Background
Methods
Study area
Study design, sampling and data collection
Data management and analysis
Ethical considerations
Results
Participants’ demographic characteristics
Knowledge of malaria signs, symptoms and their severity
Causes of malaria
‘You know our problem is that we assume all types of mosquitoes are the same. But I heard a certain type called Anopheles a long time ago in school…. When I’m bitten at night by a mosquito, how do I know that this is Anopheles or not?’ Male discussant, Kipcherere 4.
‘The female Anopheles mosquito causes malaria. It is drawn this way, [demonstrates a 45° angle]. Its legs look like this [as she draws] 45°. It stays like this, even when it wants to bite, its legs just draw back that way. If it wants to bite, its legs are raised to a 45° angle. They appear to be standing at an angle of 45°.’ Female discussant, Borowonin 1.
‘[Malaria is caused by] that female one which doesn’t make noise. It just bites and sucks blood and the following day you feel a bitter taste in your mouth.’ Female discussant, Salabani 3.
‘Malaria has become common nowadays because people take a lot of foods rich in sugar which increase bile in the body, after a few days it becomes too much and causes malaria.’ Male discussant, Borowonin 4.
‘If you eat a lot of fats, it becomes bile and then it becomes malaria.’ Male discussant, Kipcherere 3.
‘There used to be a belief, especially for us who live here [in the highlands], that if we go to lowland areas like Marigat and Lodwar, or if someone goes there and comes back they will have malaria directly. I don’t know why. I used to think that in that place the sun is very hot and when you are hit by that sun and you drink their water, when you come back here, you get malaria directly’. Female discussant, Borowonin 1.
‘Also, people in the past never knew malaria was brought by mosquitoes. They thought it was brought by water. So when somebody was going somewhere, they took some soil and when they reached there [where they were going], they asked for water and mixed a little with the soil and consumed. They did that thinking it prevents malaria because water from other places can affect you. They used to believe that but still they got malaria’. Male discussant, Kipcherere 4.
Malaria seasonality
‘During the dry season like now [March], the prevalence is low but during the rainy season we experience a lot of malarial cases’. Female discussant, Perkerra 2.
‘You know, those people who live near rivers can get malaria. For example, if you see in the hospital, those who have malaria during this dry season [July] are those people who come from down there, next to the Kerio river’. Male discussant, Litein 3.
Overall knowledge of malaria
Logistic regression | Number of obs = 560 | ||||
---|---|---|---|---|---|
LR χ2 (18) = 57.12 | |||||
Log likelihood = −357.36707 | Prob > χ2 = 0.000 | ||||
Pseudo R2 = 0.07040 | |||||
Knowledge | Odds ratio | Std. error | z | p > |z| | 95 % CI |
Sex
| |||||
Female | 1.506 | 0.312 | 1.97 |
0.048
| 1.003–2.261 |
Marital status
| |||||
Married monogamous | 0.278 | 0.184 | −1.94 |
0.053
| 0.076–1.015 |
Married polygamous | 0.322 | 0.228 | −1.60 | 0.110 | 0.081–1.290 |
Separated | 0.960 | 0.890 | −0.04 | 0.965 | 0.156–5.905 |
Widowed | 0.624 | 0.446 | −0.66 | 0.510 | 0.154–2.533 |
House type
| |||||
Male only, no female adult | 0.797 | 0.394 | −0.46 | 0.647 | 0.303–2.101 |
Female only, no male adult | 0.245 | 0.116 | −2.97 |
0.003
| 0.097–0.619 |
Age
| 0.990 | 0.007 | −1.36 | 0.173 | 0.977–1.004 |
Education
| |||||
Primary | 0.727 | 0.199 | −1.16 | 0.245 | 0.425–1.244 |
Secondary | 1.990 | 0.681 | 2.01 |
0.044
| 1.017–3.891 |
Tertiary | 3.209 | 1.633 | 2.29 |
0.022
| 1.183–8.702 |
Main livelihood activities
| |||||
Livestock farming | 0.462 | 0.111 | −3.21 |
0.001
| 0.288–0.741 |
Self-employed service delivery | 0.627 | 0.233 | −1.26 | 0.208 | 0.303–1.297 |
Self-employed goods delivery | 0.657 | 0.209 | −1.32 | 0.186 | 0.353–1.225 |
Wage employment | 0.733 | 0.250 | −0.91 | 0.363 | 0.376–1.431 |
Salaried employment | 1.069 | 0.503 | 0.14 | 0.888 | 0.425–2.690 |
None | 1.310 | 1.414 | 0.25 | 0.803 | 0.158–10.863 |
Other | 0.423 | 0.335 | −1.08 | 0.278 | 0.090–2.001 |
_cons | 6.844 | 5.539 | 2.38 | 0.017 | 1.401–33.433 |
Treatment options and pathways
Treatment actions | N | Level of knowledge | Sex | |
---|---|---|---|---|
P value | P value | |||
1 | 1st choice treatment | 492 | 0.772 | 0.307 |
2 | 2nd choice treatment | 492 | 0.494 | 1.000 |
3 | Testing for malaria | 488 | 0.366 | 0.549 |
4 | Completing AL doses | 489 | 0.840 | 0.688 |
5 | Not completing AL doses due to their undesirable qualities | 490 | 0.373 | 0.024 |
6 | Not seeking services in the nearest facility because of slow delivery | 560 | 0.822 | 0.001 |
‘To add to what the man has said, nowadays people have gone to school. You will find that the digital [young people] don’t like herbal medicines so much but the analogue [old people] continue using them’. Male discussant, Salabani 1.
‘You see these medicinal plants, not everyone knows them. Not everyone knows that they are medicinal. You know we stay in town, near the hospital. They [people] are close to the hospital and maybe they do not know those herbs so they just have to go to the hospital’. Male discussant, Perkerra 1.
‘In this area, if you take the tablets in the morning, because of the hot sun you will do nothing the whole day. You will feel bad when you go to the sun. You smell of that medicine. Your whole body and sweat is like that medicine so some people prefer taking the medicine in the night and skip taking them in the morning. I take the malaria medicines in the evening only. I take [the medicine] for six days though it is not correct to skip other times’. Female discussant, Salabani 4.
‘When I was sick I took eight tablets from the first day’s dose, then my daughter who’s in university got ill and we could not get more medicine. I gave her the rest, we shared’. Male discussant, Litein 1.
‘They [people] check the expiry date [of the remnant malaria medication], if it is past, it’s not supposed to be taken. They then visit the hospital. But if it is not yet expired they use. If they feel well they will not go to the hospital but if they don’t they will’. Male discussant, Borowonin 3.
‘But some people don’t check for the expiry date of remnant malaria medicines. You have said that because you know that one should check but what of those that do not check the expiry date?’ Male discussant, Perkerra 1.
Gender differences in health-seeking behaviour
‘You know women have a lot of work so if you get very sick, you start saying, this homestead, who will manage it so you just say I should go to see the doctor’. Female discussant, Borowonin 1.
‘The family depends upon the woman. The children and husbands also depend on the women. Also all the house chores depend on her. So she will have to go to the hospital so as to get well fast’. Female discussant, Perkerra 2.
‘It is a norm that a man must persevere. So he [sick man] does not want to show weakness even that time when he is almost dying…. He has been taught that in our culture you should not live in a bad manner [showing weakness]. You have to stay strong. If you are a man, be a man and live like a man and not like a woman’. Female discussant, Kipcherere 2.
‘They [men] think if they go to be tested for malaria, they will be tested for HIV also’. Female discussant, Perkerra 2.
‘If you are in doubt about your HIV status, people [men] fear to have their blood drawn for testing, but if you know you are okay there is no problem’. Male respondent, Borowonin 4.
‘There are those men who are patient, you can’t compare me with another man. Some men don’t want to be in the hospital queues. …. So someone may say [that] they are wasting time [in queues]’. Male discussant, Borowonin 3.
‘When it comes to men, like the old men, they don’t go to the hospital because they wonder ‘who is going to queue?’ There are those who don’t go completely and God still loves them, they still get better’. Female discussant, Borowonin 2.
‘If they [the sick person] are supposed to go to the hospital, it is the man/father/husband who contributes the money to take them’. Male discussant Salabani 2.
‘When you have a sick person at home suffering from malaria or any other disease, it is the work of the woman to take care of that person. The men help by providing money to take that person to the hospital’. Female discussant Perkerra 3.
‘There is a big difference [in asset ownership] because a man is always the head of the family and the woman should always be under him’. Female discussant Soruro 2.