Abstract
Background
In sub-Saharan Africa including South Sudan, malaria remains a major cause of morbidity
and mortality. Malaria alone accounts for about 30 - 50% of all health facility visits in the
outpatient departments, 40% of all hospital admissions, and 56% of all causes of death
in hospitals. Evaluating the adult population’s knowledge, attitude, and practices about
malaria prevention is crucial for enabling targeted interventions in the community.
Study Goal
This study evaluated knowledge of malaria, attitudes, and practices about malaria among
the general population in Wau, South Sudan.
Methods
A cross-sectional quantitative design was used in this study. The study was conducted in
the whole town of Wau and involved using a self-administered questionnaire (SAQ)
containing closed-ended questions. A simple random sampling method was employed to
recruit three hundred eighty-three (383) participants. The SPSS version 29 was used for
the analysis of data. Descriptive statistics were used to summarize the data while
multivariable logistic regression analysis was used to assess factors associated with
knowledge and practices on malaria prevention. A p-value<0.05 was considered
statistically significant.
Results
A total of 383 respondents were surveyed. The majority, 89%, had heard of malaria, and
more than 90% were able to identify the main signs and symptoms of the disease. Over
80% recognized mosquitoes as the main vectors for malaria, with approximately 67.3%
aware that mosquitoes are most active at night. The most preferred source of information
about malaria was the radio, chosen by 28.7% of respondents. Most participants, 86.9%,
agreed that malaria is a life-threatening disease, and an overwhelming 90.3% stated that
they would seek advice or treatment if they contracted malaria. In terms of prevention, a
quarter of respondents consistently sleep under mosquito nets. About 65.3% reported
that they sometimes sleep under a mosquito net, while 21.7% indicated that their family
members always use them. Only 13.6% of participants consistently check for holes and
repairs in their mosquito nets. The use of anti-mosquito repellent spray was reported by
8.6% of respondents, and 8.9% used other types of anti-mosquito spray regularly.
Additionally, only 18.3% of respondents reported regularly clearing stagnant water near
their homes.
Males were 3.6 times more likely to have heard of malaria compared to females (Adjusted
Odds Ratio [AOR]: 3.6, 95% Confidence Interval [CI]: 1.303 - 10.115). They were also
approximately 4.4 times more likely to identify mosquitoes as the vector for malaria (AOR:
4
4.4, 95% CI: 1.058 – 18.480). Additionally, male respondents were 2.9 times more likely
to indicate that a bite from an infected mosquito is a cause of malaria (Crude Odds Ratio
[COR]: 2.9, 95% CI: 1.101-7.742). Furthermore, males were more likely to recognize
bushes around houses and stagnant water as breeding sites for mosquitoes, with AORs
of 7.2 (95% CI: 1.568 – 33.893) and 4.9 (95% CI: 1.147 – 21.690), respectively.
Male respondents were 3.2 times more likely to encounter malaria patients compared to
females (Adjusted Odds Ratio: 3.2, 95% Confidence Interval: 1.184 – 8.787). However,
adult male respondents were less likely to believe that sleeping or working overnight in a
garden or forest could put them at risk of contracting malaria (Adjusted Odds Ratio: 0.3,
95% Confidence Interval: 0.139 – 0.654). Additionally, male respondents were more likely
than females to sleep under mosquito nets (Adjusted Odds Ratio: 1.8, 95% Confidence
Interval: 1.170 – 20.155), to check for holes and repair mosquito nets (Adjusted Odds
Ratio: 3.9, 95% Confidence Interval: 1.617 – 9.710), and to use mosquito repellent spray
(Adjusted Odds Ratio: 2.5, 95% Confidence Interval: 1.186 – 5.310).
Conclusion
The findings of this study demonstrated that the respondents had good malaria
knowledge and attitude. There was however a mismatch between malaria knowledge and
malaria prevention practices. There is a need for interventions that will encourage the
community to adopt good prevention practices and attitudes. The local community in Wau
should direct more efforts toward improving malaria prevention practices by adopting
targeted public health interventions. As such more emphasis should be put on
environmental management, improving housing structures, and involving the community
when designing future malaria prevention strategies.