Salale University, Faculty of Medical and Health Science,

Department of Public Health

Knowledge, Attitude and practice of malaria prevention and control

method and the underlying factors in Dambi town, Bunno Beddelle
Zone, Oromia, Ethiopia

By:-

Biyya Mohammed Hamza (BSc)

Research Proposal Submitted to Salale University, Faculty of

Medical and Health Science, Department of Public Health

December, 2023

Fitche, Ethiopia
 SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF PUBLIC HEALTH

Knowledge, Attitude and practice of malaria prevention and control

method and the underlying factors in Dambi town, Bunno Beddelle
Zone, Oromia, Ethiopia

By:-

Biyya Mohammed Hamza (BSc)

Research Proposal Submitted to Salale University, Faculty of

Medical and Health Science, Department of Public Health

December, 2023

Fitche, Ethiopia
Salale University, Faculty of Medical and Health Science,
Department of Public Health

Knowledge, Attitude and practice of malaria prevention and control

method and the underlying factors in Dembi town , Ilubabor
Zone ,Oromia, Ethiopia 2012

By:-

Biyya Mohammed Hamza (BSc)

Advisor

Ms ______________ (Bsc, MPH)

December, 2023

Fitche, Ethiopia
Abstract

Background:- Malaria kills millions around the world. Until recently it was believed to be a
disease of rural areas, since the anopheles mosquitoes, which transmit plasmodium species
breeds in rural areas. In a views of rapid growth of number small and medium size town in
Ethiopia. There is a pressing need to improve the understanding of epidemiology of malarias.
Therefore, the arm is the study was KAP of malaria prevention and control methods and the
underlying factors in Dambi town.

Objectives:- to assess malaria related knowledge, attitudes, and practice (KAP) and the
underlying factors among Dambi town 01 kebele populations to identify the association between
their awareness and positive KAP towards malaria and to identify independent predictors among
the society.

Method – cross sectional study was carried out in Dembi town from June 1, to August 28,2012
and 291 study participants were included. Socio demographic data, KAP on malaria prevention
and control methods and the underlying risk factors were collected using structured
questionnaires, logistic registration; analysis was done using manual analysis. House holder
living in Dembi town were interviewed and information was collected on demographic, KAP and
environmental and houe holders factors. Malaria incidences were measured prospectively using
active surncillance.

Results;- from the total of 291 study population in current survey, only 71.8% (209)knows as
plasmodium as causative agent of malaria and 59.1% (173) know the way of malaria
transmission, 88.00% (256) know that malaria is treatable, preventable and controllable. Among
the respondents who know plasmodium as etiology of malaria 90% of them reports malaria as a
cause of fever, they would go to health center as their first actions. Only 47.9% of them know
that Chloroquine was the first recommended treatments for malaria. Higher malaria prevalence
rate was observed among under five children’s (11%)

The respondents who does not use ITNS were more likely to be infected with malaria (OR
¿ 13−695 % , cl 4−937.2 % , p 0.001 ¿ compared ¿ thoseuse ITNS. Living in area of stagnant water
existed.
(OR¿ 2.1 ; 95 % , cl=1.00−4.2 , p=o . o 47 ¿∧its distance of existance were < 1km from house
(OR¿ 2.1 ; 95 % , cl=2.0−15.8 , P=0.001¿ were more likely to be infected with malaria parasite
compared to those who live away from stagnant at distance greater than one km.

Conclusion; - malaria is a major health problem with the plasmodium vivax becoming a
predominant species in Dembi town. The prevalence was strongly associated with the proximity
of residences to potential mosquitoes breeding site and it affects a significant proportion the
whole population and human activities, nevertheless plays an important role in bringing the
mosquitoes breeding site closer to the residences.

II
Acknowledgement

I would like to pass my deepest gratitude and heartily appreciation to my advisor

Ms/_______________(BSC,MPH).For her unreserved comments and supportive ideas to write
this research, and Secondly I would thanks my colleagues .

Adunya shifarawu –who teaches Dembi technical and vocational training collage(Dembi Tvet)

Hailu Mangasha – the secretary of Didessa health bureaus and all of my staff member for their
supportive ideas in all of my research project.
 Table of content
Abstract
……………………………………………………………………………………… I
Acknowledgement ………………………………………………………………………
II
List of table
……………………………………………………………………………….. IV
Acronomy…………………………………………………………………………………
…. V
Chapter – 1 Introduction …………………………………………………………………
1
1.1. Historical back Ground
…………………………………………………………… 1
1.2. Statement of the problem …………………………………………………….
…… 2
1.3. Objectives of the study ……………………………………………………………….
5
List of Tables
1.3.1. General Objective ………………………………………………………………
Table -51. Socio-economic characteristics of households respondents Dembi town September
2012 …………………………………..
1.3.2. 19
Specific Objective ……………………………………………………………..
Table 5- 2. Knowledge , attitude and practices of house hold on cause of malaria in
woreda
1.4. 20012 …………………………………………………
Significance of the study ………………………………………………….. 21 6
Table - 3. Distribution of respondents to some health services and environmental factors
1.5.inDelimitation
Dembi townofJulythe 2012 ………………………………………………22
study…………………………………………………………. 6
Table - 4. 1.6.Source of information
Limitation on………………………………………………………….
of the study malaria prevention and control methods 6
………………………………..
Chapter 23
- 2 Literature review…………………………………………………… 7
Table -5. Knowledge of controlling mosquitoes breeding site ………………….. 23
Chapter – 3 methods and Materials …………………………………………… 13
Table -6. Types activities to control and prevent malaria and its underlying factors
3.1.1 Study area and periods …………………………………………………… 13
…………………………..24
3.1.2. Study design ……………………………………………………………………..
13
3.1.3. Population ……………………………………………………………………….
13
Acronomys and abbreviations
 Co ¿ degree Celsius
 DDT¿ dichloride diphenyltetra chloride
 EX¿ example
 Env’tal¿ environmntal
 KAD ¿ knowledge attitude and practice
 K/M¿ kilometer
 M¿ meter
 NGO¿non governmental organization
 NO ¿number
 Gov’t ¿ government
 RDT ¿ Rapid diagnostics test
 RHS ¿ Resident house spray
 % ¿ percent
 IRS ¿ Indoor resident spray
Chapter 1 Introduction
1.1.Historical background of the study area
Malaria has always been the serious problem for the majority of mankind. The energetic action
during the eradication area had produced some reduction in morbidity and mortality. But after
the obstacle posed to the eradication effort and the grate lump side ways of late 1960, malaria has
made a comeback with vengeance (1)
The world malaria situation is deteriorating. This deterioration resulted due to un certainties and
equivocations in the after math of the failure of eradication strategy the lack of effective
interaction between project planners and health authorities . more important to the collage of the
service due to economic resources and faulty adjustment programmer. (2)
During 19 40 and early 1950 malaria control activities in Africa were very limited in terms of
programs and interventions. Except for very specific settings such as selected urban centers or
sites of epidemic importance primarily to settlements of expatriate population (2)
During the malaria eradication period, Africa hosted several pilots pre- eradication projects, but
was never included in the global malaria eradication programs, in spite of the burden of the
disease in the continent. The justifications at that time were related to the general under
development of health services communication, infrastructures, i-e more operational limitation
than technical. The limited participation of Africa countries in the eradication effort had a long
term negative impact in term of human resources and capacity building. For malaria control in
the continent (1, 2 )
In Ethiopia even though the Italians had some malaria control program in development and
settlement areas and some activities were continues by the British and the empirical Ethiopian
government on some maj virtually, no control program in the country until the early 1950
( Gondo public Health collage, health centers)
Research for malaria control program started to emerge. Very soon the eradication
strategy was accepted and after some none- conducive pilot projects in 1966 for essential
political reasons (3)
A few years later (1970 – 1971) the eradication program was dropped and a control program
was to the eventually integrated in to the general health service. A period of ambivalence and
equivocation was followed by an attempt at forced integration after Alma Ata thus; malaria
program has gone through devastating waves. (eradication control integration and now face on
other up heavily ; decentralization (4)
At present, the world health organization in it’s assembly 1990 recognized the resurgence of
malaria in various parts of the world and malaria epidemics in Africa adapted a global malaria
control strategy (5). All Africa malaria endemic countries including Ethiopia accepted the global
strategy and are on the practice to recognize the control programs to increase their human
resources and develop an appropriate strategy to address the prevailing situations based on their
national health policies. This study was conducted at Debmi Town, located 460 km South West
of Ethiopia. The town geographical coordinates are 12 o37’ N and 30o 22’ E ,Longitude. The
town was found at an average altitudes of about 2100m above the sea level. It lies with the
climate zone localy known as ‘’Woyna Dega’’ 1500—2400m above the sea level which is
considerd as ideal for agriculture and human settlements. The town is characterized by warm
climate and gets annual rain falls ranges from 150 – 200 mm and the maximum precipitation is
from June to September. Dembi town has one kebele which has total population of 3727 among
this 1933 are male and 1794 are female.

1.2. Statement of problem

Malaria is one of the most important tropical parasitic ( in faction disease) and kills more people
than any other communicable disease. In many developing countries and in Africa particularly
malaria extracts ( take a way) numerous toll in lives, in medical costs and in days of labor lasts (
Africa particularly malaria extracts ( take a way) numerous toll in lives, in medical costs and in
days of labor lasts (2)
It is the most public health problem in more than go countries and in Africa particularly malaria
extracts (take away) numerous toll in lives, in medical costs and days of labor last (2)
It is the most public health problem in more than 90 countries, in habited by 2.4. billion people
or ¼ of world population out of these 300 – 500 million people affected ever year and one
million people die each year more than 90% of all malaria cases are in sub Saharan Africa and
the vast majority death occur in the young children and women during pregnancy other at risks
groups are non- immune travelers, refuges, displaced person and labor entering epidemics area.
Malaria epidemic area related to economic difficulties environmental problems and political
instability also contribute in the most dramatic way to death toll and human suffering . it is an
endemic in the total (0) countries and boundaries(6)
Malaria is not only a medical problem but also a political, social and economical, which can’t be
solved by medical technology alone. (1) as far as affected communities are concerned more than
any other disease, malaria it’s bite the poor-malaria endemic countries are some of the world’s
purest which coss for control and work day lost estimated by 1-5% of GDP (4)
In Ethiopia, malaria is one of the most public health problem with nearly can estimated 68% (50)
million people on the country population lives in areas at risk of malaria. It is the leading cause
of morbidity and mortality, in 2004 -2005 accounting for 17% for out patient visit , 15% of
hospital admission and 29% of inpatient death. (1) from there the vast majority groups at high
risk are women and children under 5 years with accounting 10 – 40% of all cases children under
5 years most of malaria cases (60%) caused by plasmodium falciparum and (40%) plasmodium
vivax in Ethiopia.
In Ethiopia, generally area below 2000 meters altitude are considered as malariious and
sometimes occurs in areas above 2000 meter attitude when microdimate and whether condition
favorable .
The importance of malaria as health and development is well recognized in our country.
To strength this; the national malaria control program has developed as strategic plan with the
national goal to reduce the over all burden of the disease by 25% by the year 2005 and by 50%
by the year of 2010.
The national strategy congirts of three main strategies early diagnosis and prompt treatment
selective vector control and epidemic prevention and control. To ensure the implementation of
these strategies, Ethiopia has initiated a series of changes in it malaria control policy. inJuly
2004, the first line at malaria drugs for un complicated falciparum malaria was changed from
sulfakodine prymethalide to arteminisinin based culmination therapy (ACT) with the only
current available fixed combination therapy. Arteminisinin cumefrantrine. (3)
In response to the countries un met health care needs, the government in the same year (2004)
made decisions to strength and expand the primary health come level by launching the health
sector extension program.
This program is designed to achieve significant basic health care converge in the country over
the five years through the provision of staffed health part to serve every 5000 people by 2009,
more than 15,000 health parts are expected in the rural sub districts local know as kebele. These
health parts are basically death with preventive as pacts except for malaria which includes the
treatment as well. At this level, arteminisinnin-lumefratrine (AL), chloroquine and quinine are
distributed free of charge after diagnosis with therapy diagnostic tarts (RDTs) which should be
available all year round. If there is not diagnosis is dinically conducted finally the malaria control
program has in clouded the free distribution of in seeticide treatment Nets(ITNS) &indoor
insecticide spray (IIS), the ministry of health of Ethiopia aim to reach 1000% ITNS coverage in
the year 2010.
An understanding of how these strategic reach the population to gather with identification of the
main determinants that influence protective behavior are required to monitor and evaluate the
programs of malaria control efforts. This is a key element to achieve the goal 6 to discontinues
and begin to reserve the incidence and prevalence of malaria and other major disease of the
million goal development (MGD).
While few studies have been conducted in Ethiopia regarding this issue, there is a need to focus
this type of studies locally since the political , cultural , socio economic conditions and access to
health services might differ among region.
Malaria is one of the most public health problem in I/A/Bore zone which an estimated of 65% of
total land of zone population lives in high risk of malaria. The vast majority group at high risk
are women and children under five years. Most cases caused by location below 2000m attitude it
considerers as malarias areas. In this zone malaria transmission is a seasonal and un stable.
Dembi town is one parts of malarias area which located in Didessa woreda I/A/bore zone.
The preventive measures under taken in this zone follows the malaria control strategy of the
country. For the reduction of morbidity and mortality caused by malaria, in addition to malaria
control program, it is necessary to increase the community awareness of the transmission of the
disease ways of control and great impact on the preventive measures of malaria.
The studies conducted in different parts of the world in relation to (determine) knowledge,
attitude and practice of the community, towards malaria, reported that there is a gap between the
knowledge and the diseases perception of malaria which leads, not participate actively in the
control programs understanding community awareness, perception of etiology symptoms and
treatment of malaria is an important step to control of the disease and improve successful
intention.
The practice of preventive measures depends on ability of people to recognize illness and
identify their severity. The implementation of their practice also depends on how they perceive
their vulnerability and how they eradicate the results of the disease in the house hold.
Malaria preventive measures are related to the belief of the people when they think malaria risk
is low. It is more difficult to implement the protective measures (7) despite many researchers
conduct in different in part of Ethiopia to determine the level of malaria prevalence the studies
didn’t focus on the level of community awareness which has great impact on malaria preventive
activities.
This study will focus mainly on the knowledge, attitude and practice of the community to ward
malaria prevention and determine the association of knowledge, attitude and practice to their
socio demographic variable. Finally based on the result, feasible recommendation will be made
so that concerned bodies will discuss with the community members to improve their awareness
and to increase the actively participation in the control and preventive programs of malaria.

1.3 Significance of the study

The study was helps intellectual to study more into the subject study. It reveals the real feature of
the existing problem that needs attentions from the governments and the communities to
decrease morbidity and mortality.
It affords the NGOs and some donating agencies to give funds and materials.
The study helps the health professionals to know the existing problem and to make appropriate
prevention and control measure including with the underlying factors of the diseases.

1.4 Delimitation of the study

The study is conducted on assessing Knowledge, Attitude , practice and the underlying factors
among the Dembi town community towards malaria prevention and control with particular focus
of one kebele. The study look at the knowledge, attitude, practice of the society towards malaria
disease and its remedial action.

1.5 Limitation of the study

Due to time, resource and other constrains, this study has the following limitations. With regard
to the extent to the study, firstly, financial hand cape and time limitation. Secondly, shortage of
adequate reference book and internet access for further information. Finally, beside the above
limitations un able to get advisor nearby for immediate check and correction was restrict the
richness of the study.
Chapter 2
2.1 Literature Review
Mosquito control program should emphasize sanitation knowledge, education, environmental
control, engineering control and should start with sanitary survey. This should locate and map
existing the potential breeding place to make possible appraisal of the problem and planning of a
control method. Supplemental survey and surveillance are required throughout the year to
determine suitable site for early spring mosquitoes likely site favorable for latter breeding and
discovery of mosquitoes species not previously identified that might require special control (7)
Pregnant women are far more susceptible to plasmodium falcifarum in their first pregnancy. The
reason for this is not fully understood. This malaria adversely affect the pregnancy. The different
problems considered as primary in some of the patients included in complete abortion, post
partum hemorrhage and labour(5). Infants and child mortality rates are always higher in
malarious areas. This relates in part to severe malaria occurring in young children but also
reflects consequent of low birth weight(1). Because of effect of malaria during pregnancy to
mother and child, the WHO recommended initial treatment followed by chemoprophylaxis for
pregnant women in malaria region.chloroquine is the most frequently used drug for this purpose
but increasingly drug resistance has greatly reduced efficiency (13).
In the 1990’s compound with the advance of civil war, ecological changes appearance and wide
spread resistance of the malaria vectors to insecticide and parasite to anti-malaria drugs resulted
in out break of malaria in Ethiopia.
Global warming is becoming is one of the major encroachment and occurrence of malaria
epidemic in the altitude area of Africa, including Ethiopia. As some fifty percent highland mass
in Africa is rockend to be in Ethiopia, the country is considered to be prone to highland fringe
malaria(3).
Also African especially south of Sahara is a home to most deadly species of mosquito which
transmit the disease. More over many African countries lacked the infrastructure and resource
necessary to mount sustainable campaigns against malaria as a result a few benefit from effort to
eradicate malaria(19).
Vector control method can be classified in different way for different purpose. From
epidemiological point of view, it is classified to methods of reducing human vector contact,
methods aimed mainly at reducing vector density and methods aimed mainly at increasing adult
vector mortality.
 7
The method of reducing human vector contact in which barrier is established between vectors
and humans and includes mosquito nets, insecticide treated mosquito nets, repellents and
fumigant insecticide dispensers. The method aimed mainly at reducing vector density is well
recognized that the impact of vector control on the transmission potential(reproduction rate,
victorial capacity) is directly proportional to reduction of vector density. In most endemic areas it
required to achieve effective control. Reduction of vector density includes source reduction by
environmental management, larviciding, Biological control and space spraying of insecticides.
The method aimed that increasing adult vector mortality reduces their expectation of life and the
probability that the parasite will complete its development. This includes indoor residual
spraying and the community wide use of insecticide treated nets (16).
Biological measures- These measures include the stocking of ponds with Gambusia Affintis,
ambralimi (mud-minnow), the guppy, gold fish or other top feeder’s that feed on larval. Bacilus,
murnginensis, around worm nematodes and fungi to parasite mosquito larva have also been used
with limited success (9).
Insecticide treated mosquito net:- Although untreated mosquito nets have along history of use
in controlling of malaria transmission, the introduction of net treatment with parathyroid
insecticides of residual action has considerably increased their effectiveness by adding to the
barrier effect of the net the repellent and killing action of the insecticide.
In particular the repellent effect of parathyroid prevent feeding through the net and penetration of
mosquitoes through the holes in the net. Compared with indoor house spraying, it advantage of
being effective for individual protection. The mass of effect, as with any other method of control
depends on high coverage but when coverage is
low, individuals using the net are protected. For this reason their use can be progressively
introduced with information, education and communication. The main limitation is potential for
transmission by early biting vectors before people retire to sleep (16). The success of ITNs in a
few countries including Kenya shows that can be achieved a few short years with adequate
funding political will and good distribution of net work. Professor Robsnow from University of
Oxford who heads the research done in Kenya,2008, despite the 20 years of scientific evidence
the challenge of donors and government to protect children with bed net in a battle only just
beginning. Now donors money must be targeted to areas where needs are greatest.
One of the UN’s development goal aim to ensure that at least 80% of vulnerable children sleep
under ITN’s within 6 years.

8
Recently how ever more ambitious malaria targets were announced. The UN agency pledge to
renew commitments to malaria reduction worldwide given that their progress on the extending
bed net coverage so far has been modest. This target appears un imaginable for much of Africa.
(12)
Source reduction by environmental management:- this includes drainage, flushing
Filling, and rendering river and lake margins unsuitable for anopheline breeding. These are
classical method of malaria sanitation, which may be used for all mosquito breeding in general or
targeted to the specific breeding place of malaria. But this method have relatively high
investment costs and may be cost effective only in urban areas or some type of development
projects. They are suitable for the elimination of permanent breeding places, the importance of
which should be assessed before embarking on the expensive process of eliminating them.
Environmental management should be first of defense in reducing malaria transmission risk.
Larviciding:- This include the use of both chemical insecticide and those of biological
origin,such as the toxin of Bacilus thurin genesis is raelensis and insect growth regulators. It
requires the treatment of all breading place and may present the same problems as source of
reduction when temporary breeding place of great epidemiological importance. In contrast to
sanitation methods, larvicides normally have little residual effect and require regular and
frequent application (16)
Indoor residual spraying:- This include all methods indoor spraying with residual insecticides,
thus targeting the killing effect to house resting vectors and constituting a most efficient way of
using the insecticide to kill vectors likely to transmit malaria. Although pyrethrum was the
insecticide first used. In door spraying of insecticide became the most popular method of malaria
control with the introduction of DDT and other residual insecticides. Its main limitation is that
exophilic vectors may exist and may not come into contact with sprayed surfaces(18).
Treatment drug:- in many part of Africa chloroquine is nevertheless still the first line drugs and
will probably remain so because of cheapness and low toxicity. Sulphadoxine(pyrimethamne)
took over the first line drug for treatment in East Africa a few years ago but resistance is now
causing serious problem. It recently replaced by chloroquine in Malawi wide resistance to this
potentiating combination is failed and is more serious malaria causes where rapid response is
needed. Quinine needs to be followed with tetracycline or sulphadioxine or pyrimethamine.

9
Melloquine is effective in Africa but where Thailand border in Myanmar and Cambodia up to
50% resistance is reported. Artesmini and semi synthetic derivatives of this product are
increasingly used as first line drugs as where quinine and sulphadoxine or pyrimethimine
resistance is found (10)
Generally malaria control is every bodies business and every one should contribute. It requires
the partnership of community members and environment in general and in water supply,
sanitation and community development in particular. Formerly malaria control depends heavily
on the insecticide spraying but now the selective use of protection methods including vector
control is providing to be more cost effective and more sustainable (11).
Malaria remain one of the most difficult epidemiological, phannacological and immunological
challenges in the world particularly in Africa (1). In 1957 who began the coordination efforts to
wards the word wide eradication of the disease by the year 1970 s the population Fred from the
risk of malaria transmission has been decreased from 400 million to 12 million malaria has been
eradicated from the whole Europe, most South America, North America including the USA,
most of the Caribbean, Australia, Singapore, Japans Korea and Taiwan. The reintroduction of
endemic malaria in to former malarias areas of developed world is impossible be cause of
existing surveillance and control mechanisms. But the impact on developing countries could be
devastating . administrative economic and political problems in some countries and also
problems of insecticide resistance in vector and drug resistance in the malaria parasite. (8)
Malaria control programs may have a little impact on reduction of morbidity and mortality, if the
target community do not perceived the severity of malaria as a health problem (9)
As the study conducted to determine the knowledge attitude and practice of the community
about malaria and its vector control in south western India 1999 showed that a large segment of
people were less a ware a bout the danger of the diseases./ about 3/4 of the study population
didn’t quite comprehend the purpose of the decade-old national ant malaria programs while 50%
respondents were reluctant to accept the program leaking the component of community
participating but directly targeting on the control of the disease.
There fore 50% malaria patients and 60% health subjects are leaking in forking instinctive in
result to may anti malaria measures to protect them selves 27% malaria patients and 2.9 % health
subjects acknowledge correct the causes of malaria. (16)
Other study was conducted to determine the level of knowledge attitude (belief) and practice of
the relation to malaria, control of mosquito in 1995 south eastern Guatemala show that most
respondents recognize the role of mosquito in malaria transmission but few knew mosquitoes
acquired their infection or understood the risk having on entreated person in their midst.
If these were widely known respondents might put pressure on infected person to seek medical
help timely 78% of the family owned one or more bed nets, how s\ever, even though most
informants be lived that bed net help to protect malaria, the majority respond that using bed nets
is to prevent nuisance mosque bite (10)
On the same topic the study was conducted to assess the levels of community knowledge
pertaining to cause and symptoms of the malaria in Bovina distinct, Kenya , 1992. The result,
showed that the community has multiple etiologies for malaria 463 house holds interviewed
58% of the respondents associated the case of malaria with mosquitoes other etiological beliefs
including wild vegetables. (13) % water and (9.8%) milk many of the respondents indentified
malaria by several correct symptoms. In the treatment of malaria various health resources such as
public health facilities were used. Many house hold public health facilities for first choice of care
but, if the malaria parasite, other forms of treatment especially private clinics and medical
privates were used (11)
The other study carried out in Swaziland, south Africa in 2009 and a substation numbers of
participants (n=320) showed reasonable knowledge of malaria including (99.7%) correct
association between malaria and mosquito bites its potential fatal consequence and treatment
practice. Almost 90% (n-320) of the respond stated that they
would seek treatment with in 24 hours of on set of malaria symptoms with health facilities as
their first treatment option. Most people (78%) perceived clinics and vector control practice as
central to treat and prevent disease. Indoor residual spraying converge was in agreement with the
who recommendation of more than 80% of the targeted communities
A survey was under taken in central of Ethiopia, 1992 to assess knowledge attitude and practice
with respect to malaria of 300 women (household). A total of 85% were able to recognize one or
more of the common symptoms of the disease, however, the mode of transmission were
generally misunderstood 23% believed that transmission could be prevented.
More women preferred to obtain anti malaria from government clinics rather than private drugs
shop under 5 years old given priority for treatment. Severity of illness was the principal
determinant in seeking treatment. Knowledge about transmission malaria decreased with
increasing distance from the health unit (12)
Data presented for households in malarious areas which according to Ethiopia federal ministry of
health (in – 2007) are defined as being located less than 2000m attitude of 5.086 survey house
holds 65.6% owned at least on ITN. In ITN owning of hose hold 53.2 oral person slept under an
ITN the prior night including 60% children less than 5 years of age. 60.98% of women 15-45
years of age and 65.7% of pregnant women overall 20% house hold reported to have IRS in the
past 12 months of those with fever 11.86% took anti malaria drugs and 4.7% took it with in 24
hours of fever among survey 7,167 individuals of all ages as estimated cause by plasma
falciparum and plasmodium vivax (13)
Chapter 3 Objectives of the study
3.1 General Objective
 To access the knowledge and practice of preventing and control methods of malaria and
the underlying factors in Dembi town was assessed.

3.2 Specific objectives

 To access knowledge of malaria prevention and control method towards bed net
utilization.
 To access attitudes of malaria prevention and control method towards residual house
sprays.
 To access attitude towards the environmental management.
 To access the knowledge and practice of draying and destroying the breeding site of
mosquitoes.
CHAPTER 4 Method and Materials

4.1 Methodology of the study

4.1.1 The study area and periods

This study was conducted at Dambi Town, located 460 km South West of Ethiopia. The town
geographical coordinates are 12o37’ N and 30o 22’ E ,Longitude. The town was found at an
average altitudes of about 2100m above the sea level. It lies with the climate zone localy known
as ‘’Woyna Dega’’ 1500—2400m above the sea level which is considerd as ideal for agriculture
and human settlements. The town is characterized by warm climate and gets annual rain falls
ranges from 150 – 200 mm and the maximum precipitation is from June to September.
Dembi town has one kebele which has total population of 3727 among this 1933 are male and
1794 are female.

4.1.2 Study design

Quantitative study was selected, with cross sectional surveys design to describe and quantity the
distribution of certain variable and to gain important clue in an knowledge, attitudes and practice
of malaria prevention and control method with its underlying factors.

4.1.3 Study population and sample

.1.4. Study of populations
All house holders, which were selected to present the total population of Dembi Town 01
kebele.

13

3.1.5. Sample size

Sample size was determined by using statistical formula

Given
n—sample size
N¿ house holdres∈ Dembi town
P ¿50% ¿ 0.5
g¿ 1− p=0.5
2¿Standard normal deviate 95% confidence¿ 1.96
N¿ degree of accuracey=0.05
Solution
2
N 2 ×2 pg
n=
d ( N−1 )+ ( 22 ) ( pg )
2

804 ( 1.96 ) ×2 ( 0.5 ) (0.5)

¿ 2
(0.05) ( 84−1 )+ ( 1.96 ) 2 ( 0.5 ) (0.5)
787.9
n¿ =265
2.9875
NB. For Non response rate 10% is taken which is
264 ×10
¿ =26
100
Therefore 264+26=291 the sample ¿ confirmed
3.1.5 Sampling Techniques
The survey was conducted in one kebele of Debi town systematically selected from
kebele that are homogeny. The number of house holders to be selected was
determined by dividing the sample size to the average of number of family size per
house hold. The house holders who were included in study and any individuals who
were not willing to participate in the study were excluded from the study.

14

5.1.6. Sample size and sample selection

 The sample size for the study was estimated using the formula for estimating a single
1−x
proportion at 95% confidence interval(C l) level ( 2( ¿=1.96 ¿.
2
An expected prevalence o f 10.3% reported by Yewhala (2010)
A sample of 804 individual ( 291 house holds ¿ was estimated as the minimum
number of kAP on malaria preventation and control method and its underlying factors
in Dembi town.

3.1.7. Sampling procedure

Systematic random sampling technique was employed to take the sampled population
proportionally. Head of house hold from each 4th house hold was interviewed after the
selection of 1st house hold substitution was used the next households for which all the
house hold members are not available during data collection session
3.1.8. Measurement and variable
3.1.9. Independent variable
Socio-Economic characteristics such as:-
Age , sex, marital status, occupation, religion and education
Status.
Mosquitoes bits risk factors for malaria, such as housing
Conditions, and breeding site of mosquitoes.
3.2.1. Dependant variable
. Method of malaria prevention.
. Symptoms of malaria.
. Mode of malaria transmission.
.Purpose of DDT spraying
. ITN use
Knowledge about malaria
. Attitude towards malaria
.practice of malaria preventions

15
3.2.2. Data collection procedures
3.2.3. Data collections instrument
Structured questionnaire based on the study objectives and designed as possible to
meet the knowledge, attitude and practice of malaria prevention and control method
with its underlying factors of both respondents and interviewers to collect the
necessary data having the all variables.

3.2.4. Data collection technique

Data will be collected by using the format of consisting of different variable and
questionnaires administered by trained grade 10 students after 1hrs training about
data collection technique
3.2.5. Data collection procedures
Data collection procedure helps to minimize the possibility of confusion errors and
delays. Consent was asked from the relevant authority of the study area at which the
study to be carried out data collection from May, 30, 10/2012
The principal investigators was supported and regularly supervised the data collectors
on the daily basic check formats for its completeness and consistency of data before
accepting from data collectors and incomplete formats was given again to data
collectors to be corrected early.
A data collector translates questionnaires into Afan Oromo when interviewing the
respondents.
3.2.7. Data processing and analysis
Data collected from the study area was compiled manually using calculator and the
findings was presented using frequency distribution and percentages by table, figure,
chart.
The association of the respondent’s education status to their knowledge, attitude and
practice to malaria prevention will be analyzed.
 16

5.7. Data quality Assurance

A week before amatory data collection begin pretest was carried out using per
designed questionnaires by trained data collectors on five percents(5%) of sample
depending on the result obtained, a meeting session was planned to evaluate the
acceptability of instrument) reaction of respondents, performance, and adequacy of
data collectors time required for all activities was modified before actual data
collectors.
Though out the processed data collection efforts was aimed to maintain are :-
developing questionnaires’ based on clarity words, simplicity of questions and
records its preciseness. Training of data collectors and supervision of the overall
activities also under taken.
3.2.8. Operational definition
1. Attitude – is designed as a mental predisposing to act by evaluating a particular
entity with same degree of far out or disfavor.
 Positive /good attitude/ -when a person judge the proposed behavior
favorable and when he feels and evaluate the components as a positive
stimulus.
 Negative –bad attitude/- when the person feeling 21 experienced to
evaluate the object un favorably
2. Belief – is trust or confidence or something regarded by a person as truth.
3. Environmental management (manipulation) – consists of the complete and
permanent change of breeding area of mosquitoes for example draining and
finding mosquitoes producing water /wells permanent change that occur when salt
marsh is disked and kept flooding for several month to control mosquitoes.
4. Insecticide treated net – ITNS is a protection material like nets which is treated
with pyrithriod insecticide eg. Permethrine or deltametrine.
5. knowledge–is what a person knows the fact information, skills and
understanding that one going through learning.
 Bad /un favorable knowledge / is when knowledge is necessary but not
sufficient produce behavioral change in malaria prevention and control
 method
17
 Favorable knowledge – implies good feeling and evaluation join to from
positive attitude toward prevention and control method of malaria.
6. Personal protection- use of some barriers against mosquitoes bite.
7. Practice – refers to the overt behavioral habits or custum of person to prevent
malaria.
8. Good practice – when individuals status to practice the planned behavior to
prevent and control malaria.
9. Proper use of MNS- using of the net at night specially for pregnant women,
intents (children to prevent mosquitoes bites.
10. Residual house spraying (RHS)- spraying anti mosquito chemical on inside
wall of the house which is repeated every 3 or 6 month to according to
endemics.
3.2.9. Data dissemination
At the end of the study the outcome of finding and the feasible recommendation was
distributed to the area concerned body:- I,e
- Didessa woreda health bureaus
- Dembi town health center , they disseminate to Debi town health extension
worker, community health agents and to the society.
- Its copy given for Jimma University, Continuing and distance education of
health faculty and medical science Collage of health education department.
- 3.3.1. Ethical consideration
Permission slip was asked from the authorized body to obtain the desired cooperation
and participation of the community the study population was requested for the
consent to provide the required information.
3.3.2. Operational terms
- Knowledge what person knows the fact, information, skill understanding that one join
through learning.
- Attitude feeling of some one towards something practice to make use of actual
performance operation with regard to prevention of malaria
 18

CHAPTER -4
4.1. PRESENTATION AND ANALYSIS OF DATA
6.1. Socio demographic characteristics of house hold respondents of a total of 291 house hold
heads , 166 (57%) interviewees were males and 125 (43%) were females. Most respondents were
married (85.2%) with a median age of 40 years. Majority of the respondents (57.4%) were oromo
by ethnicity and Muslims was the predominant religion in the area accounting for 41.9%. the
family size of the population ranged from 1 to 12 with an average of 4.7. About 27.5% of the
study participants were illiterate while 72.5 % of them were literate. Of the total respondents,
56.4 % of them were engaged in private business and 44.7% of the participants were supposed to
have a monthly income less than 31.25
Table 1. Socio demographic characteristics of house hold respondents, Dembi town, 20

s.no Variables of respondents

frequency percentages
15-40 years 190 65.3%
41-64 years 85 29.2%
>64 years 16 5.5%
1 Age
Male 166 57 %

Female 125 43%

2 Sex
Muslim 122 41.9%
Catholic 5 1.7 %
Orthodox 188 40.5%
Protestant 45 15.5 %
3 Religion Other 1 0.3%
 Oromo 167 57.4%
Amhara 55 18.9%
Gurage 50 17.2%
Tigiree 9 3.1%
Kulloo 10 3.4 %
4 Ethnicity Other
Un married 17 5.8%
Married 248 85.2%
Widowed 9 3.1 %
5 Marital status Divorced 17 5.8 %
Illiterate 80 27.5%
Read and write 6 2.1%
Grade 1-4 19 6.5 %
Grade 5-8 92 31.6 %
6 Educational status High school& above 94 32. 3%
1—5 218 74.9%
6—10 69 23.7%

>10 4 1.4%
7 Family size
8 < 31.5 birr 130 44.7 %
Monthly income 32—65 birr 104 35..7 %
>65 57 19.6%

9 Private business 164 56.4

Occupation Government employee 64 22
House wife 32 11
Daily laborer 30 10.3
NGO works 1 0.3
 Table -1- table of socio demographic characteristics of study participants of Dembi town, July
2012
6.2. knowledge, attitude, and practice of malaria prevention and control method of house hold
respondents.
Most of the respondents 71.8% replied that plasmodium is the causative agents of malaria and
other reported that unhygienic condition(13.1%) and cold weather (1.4%) did not know the
causative agents of malaria.
Two –third of the respondents (67.4%) replied that malaria is a transmittable disease and more
than one out of five ( 21.3%) did not know whether or not malaria is a transmittable disease
while 11.3% of them believe that malaria is non transmittable disease.

20
Table -2- knowledge, attitude and practice of malaria prevention and control method in Dembi
town, 2012

s.n Variable Frequency percentages

o
Plasmodium 209 71.8%
Un hygienic condition 38 13.1%
Causes of malaria Cold weather 4 1.4%

Not known 40 13.8

1
Ways of malaria Mosquitoes bite 173 59.5
transmission Body contact with infected person 16 5.5
Respiratory routes 2 0.7
Not known 100 34.4
2
Breeding site Stagnant water 228 78.4
3 Of Animal wastes 3 1
mosquitoes Not known 60 20.6
Outcome Death 211 72.5
Of Self cure 46 15.8
Malaria not Disability 2 0.6
Treated early Not known 32 11.1
4
Yes 196 67.4
Malaria is
No 33 11.3
transmittable
Not known 62 21.3

5
Malaria is preventable, Yes 256 88
treatable
No 6 2
and controllable
6 Not known 29 10

Table -2- table of knowledge, attitude and practice of malaria prevention and control method in
Dembi town, July 2012

21
6.3. Health service and environmental factors.
 - of the total of 291 house hold heads interviewed 244 (84%) replied that they had
experienced malaria and had used anti malaria drugs. With regards to the brands of anti malaria
drugs they used, 115 (47%) replied chloroquine and 56 (23%) coartem , where as 73 (30%)
indicated that they didn’t know its brands. And distribution of some health service and
environmental factors were presented in table below.
Table -3- distribution of respondents to some health services and environmental factors in
Dembi town, July 2012

s.n Variables used for house hold respondents frequency percentages

o
Yes 244 84 %
1 Previous malaria history and who got
treatment No 47 16%

Chloroquine 115 47
2 Types of malaria drugs used Coartem 56 23
Other anti malaria drugs 73 30
One ITN 87 29.9
3 Availability of the ITNS More than one ITNs 138 47.8
No ITNs 66 22.3
4 Usage of ITNs in the home Yes 145 64.4
No 80 35.6
5 Family members who use ITNs Whole family 11 7.6
Some family members 134 92.4
6 Presence of stagnant water Yes 167 57.4
No 124 42.6
7 Distance of stagnant water near by the < 1km 89 53.3
home > 1km 78 46.7
8 Chemical spraying habit for mosquito Yes 62 21.3
prevention and control
No 229 78.1
 Table -3- distribution of respondents to some health services and environmental factors in
Dembi town, July 2012

22

Table -4- source of information on malaria transmission, prevention and the control method with
its underlying factors in Dembi town, Ilu Ababor Zone, Oromia, July 2012.
s.
no Source of information’s frequency percentage
1 Health institution 124 42.708%
2 Mass media 73 25 %
3 Public gathering 36 12.23%
4 At school 48 16.406 %
5 Other* 11 3.645%
Total 291 100 %

NB. Other*_ Reading magazine and bullets

- Most of house holders , 124 (42.708%) get information from health institution, followed
by mass media, public gathering and education at schools accounts for 157 (53.636%)
while 3.645% (11) of house holders gets information from reading magazine and bullets
table-4)

Table -5- Knowledge of controlling mosquitoes breeding sits in Dembi town, Ilu
Ababor Zone, July 2012
s.no
 Control of mosquitoes breeding site Frequency percentages
1 Filling small road excavation 14 4.687
2 Draining of stagnant water 146 50
3 Leveling of small depression 38 13.02
4 Avoiding disposed container 87 29.94
5 Other* 7 2.343
Total 291 100
*- Applying chemicals on mosquitoes breeding sites
- Most of the respondents 146 (50%) responds to draining of stagnant water while, 7(2.343%) of
them apply chemicals to control malaria breeding site (table -5)

23

Table -6- types of activities to control and prevent malaria and its underlying factors in Dembi
town in 2012

s.
no Variables Frequency percentage
Knowledge, attitude and practice ITNs usage 145 64.4
on effective prevention and IRS methods 62 21.3
1 control methods of malaria Avoidance ofstagnant 167 57.4
Dx and early treatment 256 88
 Other
Obstacles to prevent and control Lack of awareness 75 25.773
malaria and its underlying factors Lack of commitment 60 20.618

Financial problems 40 13.745

2
Poor infrastructures 10 436
Unknown factors 6 2.061

6.7. Risk factor analysis for plasmodium infection in study participants

Analysis of selected socio demographic characteristics of the study participants, significant

positive association were observed between infection of any plasmodium species in participants
and age group where more cases were observed in age group between 0—4 years (0
l=5.3 ; 95 % cl 2.0−13.8 , p=0.001∧between 5—4 years compared to group above 14 years.

Even though there was no significance differences of malaria prevalence’s between sex, the
prevalence was higher in males (6.3%) than females (4.5%)

Similarly analysis of environmental factors, significant positive association were seen between
presences of any plasmodium species in the participants and none usage of ITNs in home
(oR=13.6, cl 4.9—37.2, p=0.000) living in areas where stagnant water existed (OR= 2.05 ; 95%
cl 1.00—4.2, p=0.047) and its distance of existence <1km from the house (OR=2.1; 95% cl 2.1
—15.5, p=0.001

24

4.1.2. Discussion

In Ethiopia, epidemiological pattern of malaria transmission is generally un stable and seasonal,

the level of transmission varying from place to place because of altitude and rain fall pattern. The
major transmission of malaria follows the June to September and December, while the minor
transmission season occurs between April to May following the February and March small
shower of rain. Same localities also experiences perennial malaria, because the environmental
and climatic situation permits the continual breeding of the vectors in permanent breeding
sites(24)

Seasonal variation in malaria transmission is a well established feature of un stable malaria. In

Ethiopia had reported 2.6% in dry season April/ May and 5.8% during the wet season
(September-November). Similarly malaria prevalence survey in Kassena Nankana district of
Northern Ghana showed 22% parasite rate in May (dry low transmission) and 61% in
November(wet-high transmission (29)

Thir study revealed that P.Vivax was the predominant species in the study area. Un like the
previous paradigm of plasmod-species composition in Ethiopia (P. Falciparum 60% and P. vivax
40% of the total malaria cases. The multitude factors are supposed to orchestrate the shifts in
magnitude of the prevalence of P. Fasciparum to P. Vivax needs , far elaborative research will be
required to identify the causation and this will be not addressed in this study. This findings is in
agreement with the current trend shifts in malaria cases occur in cas during record review from
P.Falciparum to P.Vivax

Until 2008, the dominant species was P.Falciparum, but since 2008, P.Vivax was becoming the
dominant species in Ethiopia in general and the study area in particular (30)

Several study indicated that use of ITNs significantly reduced the proportion of malaria
morbidity and mortality (31). In contrary some study conducted in African countries revealed
that use of ITNS did not shows a significant differences in malaria morbidity and mortality (32).
A differences was observed in malaria prevalence among ITNS users and non—users in our
study. But there were presence of ITNS in households may not protect individuals from malaria
morbidity unless it is properly used that could also be the implication of this findings.
25

Malaria is governed by a number of environmental, socio demographic and economic factors,

which affects its distribution, seasonal occurrences and transmission intensity. In contrast to
other study from the several none of socio demographic and economic factors had significantly
associated with malaria transmission in the study area. Among the socio-demographic factors
studies indicated that malaria morbidity and mortality in individuals under 5 years of age is
higher compared to individuals above 5 years old, the results of another study shows four—folds
increases in the parasite rate in children aged 2—5 years of age compared those above 5 years.

The trans mission of malaria is determined by main factors, such as human behaviors and the
existence of malaria parasites, as well as social and health facility factors such as housing
conditions, occupation, KAP of the community towards malaria causation, transmission,
treatment seeking behavior and presence of mosquito control activities can affects malaria
prevention and control methods with its underlying factors.

The findings of this study indicated that general awareness about malaria prevention and
control method was high among Dembi town communities of the study site. It was considered as
the major health problems in the community. About 71.8% of the study participants were aware
of the facts that plasmodium is the causes of malaria. Of the 291 visited households, about 59.5%
of respondents associated malaria to the mosquito bites and this is different from a study
conducted in rural area Ethiopia in which 63.4% of respondents associated mosquito bites with
malaria. This results was also relatively low when compared to other African countries ,
Uganda(77.6%) and Kampala (84%). Of the respondent s interviewed knew that mosquitoes
transmitted malaria. The difference might be attributed to various factors. It has been considered
that malaria is exclusively affecting most of the communities and as a results focused malaria
control strategies have been in place which could be the reason for the better awareness of the
community to ward mechanism of malaria prevention and control methods and its underlying
factors is better than communities of an areas where little/no strategy is place for the same
purposes.

Examples of misconception about causes of malaria are reported in research from all over the
globe (39%) similarly this study showed that some community members still have misconception
about causes of malaria. These are the major socio- cultural setbacks in malaria in treatment,
prevention and control methods.

26

All these add up to the discrepancies in health seeking behaviors and many causes delay in
seeking appropriate a prevention and control methods and treatments.

Knowledge of the respondents about whether or not malaria is preventable, controllable and
treatable diseases was significant among Dembi town community.

The result of this study shown that 88% survey’s respondents replied s ‘’YES’’ this appeared
comparable to KAP on malaria prevention and control methods and its underlying factors study
in Ethiopia in which about 88.1% respondents replied ‘’YES’’ for the similar question (39)

Also in Dembi town KAP on potential mosquitoes breeding sites available compressing in small
sites, temporarly fresh water pools that are exposed to sun light. More breeding sites are created
by human manipulation of environments.

For environmental factors, only the presence of stagnant water in close proximity to house
(<1km) has shown a significant association. Studies also witness that the relationship between
malaria vectors density and the distance of settlement from a water body is an important
indicators of malaria prevention and control methods as revealed in ITNS study in Gambia.

The report of majority of households head s in KAP surveys that they had been using anti—
malaria drugs, mainly chloroquine as self—treatment is most common practices. The danger of
spread of the coartem/chloroquine-resistance malaria is eminent unless measure are taken by
responsible body. Although IRS had been practiced twice yearly the effects of this spray in
relation to KAP of malaria prevention and control method of the community in stopping malaria
in the area was not successful . this could be indicator of improper implementation of their KAP
or reflection of inefficient prevention and control measures, including practice of IRS and
insufficient coverage
 27

CHAPTER-5

5.1. Conclusion and Recommendation

5.1.1. Conclusion

Despite the presences of KAP on malaria prevention and control methods and its underlying
factors in the house holds was high, malaria was still a major health problems and in some
context, in a little amount it was practiced in the town.

The reason for this was awareness creation was not integrated means for appropriate utilization
of ITNS

And community mobilization for environmental manipulation was crucial to promote effective
malaria prevention and control methods and the underlying factors in Dembi town.

5.1.2. Recommendation

* Woreda health bureaus and other governmental and non- governmental organization should
mobilizes the community to increase their awareness on knowledge. Attitude and practice of
malaria prevention and control method and its underlying factors.
* Integration and collaboration with other sectors of government and NGO should be
encouraged at all level.

* Material input for malaria prevention and control like : ITNS, drugs, DDT, and other should be
initiated to get at a time.

* Health workers, health extensions workers, community health agents and other NGO should
give health education and promotion program with full community participations.

This study tried to assess KAP of malaria prevention and control methods with its underlying
factors but it was backed by actual parasitological Survey and asymptomatic malaria prevalence
in study area.

28

9.1. Appendix -1
Reference
1. Yehannis E. malaria in pregnancy, clinical feature and outcome of treatment s in
Ethiopia medical journals 1991, 29 (3);(102-107)
2. Wakgari D. Ahimad A, Fikre E. knowledge, Attitude and practices about malaria, the
mosquitoes and anti malaria drugs in a rural community, Ethiopia medical journals 2003,
17(2), 147-151
3. Professor Curisc presentation of malaria with paramethrine bed Nets. Land schools of
hygiene had topical medicine 1997, 19(2);(560-562).
4. David W. drug treatments and control of malaria in Africa, Africa health 1997;
19(2) :570-572
5. WHO, who experts committee on malaria 17 th reports , technical reports sertes
1979;719(640);356-364.
6. Official reports on malaria diseases in Dhidhessa Woreda, Denbi town of 01 kebele
reports of 2000, 2001, 2003
7. Knowledge, attitudes and practices in habitants towards the common adopted prevention
and control methods of malaria in Bantu town, South Western shoa by Kebede Diriba
2009.

29
 Appendix- 2:-Questionnaires

Jimma University
Public Health Faculty, school of health education

Questionnaires on the assessment of knowledge attitude and practice of malaria prevention and control
method and the underlying factors in Dembi town of 01 kebele, Didessa Woreda 2013.

Before the data collection introduce myself, tell the objective of the study and ask permission for response I
will noted the response thanks of the end.

1. Identification
1.1. Region ______________ Zone ____________Kebele______ house no ____
1.2. Name of the respondent_____________age ____sex ___(a)male( b) female
1.3. Educational status, a) illiterate
b) Read and write
c) Literate (specify grade)
1.4. Marital statuses (a) married (b) single (c) divorce (d) widowed
1.5. Family size
1.6. Religion (a) Muslim (b) Orthodox ( c) protestant ( d) other (specify)
1.7. Ethnicity (a) Oromo (b) Amhara (c) Gurage (d).other ______
1.8. Occupation :- (a) Gov’t employed (b) merchant (c) famers ( d) other
1.9. Average monthly income in Birr.______________

2. Knowledge Assessment
2.1 Do you know malaria? (a) yes ( b) No
2.2 Do you know how malaria is transmitted? (a) yes (b) No
2.3 If your answer for Q( 2.2) is ‘Yes’ how this disease is transmitted?
a. by bite of mosquitoes d. By hunger
b. by rain water e. other (specify)
c. with God or Allah
2.4. If the answer for Q(2.3) is ‘C’ where do you PH this information?
a. Health institution b. mass media c. public d. other (specify)
2.5. Do you agree with the method of preventing and controlling of malaria.
a. strongly agree b. agree c. neutral d. disagree c. strongly disagree
2.6. if your answer for Q(2.5) is A or B, which method you use?
a. Draining of ponds b. collecting of disposed
c. sanitation d. ITN e. other (specify)

1.7. When malaria mosquitoes bite human beings?

a. At night c. Day and night
b. At day time d. other (specify)
1.8. Do you know the use of spraying chemicals?
a. Strongly agree c. Neutral d. Disagree 30
b. Agree e. strongly by disagree
2.9 If ‘’a’’ or ‘’b’’ by what interval IRS in order taken
a. after month b. 3 to 6 month after spraying c. after a year
d. I don’t know
2.9.1. Do you know other method of malaria prevention or control method?
a. strongly agree b. agree c. I don’t know
d. disagree e. strongly agree
2.9.2. What is the use of ITNs to prevent and control malaria?
a. Give privacy and comfort b. protects from bite of mosquitoes
c. Kill all rodents d. other (specify)

2. Attitude
3.1. Would you believe the activities mentioned on Q(2.8) are effective for malaria
prevention and control
a. strongly agree b. agree c. neutral d. disagree e. strongly disagree
3.2. If your answer is strongly disagree or agree for Q(3.1)
a. Indoor residual spraying b. paper use of ITNs
c. use of replant d. environmental management e. secretion of openings
 f. other( specify )
3.3. Do you think the above method are most cost effective?
a. strongly agree b. agree c. neutral d. disagree e. strongly disagree
3.4. Are you voluntary when IRS spray comes to your home?
a. strongly disagree b. agree c. neutral d. disagree e. others
3.5 If you are strongly disagree what is the reason?
a. Bad small b. spoil house c. not effective d. free payment e. other
3.6. Would you participate with community to destroy breeding site of mosquitoes?
a. strongly agree b. agree c. neutral d. disagree e. strongly disagree
3.7. If your answer is ‘a’ or ‘b’ which method is most effective?
a. Leveling small dispassion b. draining of stored water
c. filling up of small road exacerbation d. other

3. Practice
4.1. which type of activities have you practiced to protect your self from mosquitoes bite and
endurance?
a. IRS b. ITN c. burning plants d. use of repellent
e. environment management. F. other specify
4.2. If your answer for Q(4.1) is b for which member of your family you give priority?
a. father only b. mother only c. children only
d.mothers, pregnant and children’s e. all family members use equally
f. for father and mother
4.3. If you didn’t use ITNs, what is possible reason?
a. ITNS expensive b. don’t know the use c. not comfort d. disagree e. other
4.4. Would you take percussion measure after your house sprayed?
a. strongly agree b. agree c. neutral d. disagree e. strongly disagree

31
4.5. Do you think, participation on sanitation program use for destroying breeding site of mosquitoes?
a. strongly agree c. neutral b. agree d. disagree e. strongly disagree
4.6. If your answer is a and b who tells you ?
a. NGOs b. Gov’t c. media d the public gathering
e. health worker f. other specify

Thank you!

Name of data collectors ______________________ signature ________ date ______

 32

Final thesis approval

A. Advisor s
Student Biyya Mohmmed Hamza has a completed his work per advice, comments and
recommendations given by the respective advisors. As lam his advisors, I confirm the finalization of his
thesis work or research proposal by my signature.

A .Advisors name

1. Ms Bezawit Temesgen (BSC MPH) Signature ________________

Date____________________

B. School

School of health education department appreciates approves successful completion of his thesis.
Name ________________________________
Signature _____________________________
Date _________________________________