title: Construction site workers' malaria knowledge and treatment-seeking pattern in a highly endemic urban area of India.
abstract: BACKGROUND
  Construction sites are potential breeding places for some species of mosquitoes. Construction workers usually stay at the construction sites, thus being extremely susceptible to malaria. For malaria control, a special focus on them is warranted as they often seek treatment from unregulated, private vendors, increasing their risk of exposure to substandard drugs.
  
  
  OBJECTIVE
  To elicit the socio-demographic factors associated with comprehensive malaria knowledge (symptoms, mode of spread, and preventive measures) and treatment-seeking pattern (preferred source and type of treatment) among the construction workers in Mangaluru, India; and, to study the association among their comprehensive malaria knowledge, past suffering from malaria (within 1 year) and treatment-seeking pattern.
  
  
  METHODS
  A community based cross-sectional study was conducted in nine randomly selected construction sites of Mangaluru, a high-risk city for malaria with an annual parasite incidence of >2/1000/year, from June-September 2012. A sample size of 132 was estimated assuming at least 30% of them have satisfactory malaria knowledge, 10% absolute precision, 95% confidence level, design effect of 1.5 and 10% non-responses. A semi-structured interview schedule was used, and knowledge scores were computed. Multivariate linear (for knowledge score) and logistic regressions (for preferred source and type of treatment) were applied.
  
  
  RESULTS
  One hundred and nineteen workers participated in the study (total approached-138). 85% (n = 101) of them were males. Mean knowledge score was 9.95 ± 3.19 (maximum possible score-16). The majority of them were aware of the symptoms and the mode of malaria transmission. However, <12% could explain the malaria preventive measures. Females workers (β = -0.281, p = 0.001), self stated malaria within 1 year (β = 0.276, p < 0.001) and who preferred allopathic treatment (β = 0.283, P = 0.001) displayed better knowledge scores. Male workers (AdjOR 7.21, 95% CI 2.3-22.9) and those with self stated malaria within 1 year (AdjOR 11.21, 95% CI 2.38-52.8) showed favorable treatment-seeking pattern.
  
  
  CONCLUSIONS
  There is an urgent need of intensifying and streamlining of ongoing malaria prevention activities for construction site workers in Mangaluru, India. Emphasizing the gender equity at every stage of programme implementation and addressing their treatment-seeking pattern is essential. Involvement of labour employers and building contractors in this regard is imperative.
authors.affiliation: Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, 575018, India. shivalli.bhu@gmail.com.
authors.forename: Siddharudha
authors.identifier: http://orcid.org/0000-0003-1454-7114
authors.initials: S
authors.lastname: Shivalli
authors.affiliation: Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, 575002, India.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Pai
authors.affiliation: Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, 575018, India.
authors.forename: Kibballi Madhukeshwar
authors.initials: KM
authors.lastname: Akshaya
authors.affiliation: Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, 575018, India.
authors.forename: Neevan
authors.initials: N
authors.lastname: D'Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007407:Interviews as Topic; D019359:Knowledge; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D014505:Urban Population; D055815:Young Adult
keywords: Construction worker; Knowledge; Malaria; Mobile populations; Treatment-seeking pattern; Urban