BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 Knowledge of the cause for malaria Most respondents (81%) said that malaria could be trans- mitted from one person to another. About 60% of the women perceived that malaria is transmitted by mosqui- toes, followed by a response that incriminated sleeping together (38.7%) with a malaria patient as a cause for the disease. Other respondents also mentioned breathing from malaria patient (16.9%) and exposure to swampy areas and cold weather (4.9%) as a cause for malaria. Nearly 1% of the respondents who reported the transmis- sibility of malaria did not know how it is transmitted, while 9% said that either malaria could not be transmitted from one person to another or gave "did not know" responses. The participants in all FGDs elaborated their ideas of the cause of malaria and most of them associated the disease with mosquito bites. "There is a relationship between mosquito and malaria. When mosquito bites you, it transmits malaria to you". (FGD, Gerbi Gilgile village). Some women in FGDs believed that malaria thrives dur- ing fasting when people do not get breakfast or food on time. Other mothers related the disease to the Birraa (rel- atively drier months from September to November) sea- son of the year, during which food is surplus. They associated malaria with eating eshet. Eshet is young green maize, mainly available between September and Novem- ber, usually eaten after frying it on fire, particularly in rural areas. It is during this time of the year when eshet is available that malaria is thought to be very common. Other misconceptions about the cause of malaria were also not uncommon. "Malaria is caused by drinking dirty water on which mos- quitoes breed". (In-Depth interview, Abjata village). "Malaria is a major problem during Birraa season of the year. It is transmitted by mosquitoes and also by exposure to unhygienic areas. I think it is caused when mosquito bites you". (FGD, Abjata village). The seasonality of malaria in the area was also described by the participants of the FGDs. Many perceived that malaria occurs primarily between September and Decem- ber (i.e., Birra season). They argued that during this period, there is an increase in the number of mosquitoes. In the dry season, however, most of the participants indi- cated that the prevalence of the disease is low despite the fact that cases were found in the community. of SP, 18.3% cited injections, 14.6% suggested the use of chloroquine, 3.7% indicated the use of herbal remedies and about 1% mentioned the importance of early treat- ment from health facilities. Very few (0.3%) respondents replied the use of religious healing such as holy water and debtera (i.e., local healer) for curing malaria. Less than 1% of women knew nothing about the best way to cure malaria. With regard to the question whether malaria is a treatable disease or not, 98% replied "yes". Mothers who said that malaria is a treatable disease were further asked to list the names of the then available antimalarial drugs. About 95% replied SP, 45.6% reported chloroquine, and 5.5% mentioned paracetamol. Ninety-eight (4.8%) mothers were not able to mention the name of at least one antima- larial drug. About 93% of the mothers stated that SP was the most effective antimalarial for the treatment of malaria at the time of the survey. Most respondents in the FGDs also mentioned the then used antimalarial drugs for the treatment of malaria. SP was the most commonly reported antimalarial drug and they knew that three tablets of it was the appropriate dose for adults. However, its inefficacy at the time of the survey was acknowledged among most participants in all FGDs and in-depth interviews and it was pointed out that malaria has become more difficult to treat unlike in the past. The following expression illustrates the perceived importance of SP in the treatment of malaria and the con- cern of people about its ineffectiveness. "There is an antimalarial drug which is called "mechere- sha" (local name for SP with a literal meaning of 'last resort and effective'). But I have a worry about the recent effectiveness of this drug. I think it is not working well now". (In-depth interview, Aneno village). The use of herbal remedies in the treatment of malaria was also reported particularly in the remote areas of the dis- trict as described by one of the FGD participants. The use of garlic, ginger, and the leaves of local plants such as hargisaa and irrettii were reported to be common as a first response to malaria illness both among children and adults. The FGD participants elaborated that those sub- stances were given orally to a patient with suspected malaria by grounding and mixing them with water. They believed that those substances were effective especially in reducing fever and vomiting, and if there could be no improvement, the next step identified was to take modern antimalarials at home or visiting the nearby health facili- ties. As one respondent in the FGD puts it: Knowledge and perceptions about malaria treatment The best way of curing a person with malaria was explored; and 86.4% of the respondents reported the use "If a patient is given 'irrettii' [herbal remedy] at home, then it induces vomiting and diarrhea. As a result, the health of the patient would improve". (FGD, Abjata village). Page 6 of 12 (page number not for citation purposes)