角井信弘

51

特集：合同臨地訓練
A Study of awareness of malaria among Kibera population;
implication for community based inter vention
August-November, 1999.
Karanja J1), Wambari E2), Okumu D3), Odhiambo E4), Karuri I5), Muthwii, SM6),
Kibe M7), Osawa N8), Osaki Y9)

Abstract
Objective; To determine awareness of spread, pre-disposing factors, control and effects of malaria in
Kibera slums, to facilitate designing community based interventions.
Design; Cross-sectional study
Setting; Gatwikira Village, Kibera Division, Nairobi
Subjects; 160 households (80% response rate) by stratified systematic sampling.
Main outcome measures; Awareness of malaria as disease, symptoms, relationship to vector,
predisposing factors, prevention and control measures, burden of disease and health seeking
behaviour.
Results; All respondents demonstrated awareness of malaria as disease. Main symptoms associatedwith malaria were fever (91%), headache (67%), joint pains (51%) and malaise (48%). Majority associatedmalaria with mosquito vector (72%) but a larger number (76%) with erroneous causative factors.
Predisposing factors were mosquito bleeding sites due to poorly disposed refuse (53%), rains (28%),
stagnant water (11%) and bushes (11%). Awareness of prevention and control measures included
destroying mosquito breeding sites (39%), insecticides use (38%), prophylactic drugs (32%) andmosquito nets (29%). 9% did not know of any control measures while 33% gave erroneous measures.
For health seeking behaviour, 87% went to health institutions for treatment while 62% purchase overthe-counter drugs (self-medicaion). Most felt effects as burden of disease were draining of households’
resources (76%) and work absenteeism (50%).
Conclusions; The community is aware of malaria as a disease but are handicapped by lack ofadequate knowledge on symptoms, cause, predisposing factors, prevention and control measures.
There is urgent need for health education and cost-effective sustainable community based
intervention activities for the prevention, control and curative management of malaria.
Keywords malaria, symptoms, predisposing factors, prevention1）Department of Environmental Health, KMTC Nairobi
P.O.Box 30195, Nairobi, Tel: 254-02-725711 ext 47128,
E-mail: Karanjasan@Yahoo.com
2）Department of Clinical Medicine, KMTC Nairobi3）Department of Physiotherapy, KMTC Nairobi4）Department of Nursing, KMTC Kisumu
5）Department of Medical Imaging, KMTC Nairobi

6）Faculty of Education, Kenyatta University (Supervisor)7）Department of Medical Education, KMTC Nairobi(Computer Supervisor)
8）Chief advisor, KMTC/JICA project9）Department of Hygiene, Tottori University, Japan (JICA
Expert)J. Natl. Inst. Public Health, 51 (1) : 2002

52

A study of awareness of malaria among Kibera population

Introduction
Malaria, long a disease problem to man, was associatedwith the malaria parasite in 1880 by Ross AL discoveredthat it was transmitted by the mosquito in 1885-1898.1)
Since them, despite enormous effort in finance,
manpower and other resources to combat the disease, it
is still a serious problem2). The global toll of malaria isestimated at 2.4 billion in 90 countries. There are 300-500
million clinical cases annually, with tropical Africancountries accounting for 90% of these. 1.4-1.6 million
deaths occur worldwide due to the disease with morethan 90% in Africa. Infections during pregnancy andearly childhood are important causes to low birthweights, morbidity and mortality amongst women andchildren. About 90% of the 550 million pepole in Africa
are at risk. About 75% live in high endemic areas while
18% live in epidemic prone areas 3 ) . The disease inrampant in Kenya, with 30% of all outpatient and 18% of
inpatient cases diagnosed as malaria respectively.4)
Malaria, once a rural problem has become an urban
problem, especially adversely affecting slum dwellers
due to overpopulation, poor drainage and sanitation,socio-economic factors, lack of adequate health facilities,
global warming among other issues. Burden of disease
includes cost of vector control, diagnosis, prophylaxis andtreatment and household costs.5)
The way forward seems to be arming the communities
with the necessary knowledge to use available resources
to fight the disease on their own terms, these should
include the design, implementation and evaluation ofsustainable intervention.6)
The study hopes to have gathered information ofimportance to the country, the ministry of health and allconcerned stakeholders in the devise and execution ofintervention activities geared towards the control of thedisease, and also to improve the health seeking
behaviour of the community.
Specific objectives of the study imcluded finding out theawareness of the community members of clinicalmeasures, spread, treatment, predisposing factors,
control and prevention, and effects of the disease to thecommunity.

Materials and Methods
Study area; Gatwikira Village is located in Kibera, on thesouthwest region of Nairobi, six kilometers from the city
center. Kibera slums are the largest in Kenya, occupying
an area of four square kilometers.
The population of the village is estimated to be about
40,000 people. Majority of the housing is semi-permanent,with plastered adobe walls and iron sheets roofing.
Accessibility to the interior is poor, more so during therainy season. There is sufficient piped water from thecity council mains health insitutions in the area aremainly clinics ran by individuals and NGOs.
Number of households; Approximately 8,000, majority
being one roomed rental units.
Target population; The respondents were all residentsof the village, over sixteen years of age.
Research method; Cross-sectional study
Sampling method; Cluster sampling for selection of thevillage, and stratified systematic sampling for thehouseholds was applied, each strata being taken as
households within the same street.
Sample size; 200 households
Research process; An interview schedule using multiple
responses and observation checklist were used to collectthe data.
Research period; April-November, 1999
Response rate; 160 (80%)
Contents of Questionnaire; The interviewer shedulesought to find the following;
Age, gender, educational level, period of residense,
awareness of disease, how one learnt of malaria, how onegets malaria, symptoms, health seeking behaiour when
one is infected, conditions encouraging spread of malaria,
prevention methods known, disease burden on family,
who are most affeced in the family, complications of
untreated malaria, methods of control used.
The observation checklist sought to find the following;
Type of housing, lighting, cleanliness of compound,refuse disposal methods and sites, liquid waste
management, presence of breeding sites.
Statistical Methods; Simple data analysis methods wereused and included calculations of percentages the data
findings were presented in tables and figures.

Results
A total of 160 respondents were interviewed of which
110 (69%) were females while males were 50 (31%). A
possible explanation for this ratio is that most men wereout at work. The few men found were either runningbusinesses around, jobless or unwell.
Assessment of level of education revealed that 94% ofthem had been to school; 55% attained only Primaryeducation, 36% Secondary level, 3% College, while 6%
had no education at all. The respondents interviewed
ranged between 16 and 63 years of age. The highest
percentage (45%) was within the age bracket of 20-29
years with the least percentage (1%) being 60 years andabove (See Table 1).

J. Natl. Inst. Public Health, 51 (1) : 2002

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Karanja J, Wambari E, Okumu D, et al.
Table 1 Socio-demographic characteristics
NumberTable 2 Knowledge on malaria

Percentage (%)

Education

Number

(%)

Source of knowledge

None

10

6

Sickness

125

78

Primary

88

55

Mass media

49

31

Secondary

57

36

Friends35

22College53

Health personnel

21

13

School9

6

Mosquito Presence

92

58

Poor waste disposal

85

53

Stagnant water

18

11

Thick bushes

17

11

Do not know

96

Drains family resources

122

76

Work absentism

80

50

Psychological effect34

21

Gender
Male

50

31

Female110

69

All the respondents (100%) were aware of malaria as adisease with 78% having suffered from the disease, 31%
having learnt from the Mass Media, 13% from Healthcare providers and the least percentage (6%) from school.
Responses as to what transmits malaria indicate that72% associate it to mosquito bite. However, a higher
percentage of 76% erroneously associated it with otherfactors, while 14% had no idea at all.
The predisposing factors to malaria infection mostwidely mentioned by the respondents were presence ofmosquito 58% and poor waste disposal 53% presumably
as possible breeding grounds for mosquito while 66%
gave wrong responses implying that they did not know
the predisposing factors to malaria (See Table 2).
With regard to clinical presentation fever was widely
mentioned in both children and adults as 94% and 91%
respectivey. In adult other symptoms that featured
prominently were headache 67%, joint pains 51% andbody weakness 48%. Other symptoms mentined included
vomiting 27%, abdominal discomfort 19%, loss of appetite
12% while 6% of the respondents did not know the signs
and symptoms in adults. For symptoms affecting
children the predominantly featured included loss ofappetite 55%, vomiting 48%, irritability 21%, body
weakness 17%, while 8% did not know the signs ofmalaria in children. Other important symptoms
mentioned in small percentage were convulsions 1%,
Jaundice/Anemia 2% (See fig.1).
On who was most affected by malaria in the family cell
56% said children, 18% women, and the least being men
12% while 33% felt that all were equially affected.
This community also recognizes malaria as fatal disease
when treatment is delayed. This is clearly shown by
their response where 93% felt that death may result as acomplication, 12% indicated mental confusion and 20%
were not sure of the complications of the disease. They

Predisposing factors

Burden of disease

seemed not to be aware of actual complication of malaria
before death occurs.
When sick 87% of the respondents said that they go to
the hospital or clinics, while 62% purchase drugs fromthe shops, only 2% went to the herbalist (See Table 3).
Most respondents were aware of the burden of thedisease with 76% saying that the disease drained thefamily resources, 50% work and school absentism, 21%talked of psychological effects among the family
members, while 14% had others effects which included
absence from work and school due to death of spouses,and getting other diseases due to weakness brought
about by malaria (See Table 2).
On response to preventional and control awareness andmethods used, 39% talked of destroying breeding sites,
while only 22% practiced the method. 36% were aware ofuse of insecticides and the same percentage practice themethod. 32% talked of use of prophylactic antimalarial
drugs while 31% practiced the method. 29% were awareof use of mosquito nets while only 14% used. 33% did not

Table 3 Health seeking behaviour
Number(%)

Go to hospital when sick

139

87

Purchase over-the-counter drugs

99

62

See herbalist

32

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A study of awareness of malaria among Kibera population

them learnt from school. The percentage learning fromhealth care providers is low, indicating that thiscommunity has not received adequate information fromhealth care providers. The community was found not tobe sure of the mode of malaria transmission.
On clinical manifestations of the disease, the findings
imply that although a very high perentage cited fever asa main sign, the community did not recognize some of
the important signs and symptoms of malaria in both
adults and children especially in combination with thefever. This is in line with findings of Terekega A. et.al.7)
The community recognizes that malaria is a problem inchildren but they did not realize the fact that malaria

know of any method while 34% did not use any of theprecentive and control measures; 66% used some of
preventive measure (See fig. 2).

Discussion
The study indicates that the higher percentage (61%) of
the respondents had low education, which may explain
why the awareness was generally low on some aspectsof malaria, particularly pre-disposing factors andprevention methods.
The data on how the respondents learnt about malaria
shows that most of the respondents learnt throughpersonal experience of the disease while very few of

% 200

94

ADULTS

100

CHILDREN

67
51

17

91

48
55
19

48
27

8

21

12

12

0

9

1

6
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Figure 1 Awareness of symptoms of disease

% 40

39

36

36 32

31

34
29

22
14
9

0

Figure 2 Comparison of Knowledge and practice on malaria prevention
J. Natl. Inst. Public Health, 51 (1) : 2002

Karanja J, Wambari E, Okumu D, et al.

affects both men and women equally.
On health seeking behaviour, when afflicted by thedisease, they were aware that the hospital is the bestplace to get treatment. A good proportion purchased
drugs from the shops for selfmedication. It was also
revealed that a good number first bought drugs from theshops but only went to hospital when there was no
notable improvement.
Malaria as a disease affects on socio-economic status of
an individual, family and the community as a whole. The
disease is recognized to have an economic burden on theindividual and the family as was also reported by Hill J.8)
Preventive measures undertaken by the community are
inadequate in that less than 40% of the respondents
undertake any one particular preventive measure. Fully
one third of the respondents do not practice any
measure. 33% gave wrong or ineffetive control measure
implying poor knowledge of prevention. There is also
discrepancy between usage of certain preventive
measures like bed-nets and destruction of mosquito
breeding sites and awareness of them, that is possible
due to poverty and consequent unavilability of resources.
This seems to be supported by predisposing factors
observed by the researchers. The predisposing factors
included poor quality of housing and presence of possible
mosquito breeding sites near the houses.
It can be concluded from the study that, although the
respondents are aware of malaria as a disease with
debilitating consequences, both on the individual and thecommunity, not enough is known by the community on
clinical presentation, spread, treatment, predisposing
factors and control of the disease. Most of the people
seem to find out more about the disease the hard way,that is through personal experience and that of friencs
when malaria strike. Clearly this shows that the healthcare providers concerned are doing not enough healtheducation. Consequently, control measures undertaken
prove ineffective and inadequate to combat the disease,which then continues to ravage the population with
impunity.
Thus, the community needs to be made more aware andknowledgeable on all the various aspects associated withmalaria. In this way, cost effective and sustainablecommunity based interventions can be formulated andimplemented with better success and greater
involvement of the community members who will beaware of what exactly is at stake. Community based
interventions have been carried out with success in55

Africa9) and in Kenya8, 10).
There is also need for urgent affordable and effective
curative measures to be made available within thecommunity. Other advantages of community
participation include simplicity, ease of management andflexibility11) of the chosen intervention activities.
This study was conducted as a Mid Level Manpower
Training (MLMT) program as a part of KMTC/JICA project(1999) and sponsored by JICA (Japan International
Cooperating Agency)

Acknowledgements
To all the lecturers, notably Dr. Njeru, Dr. Rakwar, of
the School of Medicine, University of Nairobi, Mr. Tetei,
Mr. Nyala, Mr. Wamalwa and Mr. Kurui, of KMTC
NairobiTo all the supervisors, notably Dr. Muthwii Kenyatta
University
To the computer supervisors, Mrs Kibe and Ms. Honda,
KMTC/NRB.
To JICA Expert/Lecturers, Prof. Takagaki To the Chief,
guides and residents of Gatwikira Village, Kibera
And to JICA/KMTC Project coordinators for making thecourse possible.

References
１．Blackie W.K., Malaria, Post graduate Press.
２．Manaworanjan R.R., Sharma Y. American Journal of
Tropical Hygiene and Medicine 61(1), 120-124, 1999
３．African Initiative for malria control in the 21st Century,
WHO, Regional Office for Africa (May 1998)
４．Annual Report, Health Information Systems, Ministry of
Health, Kenya, Nairobi, (1995)
５．World health Report, WHO (1998)
６．AMREF/GLAXO Community Malaria Prevention
Project, Annual Report for Jan-Dec 1995 (March, 1996)
７．Tarekega A et al., KAP Study in Ethiopia, WHO/MAC(1998)
８．Hill J. Second project report for UNICEF on malaria
control (programme in Kisumu District) UNICEF/KCO
1991
９．Diseko R.et.al. MALARIA No. , (AUGUST 1999)
10．March V.M. et.al., Evaluating the community education
programme on an insecticide treated bed net trial at the
Kenyan coast. KEMRI/CRC (1996)
11．Kalindi T. Community participation in healthprogrammes, PARTNERS Magazine for Medical Workers,
2, 6-8, 1997

J. Natl. Inst. Public Health, 51 (1) : 2002