Browsing by Subject "Malawi Malaria Indicator Survey"

Background: Despite increased use of insecticide-treated nets (ITNs) among children under 5 years in Malawi, use of ITNs alone is insufficient to eliminate malaria. Therefore, other prevention methods should be explored to achieve malaria elimination. Previous studies illustrated that mother’s knowledge of ITNs positively influenced her child’s ITN use. In other settings, mothers’ knowledge of ITNs led to increased ITN use and reduced parasitemia among children under 5 years. Therefore, it may be plausible that maternal knowledge of other malaria prevention methods is associated with under-five malaria parasitemia. This study examined whether maternal knowledge of other malaria prevention methods is associated with malaria parasitemia among children under five years in Malawi. I hypothesized that higher levels of maternal knowledge of malaria prevention methods would be associated with lower odds of malaria parasitemia in children under-five.

Methods: The analytic sample included 1,880 children under 5 years of age. Maternal knowledge of malaria prevention methods was assessed using 12 items from the 2017 Malawi Malaria Indicator Survey (MMIS). Each of the 12 items was given either a score of 1 for a correct response or a score of 0 for an incorrect response. All 12 items were added up to create a continuous composite score ranging from a minimum score of 0 (low knowledge) to a maximum score of 12 (high knowledge). I also classified the total score as a 3-level categorical variable: low (score: 0-3), intermediate (score: 4), and high (score: 5-12). For the binary variable, a total score of less than or equal to 4 was considered inadequate knowledge, while a total score of greater than or equal to 5 was considered adequate knowledge. Malaria parasitemia was assessed using positive and negative malaria microscopy test results. I examined the association between maternal knowledge of malaria prevention methods and under-5 parasitemia using weighted multivariable logistic regression models. I also adjusted for sociodemographic characteristics such as mother’s highest level of education, ethnicity, type and place of residence, region, child’s age, and wealth index.

Results: Maternal knowledge of malaria prevention methods was not found to be a significant predictor of under-5 malaria parasitemia. The survey items used to create the composite score had an alpha value of 0.43 which indicated poor reliability. Of the 1,880 children included in the analytic sample, 67.5% had mothers with only primary school education, 85.7% were from rural areas, and 22.8% were from the poorest wealth index bracket. After adjustment, maternal knowledge of malaria prevention methods as a composite score (adjusted odds ratio [AOR]=1.14, 95% confidence interval [CI]: 0.96, 1.35), as a three-level categorical variable (high knowledge AOR=2.28, 95% CI: 0.63-8.25), or as a binary variable (inadequate knowledge AOR=0.78, 95% CI 0.54-1.14) were not significantly associated with under-five malaria prevalence. Only maternal knowledge of burning leaves was significantly associated with a 5.44 higher odds of malaria parasitemia among children under five years.

Conclusions: In this study, I did not find evidence supporting the hypothesis that higher levels of maternal knowledge of malaria prevention methods is associated with a lower prevalence of under-5 malaria parasitemia in Malawi. This may be because maternal knowledge of malaria prevention methods is not a good indicator of actual practice. Therefore, future studies should explore the relationship between the preventative practices used by mothers and the prevalence of malaria among their children under five years. Future research identifying how alternative malaria prevention practices to ITNs impact under-five parasitemia may help Malawi progress toward malaria elimination.