We investigated the interaction between social and economic circumstances with malaria awareness in rural South African villages effectively protected from malaria infection by community-passive, indoor residual spray (IRS) performed by government. We conducted interviews with 120 caregivers of children using both open-ended and closed fixed-answer questions. The mean income was between 27
and 56% of the national mean, indicating a community under considerable pressure.
Male parents were often absent due to work commitments. Unemployment, poverty, crime, and clean water were the main, unprompted, threats, but malaria was volunteered by none. Only when malaria was prompted (caregivers had good knowledge of malaria), did its concern rise. Malaria, therefore, was not a prominent
conscious concern. This implies that alternatives to IRS that require increased community and personal engagement, behavioural changes, and time commitment (such as certain components of integrated vector management and bed nets), will face implementation challenges. Unless community-passive malaria control measures can be developed that is as good or better than IRS, it seems unreasonable to expect poor communities to adopt community-active systems. Our findings should be considered in malaria control strategies, rural policy development,
climate change adaptation, and communication strategies.