Evaluation of knowledge, perception, and attitude of malaria burden in the Upper River region of The Gambia.

BACKGROUND: Despite increased malaria interventions, the Upper River Region of The Gambia still faces a higher malaria burden compared to other parts of the country. This issue may be related to the population's knowledge of malaria, as well as environmental and socioeconomic factors that influence their prevention and treatment choices. Therefore, this study focused on assessing the level of malaria knowledge, perceptions, and attitudes among the residents of the Upper River Region, as limited studies have been conducted across the region's seven districts. METHODS: To achieve the study's objectives, a descriptive research survey using a parallel mixed method was adopted, with a robust multistage sampling approach for selecting 381 household heads involved in the quantitative study, 31 key informants, and 7 focus group discussions for the qualitative study. Descriptive statistics were performed on the assessed variables using StataSE18, and the association of socio-demographic factors with malaria prevalence was analyzed using Chi-square (Χ2). Thematic analysis was conducted for the qualitative part using NVivo. RESULTS: The results indicate a very high level of knowledge of basic malaria concepts, with a percentage index of 81. There is a statistically significant influence from factors such as district, number of health centers in the region, gender, distance to the health centre, and occupation, all at < 5%. Using a treated bed net was the most effective prevention tool, while hospital visits and herbs remain the main treatment options among the population. The trend of malaria infection shows a general decrease across most communities, although a few still experience an increase over the year. Malaria profile data reveal an 87% reduction in cases for individuals above 5 years old and a 45% reduction for those under five. Additionally, mortality rates have decreased by 98% and 89%, respectively, over the 12 years (2011-2023). DISCUSSION AND CONCLUSION: This study examined knowledge, perception, and attitudes toward malaria prevention and treatment. Results showed a high level of understanding of basic malaria concepts among the population, which influenced their perceptions and fostered a positive attitude toward managing and preventing the infection. However, differences in knowledge levels exist across districts, along with some contradictions in perceptions and attitudes. An overall decline in malaria cases has been observed across the districts and communities in the region, with a few exceptions. These findings are expected to inform the national malaria prevention efforts and assist policymakers in planning the next steps for the malaria elimination campaign.