Malaria: Knowledge and Prevention Practices among School Adolescents in a Coastal Community in Calabar, Nigeria

This article, published in the African Journal of Primary Health Care & Family Medicine (PHCFM), shares findings of a study to determine the malaria prevention practices of adolescents in the coastal community of Calabar, Nigeria. Four hundred adolescents were randomly selected from the 4,565 learners in 5 out of 17 secondary schools in southern Calabar. A self-administered, semi-structured questionnaire was administered to the respondents. The study identified knowledge gaps among school children and concluded that there is a need to empower teachers with information about the cause of malaria and prevention strategies.

According to the article, malaria among adolescents has largely been overshadowed by the huge burden of the disease among young children, as well as the huge burden of HIV/AIDS among adolescents. Yet, some surveys reveal a lack of knowledge and many misconceptions about the transmission and treatment of malaria, which could adversely affect malaria control measures and antimalarial therapy. Such a knowledge gap could have an adverse effect on schoolchildren, who could - if informed - be used as change agents and as role models for their siblings and peers in the malaria control strategy.

In the study, only nine (2.3%) respondents gave an acceptable definition of malaria as an infective disease caused by parasites that are transmitted through the bite of an infected mosquito. The most commonly mentioned local name for malaria was utoe enyin ("yellow eyes"). About half of the respondents knew of the plasmodium falciparum, the causative agent, but a similar fraction did not know the vector, the female Anopheles mosquito. Concerning the mode of transmission of malaria, 310 (77%) of the respondents were aware that the vector transmits the parasite by biting, while 77 (20%) mentioned other modes of transmission, which include swallowing the vector in contaminated food (7%), kissing, (6%) and sexual intercourse (7%). Thirteen (3%) of the respondents did not give any response.

Respondents differed greatly on the main source of their knowledge of malaria prevention. In total, 135 (33.8%) had heard about it over the radio, 90 (22.5%) through the television, 27 (6.8%) from newspapers and medical books, 25 (6.4%) from friends, and 78 (19.5%) from health care providers such as nurses and doctors, while 45 (11%) had heard about malaria from their teachers.

In total, 282 (70.5%) of the respondents were aware that insecticide-treated nets (ITNs) kill mosquitoes, while 90 (22.5%) responded that ITNs are used to treat insects. Nineteen (4.75%) respondents indicated that ITNs are used to catch fish, while 9 (2.25%) responded that they are used to trap rats. Concerning the main method of preventing malaria attacks, 54 (13.5%) of the respondents would clear the vegetation in the peri-domestic environment, 67 (16.9%) would fill potholes, 44 (11%) would open up drainage, 103 (25.7%) would use ITNs, 45 (11.2%) would use antimalarial drugs, and 32 (8%) would use various other methods, such as not accepting unscreened blood.

According to the authors, in a fairly literate population such as the one used for this study, the finding that only nine (2.25%) respondents were able to give an acceptable definition of malaria shows a wide knowledge gap that needs to be filled. The 41.75% of the respondents who were aware that the vector that transmits the malaria parasite is the female Anopheles mosquito is low compared to the 90% that were aware of this fact in a study in the Pacific coast of Guatemala. The reason for the absence of this knowledge in the current study is probably because of a low capacity of teachers informed about malaria causation or an inadequate content of health education in the curriculum for the teaching of primary and secondary schoolchildren.

The authors add that teachers were a source of information on malaria prevention for only about one-tenth of the adolescents. This very low percentage of representation of teachers is in contrast to the 47.4% found among school children in Tanzania. This finding suggests the need to empower school teachers with health information so that such information could be passed on to the learners. This may also be indicative of the collapse of the Nigerian educational system, as health education is an integral part of the curriculum at primary and secondary levels.

The study concludes that a good number of school adolescents in the study area were knowledgeable about malaria transmission, but the study identified some gaps in the knowledge of the causative agent of malaria and antimalarial preventive methods at a grassroots level. These gaps must be filled in order to make the adolescents good change agents. Even though only a small percentage, the fact that some of the respondents mentioned refusal of unscreened blood as a way to prevent malaria indicated that there could be some level of confusion between malaria and HIV/AIDS transmission, although malaria could well be transmitted through blood transfusion. The apparent confusion between malaria and HIV/AIDS transmission must be addressed through intensive public health education among adolescents and the entire population.

The study findings also note that there is a need to strengthen the educational system by empowering teachers with information about malaria causation and prevention strategies so that such knowledge could be passed on to learners. The mass media must also continue to perform its function of information dissemination, while the local governments can create television viewing centres at the grassroots level. Primary health care can also strengthen public health information through group counselling and information, education, and communication (IEC) materials.