A systematic review of knowledge, attitudes and beliefs about malaria among the South Asian population

Figures & data

Table 1 Malaria in South Asia

Country	Population	Population at risk	Reported cases (positive)	Reported deaths	Estimated cases	Estimated deaths
India	1,295,300,000	1,178,700,000	1,102,205	561	17,000,000	26,000
Pakistan	185,044,286	181,918,666	275,149	56	1,500,000	1,100
Bangladesh	159,077,513	16,480,430	10,216	45	700,000	1,600
Bhutan	765,008	121,441	48	0	50	–
Nepal	28,174,724	13,509,780	1,469	0	14,000	10
Sri Lanka	20,618,991	N/A	49	0	–	–
Maldives	–	–	0	0	–	–
Afghanistan	31,627,506	23,902,611	61,362	32	250,000	120
	1,720,608,028	1,414,632,928	1,450,498	694	19,464,050	28,830

WHO (2).

Table 2 Word groups used to identify relevant articles

Word group 1 – Population	Word group 2 – Intervention	Word group 3 – Disease or conditions, context or setting	Word group 4 – Outcomes
‘Male’ OR ‘Female’ OR ‘Adult’ OR ‘Child*’ OR ‘Elderly’	‘Insecticide treated bed net’ OR ‘ITNs’ OR ‘LLIN’ OR ‘bed net’ OR ‘Indoor Residual Spray’ OR ‘IRS’ OR ‘Intermittent’ OR ‘Prevent*’ OR ‘Treat*’ OR ‘Artemisinin-based Combination Theory’ OR ‘ACT’ OR ‘community education’ or ‘health promotion’ OR ‘public health’ OR ‘primary care’ OR ‘prevent*’ OR ‘control*’ OR ‘Preventative care’	‘Malaria’ OR ‘mosquito’ OR ‘febrile patients’ OR ‘South Asia[*1]’ OR ‘SAARC’ OR ‘Afghanistan’ OR ‘Afghanistan[*1]’ OR ‘Bhutan’ OR ‘Bhutan[*3]’ OR ‘Nepal’ OR ‘Nepal[*3]’ OR ‘India’ OR ‘India[*1]’ OR ‘Pakistan’ OR ‘Pakistan[*1]’ OR ‘Bangladesh’ OR ‘Maldives’ OR ‘Sri Lanka’ OR ‘Sri Lanka[*1]’	‘Improv*’ OR ‘improvement’ OR ‘access*’ OR ‘utilization’ OR ‘utilization’ OR ‘utilis*’ OR ‘utilize*’ OR ‘aware’ OR ‘prevent*’ OR ‘control*’ OR ‘mortality and morbidity’ OR ‘quality of life’ ‘Health need’ OR ‘outcome’ OR ‘results’ OR ‘quality’ OR ‘impact’ OR ‘effective’ OR ‘change’ ‘Knowledge’ OR ‘awareness’ OR ‘attitude’ OR ‘beliefs’ OR ‘behavior’ ‘community knowledge’ OR ‘community response’
Inclusion criteria (limit):
• Population: human
• Publication date: 1990–2015
• Document/record type: peer-review article
• Issues or attributes: studies focusing on knowledge, attitudes and belief associated with the prevention and control measures of malaria
• Location: South Asia (India, Pakistan, Bhutan, Bangladesh, Sri Lanka, Nepal, Maldives and Afghanistan)
• Language: English

All groups are combined using Boolean operators.

Fig. 1 PRISMA flow diagram.

Table 3 Summary of the articles included

					Quality appraisal [from Smith et al., 2009 (24)]
First author (year)	Title and journal (impact factor)	Country	Study design (study period)	Population group/sample size	Qualitative	Quantitative	Overall quality rating*
Ahmed et al. 2009 (25)	Knowledge on the transmission, prevention and treatment of malaria among two endemic populations of Bangladesh and their health- seeking behavior. Malar J [IF: 3.11]	Bangladesh	Survey, semi-structured questionnaire/face-to-face interview (July–November 2007)	General population (9,750)	NA	1,2,7,10	weak
Ahmed et al. 2014 (26)	Conventional or interpersonal communication: which works best in disseminating malaria information in an endemic rural Bangladeshi community? PloS One [IF 3.23]	Bangladesh	Cross-sectional survey, pretested, semi-structured questionnaire (July–November 2007 & January–February 2012)	General population (750 households)	NA	1,2,4,5,6,7,9,10	Strong
Ahmed et al. 2011 (27)	Free distribution of insecticidal bed nets improves possession and preferential use by households and is equitable: findings from two cross-sectional surveys in 13 malaria endemic districts of Bangladesh. Malar J [IF: 3.11]	Bangladesh	Cross-sectional surveys, structured interviews (2008 and 2011)	General population (3,760 in 2008 and 7,895 in 2011)	NA	1,2,3,4,5,6,7,9,10	Strong
Anand et al. 2014 (28)	Knowledge and use of personal protective measures against mosquito borne diseases in a resettlement colony of Delhi. Ann Med Health Sci Res [IF: 0.00]	India	Cross-sectional study, pre-tested, pre-designed, semi-structured questionnaire (June 2011–July 2011)	General population (100)	NA	1,2,4,5,7,10	Moderate
Bashar et al. 2012 (29)	Socio-demographic factors influencing knowledge, attitude and practice (KAP) regarding malaria in Bangladesh. BMC Public Health [IF: 2.264]	Bangladesh	Survey, structured questionnaires and the interviews, (July–October 2011)	General population (468)	NA	1,2,4,7,10	Weak
Chourasia et al. 2014 (30)	Household training vs. mass campaigns: a better method of health communication for preventing malaria. Trop Doct [IF: 0.48)	India	Interviewer-administered structured questionnaire (September–December 2012)	General population (218)	NA	1,2,4,5,7,10	Moderate
Dambhare et al. 2012 (31)	Knowledge, attitude and practice of malaria transmission and its prevention among the school going adolescents in Wardha District, Central India. Glob J Health Sci [IF: 0.00]	India	Cross sectional study, pre-designed, pre-tested questionnaire (October–December 2010)	School going adolescents (1,096)	NA	1,2,4,5,6,7,10	Moderate
Das and Ravindran 2010 (32)	Factors affecting treatment-seeking for febrile illness in a malaria endemic block in Boudh district, Orissa, India: policy implications for malaria control. Malar J [IF: 3.11]	India	Cross-sectional community-based survey, using structured interviews (2006)	General population (323) [300-service users and 23 – service providers]	1,2,3,4,5,7,8,9,10	1,2,7,8,9,10	Moderate
Das and Ravindran 2011 (33)	Community knowledge on malaria among febrile patients in an endemic district of Orissa, India. J Vector Borne Dis [IF: 0.806]	India	Cross-sectional community-based survey, structured interviews (June–August 2006)	General population (300)	NA	1,2,4,5,7,9,10	Moderate
Dhawan et al. 2014 (34)	Malaria-related knowledge and prevention practices in four neighborhoods in and around Mumbai: a cross sectional study. Malar J [IF: 3.11]	India	Quantitative – cross-sectional, structured interviewers-administered questionnaire (December 2010–January 2011)	General population (119)	NA	1,4,7,10	Weak
Fernando et al. 2008 (35)	Community factors affecting long-lasting impregnated mosquito net use for malaria control in Sri Lanka. Trans R Soc Trop Med Hyg [IF: 1.931]	Sri Lanka	Community-based cross-sectional survey among (June–July 2007)	General population (2,467)	NA	1,2,4,5,7,10	Moderate
Howard et al. 2010 (36)	Malaria control under the Taliban regime: insecticide-treated net purchasing, coverage, and usage among men and women in eastern Afghanistan. Mala J[IF: 3.11]	Afghanistan	Mixed methods – focus group discussions, in-depth and quantitative household survey (February–September 2000)	General population (566) [Fifteen focus group discussions (82+40) and 30 in-depth interviews, 414 households]	1,2,3,4,5,6,7,8,9,10	1,2,4,5,7,9,10	Strong
Hussain et al. 2013 (37)	Public health system readiness to treat malaria in Odisha State of India. Malar J [IF: 3.11]	India	Cross-sectional study, key informant interviews, semi-structured interviews and health facility assessments (February–July 2012)	Auxiliary nurse midwives and accredited social health activists (455)	NA	1,2,7,10	Weak
Joshi and Banjara 2008 (38)	Malaria related knowledge, practices and behaviour of people in Nepal. J Vector Borne Dis [IF: 0.806]	Nepal	Cross-sectional study using structured questionnaire and focus group discussions (December 2004–April 2005)	General population (1,330)	NA	1,2,4,7,10	Weak
Kirkby et al. 2013 (39)	Knowledge, attitudes and practices relevant to malaria elimination amongst resettled populations in a post-conflict district of northern Sri Lanka. Trans R Soc Trop Med Hyg [IF: 1.931]	Sri Lanka	Descriptive cross-sectional, structured questionnaire. Questionnaire (2011)	General population (300)	NA	1,2,4,5,6,7,10	Moderate
Kumar et al. 2014 (40)	Spatial trend, environmental and socioeconomic factors associated with malaria prevalence in Chennai. Malar J [IF: 3.11]	India	Questionnaire, field survey (2005–2011)	Not provided	NA	1,2,7,10	Weak
Lwin et al. 2014 (41)	‘It's effective but should I bother?’ A study of personal protection measures against Malaria in urban India. Public Health [IF: 1.434]	India	Quantitative – survey, interview questionnaire (March–June, 2012)	General population (1,000)	NA	1,2,7,10	Weak
Nandwani et al. 2014 (42)	Clinical profile of severe malaria: study from a tertiary care center in north India. J Parasit Dis [IF: 0.00]	India	Retrospective observational study (August 2010 to October 2010)	Patients (160)	NA	1,2,7,10	Weak
Pandit et al. 2010 (43)	Awareness and practice about preventive method against mosquito bite in Gujarat. Healthline [IF: 0.00].	India	Quantitative – cross-sectional, questionnaire (June 2009)	General population (311)	NA	1,7,10	weak
Qayum et al. 2012 (44)	SPHERE-based assessment of knowledge and preventive measures related to malaria among the displaced population of Jalozai, Pakistan. J Pak Med Assoc [IF 0.414]	Pakistan	Descriptive cross-sectional, structured questionnaire (March–November 2010)	General population (116)	NA	1,2,4,5,7,10	Moderate
Sabin et al. 2010 (45)	Attitudes, knowledge, and practices regarding malaria prevention and treatment among pregnant women in Eastern India. Am J Trop Med Hyg [IF: 2.699]	India	Qualitative using in-depth interviews and focus group discussions (April–May 2007)	Pregnant women (73) [32 in-depth interviews and six focus group discussions]	1,2,3,4,5,6,7,8,9,10	NA	Strong
Saha et al. 2015 (46)	Establishing communication mechanism for malaria prevention in Baiga tribal villages in Baiga chak area of Dindori district, Madhya Pradesh. Indian J Med Res [IF: 1.4]	India	Quasi experimental design using questions (November 2011–February 2012)	General population (2,350)	NA	1,2,3,4,5,6,7,9,10	Strong
Sarkar et al. 2009 (47)	Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action. Malar J [IF: 3.11]	India	Quantitative – using pre-tested structured questionnaire (2007–2008)	Total population (168)	NA	1,2,3,4,5,6,7,9,10	Strong
Sharma et al. 2015 (48)	Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India. Indian J Med Res [IF: 1.4]	India	Baseline survey using interviews (May 2005–June 2008)	General population (7,117)	NA	1,2,4,5,6,7,9,10	Strong
Sood et al. 2010 (49)	Community awareness, perceptions, acceptability and preferences for using LLIN against malaria in villages of Uttar Pradesh, India. J Vector Borne Dis [IF: 0.806]	India	Community-based survey, structured questionnaire (April–May 2009)	General population (596)	NA	1,2,7,10	weak
Sundararajan et al. 2013 (50)	Barriers to malaria control among marginalized tribal communities: a qualitative study. PloS One [IF: 3.234]	India	Qualitative data using multiple key informants and groups. (July 2012)	General population (84) [76-focus groups, and 8- individual interviews]	1,2,3,4,5,6,7,8,9,10	NA	Strong
Tobgay and Lhazeen 2010 (51)	Malaria perceptions and practices in Bhutan. Southeast Asian J Trop Med Public Health. [IF: 0.719].	Bhutan	Qualitative using focus group discussions and interviews (July–August 2007)	Eight focus group discussions (n=80) [three with medical profession, three with community members, and two with village health workers]	1,2,3,4,6,7,8(partly),9,10	NA	Strong
Tobgay et al. 2013 (52)	Community-directed educational intervention for malaria elimination in Bhutan: quasi-experimental study in malaria endemic areas of Sarpang district. Malar J [IF: 3.11]	Bhutan	Quasi-experimental study, both qualitative and quantitative data collection methods (Study period – not provided)	General population (25+560) [13 in-depth interviews and 12 focus group discussions] & 560 households interviewed	NA	1,2,3,4,5,6,7,9,10	Strong
Vijayakumar et al. 2009 (53)	Knowledge, attitude and practice on malaria: a study in a tribal belt of Orissa state, India with reference to use of long lasting treated mosquito nets. Acta Trop [IF: 2.519]	India	Mixed methods: quantitative (questionnaire) and qualitative (key informant interview and focus group discussions) (2002)	General population (656)	1,3,7	1,2,4,7,10	Moderate
Yadav et al. 2013 (54)	Knowledge, treatment-seeking behaviour and socio-economic impact of malaria in the desert of Rajasthan, India. South African India. South Afr J Epidemiol Infect [IF: 0.00]	India	Quantitative – cross-sectional, community-based study, questionnaire (Study period: not provided)	General population (540)	NA	4,7,10	weak
Yasuoka et al. 2006 (55)	Impact of education on knowledge, agricultural practices, and community actions for mosquito control and mosquito-borne disease prevention in rice ecosystems in Sri Lanka. Am J Trop Med Hyg [IF: 2.7]	Sri Lanka	Cross-sectional, – two surveys before and after the intervention (2003)	General population (75 households)	NA	1,2,4,5,7,8,9,10	Moderate
Zaidi et al. 2015 (56)	The quantitative evidence of malarial transmission and its associates in Bahawalpur, Pakistan. J Ayub Med Coll Abbottabad (IF: 0.00)	Pakistan	Cross-sectional, semi-structured questionnaires (January–June, 2008)	General population (1,623)	NA	1,2,4,5,7,10	Moderate

*(i) Some studies did not report sufficient details about the quality, so missing quality appraisal criteria/question(s) mean not particular appraisal question(s) applicable or not reported. (ii) Overall quality rating scale: strong (9–10 criteria/questions of yes); moderate (6–8 criteria/question of yes); weak (1–5 criteria/question of yes).

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