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Knowledge, attitude and practices regarding malaria among residents of rural Mangalore, India

Background: Malaria is one of the most prevalent parasitic diseases worldwide and India has fourth highest number of malaria cases and deaths in the world. Prevention of the disease through better knowledge and awareness is the appropriate way to keep the disease away and remain healthy. Thus, the present study was aimed to assess the knowledge, attitude and practices regarding malaria among residents of Mangalore. Methods: Community based cross sectional study was conducted among residents in Mangalore. The data was collected by using pre-tested semi-structured questionnaire which include socio-demographic data, basic knowledge about malaria, transmission and preventive measures and health seeking behaviour regarding malaria through interview method. Results: Almost 98.4% respondents heard of malaria disease and 96% respondents had knowledge that malaria is caused by mosquito bite. Even, majority (72%) of respondents knew that malaria can be fatal. Regarding the symptoms of malaria, 52.4% respondents mentioned fever with chills and 11.6% respondents don’t know about malarial symptoms. Conclusions: Majority of the respondents were familiar with the malaria symptoms, mode of transmission and vector control measures. They had good knowledge of malaria disease and good practices of malaria control measures.


INTRODUCTION
Malaria is one of the most prevalent and widespread parasitic diseases in the world with an estimated of 216 million cases in 2016. 1,2 In Southeast Asia region, India contributes around 70% of total malarial cases and about 82% of the population are at risk of malaria infection. 3,4 According to WHO Malaria Report, India has fourth highest number of malaria cases and deaths in the world. 2 Malaria is highly endemic in Southern region of India, mostly in coastal area of Karnataka throughout the year. 5 Mangalore, a city in southwest coastal region of Karnataka, considered to be one of the highly endemic place for malaria with 2.92 Annual Parasitic Index. 6 Early case finding and treatment, vector control measures are some of the important strategies of Malaria control under National Vector Borne Disease Control Programme (NVBDCP). 7 But some of the beliefs, customs and practices of malaria, are often related to culture, which can influence the effectiveness of malaria control strategies. 8 Prevention of the disease through better knowledge and awareness is the appropriate way to keep the disease away and remain healthy. Studies pertaining to knowledge, attitude and practices showed that direct interaction with community plays an important role in circumventing malaria problem. 9,10 Community beliefs, perception, and attitude towards malaria symptom identification, treatment, prevention and control can influence efforts to address malaria and are often overlooked in control efforts. 10,11 Thus, the present study was done to assess the knowledge, attitude and practices regarding malarial transmission and health seeking behaviour.

METHODS
A community based cross sectional study was carried out in Pavanje village, which comes under Mangalore Taluka of Dakshina Kannada district. The study was conducted for a period of 45days from 15 th May to 30 th June 2018. The study population was all the houses in Pavanje village. House to house visit was done and adult family member (head of the house hold or senior family member) present at the time of visit was interviewed in local language (Kannada) for collection of information regarding malaria. Only one family member per household was included in this study and the purpose of the study was enlightened to the respondent. The locked house or non-responsive respondents and children were excluded from the study. Informed written consent was taken from all respondents and confidentiality was ensured throughout the study.
The data was collected by using pre-tested semistructured questionnaire which had two parts. The first part of the questionnaire included socio-demographic characteristics like age, gender, education, socioeconomic status. The second part of the questionnaire included knowledge, attitude and practices of residents about malaria in respect to symptoms, malaria transmission, resting places and biting time of mosquito, treatment of malaria, preventive measures of malaria and health seeking behaviour of malaria prevention.
After obtaining the information from the respondents, the health education regarding malaria prevention and transmission was given to every family member in the house irrespective of their knowledge regarding malaria.

Statistical analysis
The data was entered and tabulated in Microsoft Excel sheet and was analyzed using statistical software (SPSS trial version).

RESULTS
A total of 250 respondents were enrolled in the study, out of which 148 (59.2%) and 102 (40.8%) were male and female respectively. The maximum respondents were in the age group of 21-30 years (29.2%) and educated till graduation (32.8%) ( Table 1).
Almost 98.4% respondents heard of malaria disease and 14.8% respondents had malaria in the past. Around 96% respondents had knowledge that malaria is caused by mosquito bite and 94% respondents knew that malaria can be prevented. Even, majority (72%) of respondents knew that malaria can be fatal. Regarding the symptoms of malaria, 131 (52.4%) respondents mentioned fever with chills and 29 (11.6%) respondents don't know about malarial symptoms. Majority (79.2%) of respondents knew that the resting place for mosquito is stagnant water. The source of information regarding malaria was TV (45.6) followed by hospital (22.4%) ( Table 2).  (Table 3).
Maximum (69.6%) of the respondents were not using bed nets and 86.4% respondent had a habit of cleaning their surrounding regularly. Majority of the respondents (65.2%) were using mosquito replants like all out or coils followed by window mesh or nets (29.2%) ( Table 4).

DISCUSSION
The aim of the study was to assess the knowledge, attitude and practices of malaria transmission and prevention. KAP assessment is the initial as well as crucial steps of planning and implementation of health programme. It also helps to develop cost effective behavioural changes strategy in the community regarding malaria control. In this study, the knowledge about malaria was quite good. Majority of the study respondents heard of malaria and knew that malaria can be prevented, and it can become fatal, if untreated. The similar finding was found in the study done by Gupta RK et al. 12    18 The reason for not using bed nets may be cost of nets and use of mosquito repellents. Mosquito repellent coil or liquid vaporizer (65.2%) was most commonly used to prevent mosquito bite in this study and this was consistent with the finding of De M et al, and Sharma A et al. 15,16 Overall, majority of the respondents had good knowledge of malaria disease as well good practices of personal protective measures.

CONCLUSION
The study revealed that the respondents were familiar with the malaria symptoms, mode of transmission and vector control measures. They considered malaria as serious health problem and their attitude towards treatment was prompt. IEC activities should be done to increase awareness and to promote malaria prevention in terms of bed nets use.