A Cross-Sectional Survey on the Malaria Control and Prevention Knowledge, Attitudes, and Practices of Caregivers of Children Under-5 in the Western Area of Sierra Leone

Abstract

(1) Background: Children under 5 years of age are the most vulnerable to malaria infection, and they suffer serious complications. Sierra Leone is one of the countries with the highest malaria burden in the world. This study aimed to assess the knowledge, attitudes, and practices (KAPs) toward malaria control and prevention among caregivers of children under 5 in the Western Area of Sierra Leone. (2) Methods: A cross-sectional survey was conducted among caregivers of children under-5 visiting the out-patient department of six selected hospitals/community health centers. Data were collected via questionnaire interviews with 350 caregivers. (3) Results: A total of 97.1% of the respondents were women and the majority of them were young mothers; 46.3% of respondents were unemployed; and 27.1% received no education. Only 1.4% accessed malaria related information from the internet/social media. This KAPs survey indicated that a misconception of the cause, transmission, and clinical symptoms of malaria; unawareness of its lethality and its severity; and inappropriate prevention and treatment behaviors, such as self-medicating, were still in existence among some caregivers. However, a positive correlation in knowledge−attitudes (rs = 0.13, p < 0.05) and in attitudes−practices (rs = 0.45, p < 0.001) was revealed. The caregivers, being mothers and having at least a secondary education, demonstrated positive attitudes and practices. Meanwhile, more urban caregivers (79.8%) followed a complete malaria treatment course of artemisinin-based combination therapies than the rural (63.3%), but in view of insecticide treated net use, more rural caregivers presented positive attitudes (85.3%) and practices (70.1%) than the urban (69.9%, 52.0%). (4) Conclusions: For better protection of children under-5 against lethal malaria, it is essential to provide better guidance at the community level for their caregivers, especially young mothers, in order to reduce some misconceptions and inappropriate behaviors. An increase in education and employment opportunities for women, establishment of an accessible community-based malaria counselling service, and construction of an effective communication channel are also needed.

Keywords: Sierra Leone; caregivers; children under-5; community-based intervention; knowledge, attitudes, and practices (KAPs); malaria.

Figure 1

Geographic location of the study sites. Health care facilities in WAU included: Ola During Children’s Hospital (ODCH) (8°29′25″ E, 13°13′7″ S), King Harmann Road Government Hospital (8°28′27″ E, 13°14′52″ S), and Jenner Wright Hospital (8°29′7″ E, 13°12′43″ S). Health care facilities in WAR included: Waterloo Community Health Center (8°20′08″ E, 13°4′24″ S), Grafton Community Health Center (8°23′34″ E, 13°9′23″ S), and Lakka Community Health Center (8°23′49″ E, 13°15′50″ S).

Figure 2

Sources of malaria related information mentioned by caregivers of children under-5. The upper right diagram shows the proportion of each source of malaria related information selected by the caregivers in this study, the different colors represent different sources. The bar plot shows the popularizing rate of the specific source across rural and urban districts, blue and red represent the rural and urban, respectively.

Figure 3

Correct response rates for questions in sections: Knowledge, Attitudes, and Practices. Each item scores 1, except for, “Sleeping under an ITN” in section Practices scoring 2, which were evaluated by the scoring system described in Supplementary file S2.

Figure 4

Protective measures against mosquito bites and the reasons for not sleeping under a bed net. The upper right diagram shows the reasons why some caregivers did not use insecticides treated nets (ITNs) in both rural and urban districts, and the proportion of the reason is shown behind the legend as Rural: Urban (%). The bar plot shows the protective measures against mosquito bites employed by caregivers of children under-5 in rural and urban districts. Blue and red represent the rural and the urban, respectively.