Knowledge and practices surrounding malaria and LLIN use among Arab, Dazagada and Fulani pastoral nomads in Chad

Chadian pastoral nomads are highly exposed to malaria due to their lifestyle and their mobility between various endemic areas. To inform strategies to reduce nomads' risk of malaria and associated morbidity and mortality, it is important to understand the factors associated to their knowledge of malaria transmission and prevention practices.

A cross-sectional study among Arab, Dazagada and Fulani pastoral nomadic groups was conducted in February and October 2021. A validated structured electronic questionnaire was administered to assess knowledge of malaria. Attitudes and malaria prevention practices were assessed on the basis of perception of the causes of malaria and the use of a long-lasting insecticide-treated net (LLIN) the day before the survey. Data were analyzed using Chi-square tests and multivariate logistic regression with covariates adjustment.

A total of 278 nomads aged 20 to 65 years were included in the study. Overall, 90.7% of participants surveyed had a good knowledge of malaria. Fulani respondents were more likely to have a good knowledge of malaria than Arab respondents (Adjusted Odd ratio (AOR): 5.00, 95% CI: 1.04-24.03) and households possessing a LLIN were more likely to have a good knowledge of malaria (AOR: 9.66, 95% CI: 1.24-75.36). Most nomad households surveyed reported sleeping under a mosquito net the night before the survey (87.1%) while 98.9% owned a LLIN. Daza respondents (AOR: 0.23, 95% CI: 0.09-0.56) were less likely to use LLINs than Arab respondents. The middle (AOR: 2.78, 95% CI: 1.17-6.62) and wealthier households (AOR: 6.68, 95% CI: 3.19-14.01) were more likely to use LLINs. Knowledge of malaria was associated with the use of LLIN (AOR: 12.77, 95% CI: 1.58-102.99).

There remains a need to improve nomads' understanding of Plasmodium falciparum-carrying mosquitoes as the vector for malaria transmission and the quality of information provided. Knowledge of malaria and its prevention strategies in nomadic setting lead to the use of LLINs. Further reductions in malaria morbidity can be achieved by improving nomads' access to LLINs. This study can inform on the design policies to improve nomadic communities' knowledge of malaria prevention and promoting LLIN use as requested by the national policy against malaria.