Cognitive and Behavioral Factors in Community-Based Malaria Control in Malawi

Monitoring of preventive health behaviors and their determinants at the level of households is an important component in field research for malaria control programs. Household members in twelve rural villages in south central Malawi participated in a study to show change over time in perceptions and behaviors in an area undergoing multiple malaria control interventions. Focus group interviews were used initially to elicit the major concepts villagers used to define and respond to the threat of malaria. A longitudinal household survey (T1: n = 2460; T2: n = 2149) measured biomedical or traditional knowledge about malaria causation and control, attitudes toward mosquitoes, barriers to taking preventive actions, and preventive behaviors defined as sanitation, traditional, or commercial methods to control mosquitoes. While adherence to traditional beliefs and behaviors was found among some, the majority of respondents also had adopted many biomedical beliefs and attitudes about malaria causation. Changes reflected both national and local initiatives to improve health status and control malaria. Behaviors changed over time and were associated with a village level intervention and with structural, situational, and cognitive attributes of respondents.