P5 - Barriers and enablers to malaria prevention efforts

1) Identifying perceptions and practices of school age children concerning malaria (causes, prevention, options for treatment)

2) Assesing how bed bug infestations influence bed net use

3)Understanding knowledge, perceptions and practices of stakeholders, caregivers, and school age regarding COVID-19

This cross-sectional, qualitative and descriptive study uses free-listing interviews, focus-group discussions, key informant interview and semi-structured interviews to

Focus group discussions identified several potential contributors:
  • Young adults chat outside in the evenings
  • They patronize discos and video shows
  • They attend traditional dances at night
Barriers to obtaining treatment included:
  • Long distance to facilities
    • Short service hours
    • Staff perceived as being unhelpful
  • Cultural beliefs (associating malaria with witchcraft)
This topic was probed during a series of free-listing interviews, focus group discussions and semi-structured interviews, and in general, there were 3 main reasons for not using LLINs:
  • Side-effects
    • Skin irritations
    • Breathing difficulties
    • Being uncomfortably hot
    • Bed bug late
  • Cultural beliefs
    • Similar to a “geneza” (who Moslims us to carry dead bodies)
    • Decreased sexual drive in men
    • More easily identified by witches
    • The LLINs themselves suck blood.
Using several different qualitative approaches, the investigators were able to ascertain that both school age children and the community at large were generally aware of COVID-19 and its prevention measures.

The impact of COVID-10 on malaria control and prevention programs is significant:  outreach clinics have largely stopped and people are afraid of going to health facilities for fear of contracting COVID-19


Lauren Cohee M.D., Ms.C
University of Maryland


Charles ManganiM.D. Ph.D.  
Assistant Professor of Epidemiology
College of Medicine

Mark Wilson
University of Michigan

Peter Ntenda
College Of Medicine
Don Mathanga M.D., Ph.D.  
Director of the COM-MACCDAC
Associate Professor
College of Medicine
Effie Chipeta M.D., Ph.D.   
Associate Professor 
Department of Osteopathic 
Medical Specialities 
College Of Medicine 

Project Location

  • Machinga
  • Balaka



Project Publications

  1. Sisya TJ, Kamn’gona RM, Vareta JA, et al. Subtle changes in Plasmodium falciparum infection complexity following enhanced intervention in Malawi. Acta Trop. 2015;142:108-114. doi:10.1016/j.actatropica.2014.11.008.

  2. Mathanga DP, Halliday KE, Jawati M, et al. The High Burden of Malaria in Primary School Children in Southern Malawi. Am J Trop Med Hyg. 2015;93(4):779-789. doi:10.4269/ajtmh.14-0618.

  3. Kabaghe AN, Chipeta MG, McCann RS, et al. Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study. Malar J. 2018;17(1):104. doi:10.1186/s12936-018-2253-1.

  4. Ramirez JL, Garver LS, Dimopoulos G. Challenges and approaches for mosquito targeted malaria control. Curr Mol Med. 2009;9(2):116-130. Accessed May 23, 2018.

  5. Walldorf JA, Cohee LM, Coalson JE, Bauleni A, Nkanaunena K, Kapito-Tembo A,Seydel KB, Ali D, Mathanga D, Taylor TE, Valim C, Laufer MK (2015). School-Age Children Are a Reservoir of Malaria Infection in Malawi. PLoS One. 10(7):e0134061.

  6. Coalson JE, Walldorf JA, Cohee LM, et al. High prevalence of Plasmodium falciparum gametocyte infections in school-age children using molecular detection: patterns and predictors of risk from a cross-sectional study in southern Malawi. Malar J. 2016;15(15). doi:10.1186/s12936-016-1587-9

  7. Nankabirwa J, Brooker SJ, Clarke SE, et al. Malaria in school-age children in Africa: an increasingly important challenge. Trop Med Int Health. August 2014. doi:10.1111/tmi.12374

  8. Parker, W., Community health priorities: Lessons for malaria prevention from Balaka district, Malawi. Malawi Medical Journal, 2018. 30(2): p. 99-102.

  9. Heggenhougen HK, Hackethal V, Vivek P. The behavioural and social aspects of malaria and its control: an introduction and annotated bibliography. Special programme for research and training in tropical diseases (TDR). Geneva: UNDP, World Bank, WHO; 2003.

  10. Ayi I, Nonaka D, Adjovu J, Hanafusa S, Jimba M, Bosompem K, et al. School-based participatory health education for malaria control in Ghana: engaging children as health messengers. Malar J. 2010;9:98.

  11. Hergenrather C,  Rhodes S.D,  Cowan CA, Bardhoshi G, Pula S. Photovoice as Community-Based Participatory Research: A Qualitative Review. American Journal of Health Behaviour. November 2009.

  12. Reason, P., Bradbury, H.,. ( 2001). Handbook of Action Research: Participative Inquiry and Practice S. Publications (Ed.)