INTRODUCTION:

Malarial disease is a type of infectious disease which is of mosquito borne origin. The major etiological agent is by means of protozoan parasites of genus Plasmodium. Five species of plasmodium which causes malaria are P. falciparum. P. malariae. P. vivax, P. ovale and P. knowlesi. P. falciparum accounts as the most virulent among the 5 malaria species and it majorly increases the mortality rate also.¹ACT (Artemisinin based Combination Therapy) is recommended for both severe and complicated cases of malaria by Plasmodium falciparum, according to a W.H.O report.² About 216 million cases of malaria occurred in the year 20 16 with an estimated 445,000 to 731,000 deaths.^3,4 It is considered to be one of the most serious infectious disease which occurs in Southeast Asia including our country India. Nearly 36% of the world's population i.e. 2020 million is being exposed to malaria in about 90 countries. ⁵ Malaria incidence cases in India accounts for 58% in south East Asia region of WHO. ⁶ The malarial infection stands 5^th in the mortality rate around the globe after respiratory infection, HIV/AIDS. Diarrheal disease and TB and in Africa it stands as the second leading cause of death from infectious disease after HIV/AIDS. ⁷ Young children and pregnant women are the most vulnerable to malarial disease. According to a study conducted among different age group in Pakistan, approximately world's half of the population has been affected by malaria. Particularly due to lack of awareness especially in Asia, A study conducted among the school's students proved insufficient knowledge regarding the pathological mechanism and its prevention.⁸Communicator's socio-economic conditions generally have direct bearing on the problem of malaria. Preventing the disease through better knowledge and awareness is one of the appropriate way to keep this disease away and educating the community members regarding the management and prevention play an important role in eradicating this problem of malaria to an extent.

MATERIALS AND METHOD:

Methodology:

Community members of CORA campus, Thalakancherry and Meenambakam were involved in this study. The participating members should be above the age 15 to be eligible for the study. Members above the age 55 were excluded from the study. Informed consent forms were collected from each participating member and patient leaflet were distributed among community members who participated in the study.

Ethical consideration:

Institutional Ethics Committee (ICE) of VISTAS SPS (Ref. No. VISTAS-SPS/IEC/VI/20 18/08) approval was obtained for the study to be conducted among the general public. Informed consent forms were collected from each member and patient leaflet were distributed among community members who participated in the study. The calculation of the sample size was fine using the following formula among an infinite population.

The sample size calculation was carried out by the formula

SS = (z)² p (1- p) I c²

Where

SS= Sample size

z= level of confidence according to standard normal distribution (for a level of confidence of 95%. z - 1.96. for a level of Confidence of 99%, z -2.575 and for 90%, z = 1.645). Here we use z = 1.64 (90 % level of confidence)

p = estimated proportion of the population that presents the characteristics (when unknown. we use p - 0.5). Proportion is unknown, hence we take p = 0.5

c = confidence interval (5%)

SS = (z)²* p (l- p) / C²

= (1.64)2 • (0.5) (1- 0.5) I (0.5)2 = 269

The estimate proportion of the population that presented the characteristic [p] was taken as 0.5 and 90% level of confidence to determine a sample size of 269.This cross sectional study included questionnaire distributed among the community members to evaluate the awareness of this malaria disease in general public to conclude the knowledge among them.

Data collection:

Questionnaires were adopted from two studies after getting permission from their respective authors. Table 1 was on socio-demographic studies, Table 2 was on knowledge of public about malaria prevention and control. Table 3 was on member’s attitudes regarding malarial prevention and control. Table 4 was on publics practices regarding malarial prevention and control and Table 5 was on general knowledge of public about malaria. In the given below 5 tables, N= frequency, %= percentage

Table 1: Socio-demographic characteristics

Socio- demographic characteristics	N	%
Sex
Female	143	53
Male	126	46.8
Marital status:
Single	90	33.4
Married	179	66.5
Education:
Secondary	42	15.6
Higher school	89	33
University	138	51.3
Employed:
Yes	179	66.5
No	90	33.4

Table 2: Public’s knowledge on malaria prevention and control

Knowledge among the public about malaria prevention and control	N	%
Do you know about malaria?
Yes	269	100
No	-	-
Measures to prevent and control malaria
What measures you follow to prevent and control malaria?
Sleeping under bed net	223	83
Wearing long clothes	58	22
Making fire and smoke	17	6.3
Spraying insecticides	44	16
Clear bushes around the house	46	17
Cleaning the house	22	8.1
Mosquito bite
Malaria is caused due to mosquito bite during?
Day time	49	18.2
Night time	92	34.2
Both day and night time	128	48
Group mostly affected
Which age group of people is mostly affected by malaria?
Adults	96	36
Children <5 years	78	29
Pregnant women	38	14.1
Both children <5 years and pregnant women	57	21
Preferred information to get on malaria
Among the following which information you prefer to get on malaria
Information on treatment	98	36.4
Information on control	64	24
Information on prevention	79	29.3
Information on signs and symptoms	32	12
Source of information
You came to know about malaria by the source of
Television	151	56.1
Newspaper	72	27
Formal training in school	58	22

Table 3: Public’s attitude on malaria prevention and control

Attitude on malaria prevention and control	N	%
You consider malaria to be a:
Serious and life threatening disease	59	22
Can be prevented by avoiding mosquito bite	151	56.1
Caused by witchcraft	4	1.5
Best treated in hospital	42	16
Best treated by traditional doctors or with herbs	20	7.4

Table 4: Public’s practices regarding malaria prevention and control

Practices regarding malaria prevention and control	N	%
Your idea to the society regarding malaria prevention and control
Use impregnated bed net in community	59	22
Give health education on hygiene and stimulate society	137	51
Involved in home diagnosis and treatment with ACT	9	3.3
Indoor spraying to kill insecticides	63	23.4
Distribute information leaflet on malaria	-	-
Source of training
You are trained about malaria by means of
Seminar/Workshops	20	7.4
Training in school	116	43.1
Radio/T.V	93	35
Newspaper/Posters	63	23.4

Table 5: General knowledge of public about malaria

General knowledge of public about malaria	N	%
Malaria is transmitted by
Mosquito	260	97
House fly	1	0.4
Drinking of dirty water	7	3
Due to sins	1	0.4
No idea	-	-
Name of malaria vector
Female Anopheles	247	91.8
Male Anopheles	11	4.08
Aedes Mosquito	2	0.8
No idea	9	3.3
Malaria vector breeds in
Dirty stagnant water	135	50
Clean stagnant water	91	34
Dirty flowing water	29	11
Clean flowing water	10	3.7
No idea	4	1.5
When infected with malaria you consult to?
Government hospital doctors	207	77
Private clinics	7	3
Deshi treatment	52	19
Jar punk by ojha etc.	1	0.4
Did nothing	2	0.8
Malaria parasite belong to
Bacteria	22	8.1
Virus	52	19
Protozoan	120	45
Amoeba	2	0.8
No idea	73	31
According to you malaria control should be carried out by	N	%
Govt. agencies only	55	20.4
Public agencies only	21	7.8
Private agencies only	11	4.6
Govt. plus public agencies	175	65
No idea	7	3
Any information regarding medicines used to treat malaria
Chloroquine	52	19
Quinine	76	28.2
Other medicines	55	20.4
No idea	86	32
Can you name some of insecticides Commonly used
DDT	176	65.4
Finite	6	2.2
Others	4	1.5
No idea	83	31

Statistical analysis and data management:

Collected data was documented on the printed questionnaire. Determination of socio-demographic characteristics was done by using means and percentage were used for the categorical variables. The questionnaire designed was classified based on the knowledge, attitude and practices to determine general public's knowledge, attitude and practices regarding malaria prevention and control

RESULT:

Demographic consideration:

Socio-demographic characteristics of the members is documented in Table I. Majority of the members (51.3%) had university level of education whereas (33.4%) of members were unemployed, (53%) of participating population was female and (47%) were male.

Public's knowledge on malaria prevention and control:

The extent of participant's knowledge on malaria prevention and control is depicted in Table2. Almost each and every participant (100%) knew the disease malaria. Two hundred and twenty three members (83%) knew that using bed net during sleeping time is a better way of malaria prevention and control. While 48% of the members think that mosquitoes transmitting malaria, bites human both day and night. Public had less knowledge regarding age group majorly affected, as only 21% claimed that children less than 5 years of age and pregnant women are the most commonly affected group with malarial infection. About 36.4%, 24%, 29.3% and 12% of general public preferred information on treatment, control, prevention and on signs and symptoms respectively. More than half of the participants (56%) considered television to be the major source of information on malaria.

Public's attitudes towards malaria control and prevention:

Table 3; depicts the public's attitudes towards malaria control and prevention. Among the 269 members who participated in the study, more than half of the population (56%) agreed that by avoiding mosquito bites malaria can be prevented and 59 members (22%) co8dered malaria to be serious and life threatening disease. Few population (1.5%) of the members had the wrong belief that malaria can also be caused by witchcraft whereas 7.4% of the members stated that use of herbs by traditional system of medicine for treatment of malaria can be as a way for prevention.

Public's practices towards malaria control and prevention:

Table 4 depicts the public's practices towards malaria control and prevention. Regarding the practices followed by the public for malaria prevention and control, (51%) kept the idea of providing health education on hygiene and sanitation to the community 8.4% believed indoor spraying of insecticides and 22% members stated that using impregnated bed net in the community plays an effective way for malarial prevention and control.

General knowledge of the public about malaria:

The public general knowledge regarding malaria was quiet high. Among the participant’s 260 (97%) knew that malaria is transmitted by mosquito. Their knowledge regarding malaria vector and its breeding site was appreciably good with 91.8% and 50% respectively having the idea that female Anopheles is the malaria vector breed which breeds in the clean stagnant water. More than half of the participant’s (65.4%) stated that DDT is one of the common insecticides used. Despite all this, general public lacked knowledge about category of malarial parasite and the medication for malaria treatment. However their missing knowledge was enhanced by providing them with patient leaflet.

DISCUSSION:

According to the WHO report 2015 about 214 million new cases of malaria had occurred in the year of 2015 resulting in 438,000deaths.⁹ Children under the age of 15 are the most (60%) vulnerable group affected by this disease.¹⁰ Assessing KAP is quiet a good initial step for planning public health intervention. It is of much greater value in disease such as malaria, wherein awareness about the spread and cause is a major stake hold for its prevention. The high level of awareness among the members can be explained by increased access to mass media and health education by government agencies.

The members who had some ideas about the aspects of malaria were assessed for their thoughts and practices regarding malarial prevention and control, in this study, to appreciate general public's knowledge, altitudes and practices (KAP) regarding malaria prevention and control. Some question s in the questionnaire were also formed to assess the general knowledge of the public regarding malaria. Majority of the respondents made correct association between malaria and mosquito bite. We found that all the participants knew about malaria. We also documented that percentage of the members who know about malarial transmission by mosquitoes and best protection can be can be done by sleeping under the bed net, was also quiet high. Despite this, we found that the percentage of members who knew the time of malarial mosquito bite, know the group of person most affected by this disease are somehow low (34% and 29%) respectively. We also gathered data about the attitudes of the general public regarding malaria prevention and control are quiet appreciable with 22% and 56% respectively, considering malaria to be a life threatening infectious disease and it can be prevented by avoiding mosquito bite. However a small percentage of the members 1.5% and 7.4% respectively had the belief that malaria is caused by witchcraft and that it can only be best treated by traditional medicine with herbs. The practices of the members in accordance with malaria prevention and control are also good with a high percentile of the members stating that giving health education on hygiene and sanitation to the community members and using impregnated bed net in the community are the most effective ways for the prevention and control of the disease. Whereas among the 269 participant, 63 members stated that indoor spraying of insecticides can also be adopted a major technique for malaria prevention and control. The general knowledge of the public about malaria was also quite well. Majority the members knew that malaria transmitted b) the mosquitoes and 247 members (91.8%) correctly answered for the malaria vector. We also documented that 207 members (71%) had the idea that when infected with disease (malaria) it can be best treated only in hospitals. Public's knowledge about the insecticides used for its control was also in high members with 65.4%. However they lacked knowledge about the breeding area of the vector and medication for malaria treatment. They were provided with patient leaflet 9cquire their missing knowledge regarding the malaria disease. According to our study 7.4% of the Population believed that malaria is best treated by traditional system of medicine with herbs.

Some other studies conducted were based on the traditional medicine use for malarial prevention and control. According to one of the study isolation of quinine from Cinchona bark, proved to be a major historical milestone in modern medicines for malaria. A variety of other synthetic derivatives of quinine (pamaquine, cloroquine, amodiaquine, pentaquine, primaquine and mefloquine - aminoquinoline based anti-malarial) were developed later.¹¹0ne of the other study focused on the potent isolated flavonoids for their effect on malaria parasites, screening methods and their mechanisms.¹² A study conducted on sunflower leaves showed that inhibition of growth of P. falciparum 3D7 strain can be done by methanol extract of sunflower leaves.¹³According to a study conducted in Chhattisgarh, thrombocytopenia was considered as the major predictor of severe malaria cases of falciparum species.¹⁴The data collected in our study had similarity with the study conducted in Bastar District Chhattisgarh which includes transmission, prevention, and knowledge of malaria among the tribes of Bastar.¹⁵ There was no significant association found between socio-demographic characteristics and public knowledge on malaria prevention and control. However a study conducted by Salwa Dawaki in Kano state (Nigeria) made significant association between public knowledge and their education, age, gender and monthly income.¹⁶ Our study was compared with the study done by Andargie Abate in north-eastern Ethiopia and we observed that their study documented 85.2% respondents associating cause of malaria with the mosquito bite, whereas our study showed 97% results.¹⁷The study included the socio-demographic study similar to the study done in Saudi Arabia¹⁸ and in Columbia.¹⁹ We compared our study results regarding malaria transmission with KAP study conducted by Rupashree Singh in Aliero (northern Nigeria)²⁰ and found the percentile of awareness about malaria transmission in public is 11.8% and our study have 97%.

Several studies are conducted on detection of malarial parasites by various screening techniques in various articles. A study conducted showed that the presence of malarial parasite can be screened by using image processing techniques based on the colour discrimination with 86% of accuracy and high level of efficiency.²¹ A similar kind of study was conducted on thin blood smears to detect the presence of plasmodium parasites using Artificial Neuron Network which showed 95% of accuracy in detection in the infected erythrocyte.²² The results of one another 8dy conducted on diagnostic test for malaria by Polymerase Chain Reaction (PCR) assay showed varied prevalence’s of P. vivax and P. falciparum in different locations and also mixed species infections with 49:5 1 proportion of P. falciparum and P. vivax cases respectively.²³ Studies conducted in Ecuador for total malaria prevalence by PCR technique showed a total of 7.5% with 6.9% and 0.6% cases of P.vivax and P. falciparum cases respectively.²⁴

CONCLUSION:

Public's attitudes and practices regarding malaria seemed quite high. Community members still require education and training on malaria prevention and control. However they also lacked knowledge about the breeding area of the vector and medication for malaria treatment. They were provided with patient leaflet to acquire their missing knowledge regarding the disease.

ACKNOWLEDGEMENTS:

We render our thanks to all the participating members of our community.

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Received on 11.03.2020 Modified on 14.04.2020

Asian J. Res. Pharm. Sci. 2020; 10(3):165-170.

DOI: 10.5958/2231-5659.2020.00032.6