title: Multi-dimensional knowledge of malaria among Nigerian caregivers: implications for insecticide-treated net use by children.
abstract: BACKGROUND
  Poor malaria knowledge can negatively impact malaria control programmes. This study evaluates knowledge distribution in the domains of causation, transmission, vulnerability, symptoms, and treatment of malaria. It assesses the association between a caregiver's knowledge about malaria and ownership and use of insecticide-treated nets (ITNs) by children.
  
  
  METHODS
  Some 1939 caregivers of young children were recruited through a school-based survey in two Nigerian states. A 20-item, multi-dimensional survey instrument was developed and used to rank each caregiver's knowledge in five dimensions (cause, transmission, vulnerability, symptoms, treatment of malaria). Scores for each domain were used to create an aggregate knowledge score for each caregiver. The outcome measures were ITN ownership, and ITN use the night and week before the study. Regression models were used to evaluate the relationship between caregiver's knowledge (individual domains and aggregate score) and ownership and use of ITN after controlling for likely confounders.
  
  
  RESULTS
  The main predictor of ITN use was ITN ownership (r = 0.653; p < 0.001); however, ownership only explains 43 % of variance in net use. Total knowledge index for the study population was significantly associated with both ITN ownership (r = 0.122; p = 0.001) and use (r = 0.095; p = 0.014). The spectrum of caregiver's knowledge of malaria and its causes captured in the various domains was, however, found to be poor. Fifty percent of the respondents knew that malaria is transmitted by female mosquitoes and 65 % still believe that too much exposure to the sun is a risk factor for malaria. Knowledge of populations most vulnerable to malaria (83 %) and knowledge of malaria transmission (32 %) were the domains with the highest and lowest average correct answers.
  
  
  CONCLUSIONS
  There is a need to improve ITN coverage in Nigeria as ITN ownership was associated with ITN use. Additionally, treating knowledge as a multi-dimensional phenomenon revealed that a lot of misperceptions about malaria still exist. Distribution of ITNs through the public/private sector may need to be augmented with tailored behavioural change communication to dispel myths and improve the multi-dimensional knowledge of malaria in the local population.
authors: School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. lovadje@umich.edu.
authors: Lauretta
authors: http://orcid.org/0000-0002-1579-3328
authors: L
authors: Ovadje
authors: School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
authors: Jerome
authors: J
authors: Nriagu
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods*; D009549:Nigeria; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Behaviour change communication; Insecticide-treated net; Malaria control; Malaria knowledge; Misperceptions; Nigeria