Knowledge, Attitudes and Practices Among Adult Malaria Patients Co-Infected with Opportunistic Intestinal Coccidian Parasites in Fundong Health District, Northwest, Cameroon: A Cross Section Study Design
Authors: Atah Formbui Paul , Longdoh Njunda Anna , Thumamo Benjamin Pokam , Akoachere Jane Francis 
Published: August 2023

Introduction: Malaria and intestinal coccidian parasitic co-infections, are becoming a public health emergency affecting millions of people around the world. They are among the leading cause of socio-economic problems, long suffering and death especially in developing countries like Cameroon. Introducing new appropriate preventive and control measures to the population requires thorough assessment of community and patient-based knowledge, attitude and preventive practices towards malaria and pathogenic intestinal coccidian parasites is crucial. Our study aimed to describe knowledge, attitudes, and practices and the risk factors among adult malaria patients co-infected with intestinal parasitic infections in the Fundong Health District, a locality in the Northwest Region of Cameroon. Methods: This was a cross-sectional study carried out between February and December, 2022 involving sixteen (16) health facilities in Fundong Health district. A total number of 330 patients participated in the study. Normal saline wet mount and formol-ether concentration techniques were employed in coccidian parasitic detection. Blood samples were subjected to Giemsa stained and viewed microscopically to detect the Plasmodium parasites. Pretested structured questionnaires were administered to collect information on patient’s socio-demographic factors and determine patients’ knowledge, attitudes and practices towards malaria and intestinal coccidian parasites, as well as their prevention and control. The Pearson’s Chi-Square (χ2) and Student T-test were performed a part of the statistical analysis to check for associations between malaria, infection and between malaria-coccidian co-infection and demographic factors. Statistical significance was set a P-value<0.05. Results: Participants main sources of information on malaria were: Television (TV) and radio 111/330 (34%), community health workers 109/330 (33%), and Hospitals (37%). Participants had good knowledge of mosquito bite as the malaria transmission route, 296/330 (90%), night time is the frequent biting time for the mosquito 296/330(90%), dark corners 229 (69%) and dirty areas 175(53%) as mosquito resting places. Knowledge score was also good on cleaning of the house surroundings, 281/330(85%), clearing the bushes 180/330(55%), poor knowledge score on drainage of stagnant water113/330 (34%) as ways to prevent the mosquito from multiplying. Participants had good knowledge of insecticide treated bed nets 295/330 (89%) as the best way to prevent mosquito bites. However, participants also expressed poor knowledge on edges of the river or streams 7(20%), and animal shed 20/330 (6%) as mosquito hiding places, and Plasmodium specie as malaria causative agent 8/330 (2%) (P-value=0.011). Poor scores were recorded on knowledge of opportunistic intestinal coccidian parasites (19.4%) (P=0.427), and was significantly low on unsafe water (47.2%) (P-value=0.036) as possible transmission routes for coccidian parasites. The knowledge score was also low on the at-risk population for malaria and intestinal coccidian infection (31.9%) P-value=0.009. Participants who had poor knowledge about coccidian transmission routes were less likely to drink from protected water source with an odds of 0.713(95% CI: 0.297-1.711) P value=0.449, compared to those who were more knowledgeable and who were 2.981(95% CI: 1.367-6.115) P value=0.005, more likely to use protected source of drinking water. Participants who had hand washing facility in the household were 3.488 (1.760-6.912) value=0.001 times more likely have better knowledge of coccidian transmission routes compared to those who did not have 0.748 (95% CI: 0.406-1.376) P value=0.350. Poor knowledge score of poor hygiene as major cause of coccidian infection significantly associated with poor practice score of sometime or not at all disinfecting animal shed to prevent coccidian infection among study participants (P =0.039). Conclusion: The overall knowledge scores, attitude and practices level of participants towards malaria and opportunistic intestinal coccidian parasites were relatively good. A significant proportion of the participants still have misconceptions about cause, modes of transmission and practices towards malaria and coccidian prevention methods. A combined health education programmes for malaria and intestinal coccidian parasites aimed at raising community awareness needs to be evidence based and requires innovative approaches, to address the gaps identified in the study.