Determinants of Utilization of Malaria Prevention Strategies in Mariakani, Kilifi County, Kenya

Abstract

In Kenya, an estimated 27 million people (about 70% of the population) are at risk of infection by Plasmodium falciparum parasite which causes malaria. In Kilifi County, the disease accounts for 31.5% of all first outpatient visits to hospitals. Understanding the utilization patterns of various malaria prevention strategies is therefore important since it will provide a basis for designing specific and targeted interventions to reduce malaria incidences in this area. The main objective of this study was to establish the determinants of malaria prevention strategies in Mariakani area of Kilifi County, Coastal Kenya. This study was conducted in November 2016 and it was a descriptive cross sectional study design with a sample size of 384 households heads in Kadzonzo, Mitangoni and Township administrative locations. Cluster sampling technique was used to select villages while simple random sampling was used to select household heads. Data obtained from 327 household heads using structured questionnaires was cleaned, coded, summarised and processed using ms excel and exported to spss version 21 for analysis using descriptive statistics and inferences drawn using Chi-square and logistic regression at 5% level of significance. Study findings were presented using frequency table’s graphs and charts. Ethical considerations was sort from pwani ethical review committee. The findings indicated that 86.5% of the participants had suffered from malaria in the past. The findings also showed that 91% of those who suffered from malaria received treatment from hospital due to perceived better facilities. Among the participants who went to hospital, 97.7% had their blood tested for malaria parasites and completed the prescribed dose with 100% recovery. Majority (96.9%) reported that mosquitoes were the source of malaria. On malaria prevention strategies, 94.8% of the participants had used Insecticide Treated Nets, 36.9% had used Intermittent Preventive Treatment during pregnancy, while 31.2% had used IPT for children (IPTi). The study also established that 96.9% of the participants knew that mosquitoes were the source of malaria while and 20.5% knew that using drugs from the hospital was the best way to treat malaria. On prevention of mosquito bites, 79.5% indicated sleeping under ITNs and clearing of surrounding bushes, while 4.3% indicated use of vaccines. Chi square analysis showed significant associations between ITN use and sex (p=0.014), age (p=0.000), occupation (p=0.022), past malaria experience (p=0.000), source of treatment for past malaria experience (0.004), knowledge of ITNs (p=0.015) and past use of ITN (p=0.000); IPTp use and level of education (p=0.000), occupation (p=0.025), malaria past experience (p=0.015), source of malaria (p=0.001), and knowledge of IPTp (p=0.000); IPTi and sex (p=0.039), age (p=0.001), marital status (p=0.000), occupation (p=0.004), malaria past experience (p=0.001), source of malaria (p=0.030), and knowledge of IPTi (p=0.000); case management and recent malaria attack (p=0.029). Regression analysis showed that the significant determinants for ITN utilization were mainly sex, age, malaria past experience, source of treatment for past malaria experience, knowledge of ITN and past use of ITN. Female participants were 2.104 times more likely to use ITNs compared to male participants (p = 0.023); participants who were aged between 26 and 35 years were 1.146 times more likely to use ITN compared to those aged between 18 and 25 years (p= 0.037). The odds of ITN utilization among participants who had no past experience with malaria, had sought treatment from chemist, had not heard of ITN and had not used ITN in the past (AOR = 0.275, p = 0.047; AOR = 0.566, p = 0.046; AOR = 0.194, p = 0.048; AOR = 0.214, p = 0.001), were less compared to those who experienced malaria in the past, had sought treatment from hospital, had heard about ITN and ad used ITN in the past respectively. For IPTp utilization, significant determinants were level of education, occupation, past malaria experience, source of malaria treatment, knowledge of IPTp and source of malaria. The odds of IPT uptake during pregnancy among participants who had no past experience with malaria, had sought treatment from chemist, did not perceive mosquitoes as the source of malaria and had not heard of IPT (AOR = 0.080, p = 0.036; AOR = 0.008, p = 0.043; AOR = 0.239, p = 0.001; AOR = 0.316, p = 0.002), were less compared to those who had past experience with malaria, had sought treatment from hospital, perceived mosquitoes as the source of malaria and had heard of IPT respectively. In addition, female participants were 1.896 times (p = 0.034) more likely to use IPT for children compared to male participants. The odds of IPT uptake for children among participants aged 26 to 35 years, 36 to 45 years, 46 to 55 years, and 56 to 65 years (AOR = 4.455, p = 0.000; AOR = 1.674, p = 0.038; AOR = 2.326, p = 0.006; AOR = 2.250, p = 0.018), were more compared to participants aged 18 to 25 years. On the other hand, the odds of IPT uptake for children among participants aged 66 to 75 years and 76 to 85 years was less (AOR = 0.215, p = 0.011; AOR = 0.231p = 0.011 respectively), compared to participants aged 18 to 25 years. The odds of IPT uptake for children among participants who had no past experience with malaria, did not perceive mosquitoes as the source of malaria and had not heard of IPT (AOR = 0.190, p = 0.001; AOR = 0.242, p = 0.001; AOR = 0.449, p = 0.041), were less compared to those who had past experience with malaria, perceived mosquitoes as the source of malaria and had heard of IPT respectively. Residents of Mariakani, Kilifi County are aware of malaria infection and prevention. The factors which were significantly associated with utilization of malaria prevention strategies in this region included age, sex, marital status, level of education, occupation, knowledge and attitudes on transmission and prevention of malaria, and experience and practice of malaria treatment. The study recommends that the Medical Officer in the Department of Health in Kilifi County, together with other stakeholders should enhance sensitization on IPT while continuing to promote compliance in the use of ITNs in order to reduce the risk of infection.