Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP. A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs. The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2-52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81-3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75-5.11). Of the total participants, 81.3% (95% CI: 79.1-83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6-77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9-41.9), 59.1% (95% CI: 55.9-62.3), and 46.0% (95% CI: 42.3-49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting. Malaria awareness of rural adults needs to be improved to address Indonesia's national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.