The Knowledge, Attitudes and Practices of Malaria and The Risk of Malaria Infection Among Chinese Population in Sierra Leone
Authors: Tu Hong , Ning Zhao , Feng Jun , Yin Jianhai , Xia Zhigui , Duan Zhaojun , Zou Xiaohui , Wang Lili , Liu Yang , Wan Jiayu , Zhao Yingze , Zheng Xiao , Sun Yong , Ma Jiangtao , Luo Wei 
Published: September 2020

Abstract
Background: The risk of malaria importation from malaria hyperendemic regions has threatened the achievement of the malaria elimination goal of China. However, few studies have focused on malaria control interventions among Chinese population in Africa. The aims of this study were to assess the knowledge, attitudes and practices (KAP) of malaria and the risk of malaria infection among Chinese population in Sierra Leone, then to improve the knowledge of malaria among Chinese population in Sierra Leone through health education interventions. Methods: Cluster random sampling method was undertaken to select the overseas Chinese from 27 Chinese institutions as respondents in Sierra Leone. Cross-sectional surveys of malaria KAP and the risk of malaria infection were performed on respondents by trained investigators. Health education training were conducted to educate respondents knowledge of malaria after the surveys. The same questionnaires of malaria KAP as before the training were used to evaluate the effect of health education interventions. Correlation analyses of results were performed by T test, ANOVA, Chi-Square and Logistics regression model.Results: A total of 134 respondents fully completed questionnaires were analyzed before health education training with mainly engaged in (73.88%) outdoor work. Majority of participators (82.84%) were from 20 Chinese provinces. About half of participators (49.25%) had not received malaria health education before going abroad. The practices of prevention malaria were used in most respondents, 84.33% (113/134) used mosquito net every day, 90.30% (121/134) were equipped with screen doors and Windows in their dwellings, 73.88% (99/134) used mosquito repellent when going out, and 74.63% (100/134) used mosquito insecticide at home. The average awareness rate of malaria knowledge of respondents without malaria training before going abroad (41.69 %) was significantly lower than that of with malaria training (53.41%) (T =3.337, P=0.001).According to Logistics regression analysis, age (OR=2.6, 95%CI(1.0,8.8)) and male (OR=3.2, 95%CI(1.1,9.4)) were the main factors whether the awareness rate of malaria knowledge reaches 60% before the training. After health education training, the awareness rate of malaria knowledge of 134 respondents increased to 87.62 %, which was significantly higher than that of before the training (44.4%) (P < 0.05). 29.10% (39/134) of all respondents had infected malaria in the past year. 37.37% (37/99) of outdoor workers were infected with malaria, which was significantly higher than 5.71% (6/35) of indoor workers with a significant difference (χ2=12.561, P=0.000).According to Logistics regression analysis, outdoor work was the main risk factor for malaria infection (OR=6.5, 95%CI(1.3,31.7)).Conclusion The Chinese in Sierra Leone lacked malaria knowledge training with a low awareness of malaria knowledge, and had inadequate personal prevention with high risk of malaria infection. Health education training could improve their knowledge of malaria. That implies the publicity of malaria prevention and control and outdoor prevention and control measures for overseas Chinese in Sierra Leone should be strengthened.