Indigenous knowledge systems and malaria prevention in Zimbabwe: a market basket analysis.

BACKGROUND: Malaria remains a major public health challenge in Zimbabwe, reporting the highest prevalence in Manicaland Province, where indigenous health practices and religious beliefs influence healthcare-seeking behaviours. Understanding the interplay between biomedical and traditional approaches is essential for designing culturally sensitive malaria control strategies. The study explored malaria prevention practices and the role of indigenous knowledge systems, including traditional and spiritual health practices, among adults in Manicaland Province, Zimbabwe. METHODS: A cross-sectional study was conducted among 480 adults aged 18 years and above, recruited through stratified random sampling. Data were collected using structured questionnaires administered in face-to-face interviews. Variables included sociodemographic characteristics, recent malaria experiences, use of indigenous and biomedical malaria prevention methods, and visits to health facilities, traditional healers, or church prophets. Descriptive statistics were computed, and association rule mining (ARM) using the Apriori algorithm in R was employed to identify frequent co-occurring behaviours and health-seeking patterns. RESULTS: Participants were predominantly female (69.0%) and within the 25-44 age range (57.5%). A majority reported employment (60.0%) and low household income (47.9%). In the previous three months, 36.7% of respondents and 54.0% of families had experienced malaria. Primary sources of indigenous knowledge included older people (27.7%), informal discussions (7.7%), and observations (5.6%). Association rule mining revealed strong linkages between visits to church prophets and avoidance of traditional healers, as well as notable patterns involving use of cow dung, health facility visits, and indigenous practices. For instance, individuals who visited prophets were highly likely not to have visited traditional healers (support = 0.66, confidence = 0.91, lift = 1.08). CONCLUSION: Health-seeking behaviour for malaria in Manicaland Province is influenced by complex interactions between spiritual, traditional, and biomedical systems. Indigenous knowledge plays a significant role in malaria prevention and treatment. Public health programmes should integrate culturally informed strategies that respect local belief systems while promoting effective malaria control interventions.