Community perceptions on malaria and care-seeking practices in endemic Indian settings: policy implications for the malaria control programme

Abstract

BackgroundThe focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services.MethodsA qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed.ResultsThe 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services.ConclusionApart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate the community perceptions and practices on malaria management. The current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. Promoting active community involvement and ownership in malaria control and management through strengthening community based organizations would be relevant. Further, timely availability of drugs and commodities at the community level can improve their confidence in the public health system.

Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

“…The deployment of female CHWs and women's groups in community health management is likely reflected in terms of community health awareness and behaviour [30][31][32][33]. The community's health-seeking pattern for fever distinctly shifted from untrained to trained providers, which suggests the potential for minimizing inappropriate treatment regimens, catastrophic health expenses and consequent fatalities [3,10]. These findings are consistent with the evidence from similar Asian and African settings about leveraging local capacity to ensure sustainability of community health approaches [34].…”

“…The ASHAs have been trained to test for Plasmodium falciparum malaria cases using rapid diagnostic tests and to treat these cases with artemisinin combination therapy (ACT). To further prevent any delays in the diagnosis or treatment of malaria, the ASHAs have also been provided with the requisite supplies of Rapid Diagnostic Test (RDT) kits and ACT [7,10]. In addition, long-lasting insecticidetreated bed nets (LLIN) have been distributed free of cost to populations in high endemic districts to strengthen prevention activities [7].…”

Knowledge and practices on malaria prevention in two rural communities in Wakiso District, Uganda

“…However, beyond the ITNs provided by the Government, many families could not afford to buy such nets which directly relates to the low income levels in rural areas in Uganda as established by this and other studies 16,17 . Poverty not only affected use of malaria prevention methods in this study but also health seeking behaviours which has been documented in other studies 18,19 . Since poverty remains high in rural areas of Uganda, the Government's strategy of free distribution of ITNs is likely to greatly benefit such communities.…”

Public awareness of malaria at the beginning of a national malaria elimination program in China

“…A lack of reasonable knowledge of infectious diseases contributes to low detection rates, interruption of treatment, and discrimination [4,8]. The improvement of public perception about malaria could not only help the general population protect themselves, but could also promote those individuals suspected of being infected to seek medical help early and be treated more completely [8][9][10][11]. This cross-sectional survey aimed to understand the level of awareness of malaria in residents in China at the very beginning of the China NMEP.…”