Components related to information about malaria prevention amongst ladies of reproductive age, Tete Province, Mozambique, 2019–2020 | Malaria Journal


Study design and settings

This analysis used data from a cross-sectional study that was intended to serve as the baseline of the study on “cost-effectiveness of malaria communication strategies on social and behavioral change”, conducted in November 2019 in Mágoe district, Tete province in Mozambique. Magoe District has a population of 89,273 inhabitants, with a population density of 10.3 inhabitants per square kilometer, and is located in the southwest of Tete province, bordered to the north by Zumbo and Maravia districts, to the east and south by the Republic of Zimbabwe , and to the east with Cahora Bassa District [15, 16]. Two administrative posts were included for the study, Mphende and Mucumbura. Mphende is the headquarters of the Mágoe district, and Mucumbura is located near the border with the Republic of Zimbabwe. The health services of Mucumbura, attend besides the population of Mozambique, the population of Zimbabwe. Mágoe district was selected because it had high malaria incidence with 27 cases per 1,000 habitants in the year 2019, has high community radio coverage, and was not covered by interpersonal communication malaria SBC interventions at the time of data collection.

Data collection

Two structured questionnaires, a household questionnaire and a questionnaire for women of reproductive age (15–49 years old) were utilized. These questionnaires were based on the Malaria Behavior Survey and MIS questionnaires and were tested in a rural area of ​​Tete City to validate the questions and ensure its functionality and appropriateness for the local context. The questionnaires included questions related to socio-economic indicators, possession of ITN, history of fever in the past 2 weeks, history of recent travel, and current pregnancy, along with extensive questions on ideational factors associated with each key malaria behavior (eg self- efficacy to use on ITN). Before the research began the interviewers were trained on the methods of obtaining consent and conducting the interviews. The interviewers were individuals with knowledge of the Cinyungwe, Shona, Tawala and Portuguese languages, as these are the most widely spoken languages ​​in the region.

All enumeration areas in Mágoe District were eligible to be randomly selected for the study. Pre-existing lists of all enumeration areas (EA), including population size estimates and maps from Mozambique’s National Institute of Statistics were used to develop a list of the EA to be selected for inclusion in the study. A sub-group of EA was selected in a manner designed to minimize bias by ensuring as much geographic separation of the EA as possible. Once selected, 120 EA were visited and fully enumerated. In each EA, 15 households were randomly selected. Households eligible for the study had to have one child under five years old and at least one mosquito net for every two residents under 5 years old.

Study variables

In this study, the following socio-demographic variables were analyzed: age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44 and 45–49), place of residence (Mphende Locality /Mucumburra Locality), marital status (single/married), education level (none, primary, complete primary, secondary, secondary completed and above), literacy (does not read, read part of a sentence, read a whole sentence), number of births (none, 1 to 2, 3 to 4, 5 and more births), language used for the interview (Portuguese, English, Cinyungwe, Cyiau, other), exposure to malaria messages in the six months before the survey (yes/ no) and wealth quintile (lowest, second lowest, middle, second highest, highest).

The variable complete knowledge about malaria was a composite variable composed of the following five variables: signs and symptoms of malaria, mode of transmission, prevention, treatment, and whether malaria is curable. For signs and symptoms, the woman had to answer fever as a symptom of malaria, for mode of transmission she had to answer mosquito bite, for prevention she had to refer to mosquito net treated or not with insecticide, and for malaria treatment the women had to indicate at least one antimalarial drug in order to be categorized as having complete malaria knowledge.

Data analysis

Weighted analyzes were performed in the statistical program STATA 16.1 (StataCorp LLC., College Station, Texas). Sociodemographic and other characteristics were presented as percentages and frequencies. The assessment of factors associated with knowledge about malaria was through logistic regression and knowledge about malaria was considered as dependent variable. To measure complete knowledge about malaria, in yes/no, the woman had to answer five questions about malaria. If she answered all five questions correctly, she was considered to have complete knowledge about malaria, otherwise, she was not considered to have complete knowledge. Variables that were statistically significant (p-value < 0.05) in the bivariate logistic regression analysis at 95.0% confidence interval (CI) or considered important a priori based on existent literature, were included in the multivariate regression to calculate the adjusted odds ratio (aOR ).

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