Malaria knowledge and bed net use in southern Africa

2 December, 2018

Dear HIFA and CHIFA colleagues,

Previous research has found surprisingly low levels of awareness of the link between mosquitoes and malaria, so this study is reassuring (85% correctly linked the two). Community health workers have likely played (and will play) an important role (if they are properly supported to do so). What more do we know about the links between knowledge (including environmental knowledge as well as bed nets), behaviour, and the effectiveness of communities to reduce malaria transmission? And what do we know about the effectiveness of different methods to raise awareness and promote change in different settings?

What are the most effective interventions to promote use of bed nets for different age groups in different settings?

CITATION: Malaria knowledge and bed net use in three transmission settings in southern Africa

Mufaro Kanyangarara, Harry Hamapumbu, Edmore Mamini, James Lupiya, Jennifer C. Stevenson, Sungano Mharakurwa, Mike Chaponda, Philip E. Thuma, Lovemore Gwanzura, Shungu Munyati, Modest Mulenga, Douglas E. Norris, William J. Moss and For the Southern Africa International Centers of Excellence for Malaria Research

Malaria Journal 2018 17:41


Background: Insecticide-treated nets (ITNs) reduce malaria morbidity and mortality in endemic areas. Despite increasing availability, the use of ITNs remains limited in some settings. Poor malaria knowledge is a barrier to the widespread use of ITNs. The goal of this study was to assess the levels of malaria knowledge and evaluate factors associated with bed net use among individuals residing in three regions of southern Africa with different levels of malaria transmission and control.

Methods: A cross-sectional study was conducted on a sample of 7535 residents recruited from 2066 households in Mutasa District, Zimbabwe (seasonal malaria transmission), Choma District, Zambia (low transmission) and Nchelenge District, Zambia (high transmission), between March 2012 and March 2017. A standardized questionnaire was used to collect data on demographics, malaria-related knowledge and use of preventive measures. Multivariate logistic regression analyses were used to assess determinants of bed net use.

Results: Most of the 3836 adult participants correctly linked mosquito bites to malaria (85.0%), mentioned at least one malaria symptom (95.5%) and knew of the benefit of sleeping under an ITN. Bed net ownership and use were highest in Choma and Nchelenge Districts and lowest in Mutasa District. In multivariate analyses, knowledge of ITNs was associated with a 30–40% increased likelihood of bed net use after adjusting for potential confounders across all sites. Other factors significantly associated with bed net use were age, household size and socioeconomic status, although the direction, strength and size of association varied by study site. Importantly, participants aged 5–14 years had reduced odds of sleeping under a bed net compared to children younger than 5 years.

Conclusion: Relevant knowledge of ITNs translated into the expected preventive behaviour of sleeping under a bed net, underscoring the need for continued health messaging on malaria prevention. The implementation and delivery of malaria control and elimination interventions needs to consider socioeconomic equity gaps, and target school-age children to ensure access to and improve utilization of ITNs.


Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children:

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: /