Village-based Health Research Articles

Villages SDG's response to mental health: Better late than never

Purpose: This article presents village-based mental health policies in response to sustainable development goals. Research methodology: A qualitative research approach was used in conjunction with library research. Results: According to the findings of this study, the focus of development goals, namely living a healthy and affluent life, has not been on mental health. Furthermore, there are findings on advocacy, research and innovation, partnership, and integration of mental health and other SDGs. Contribution: Based on the findings of this study, several recommendations were made, including developing wise mental health policies in rural areas, increasing mental health commitments and budgets, mobilizing communities to respond to rural mental health policies, and improving treatment facilities and mental health response services. Novelty: Although the goals of sustainable development place a special emphasis on healthy and prosperous lives, insufficient data on mental health have been collected, and mental health policies based on village wisdom have not become a theme that many central and regional governments have implemented.

Updates on Mosquito Control Methods

Control of mosquito involves the use of all appropriate technological and management techniques that brings about an effective degree of mosquito prevention and suppression in a safe, cost effective, and environmentally sound manner with inter-sectoral participation. Approaches to mosquito management can be direct or indirect. Direct interventions include the removal of breeding habitat, use of biological controls or the application of pesticides. Indirect approaches reduce human-mosquito conflict, for example utilizing planning mechanisms and educating the public to avoid mosquitoes. Another important indirect approach is for mosquito managers are actively link and collaborate with other departments/authorities to minimize the potential for mosquito breeding. Integrating malaria prevention activities with other health programming, pioneering village-based health care delivery systems that share resources, personnel, health education, and treatment to address several diseases at once.

Participating in eradication: how Guinea worm redefined eradication, and eradication redefined Guinea worm, 1985-2022.

Guinea worm disease (dracunculiasis) is a debilitating waterborne disease. Once widespread, it is now on the brink of eradication. However, the Guinea Worm Eradication Programme (GWEP), like guinea worm itself, has been under-studied by historians. The GWEP demonstrates an unusual model of eradication, one focused on primary healthcare (PHC), community participation, health education and behavioural change (safe drinking). The PHC movement collided with a waterborne disease, which required rapid but straightforward treatment to prevent transmission, creating a historical space for the emergence of village-based volunteer health workers, as local actors realigned global health policy on a local level. These Village Volunteers placed eradication in the hands of residents of endemic areas, epitomising the participation-focused nature of the GWEP. This participatory mode of eradication highlights the agency of those in endemic areas, who, through volunteering, safe drinking and community self-help, have been the driving force behind dracunculiasis eradication. In the twenty-first century, guinea worm has become firstly a problem of human mobility, as global health has struggled to contain cases in refugees and nomads, and latterly a zoonotic disease, as guinea worm has shifted hosts to become primarily a parasite of dogs. This demonstrates both the potential of One Health approaches and the need for One Health to adopt from PHC and the GWEP a focus on the health of humans and animals in isolated and impoverished areas. Guinea worm demonstrates how the biological and the historical interact, with the GWEP and guinea worm shaping each other over the course of the eradication programme.

Evaluation of a village-based digital health kiosks program: A protocol for a cluster randomized clinical trial

Evaluation of a village-based digital health kiosks program: A protocol for a cluster randomized clinical trial

Evaluation of a village-based digital health kiosks program: A protocol for a cluster randomized clinical trial.

BackgroundTo address disparities in healthcare quality and access between rural and urban areas in China, reforms emphasize strengthening primary care and digital health utilization. Yet, evidence on digital health approaches in rural areas is lacking.ObjectiveThis study will evaluate the effectiveness of Guangdong Second Provincial General Hospital's Digital Health Kiosk program, which uses the Dingbei telemedicine platform to connect rural clinicians to physicians in upper-level health facilities and provide access to artificial intelligence-enabled diagnostic support. We hypothesize that our interventions will increase healthcare utilization and patient satisfaction, decrease out-of-pocket costs, and improve health outcomes.MethodsThis cluster randomized control trial will enroll clinics according to a partial factorial design. Clinics will be randomized to either a control arm with clinician medical training, a second arm additionally receiving Dingbei telemedicine training, or a third arm with monetary incentives for patient visits conducted through Dingbei plus all prior interventions. Clinics in the second and third arm will then be orthogonally randomized to a social marketing arm that targets villager awareness of the kiosk program. We will use surveys and Dingbei administrative data to evaluate clinic utilization, revenue, and clinician competency, as well as patient satisfaction and expenses.ResultsWe have received ethical approval from Guangdong Second Provincial General Hospital (IRB approval number: GD2H-KY IRB-AF-SC.07-01.1), Peking University (IRB00001052-21007), and the University of North Carolina at Chapel Hill (323385). Study enrollment began April 2022.ConclusionsThis study has the potential to inform future telemedicine approaches and assess telemedicine as a method to address disparities in healthcare access.Trial registration number: ChiCTR2100053872

Indonesian Authors in Geneeskundige Tijdschrift voor Nederlands Indie as Constructors of Medical Science

Access to the publication Geneeskundig Tijdschrift voor Nederlandsch-Indië (GTNI), a Dutch Indies medical journal, was limited to European doctors. Although Stovia (School ter Opleiding van Inlandsche Artsen) was established to produce indigenous (Bumiputra) doctors, its students and graduates were not given access to GTNI. In response, educators at Stovia founded the Tijdschrift Voor Inlandsche Geneeskundigen (TVIG) as a special journal for indigenous doctors. Due to limited funds, TVIG – the only scientific medical publication for indigenous doctors – ceased publication in 1922. The physicians formed Vereeniging van Inlandsche Geneeskundigen (VIG) an association for pribumi (native) doctors to express various demands for equal rights, one of which was the right to access GTNI. The protests and demands of the bumiputra doctors resulted not only in being granted reading access rights but also being able to become writers for GTNI. Bumiputra doctors who contributed to GTNI included Bahder Djohan and Johannes Leimena. However, they were not the only authors who contributed to GTNI during the Dutch East Indies era. After Indonesia became independent, both doctors played major roles in laying the foundation for Indonesia’s health education system and implementing village-based health policies. This article is part of a research project on Indonesia’s health history using the archives of the GTNI, TVIG and books written by doctors who contributed to GTNI which were published from the early twentieth century onwards. This paper reconstructs the role of GTNI writers in building Indonesian health knowledge.

A qualitative study of patient perspectives of diabetes and diabetic retinopathy services in Vanuatu.

Diabetes mellitus is an increasing global health problem, particularly in Vanuatu, where it poses a major health burden. There is paucity of information on how patients in Vanuatu perceive diabetes, diabetic retinopathy, access to services and management, health promotion and intervention services to alleviate the issues. This study aimed to explore the perceptions of diabetic patients in Vanuatu on these issues, to help inform the design of health promotion materials and community activities to empower people to self-manage and shape diabetic services that are integrated and people-centred. Qualitative Talanga and Kakala Pacific research methodologies were applied. Participants were diabetic patients from both urban locations and rural villages in Vanuatu. Data were collected from four (two male, two female) focus group interviews and thematically analysed. There were 26 participants. System failures became apparent, including the inability of the health care services to meet the complex needs of patients with diabetes. The protective factors to reduce the risk and increasing incidence of diabetes and diabetic retinopathy included comprehensive village-based health promotion and community development programmes at the primary prevention level. This study described patients' experiences of their diabetic care and identified key barriers and facilitators of service delivery pathways. SO WHAT?: Vanuatu needs to expand nationwide health promotion and education programmes on nutrition and exercise, food insecurity and access through trade agreements and provide well-trained nursing and medical specialists for early diagnosis and adequate management of diabetes that all people can access and afford.

Reducing Hygiene-Related Disease and Malnutrition in Rwanda

Water sanitation and hygiene-related disease and malnutrition are a high priority in developing countries, including Rwanda. Interventions that can trigger and sustain household-level behavioral change and practice are needed. A case-control study was conducted to assess the potential of the Community Health Club (CHC) intervention, which consisted of village-based health education on water sanitation, hygiene, nutrition, and monitoring of households’ practices to reduce water sanitation and hygiene-related disease and malnutrition. The study targeted one village which had been exposed to the CHC. As a control, one village was picked from among villages that had not been exposed to CHC intervention. The two villages were in the catchment area of the Nyabitimbo Health Center and shared the same water sources for domestic use in the Rusizi district in Rwanda. The study examined the prevalence of intestinal worms, diarrhea, and malnutrition among children under 5 years old as recorded in the registries of Nyabitimbo Health Center for the period of the study, 2013–2015. The study results revealed that the CHC intervention was associated with a reduction of intestinal worms, diarrhea, and malnutrition, but the results were only statistically significant for intestinal worms and malnutrition. The present study, being exploratory, can serve for planning and practice purposes at the specific study area.

Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India.

Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018. Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.

Effect of Home-based Family Counselling to the Mothers’ and Caregivers’ Knowledge and Practices on Infant and Young Child Feeding in Selected Rural Villages in Leyte, Philippines

Infant and young child feeding practices are affected by the knowledge of mothers and caregivers. We determined the effect of home-based family counselling on the knowledge and practices of mothers and caregivers relative to infant and young child feeding. Participants included 22 and 21 mothers and caregivers in the intervention and control groups, respectively with 6-15 month-old children categorized as severely underweight and underweight based on World Health Organization (WHO) child growth standard. The intervention group received counselling by the trained village-based health care providers on WHO-recommended complementary feeding messages. We determined the knowledge of breastfeeding mothers and caregivers on complementary feeding by summing up the correct responses on a knowledge test based on the 10 guidelines on complementary feeding. For infant and young child feeding practices, we used a revised standard questionnaire to suit to local condition. We obtained the dietary diversity and meal frequency using the 24-hour food recall for a typical diet of the child for two rounds (before and after intervention). At baseline, the control and intervention groups were comparable in terms of socio-demographic characteristics and knowledge level on complementary feeding. At endline, mothers and caregivers’ knowledge level on infant and young child feeding was higher in the intervention group. Significantly higher effects were observed in the intervention group in terms of the proportions of ever breastfed 12-24 month-old children meeting the minimum dietary diversity, minimum meal frequency, and minimum diet acceptability. This study provides evidence that home-based counselling positively influenced the knowledge and practice of mothers on infant and young child feeding.

Patient Perspectives of Diabetes and Diabetic Retinopathy Services in Kiribati: A Qualitative Study.

Diabetes mellitus is an increasing global health problem affecting millions of people worldwide, especially true in the Republic of Kiribati, with >20% of adults suffering from type 2 diabetes, and the prevalence is rising. Information on I-Kiribati patients' understanding of diabetes and perception of access to relevant services is sparse. This study explores patient perspectives on their condition and its management using Talanga and Kakala Pacific research methodologies. Data were collected from Kiribati patients in four focus group interviews. Key themes to emerge were knowledge about diabetes, understanding and accessing the health care system, making lifestyle changes, and suggestions for improvement. Health system failures to meet the complex health care needs of these patients and health care services gaps are apparent. Improvements suggested include a comprehensive village-based health promotion and community development program focusing on youth and schools from early childhood and onward, increase in the skilled workforce, and an integrated approach to service delivery.

SMARThealth India: A stepped-wedge, cluster randomised controlled trial of a community health worker managed mobile health intervention for people assessed at high cardiovascular disease risk in rural India.

BackgroundCardiovascular diseases (CVD) are rising in India resulting in major health system challenges.MethodsEighteen primary health centre (PHC) clusters in rural Andhra Pradesh were randomised over three, 6-month steps to an intervention comprising: (1) household CVD risk assessments by village-based community health workers (CHWs) using a mobile tablet device; (2) electronic referral and clinical decision support for PHC doctors; and (3) a tracking system for follow-up care. Independent data collectors screened people aged ≥ 40 years in 54 villages serviced by the PHCs to create a high CVD risk cohort (based on WHO risk charts and blood pressure thresholds). Randomly selected, independent samples, comprising 15% of this cohort, were reviewed at each 6-month step. The primary outcome was the proportion meeting systolic blood pressure (SBP) targets (<140mmHg).FindingsEight-four percent of the eligible population (n = 62,254) were assessed at baseline (18.4% at high CVD risk). Of those at high risk, 75.3% were followed up over two years. CHWs screened 85.9% of the baseline cohort and doctors followed up 70.0% of all high risk referrals. There was no difference in the proportion of people achieving SBP targets (41.2% vs 39.2%; adjusted odds ratio (OR) 1.01 95% CI 0.76–1.35) or receiving BP-lowering medications in the intervention vs control periods respectively. There was a high discordance in risk scores generated by independent data collectors and CHWs, resulting in only 37.2% of the evaluation cohort exposed to the intervention. This discordance was mainly driven by fluctuating BP values (both normal variability and marked seasonal variations). In the pre-specified high risk concordant subgroup, there was greater use of BP-lowering medications in the intervention period (54.3% vs 47.9%, OR 1.22, 95% CI 1.03–1.44) but no impact on BP control.ConclusionsThe strategy was well implemented with increased treatment rates among high risk individuals assessed by CHWs, however effects on BP were not demonstrated. Use of guideline-recommended BP thresholds for identifying high risk individuals substantially affected the reproducibility of risk assessment, and thus the ability to reliably evaluate the effectiveness of the intervention. In addition, unanticipated seasonal variation in BP in the context of a stepped-wedge trial highlights the inherent risks of this study design.Trial registrationClinical Trials Registry of India CTRI/2013/06/ 003753.

Pluralism and practicality: village health workers’ responses to contested meanings of mental illness in Southern Malawi

The individual and social construction of psychological distress is fundamental to help-seeking and the extent to which interventions are seen as credible. Where pluralistic attributions for mental health problems predominate, the development of global mental health (GMH) interventions in the form of task-shifting approaches create increased access to new ways of understanding and responding to distress. However, little is known about how participants in these initiatives manage these encounters. This qualitative study in Malawi explored village-based health workers’ (HSAs) and patients’ and carers’ views of the causes of distress and how these beliefs influenced help-seeking and the health workers’ response.Eight HSAs and nine paired patients/carers were interviewed separately to enable each of nine experiences of distress to be explored. Findings revealed a complex set of personal, social and cultural influences that informed causative attributions and help-seeking decisions. Patients/carers viewed psychosocial stresses as compelling explanations and readily reported others attributing their distress to supernatural causes (bewitchment). Yet attributional beliefs alone were not the only influence over help-seeking, which evolved pragmatically in response to the impact of treatments and social pressure for conformity. In turn HSAs navigated the interactions with patients/carers by emphasising the biomedical approach and discrediting bewitchment attributions. This caused tensions when biomedical interventions were unhelpful or the traditional healers’ approach proved beneficial.Conclusions add to the call for such task-shifting approaches to work with communities to discern authentic and practical responses to mental distress that mirror the ‘pluralism and pragmatism’ found in the communities they serve.

A real-time medical cartography of epidemic disease (Nodding syndrome) using village-based lay mHealth reporters.

BackgroundDisease surveillance in rural regions of many countries is poor, such that prolonged delays (months) may intervene between appearance of disease and its recognition by public health authorities. For infectious disorders, delayed recognition and intervention enables uncontrolled disease spread. We tested the feasibility in northern Uganda of developing real-time, village-based health surveillance of an epidemic of Nodding syndrome (NS) using software-programmed smartphones operated by minimally trained lay mHealth reporters.Methodology and principal findingsWe used a customized data collection platform (Magpi) that uses mobile phones and real-time cloud-based storage with global positioning system coordinates and time stamping. Pilot studies on sleep behavior of U.S. and Ugandan medical students identified and resolved Magpi-programmed cell phone issues. Thereafter, we deployed Magpi in combination with a lay-operator network of eight mHealth reporters to develop a real-time electronic map of child health, injury and illness relating to NS in rural northern Uganda. Surveillance data were collected for three consecutive months from 10 villages heavily affected by NS. Overall, a total of 240 NS-affected households and an average of 326 children with NS, representing 30 households and approximately 40 NS children per mHealth reporter, were monitored every week by the lay mHealth team. Data submitted for analysis in the USA and Uganda remotely pinpointed the household location and number of NS deaths, injuries, newly reported cases of head nodding (n = 22), and the presence or absence of anti-seizure medication.Conclusions and significanceThis study demonstrates the feasibility of using lay mHealth workers to develop a real-time cartography of epidemic disease in remote rural villages that can facilitate and steer clinical, educational and research interventions in a timely manner.

Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia.

In South-East Asia, the maternal and child mortality rate has declined over the past decades; however, it varies among and within the countries in the region, including Cambodia. The continuum of care is an integrated series of care that women and children are required to avail continuously from pregnancy to the child/motherhood period. This study aimed to assess the completion rate of the continuum of care and examine the factors associated with the continuum of care in Ratanakiri, Cambodia. A cross-sectional study was conducted in Ratanakiri. Overall, 377 women were included, and data were collected via face-to-face interviews using a semi-structured questionnaire. Among them, 5.0% completed the continuum of care (antenatal care at least four times, delivery by skilled birth attendant, and postnatal care at least once). Meanwhile, 18.8% did not receive any care during pregnancy, delivery, and after birth. The highest discontinuation rate was at the postnatal care stage (73.6%). Not receiving any perinatal care was associated with neonatal complications at 6 weeks after birth (adjusted odds ratio [AOR]: 3.075; 95% confidence interval [CI]: 1.310–7.215). Furthermore, a long distance to the health center was negatively associated with completion of the continuum of care (AOR: 0.877; 95% CI: 0.791–0.972). This study indicates the need for efforts to reduce the number of women who discontinue from the continuum of care, as well as who do not receive any care to avoid neonatal complications. Since the discontinuation rate was highest at the postnatal care, postnatal care needs to be promoted more through the antenatal care and delivery services. Furthermore, given that long distance to health facilities was a barrier for receiving the care continuously, our findings suggest the need for a village-based health care system that can provide the basic continuum of care in remote areas.

Distribution and Utilisation of Ivermectin ( Mectizan ) : A Chemotherapeutic Approach to the Control of Onchocerciasis in Old Ohaozara LGA , Ebonyi State , Eastern Nigeria

Onchocerciasis (river blindness) is a devastating, debilitating Stigmatising and incapacitating parasitic disease that is endemic in tropical and subtropical regions of the world, including Nigeria. Mass distribution of ivermectin (Mectizan) to the endemic parts of the world was initiated by the Onchocerciasis Control Programmes (OCPs). Absolute compliance to the regimen for up to 15 years has been reported to be effective in the control of the disease. The study was carried out in Ohaozara LGA, Onicha LGA and Ivo LGA. The three (3) LGAs made up the defunct Old Ohaozara LGA. A structured questionnaire was used to generate information on knowledge of Onchocerciasis and on the use of ivermectin by the inhabitants of the communities of the study areas. The distribution coverage of ivermectin in the study areas dating from 2010 to 2014 was ascertained with drug distribution charts obtained from Ebonyi State Health Management Board (ESHMB), Abakaliki (the point source of distribution in the state), and from the health centres in communities of old Ohaozara LGA (the service delivery points (SDPs) to inhabitants of the communities. Data was analysed using descriptive statistics. Utilization of the regimen was ascertained by determining the actual number of tablets of mectizan that was administered to the patients at the various health cenrtes (service delivery points (SDPs) in the communities. The percentage utilization of the regimen was determined by dividing the number of mectizan tablets administered to the patients at SDPs with the number of mectizan tablets supplied from state point source of distribution and multiplying by 100. A total of 347, 299 out of 1, 919135 tablets of mectizan supplied to the study areas from 2010 to 2014 were actually utilized, forming an overall percentage utilization of 18.10%. There was adequate supply but very poor utilization of the regimen. The poor utilization resulted from factors including locating of health centres very far from homes of some of the rural villagers, non-yearly compliance with regimen administration, poor health sensitization and education and lack of incentives orpoor incentives to the village-based health workers (VBHWs). Intensification of efforts to cover the lapses in the utilization of the regimen is advocated for a more effective control of the disease.

Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn and child health services in rural areas of India

BackgroundA new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low.ObjectiveThis article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs.DesignThe Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery.ResultsInadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for enhancing value and supervision of Primary Health Center (PHC) staff.ConclusionsThe effectiveness of the improved ImTeCHO intervention will be now tested through a cluster randomized trial.

Assessing diagnostic accuracy of Haemoglobin Colour Scale in real-life setting.

The study was undertaken to determine diagnostic accuracy of Haemoglobin Colour Scale (HCS) in hands of village-based community health workers (CHWs) in real-life community setting in India. Participants (501 women) were randomly selected from 8 villages belonging to a project area of SEWA-Rural, a voluntary organization located in India. After receiving a brief training, CHWs and a research assistant obtained haemoglobin readings using HCS and HemoCue (reference) respectively. Sensitivity, specificity, positive and negative predictive-values, and likelihood ratios were calculated. Bland-Altman plot was constructed. Mean haemoglobin value, using HCS and HemoCue were 11.02 g/dL (CI 10.9-11.2) and 11.07 g/dL (CI 10.9-11.2) respectively. Mean difference between haemoglobin readings was 0.95 g/dL. Sensitivity of HCS was 0.74 (CI 0.65-0.81) and 0.84 (CI 0.8-0.87) whereas specificity was 0.84 (CI:0.51-0.98) and 0.99 (CI:0.97-0.99) using haemoglobin cutoff limits of 10 g/dL and 7 g/dL respectively. CHWs can accurately diagnose severe and moderately-severe anaemia by using HCS in real-life field condition after a brief training.

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction

ObjectiveTo evaluate the impact of a model of rural community health service (CHS) on the use and acceptability of primary healthcare services.DesignQuasi-experimental.SettingTwo adjacent rural counties in China.Participants5842 residents in 2009...

Knowledge of Malaria and Its Association with Malaria-Related Behaviors—Results from the Malaria Indicator Survey, Ethiopia, 2007

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.