Knowledge of Malaria and Its Association with Malaria-Related Behaviors—Results from the Malaria Indicator Survey, Ethiopia, 2007

BACKGROUND In 2005, the Ministry of Health in Ethiopia launched a major effort to distribute over 20 million long-lasting insecticidal nets, provide universal access to artemisinin-based combination therapy (ACTs), and train 30,000 village-based health extension workers. METHODS AND FINDINGS A cross-sectional, nationally representative Malaria Indicator Survey was conducted during the malaria transmission season in 2007. Multivariate logistic regression analyses were performed to assess the effect of women's malaria knowledge on household ITN ownership and women's ITN use. In addition, we investigated the effect of mothers' malaria knowledge on their children under 5 years of age's (U5) ITN use and their access to fever treatment on behalf of their child U5. Malaria knowledge was based on a composite index about the causes, symptoms, danger signs and prevention of malaria. Approximately 67% of women (n=5,949) and mothers of children U5 (n=3,447) reported some knowledge of malaria. Women's knowledge of malaria was significantly associated with household ITN ownership (adjusted Odds Ratio [aOR]=2.1; 95% confidence interval [CI] 1.6-2.7) and with increased ITN use for themselves (aOR=1.8; 95% CI 1.3-2.5). Knowledge of malaria amongst mothers of children U5 was associated with ITN use for their children U5 (aOR=1.6; 95% CI 1.1-2.4), but not significantly associated with their children U5 seeking care for a fever. School attendance was a significant factor in women's ITN use (aOR=2.0; 95% CI 1.1-3.9), their children U5's ITN use (aOR=4.4; 95% CI 1.6-12.1), and their children U5 having sought treatment for a fever (aOR=6.5; 95% CI 1.9-22.9). CONCLUSIONS Along with mass free distribution of ITNs and universal access to ACTs, delivery of targeted malaria educational information to women could improve ITN ownership and use. Efforts to control malaria could be influenced by progress towards broader goals of improving access to education, especially for women.