Study design and Setting
Community-based cross-sectional mixed quantitative study and qualitative study was conducted from April to June 2019.
This study was conducted in West Belessa district which is situated in Amhara Regional State, North West Ethiopia. Ethiopia is one of the countries in East Africa with 1.104 million km² areas and 112,078,730 population in 2019. It has 9 regional states and 670 rural districts. West Belessa is one of these districts.
West Belessa is, situated at an altitude of 1501 to 3000 meters above sea level. The capital city of West Belessa is Arbaya. It is located at a latitude and longitude of 12o 15'N and 37° 45'E respectively. High Rainfall is registered from June to August with a shortage and heavy rain intermittently. The mean monthly temperature is 33.50c. There are mountainous, lowlands, and water bodies including a known river Mena. The district has 3 climatic zones, which are hot zones (kola) 60%, cold zones (dega) 35%, and moderate zones (weyna dega) 5%. From the total district land area 92.9% are malarious. In 2019 the estimated total population of the district was 197,326.
Study population and sampling technique
The source population for this study was all households in 23 malarious rural kebeles. There are a total of 25 kebeles in the district. The study population was all households in 5 selected malarious kebeles. The sample size for the survey was determined by using a single population formula. We used the proportion of knowledge towards malaria prevention methods (64.8%)(13), 95% CI, and a margin of error of 0.05 then 350 has been calculated. By adding 10% non-response rate and design effect 2 the final sample size became 770. There are 25 total kebeles in West Belessa. First of all these kebeles divided into 3 clusters (Malarious, non-malarious and urban). From the rural malarious kebeles’ 5 kebeles were selected by using the lottery method. The sample size was allocated proportionally based on Keble’s population. Using household registration from health post, we selected households by systematic sampling every 15 households. The interviewees are household heads.
Inclusion and Exclusion criteria
Inclusion criteria: All households’ head in the selected kebeles and have been living there for at least 6 months before the interview.
Exclusion criteria: Very sick individuals who were unable to communicate excluded from the study
Data Collection Methods and data quality control
The data collection tool was adopted from 2004 WHO/UNICEF guidelines for core population coverage survey(14) with some modifications. Originally prepared in English then translated into the local language (Amharic) then back to English to ensure reliable information. Twelve numerators who had graduated from college were recruited and trained about the purpose of the study; how to approach respondents; how to obtain written consent and overview of malaria prevention methods for one day. An interviewer-administered questionnaire was used. Completeness of questionnaire was checked every day and incomplete questionnaires were returned to the data collectors on the following day for correction by re-visiting the households. Absence households were revisited on the following days. Pre-testing was conducted in one of the malarious kebeles out of the study area.
A total of 4 FGDs were conducted in 4 kebeles (Abay tera, Kalay, Aswagari, and Menti kebeles). Participants with full of information about malaria prevention and control methods were selected for the discussion by using health extension workers as a key informant in each kebele. The FGD had 6 to 10 participants in each group and comprised a total of 30 study participants in 4 groups. Each FGD was conducted by recording sounds and taking notes. The selected interviewees were expected to answers the semi-structured questionnaires. The content of semi-structured questionnaires were issues about knowledge of malaria prevention and control methods.
Variables of the study
Knowledge about malaria prevention and control was a dependent variable of the study.
Knowledge: A study participant who scored above or equal to the median score of knowledge questions was considered as having good knowledge and others considered as having poor knowledge. (15) The media was 7 out of 12 malaria prevention knowledge questions.
Age; sex, marital status, occupation, religion, ethnicity, address, family size, educational status, and wealth index are independent variables.
Wealth quintiles: determined using durable household assets. A total of 18 different durable assets were identified and assigned as dummy variables. After adjusting and coding we used multivariate analysis i.e. principal component analysis after we re-categorized into five different wealth quintiles, each with an approximately equal number of households.
Data processing and Analysis
Quantitative data entered and coded using Epi info version 7 and exported to SPSS version20. Variables were analyzed using logistic regression in SPSS to determine the association between the variables determined by looking at the level of significance of 0.05 with a 95 % Confidence Interval (CI).
Qualitative data were transcribed in the original language of interview first word by word from the audiotapes and field notes, then it was translated to English for analysis. The primary theme was produced through manual coding using a pen of different colors, then it was pooled into broader concepts to form main themes.
Approval to carry out the study was sought and obtained from the University of Gondar Ethics Review Board. Written consent was obtained from all study participants after a detailed explanation of the purpose of the study.