Abstract:
BACKGROUND : Use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria
education, prompt diagnosis and treatment are key programme components of malaria prevention and control in
Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including
insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household
factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’
perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing
interventions in Ethiopia (LLINs, IRS, community mobilization house screening).
METHODS : The study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March
2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic
survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological
differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to
determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained
from the district health office to understand the disease dynamics.
RESULTS : Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during
the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge
in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On
average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per
episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found
to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total
cases reported from households being from among individuals who were 15 years or older. The second most affected
group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden,
respectively.
CONCLUSION : Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control
interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge.
Therefore, continued community education and communication work should be prioritized in the study area to bring
about the desired behavioural changes.