Malaria knowledge, attitudes and practices in Malawi: policy implications for the National Malaria Control Program.

Following data analysis and the presentation of the summary report to Ministry of Health officials a group of Ministry of Health staff examined results for implications for national policy development those elements which were relevant to 1) health education messages; 2) the development of programmatic indicators; 3) constraints on the use of services and access to treatment and prevention; and 4) direct and indirect costs of malaria in Malawi. Despite years of chloroquine use less than 30% of children were reported to receive an appropriate dose thereby limiting effective therapy. Plans to implement a new first line drug for therapy for use of sulfadoxine-pyrimethamine must be clearly spelled out. 10% of children attending government clinics and 43% of those attending private facilities receive an injection for malaria a gross overuse of injectable drugs. With 83% of women perceiving malaria as a problem during pregnancy and 68% thinking that antimalarials can prevent it there is a need for increased management of malaria in pregnancy. Use of malaria preventive measures is very low and income-dependent. Educational messages must include teaching that mosquitoes transmit malaria as only 55% of household heads reported this as the cause of malaria fevers. In certain locally based public health projects use of bed nets could be much higher. There is an imbalance between the average household expenditure on treatment (US $13.33) compared to prevention ($2.47). In addition 40% of households have an annual income of less than US $110 and expenditure on treatment exceeds 10% of these family incomes. The use of malaria prevention measures was closely linked to household income and estimated annual expenditure on sprays coils and bed nets was high ($42.60 $12.56 and $12.42 respectively). This underscores that 1) households that do spend money on prevention tend to spend substantial amounts; and 2) the money spent might be more effective if it were spent on bed nets rather than sprays.