Abstract
Background: International workers deployed to malaria-endemic regions in sub-Saharan Africa are at an increased risk of contracting malaria while working for their respective companies in remote and rural areas. This risk is compounded by misconceptions about chemoprophylaxis and malaria risk prevention measures, which can lead to inadequate protective measures against the disease among workers who work in high-risk malaria zones. The COM-B framework (Capability, Opportunity, and Motivation-Behaviour) explains malaria prevention practices among international workers. Capability relates to their knowledge and skills in applying strategies, such as prophylaxis and the use of insecticide-treated nets (ITNs), while company policies and resource availability shape opportunity. Finally, motivation reflects their attitudes, beliefs, and willingness to comply, which may be hindered by misconceptions and concerns about the use of long-term chemoprophylaxis. These factors interact to shape protective behaviours and point to key areas for interventions.
Recognizing the need for effective malaria prevention strategies, the study aimed to investigate the knowledge, attitudes, and practices related to malaria prevention among international workers from four major companies that operate these regions. The study set out to identify knowledge gaps and provide evidence-based recommendations for healthcare providers and companies in an effort to lower malaria risk among workers traveling to high-risk malaria areas.
Methods: The study followed a quantitative, descriptive, non-experimental, contextual, cross-sectional research design using a survey research method to determine international workers’ knowledge of, attitudes, to practices related to malaria prophylaxis and risk prevention measures. Data were collected through an online self-reported questionnaire, approved by the university and the relevant corporate entities. Respondents were asked to give informed consent to ensure that they understood the survey’s purpose. Three companies permitted their international workers to participate in the study. A stratified random sampling method was employed to guarantee representation across different groups based on company affiliation and length of stay, resulting in 117 respondents, including 107 (91.5%) males and 10 (8.5%) females. The ethics principles of informed consent, confidentiality, anonymity, and the right to fair treatment were upheld throughout the study process.
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Data analysis: The collected data were entered into a Microsoft Excel spreadsheet and analysed using IBM’s SPSS version 29.0. The analysed data are presented as descriptive statistics, cross-tabulation, and logistic regression. The validity and reliability of the data were maintained throughout the analysis process.
Results: Among the 117 respondents, 45.3% were deployed in sub-Saharan Africa for less than two weeks, and on more frequent visits, 33.3% were expatriates, and 21.4% were business travellers. The results indicated that all participants (100%) had a basic understanding of malaria, as 98.3% knew the risk of malaria, 97.4% understood the dangers of the disease, 93.2% recognized that malaria can be life-threatening, and 59.8% expressed concern about the use of long-term prophylaxis. However, significant misconceptions remained, with 34.2% misunderstanding immunity to malaria, 18.8% believing that malaria is spread through contaminated water, and 6.9% believing that it spreads via physical contact. Furthermore, 86.3% used insect repellents, and 74.4% slept under mosquito bed nets. A significant correlation was found between the length of stay and attitudes towards the use of ITNs, χ²(3, N=117)=7.933, p=.047, indicating that as the length of stay increases, participants’ perspectives on ITNs tend to change. There was also a correlation between occupation and sleeping under ITNs χ²(4, N=117)=12.038, p=.017, suggesting that different occupations influence how respondents use ITNs. The logistic regression analysis revealed that as age increases, belief in the safety of long-term malaria prophylaxis decreases by 35.2%, while education levels increase belief in the efficacy of prophylaxis by 44.8%, and decrease beliefs in the benefits of sleeping under ITNs by 36.4%.
Recommendations: The study recommends that companies improve health awareness programmes, promote prophylaxis compliance, promote cultural sensitivity training on malaria prevention, and review safeguarding policies for workers deployed to malaria-endemic areas. Using the COM-B framework, these strategies should simultaneously strengthen international workers’ capabilities, provide supportive opportunities, and reinforce motivation to adopt consistent protective behaviours.