Awareness on malaria among healthcare providers and public during the prevention of re-establishment phase in Sri Lanka

J Hamsananthy^1, A R Wickremasinghe²

1. Ministry of Health and Mass Media, Sri Lanka
2. Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka

OPEN ACCESS

PUBLISHED: 31 January 2025

CITATION: HAMSANANTHY, J; WICKREMASINGHE, A R. Awareness on malaria among healthcare providers and public during the prevention of re-establishment phase in Sri Lanka. Medical Research Archives,  . Available at: <https://esmed.org/MRA/mra/article/view/6213>.

COPYRIGHT: © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI: https://doi.org/10.18103/mra.v13i1.6213

ISSN 2375-1924

 

Abstract

Prevention of re-establishment of malaria is a challenge for Sri Lanka due to the influx of foreign expatriates and migrant workers. As imported malaria cases are being reported, awareness on malaria among both healthcare providers and the public is crucial in preventing re-establishment of malaria in the country.

Keywords

• Malaria
• Healthcare Providers
• Public Awareness
• Sri Lanka

Introduction

Exactly 20 years after a missed opportunity to eliminate malaria, Sri Lanka reached a milestone in its malaria history. In September 2016, Sri Lanka was certified as a “malaria-free” country by the World Health Organization (WHO). The expansion of development projects, businesses, tourism, industry, and the influx of foreign labour and refugees from neighbouring malarious countries combined with the continued presence of malaria vectors in formerly endemic areas make the country receptive with a high importance risk threatening the prevention of re-establishment of malaria programme. Also as a re-establishment remedy, importation of parasitism has been a forgotten disease among health professionals and the public.

Methods

Sri Lanka is an island nation in the Indian Ocean, with a total land area of 65,610 km². The population of Sri Lanka is approximately 22 million, a large proportion resident in rural areas. Administratively, Sri Lanka is divided into 9 provinces, and the 9 provinces are further divided into 25 districts. The Medical Officer of Health (MOH) is responsible for preventive health services in a defined area. The MOH area is further divided into Public Health Inspector (PHI) and Public Health Midwife (PHM) area.

Study Population, Sample Size and Sampling

Two cross sectional surveys were conducted among healthcare providers and the public. The healthcare providers’ questionnaire was administered to 766 healthcare providers selected from each district. 12 PHM areas were randomly selected from the selected MOH areas (on average 2 PHM clusters per MOH area). From each PHM area cluster, the starting point of the household survey was randomly selected by dropping a headed pin on the PHM area map and the house closest to the pointed edge was selected. After the first house was identified, every tenth house in the list of the selected house was chosen until 12 households for that PHM area were surveyed.

Development of the Data Collection Tool

The healthcare providers’ questionnaire was a self-administered questionnaire, comprising information on demographics, knowledge, and awareness on malaria. The questionnaire was pre-tested among 30 healthcare providers, and necessary modifications were made based on the feedback received.

The association between the awareness and the socio demographic factors was assessed by binary logistic regression analysis, based on the awareness score more or less than the median, as the dependent variable adjusted for independent variables age, gender, ethnicity, institutional area, type of institution, duration of service, designation and ever seen a malaria case. Awareness was significantly associated with the area of the institution (urban/rural/estate) and the type of institution. Those who worked in urban and rural sector health care institutions were
3.5 times (OR=3.5, 95% CI: 1.1-11.6) and 4.4 times (OR=4.4:95% CI;1.3-14.2) more likely to have better awareness on malaria than estate sector healthcare providers after controlling for other variables. Those who worked in the preventive sector were 2.2 times (OR=2.2, 95% CI-1.2-4.0) more likely to have better awareness on malaria than those working in other sectors adjusted for other variables. Ever seen a malaria case was not significantly associated with better awareness on malaria among healthcare professionals (Table 3).
Table 3: Results of logistic regression analysis using awareness on malaria of healthcare providers and their socio-demographic and professional characteristics

Seen/heard messages about malaria in the past 6 months No  1.565 0.240 <0.001 0.209 0.131 0.335 Yes  Reference

Been abroad within last 3 years Yes  0.642 0.136 <0.001 1.900 1.456 2.481 No  Reference

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Discussion

Awareness on malaria is the level of understanding about the importance and implications of malaria prevention especially in the prevention of re-establishment phase. Raising awareness is not the same as telling them what to do. It is explaining issues and disseminating knowledge to persons so that they can make their own decisions. High public awareness occurs when a significant proportion of society agrees to certain decisions. When public awareness is low, a majority of people do not know or do not care about importation of malaria cases. During the prevention of re-establishment phase of malaria in Sri Lanka, a national representative assessment is important to prevent even a single case of indigenous malaria leading to emergence of local transmission with rapid population movement within the country. This study is a national representative assessment on awareness both among the public and healthcare providers of malaria.

The present study shows that the overall awareness score (median 55%) is low among healthcare providers possibly due to the fact that nearly eighty percent of the healthcare providers had not seen, diagnosed or treated a malaria case during the last 5 years. Awareness on malaria is not significantly associated with the selected variables including ever seen malaria. It is only significantly associated with the area (urban/rural/estate) in which the institution is located and type of institution possibly reflecting better access to information in urban and rural sectors as compared to the estate sector. Thus, the suspicion of malaria in the differential diagnosis of fever by healthcare providers might be low even though the majority (>65%) knows the symptoms of malaria and 99.1% answered fever as one of the symptoms.

During the control phase, knowledge and attitudes of Public Health Midwives in the Anuradhapura district, a previously malaria endemic area, were very satisfactory and the responses of younger respondents with a 6–9 year service period were significantly better than those of respondents who were over 40 years with a service period of over 10 years. In a primary healthcare institution, clinicians’ suspicion of malaria in referring for blood smear examination was no better than patients’ self-diagnosis; the authors surmised that the decision for screening patients by microscopy need not be made by a clinician at the outpatient clinics thus saving clinicians time for more needed services.

A study done during the pre-elimination phase in a resettled population after 30 years of displacement in the Mannar district, reported that the population had good knowledge and practices about malaria; 71% had sought treatment quickly and 67% had access to diagnostic facilities. Another assessment on the existing knowledge and attitudes among pregnant women and service providers showed gaps in knowledge and attitudes regarding malaria. A health education intervention including focus group discussions was done and recommendations were given to employ the same on a larger scale to improve compliance to chemoprophylaxis. In 2008, findings of a study conducted to evaluate the effectiveness of

Author Declarations

Conflict of interest: The authors declare that they have no conflict of interest.

Acknowledgement: The authors wish to acknowledge the Director and all regional and central staff involved in malaria control in Sri Lanka for the support given during this study.

Availability of data and materials

All data generated or analyzed during this study are available from the corresponding author on reasonable request.

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