A total of 300 households were investigated, and 262 qualified questionnaires were finally included to the following analysis after data checking. It covered 1645 residents, and about 6 persons were in per family. And the average cost for meals per day is around 30000 Leones in each household. Three groups were set up according to the meal cost level. Group 1 was ≤ 20000 Leones/household per day, there were 475 persons in 97 households; Group 2 was ≤ 40000 Leones/household per day, 778 persons were in 123 households; and a sum of 392 persons from 42 households were in Group 3 at the meal cost > 40000 Leones/household per day.
Malaria infection, diagnosis and treatment
A total of 308 persons in 87 households, 430 persons in 106 households and 191 persons in 39 households from Group1 – 3 respectively were reported to have fever in the year of 2018 (Fisher’s exact test value = 2.752, P = 0.594). The frequency and the population of malaria suffering among them was shown in Table 1.
Moreover, there were about 79.4%, 79.7% and 88.1% of the respondents from group 1-3 accordingly seeking health advice or treatment for the illness from any source (Fisher’s exact test value = 3.847, P = 0.421). And, 76.6%, 71.4% and 64.9% of the respondents among three groups reported to prefer public medical sectors only respectively (Fisher’s exact test value = 9.218, P = 0.117) (Table 2). In addition, no significance was found related to the selection of different medical sectors among three groups referring to public sectors (Fisher’s exact test value = 4.963, P = 0.765) and private sectors (Fisher’s exact test value = 11.289, P = 0.468) separately (Table 3).
Furthermore, 84.5%, 84.6% and 83.3% of the respondents from Group 1 – 3 respectively reported that they and their family members always went to see a health worker or doctor when they were suspected to be infected with malaria (Fisher’s exact test value = 3.429, P = 0.487). Of those went to see a health worker or doctor, they went every time or most of times when being suspected as malaria and the overall frequency was similar among the three groups (χ2 = 2.882, df = 6, P = 0.830) (Table 4).
In their memory, the health worker or doctor performed a malaria test when they visited due to the suspected malaria (80.1%) (Fisher’s exact test value = 3.744, P = 0.435), and malaria RDT was the most test used (Fisher’s exact test value = 2.498, P = 0.882), but nearly half of the doctors or health workers didn’t explain the test for them (χ2 = 2.783, df = 6, P = 0.841) (Table 4).
Most of respondents took anti-malarial medicine every time when being diagnosed as malaria or most of the time (Fisher’s exact test value = 10.671, P = 0.344), and about 79.8% of them took the full dosages every time prescribed by doctor/health worker (Fisher’s exact test value = 5.270, P = 0.489), and Artesunate + Lumafantrine (51.7%) and Artesunate + Amodiaquine (19.1%) were the first two choices. The reason of not taking all medicine was mainly that they got recovery before finishing all the dosages (Fisher’s exact test value = 2.876, P = 0.815). Moreover, about 80.2% of the respondents reported to start taking the anti-malarial medicine since the same day when they were fever (Fisher’s exact test value = 12.159, P = 0.095), and about 64.5% of them responded that all kinds of the anti-malarial medicine were not free (Fisher’s exact test value = 6.047, P = 0.399) (Table 4).
Malaria prevention measures
In this survey, 188 households had long-lasting insecticidal nets (LLINs) (χ2 = 1.466, df = 2, P = 0.482), but more nets were required because 189 respondents said that they didn’t have enough LLINs in their households (Fisher’s exact test value = 5.132, P = 0.253), so resulting in children under 5 years in 66 households couldn’t sleep under LLINs (Fisher’s exact test value = 5.902, P = 0.410). And only 146 respondents slept under nets at the night before the survey (Fisher’s exact test value = 4.477, P = 0.331). To make matters worse, some members in 162 households didn’t sleep under LLINs which would cause cross-infection (χ2 = 4.359, df = 4, P = 0.363). The LLINs were mainly distributed by the governmental hospital/health centers and community health centers (Table 5).
Besides, a total of 143 households never sprayed insecticide indoor to kill mosquitoes (Fisher’s exact test value = 10.246, P = 0.217), and 225 households never sprayed insecticide outside (Fisher’s exact test value = 19.422, P = 0.003), especially among group 1 (89.7%) and group 2 (89.4%). Furthermore, more than three quarters of the respondents reported that they didn’t have doors or windows screen for preventing mosquitoes enter into their houses (Fisher’s exact test value = 9.834, P = 0.020), especially in the first group (85.6%). Additionally, most families reported staying outside of the house at night (Fisher’s exact test value = 4.693, P = 0.800) (Table 5).
Knowledge of malaria
In this survey, almost all respondents have heard about malaria (98.1%, 257/262) and its main transmission pattern is mosquito biting (86.6%, 227/262). Fever, body ache or joint pain, and loss of appetite were the top three clinical manifestations they reported (Table 6). A total of 173 respondents reported that they would always go to see the doctor/health worker when they were suspected as malaria, and 48 interviewees would take some anti-malarial medicine kept in house firstly. Expensive costs (mentioned by 176 respondents) and the far distance (mentioned by 26 respondents) were the main factors that stop people seeing the doctor/health worker (Table 6). Sleeping under LLINs (198), keeping surrounding clean (84) and using mosquito insecticide spray (20) were the most selected choices for the malaria prevention (Table 6).