Knowledge, attitudes and behaviors: The evaluation of a malaria education program in Southeastern Uganda

Background: The global burden of malaria is substantial; Uganda alone has an estimated 12.8 million annual cases of malaria and 47,000 deaths. Long Lasting Insecticidal Nets(LLINs) are the most effective means of preventing malaria. Initiatives exist to improve LLIN utilization, but often are not evaluated. We evaluated a single-session malaria education program delivered by community health workers from a non-governmental community clinic in Southeastern Uganda. The program educates villagers about causes of malaria, treatments, benefits of and proper use of LLINs and provides nets at a subsidized rate. Methods: We compared malaria related knowledge, attitudes, self-reported health care seeking and LLIN usage by program participants surveyed post-intervention (n=270) and a convenience sample of local non-participants (n=146). Results: Compared to controls, participants in the education program had higher odds of reporting household members (OR=3.15, 95% CI 1.52-6.54) and children sleeping under LLINs (OR=3.24, 95% CI 1.52-6.54), of knowing that mosquitoes cause malaria (OR=5.05, 95% CI 2.60-9.83) and they perceive more benefits (c²=6.67, p=0.036) and less problems (c²=5.20, p=0.023) with nets. However, participants reported lower odds of having recent cases tested (OR=0.45, 95% CI 0.29-0.76) and there were no significant differences in knowledge about malaria symptoms and treatments. Discussion: Although preliminary, results indicate that a brief community-led malaria education program can be effective at improving attitudes toward LLINs and LLIN usage. The unexpected findings indicate that there may be many barriers to following health care recommendations (e.g.,financial barriers) and educating people on this topic may be more challenging than promoting LLIN usage.