The Role of Beliefs in Malaria Prevention and Treatment Behavior: Analysis of the 2021 Nigeria Malaria Indicator Survey

Background and Purpose: Malaria remains a major global public health problem, especially in Sub-Saharan Africa. In 2020, Nigeria accounted for 26.6% of global cases and 38.4% of global deaths among children under the age of five. Underuse of effective tools for prevention and treatment undermines progress against the disease. For example, recent household surveys from Sub-Saharan Africa suggest that only 47% of the population slept under a net, and 33% of children under the age of five did not receive treatment for a fever. We analyzed the 2021 Nigeria Malaria Indicator Survey to examine how people’s knowledge and beliefs about malaria were associated with their prevention and treatment behaviors. The health belief model and diffusion of innovation theory guide this work.

Methods: The DHS Malaria Indicator Survey is a nationally representative survey conducted using a stratified two-stage cluster design. The survey included 13,727 households with 14,476 women respondents and 3,947 children ages 5-69 months who reported fever two weeks before the survey. Biomarker data for testing anemia and malaria were also collected from children using a rapid diagnostic test (RDT) and microscopy. We analyzed the data using logistic regression.

Results: Controlling for age, wealth quintile, education level, region, and residence type (urban/rural), women who had heard a message about malaria in the previous six months had significantly higher odds of sleeping under a bed net (OR=1.21, 95% CI [1.07 1.35]), as did women who believed their families were susceptible to malaria (OR=1.30, 95% CI [1.05 1.60]), who believed malaria was a serious disease (OR=1.16, 95%CI [1.02 1.32]) and who perceived widespread community norms around malaria prevention and treatment (OR=1.42, 95% CI [1.23 1.63]). Hearing a message about malaria, perceived susceptibility to malaria, and beliefs about community norms were also significantly positively associated with children under the age of five getting treatment for a fever outside the home.

Conclusions and Implications: Our results indicate that people’s beliefs are important in malaria prevention and treatment behavior. Moreover, the findings suggest that sharing information about malaria, particularly regarding the risk of infection and severity of disease, and highlighting the degree to which the community engages in malaria prevention and treatment behaviors, could be effective strategies to increase both the use of bed nets and treatment of fevers. Our findings inform the United Nations Sustainable Development Goal #3, which focuses on ensuring healthy lives and promoting well-being for all at all ages. Specifically, this work contributes towards eradicating malaria in endemic areas and reducing under-5 child mortality rates. Social work professionals could work with individuals, families, and communities to increase awareness about malaria and the use of bed nets.