attitudes, and Practices of Family Planning among Currently Married Women in Jordan Badia

This article reports the results of the first household survey ever conducted in Jordan Badia to include questions on knowledge, attitude, and practices (KAP) among 15–49 currently married women in Jordan Badia toward family planning. The Jordan Badia is the eastern part of Jordan populated by Bedouins who make up about 7 to 9 percent of the 4.8 million total population of Jordan. Using convenience sampling procedure, a total of 450 respondents, 50 from each of nine villages, were selected for participation. The mean age of the study population was 30.9 years and the women's age at marriage ranged from 13 to 35 years, with a mean age at first marriage of 16.8 years. More than 37 percent of the women were illiterate. Over 91 percent of the women know about family planning, but proportions of ever-users or currently-users of contraception are found to be 35.7 percent and 31.7 percent respectively. The social support network, including the husbands, mothers, and mothers-in-law, was explored. Husbands' support for family planning was significantly higher ( p &lt; 0.001, Chi Square test, df = 2) than the support of both the mothers and mothers-in-law. In view of the limited data-based literature in the area of family planning, findings of this survey can assist in the formulation of culturally appropriate population policy and viable family planning programs for this Bedouin community. Based on the results of this KAP survey, appropriate recommendations aiming at increasing the demand for family planning services among women in Jordan Badia are provided.

Family planning KAP survey in Gaza

This study explores the reproductive attitudes, contraceptive use, demand for family planning and related topics of a representative sample of the female population of reproductive age resident in a Refugee Camp in the Gaza Strip. A cluster sample of 841 resident women of reproductive age (15–49 years) was interviewed in their homes. Univariate and multivariate statistical analyses were performed using BMDP software. 98% of the interviewees favour family planning and 88% plan to use a contraceptive in the future. However, 52% of the women at risk do not use any contraception because of their husband's opposition, fear of side effects or lack of knowledge. The risk of having seven or more children is positively associated with a woman's low educational level and husband's desire for more than seven children. Despite favourable attitudes regarding family planning, there is ignorance and the prevalence of contraception use is low. There is a gap between fertility preference and achievement.

Family Planning Attitudes and Use in Nigeria: A Factor Analysis

This study examined the association between family planning (FP) attitudes and contraceptive use in Nigeria. Data were obtained from a random sample of 927 married men and women stratified in urban areas by social class (elites mixed migrant working class and indigenous) who responded to a KAP survey conducted during 1992-93 in the capital city and a rural village in the states of Enugu Kano and Lagos. Over 67% were Ibos or Hausas; 25% were Yorubas. Around 75% of men and 59% of women had formal education. 76% knew a contraceptive method but only 28% were currently using contraception. 47% had ever used. Women were more likely than men to have ever used. Respondents were supportive of FP. Men were less positive about FP and marital relations than women. 20 factors were identified as relating to use. Three factors explained 53% of the variance in current contraceptive use: 1) the association of FP with health benefits; 2) the association of contraceptive use with conflict in the home; and 3) support for daughters completion of school before marriage. Logistic models reveal that contraceptive use was best predicted by education religion approval of FP mass media exposure spousal communication and approval of educating girls and women. For men the critical explanatory factors for adoption of contraception were religion and ethnicity.

Fertility, Contraceptive Use and Family Planning Program Activity in the Islamic Republic of Iran

This study examined contraceptive prevalence in Iran modern method mix sources of supply unwanted pregnancy fertility and desire for small families. Data were obtained from KAP surveys conducted in 1989 and yearly during 1992-97 among about 10000 rural and 10000 urban women 15-49 years old. A demographic and health type survey is planned for 1999. The Islamic government increased commitment to family planning and small family size in the 1990s. Findings indicate that contraceptive prevalence increased from 37% to 65% during the 1970s to 1992. In 1997 66% of rural women and 77% of urban women were using contraception. The pill was the most popular method in 1992. About 43% of modern method use in urban areas and 64% in rural areas was the pill. 21% of modern method users in urban areas used the IUD. 18% of modern method users in rural areas had tubectomies. Condoms were 17% of modern method use by urban women and 10% by rural women. By 1997 pill use declined; tubectomy use increased. 57% of modern methods were obtained from public services. In 1996 many illiterate women chose tubectomy; a smaller proportion of illiterate men chose vasectomy. About 30% of pill users did not take the pill correctly. High parity pregnancies were more likely to be unwanted. Fertility in 1996 was 2.8 births/woman. Literacy in 1996 was 74% for women over 6 years old. Literacy for rural women was 62%.

The Impact of Multimedia Family Planning Promotion on the Contraceptive Behavior of Women in Tanzania

This study examined effects of mass media campaigns promoting family planning (FP) on contraceptive use in Tanzania. Nationally representative data were obtained from a 1994 KAP Survey and a 1991-92 Demographic and Health Survey. Tanzania integrated FP into maternal and child health services in 1988. It adopted 1992 IEC policy a national communication program and social marketing of condoms in 1992. The FP Communication Project operated during 1991-94 and educated men and women about the health benefits of modern contraception. The multimedia campaign relied on radio spots in 1993 and 1994 a radio serial drama during 1993-94 a Green Star logo posters leaflets newspapers and audiocassettes. Other campaigns by five other organizations or programs were complementary. Analysis reveals that womens exposure to mass media sources of FP messages was associated with increased contraceptive use especially modern methods. Women exposed to FP messages were more likely than other women to discuss FP with their spouses and to visit health facilities. These effects remained after controls for residence education age marital status parity approval of FP partners views on FP and radio ownership. Most women who recalled mass media messages were not already using or had not ever used contraceptives. The impact was greater when women were exposed to multiple sources. Messages reached about 55% of reproductive-age women.

The Balance of Self-Reported Heterosexual Activity in KAP Surveys and the AIDS Epidemic in Africa

The Balance of Self-Reported Heterosexual Activity in KAP Surveys and the AIDS Epidemic in Africa

Investigating women's s gynaecological morbidity in India: Not just another KAP survey

This paper discusses major lessons learnt from seven community-based prevalence studies of gynaecological morbidity among poor women in India, methodological challenges associated with this research and implications for future research: (i) close interaction with the community is an important determinant of a successful study; (ii) appropriate medical treatment should be provided to respondents, as it maybe the only opportunity to address many women's reproductive health problems; (iii) it is important to complement quantitative assessments of morbidity with in-depth qualitative research; (iv) women may significantly under-report gynaecological problems; (v) specific questions, detailed probing and consideration of severity may improve reporting validity; (vi) sample loss and self-selection due to women's unwillingness to undergo clinical examination are serious problems; (vii) there is significant variation in clinical definitions and criteria for gynaecological morbidity across studies. The paper concludes that future research can be designed to achieve greater accuracy regarding prevalence and should go beyond a narrow medical focus to include causal factors, social and sexual behavioural issues and consequences of morbidity for women's lives, and suggests alternatives to full studies, which voluntary groups and researchers could more easily undertake.

Accidental exposures and KAP surveys concerning theuniversal precaution among the clinical-year medicalstudents of Faculty of Medicine, Chulalongkorn University

Accidental exposures and KAP surveys concerning theuniversal precaution among the clinical-year medicalstudents of Faculty of Medicine, Chulalongkorn University

A survey of knowledge, attitude, and practice of cervical screening among Lebanese/Armenian women

A 1995 KAP survey of 290 female members of the Armenian Relief Cross in Lebanon revealed strong associations between educational level and Papanicolaou cervical cancer screening. 70% of respondents were over 41 years of age; 37.7% had a secondary school education or higher and 92% rated their economic status as average or above average. Both educational level and economic status were positively associated with knowledge about the purpose of the Pap smear. Among the 174 respondents who were aware of the Pap test the percentage who wanted to undergo screening increased significantly with educational level but was unaffected by economic status. A significantly higher number of women with poor and average perceived economic status compared with good or very good status cited embarrassment and cost as obstacles to seeking screening. 62.4% of respondents had actually received a Pap smear. Practice was significantly associated with educational level but not economic status. Overall 88.4% of women with very good levels of knowledge and a favorable attitude toward screening scored above average on the practice index while 87.2% of women with poor levels of knowledge and attitude had poor practice scores. Among women with average levels of knowledge and attitude 64.2% had poor practice scores 24.7% had average scores and 11.1% had very good scores. Since poor women with low levels of formal education are at increased risk of cervical cancer health education campaigns targeted at this group are recommended to promote awareness and uptake of Pap screening.

Factors affecting use of contraception in Matlab, Bangladesh.

This study examines the relationship between family planning, perceived availability of contraceptives, and sociodemographic factors in rural Bangladesh. Data are from the 1990 KAP survey in the Matlab treatment and comparison areas, using a sample of about 8500 married women of reproductive age. The contraceptive prevalence rate was 57% in the treatment area but substantially lower in the comparison area where mainly traditional methods of family planning were used by women who did not know of a source of supply of contraceptives. Education has no effect on contraceptive use in the treatment area but in the comparison area, modest but consistent differentials in use by level of education were found. Number of living children is the best predictor for contraceptive use, followed by number of living sons, and the attitude of respondents and their husbands towards family planning.