Attitudes to malaria, traditional practices and bednets (mosquito nets) as vector control measures: a comparative study in five west African countries

Abstract

Five West African communities were visited to assess the knowledge of the cause of malaria and to document traditional ways of treating and preventing the infection. Knowledge of the cause of malaria was low in the five communities visited. People were more concerned about mosquitoes being a nuisance than a cause of the infection. Various herbs were used as mosquito repellents. Malaria was treated by a number of traditional practices, including herbal remedies. Bednets were used to a varying extent, from 44% Ghana to 86% Gambia, in each community to protect against mosquito bites but also for other purposes such as privacy, decoration and protection from roof debris dropping on the bed.

PIP: A previous study among Gambian children aged 1-4 years found that overall mortality was reduced by 63% after use of insecticide-treated bednets. In this study, the aim was to determine the degree to which bednets were used and the factors affecting their use in Farafenni, The Gambia; Navrongo in eastern Ghana; suburban Bandim outside Bissau Town, Guinea-Bissau; Niakhar in Senegal; and a rural village around Bo in Sierra Leone. Bednets were known and used to protect children from mosquito bites in the 5 West African countries; bednets were also used for privacy and to protect from falling roof debris. A structured questionnaire was administered. Background information had been collected prior to the survey administration on local terminology for symptoms of malaria, the extent of health education campaigns, availability of Western and traditional treatment regimens, use of bednets, and constraints to use. Each of the study areas was described in terms of the social and demographic characteristics of the population. The findings indicated that about 50% of people in Ghana Guinea-Bissau, and Sierra Leone were aware that mosquitoes caused malaria. Only about 25% were aware in The Gambia. Heavy rains and the cold weather that followed were also linked with malaria causes in Ghana and Guinea-Bissau. Stepping in goat urine was viewed as a cause of malaria in Senegal. In The Gambia, other causes indicated were eating of seasonally foods excessively, and an act of God. Fever was the most common symptom associated with malaria. Some differentiated in subtle ways between malaria fever and other fevers. Treatment was viewed in all countries as herbal, which was available from markets or traditional healers. About 50% of the 996 Ghana respondents used some form of traditional treatment for malaria. 86% used bednets in The Gambia and Guinea-Bissau. Only about 33% used them in Senegal, and very few used bednets in Sierra Leone and Ghana. Most were concerned about the irritation to sleep from mosquitoes. In all countries, cost of bednets was a constraint to use. Public health programs should stress the cost effectiveness and advantages of insecticide treated bednets, and information on malaria causes. Where Ghanians sleep on roofs, a new bednet design is needed.