Examining community perceptions of malaria to inform elimination efforts in Southern Mozambique: a qualitative study

In a background of renewed calls for malaria eradication, several endemic countries in sub-Saharan Africa are contemplating malaria elimination nationally or sub-nationally. In Mozambique, a strategy to eliminate malaria in the south is underway in the context of low endemicity levels and cross-border initiatives to eliminate malaria in South Africa and Eswatini. In this context, a demonstration project aiming to interrupt malaria transmission through mass antimalarial drug administrations and intensified vector control programmes accompanied by community engagement and standard case management was implemented in the Magude District. To ensure the necessary uptake of these interventions, formative qualitative research explored the perceptions, beliefs, attitudes, and practices related to malaria, its prevention and control. The current article describes the results of this study.

Seventeen focus group discussions were conducted between September and October of 2015 with the community leaders (6), adult men (5), women of reproductive age (5), and traditional healers (1) in Magude prior to the implementation of the project interventions. Respondents discussed perceptions around malaria symptoms, causes, preventions, and treatments.

Knowledge of malaria was linked to awareness of its clinical presentation, and on-going vector control programmes. Perceptions of malaria aetiology were fragmented but related mainly to mosquito-mediated transmission. Reported preventive measures mostly involved mosquito control although participants were aware of the protective limitations of vector control tools. Awareness of asymptomatic carriers and the risk of outdoor malaria transmission were varied. Fever and malaria-like symptoms triggered immediate care-seeking community at health facilities. The identified barriers to malaria treatment included fear/mistrust in Western medicine, distance to health facilities, and lack of transportation.

Several constraints and opportunities will potentially influence malaria elimination in Magude. Malaria awareness, trust in health institutions, and the demand for chemoprophylaxis could facilitate new interventions, such as mass drug administration. A lack of awareness of asymptomatic carriers, inadequate understanding of residual transmission, and barriers to care seeking could jeopardize uptake. Hence, elimination campaigns require strong community engagement and grassroots mobilization.