DOI QR코드

DOI QR Code

Ethnic Variation and Its Association With Malaria Awareness: A Cross-sectional Study in East Nusa Tenggara Province, Indonesia

  • Guntur, Robertus Dole (Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology) ;
  • Kingsley, Jonathan (Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology) ;
  • Islam, Fakir M. Amirul (Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology)
  • Received : 2021.07.01
  • Accepted : 2021.11.12
  • Published : 2022.02.03

Abstract

Objectives: This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. Methods: A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. Results: The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). Conclusions: Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government's national commitment to achieve a malaria elimination zone by 2030.

Keywords

Acknowledgement

We further would like to express our gratitude to the Health Ministry of Indonesia, the governor of ENTP, the heads of the East Sumba, Belu, and East Manggarai district, 9 heads of subdistricts, and 49 village leaders for allowing this research to be conducted in their region. The funders had no role in the design of the study, data collection, analysis, or interpretation of data, or writing the paper.

References

  1. Centers for Disease Control and Prevention. Malaria's impact worldwide [cited 2021 Mar 17]. Available from: https://www.cdc.gov/malaria/malaria_worldwide/impact.html.
  2. World Health Organization. World malaria report 2020: 20 years of global progress and challenges; 2020 [cited 2021 Mar 17]. Available from: https://www.who.int/publications/i/item/9789240015791.
  3. Asia Pacific Malaria Elimination Network. Indonesia national strategic plan 2020-2024; 2020 [cited 2021 Jan 17]. Available from: https://www.apmen.org/resources/indonesia-nationalstrategic-plan-2020-2024.
  4. Indonesia Ministry of Health. The current development situation of malaria control program in Indonesia 2019. Jakarta: Indonesia Ministry of Health; 2020 (Indonesian).
  5. Central Bureau of Statistics East Nusa Tenggara Province. Nusa Tenggara Timur Province in figures 2020 [cited 2021 Mar 18]. Available from: https://ntt.bps.go.id/publication/2020/04/27/080aa7bde0454f07e7848b49/provinsi-nusa-tenggara-timurdalam-angka-2020.html (Indonesian).
  6. Health Department of the ENTP. The East Nusa Tenggara Province (ENTP) health profile in 2018 Indonesia. Kupang: ENTP Health Department; 2019, p. 119-122 (Indonesian).
  7. Jontari H, Kusnanto H, Supargiyono S., Hamim SA, Satyagraha AW, Novijanti N, et al. Malaria pre-elimination assessment in Eastern Indonesia. Outbreak Surveill Investig Rep 2016;9(1):1-7.
  8. Yoshikawa H, Tokoro M, Nagamoto T, Arayama S, Asih PB, Rozi IE, et al. Molecular survey of Blastocystis sp. from humans and associated animals in an Indonesian community with poor hygiene. Parasitol Int 2016;65(6 Pt B):780-784. https://doi.org/10.1016/j.parint.2016.03.010
  9. Syafruddin D, Bangs MJ, Sidik D, Elyazar I, Asih PB, Chan K, et al. Impact of a spatial repellent on malaria incidence in two villages in Sumba, Indonesia. Am J Trop Med Hyg 2014;91(6):1079-1087. https://doi.org/10.4269/ajtmh.13-0735
  10. Moonen B, Cohen JM, Snow RW, Slutsker L, Drakeley C, Smith DL, et al. Operational strategies to achieve and maintain malaria elimination. Lancet 2010;376(9752):1592-1603. https://doi.org/10.1016/S0140-6736(10)61269-X
  11. Kanyangarara M, Hamapumbu H, Mamini E, Lupiya J, Stevenson JC, Mharakurwa S, et al. Malaria knowledge and bed net use in three transmission settings in southern Africa. Malar J 2018;17(1):41. https://doi.org/10.1186/s12936-018-2178-8
  12. Saha A, Sarker M, Kabir M, Lu G, Muller O. Knowledge, attitudes, and practices regarding malaria control among the slash and burn cultivators in Rangamati Hill tracts of Bangladesh. Malar J 2019;18(1):216. https://doi.org/10.1186/s12936-019-2849-0
  13. Iyanda AE, Osayomi T, Boakye KA, Lu Y. Regional variation and demographic factors associated with knowledge of malaria risk and prevention strategies among pregnant women in Nigeria. Women Health 2020;60(4):456-472. https://doi.org/10.1080/03630242.2019.1643818
  14. Sixpence A, Nkoka O, Chirwa GC, Milanzi EB, Mangani C, Mathanga DP, et al. Levels of knowledge regarding malaria causes, symptoms, and prevention measures among Malawian women of reproductive age. Malar J 2020;19(1):225. https://doi.org/10.1186/s12936-020-03294-6
  15. Tang S, Ji L, Hu T, Bishwajit G, Da Feng, Ming H, et al. Determinants of public malaria awareness during the national malaria elimination programme: a cross-sectional study in rural China. Malar J 2016;15(1):372. https://doi.org/10.1186/s12936-016-1427-y
  16. Singh MP, Saha KB, Chand SK, Savargaonkar D. Socioeconomic determinants of community knowledge and practice in relation to malaria in high- and low-transmission areas of central India. J Biosoc Sci 2020;52(3):317-329. https://doi.org/10.1017/s0021932019000440
  17. Ahmed SM, Haque R, Haque U, Hossain A. Knowledge on the transmission, prevention and treatment of malaria among two endemic populations of Bangladesh and their health-seeking behaviour. Malar J 2009;8:173. https://doi.org/10.1186/1475-2875-8-173
  18. Naing PA, Maung TM, Tripathy JP, Oo T, Wai KT, Thi A. Awareness of malaria and treatment-seeking behaviour among persons with acute undifferentiated fever in the endemic regions of Myanmar. Trop Med Health 2017;45:31. https://doi.org/10.1186/s41182-017-0070-9
  19. World Health Organization. Malaria in South-East Asia [cited 2020 Aug 8]. Available from: https://www.who.int/southeastasia/health-topics/malaria.
  20. Ananta A, Arifin EN, Hasbullah MS. Demography of Indonesia's ethnicity. Singapore: ISEAS Publishing; 2015, p. 119-122.
  21. Simanjorang C, Kodim N, Achmadi UF, Miko TY. Knowledge and compliance with the use of insecticide-treated nets in Manalu Sangihe Islands Regency of North Sulawesi Indonesia. Indian J Public Health Res Dev 2020;11(5):626-629.
  22. Rahmasari FV, Setyonugroho W, Swarjana IK, Arisandi D, Kesetyaningsih TW. The association between demographic and attitude factors with the practice of malaria prevention among the rural community in Purworejo district, Indonesia. Qanun Med 2015;5(1):113-124.
  23. Guntur RD, Kingsley J, Islam FM. Malaria awareness of adults in high, moderate and low transmission settings: a cross-sectional study in rural East Nusa Tenggara Province, Indonesia. PLoS One 2021;16(11):e0259950. https://doi.org/10.1371/journal.pone.0259950
  24. Indonesia Ministry of Health. The current development situation of malaria control program in Indonesia 2018. Jakarta: Indonesia Ministry of Health; 2019 (Indonesian).
  25. Indonesia Ministry of Health. National report of basic health research 2018; 2019 [cited 2019 Mar 16]. Available from: https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/ (Indonesian).
  26. Guntur RD, Kingsley J, Islam FM. Epidemiology of malaria in East Nusa Tenggara Province in Indonesia: protocol for a cross-sectional study. JMIR Res Protoc 2021;10(4):e23545. https://doi.org/10.2196/23545
  27. Tang S, Ji L, Hu T, Wang R, Fu H, Shao T, et al Public awareness of malaria in the middle stage of national malaria elimination programme. A cross-sectional survey in rural areas of malaria-endemic counties, China. Malar J 2016;15(1):373. https://doi.org/10.1186/s12936-016-1428-x
  28. National Research Council. Reducing maternal and neonatal mortality in Indonesia: saving lives, saving the future. Washington, DC: National Academies Press; 2013, p. 41.
  29. Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int 2009;24(3):285-296. https://doi.org/10.1093/heapro/dap014
  30. Blanch-Hartigan D, Viswanath K. Socioeconomic and sociodemographic predictors of cancer-related information sources used by cancer survivors. J Health Commun 2015;20(2):204-210. https://doi.org/10.1080/10810730.2014.921742
  31. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011;155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
  32. Alsous M, Abdel Jalil M, Odeh M, Al Kurdi R, Alnan M. Public knowledge, attitudes and practices toward diabetes mellitus: a cross-sectional study from Jordan. PLoS One 2019;14(3):e0214479. https://doi.org/10.1371/journal.pone.0214479
  33. Larson PS, Mathanga DP, Campbell CH Jr, Wilson ML. Distance to health services influences insecticide-treated net possession and use among six to 59 month-old children in Malawi. Malar J 2012;11:18. https://doi.org/10.1186/1475-2875-11-18
  34. Indonesia Ministry of Health. Basic database of public health centre in East Nusa Tenggara Province Indonesia, condition at 31 December 2018; 2019 [cited 2020 May 20]. Available from: https://pusdatin.kemkes.go.id/resources/download/pusdatin/data-dasar-puskesmas/2019/19.%20Buku%20%20Data%20Dasar%20PKM-NTT.pdf (Indonesian).
  35. Indonesia Ministry of Health. Guidelines for implementing the distribution of treated mosquito nets in Eastern Indonesia 2017. Jakarta: Indonesia Ministry of Health; 2017 (Indonesian).
  36. Deressa W, Ali A. Malaria-related perceptions and practices of women with children under the age of five years in rural Ethiopia. BMC Public Health 2009;9:259. https://doi.org/10.1186/1471-2458-9-259
  37. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health 2013;38(5):976-993. https://doi.org/10.1007/s10900-013-9681-1
  38. Whittaker M, Smith C. Reimagining malaria: five reasons to strengthen community engagement in the lead up to malaria elimination. Malar J 2015;14:410. https://doi.org/10.1186/s12936-015-0931-9
  39. Guntur RD, Lobo M. Statistical modelling for dropped out school children (DOSC) in east Nusa Tenggara Province Indonesia. J Phys Conf Ser 2017;812:012073. https://doi.org/10.1088/1742-6596/812/1/012073
  40. Aung PL, Pumpaibool T, Soe TN, Burgess J, Menezes LJ, Kyaw MP, et al. Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar. Malar J 2019;18(1):362. https://doi.org/10.1186/s12936-019-2985-6