1. education

INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015
E-ISSN: 2349-7610
Study on Distribution of Socio-Demographic Data
on Knowledge of Malaria Among Orang Asli
Communities in Pos Sinderut of Kuala Lipis
District, State of Pahang, Malaysia
Mohammad Wisman Abdul Hamid1, Adlina Suleiman2, Chan Boon Tek Eugene3,
Zulkarnain Md Idris4, Emelia Osman5
1
Dr. Mohammad Wisman Abdul Hamid, Jabatan Parasitologi & Entomologi Perubatan, Bangunan PraKlinikal
Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia
1
[email protected]
2
Prof. Dr. Adlina Suleiman, Fakulti Perubatan dan Kesihatan Pertahanan, Universiti Pertahanan Nasional Malaysia,
Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia
2
[email protected]
3
Assoc. Prof. Dr. Chan Boon Teik, Jabatan Parasitologi & Entomologi Perubatan, Bangunan PraKlinikal
Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia
3
[email protected]
4
Zulkarnain Md Idris, Jabatan Parasitologi & Entomologi Perubatan, Bangunan PraKlinikal
Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia
4
[email protected]
5
Dr. Emelia Osman, Jabatan Parasitologi & Entomologi Perubatan, Bangunan PraKlinikal
Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia
5
[email protected]
ABSTRACT
Assessment on knowledge, attitudes and practices (KAP) on malaria in endemic states of Malaysia is important to investigate and
evaluate the effectiveness of malaria control programme in the country. We conducted a descriptive cross-sectional study to assess
the knowledge domain regarding malaria among 202 Orang Asli people of Pos Sinderut in Kuala Lipis district, state of Pahang,
Malaysia. The study revealed that most of the subjects (61.9%) had no formal education and this low literacy level affected their
knowledge regarding malaria prevention. There was a significant difference between sex, age group, education level and
occupation of the subjects to certain aspects of their knowledge regarding malaria control (p<0.05). The level of knowledge on
malaria was better among subjects with the following characteristics: male, age group of 13-30 years, those with formal education
and those who are working in jungle-related occupation. In conclusion, the knowledge regarding malaria among Orang Asli in our
study is unsatisfactory and needs to be improved with educational programs.
Keywords — Knowledge, Attitude and Practice (KAP), Malaria, Orang Asli.
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E-ISSN: 2349-7610
Ethics (FF-408-2012) & Medical Research Committee,
1. INTRODUCTION
For more than 100 years of malaria control in Malaysia, not
Ministry of Health Malaysia (NMRR-12-883-13601).
many published surveys on KAP focused on the Orang Asli
3. RESULTS
community. The prevalence rate of malaria among Orang Asli
communities in district of Raub, Pahang ranges from 4.2% to
Of the 202 respondents, 73 (36.1%) were males and 129
23.1% [1]. In an effort to gain successful elimination of
(63.9%) were females. Majority of the respondents belonged
malaria transmission, efforts should be focused on local
to the age group of 31 to 40 years old (n=56, 27.7%) with a
communities to enhance their understanding of malaria,
mean age of 32 ± 13.5 years, had no formal education (n=125,
especially on the disease and its prevention, in order to reduce
61.9%) and most of them had a jungle-related occupation
or halt the disease transmission. The lack of knowledge may
(n=132, 65.3%), with monthly income less than RM200 per
give negative impact on the effectiveness of control measures
month. The demographic characteristic of the studied
[2].
The main purpose of this study was to assess the KAP
population are described in Table 1. With regards to the status
regarding malaria control among Orang Asli community in
of education level, a significant comparison was found
Pos Sinderut of Kuala Lipis district, state of Pahang,
(p<0.05) between this factor with relation to male, aged group
Peninsular Malaysia.
of 13-30 years and those who work in jungle-related
occupation.
2. MATERIALS AND METHODS
Pos Sinderut has about 14 Orang Asli villages with about 500
houses and occupied by almost 2800 households, all of whom
belong to the Senai tribe. In terms of household structure,
more than 90% of the houses are built from bamboo with no
Socio-demographic
A total of 202 participants from six villages (Kampung Kuala
N (%)
Male
73
36.1
Female
129
63.9
Age (years)
13-20
49
24.3
Bukit Long, Kampung Tual and Kampung Regang) were
21-30
43
21.3
selected during routine mass blood screening for malaria
31-40
56
27.7
performed by the Health Department of Lipis district. All
41-50
39
19.3
subjects aged 13 years and above were chosen as respondents.
>50
15
7.4
Primary
51
25.2
Secondary
26
12.9
No formal education
125
61.9
132
65.3
70
34.7
<5
69
34.2
6-10
103
51.0
>10
30
14.9
included demographic characteristics, knowledge, attitude and
practices of Orang Asli regarding malaria control.
This
questionnaire was utilized with the aid of trained interviewers.
Respondents were interviewed using the Malay language and
Jungle related (farmer,
hunter, jungle
produced, gatherer)
Collected data were analysed using SPSS software version 20
Others/housewife/not
where descriptive analysis and χ2 test were used to compare
working
Research Committee of Universiti Kebangsaan Malaysia and
VOLUME-2, ISSUE-3, MARCH-2015
±13.5
Occupation
respond to all questions were excluded from the study.
the level of significance. This study was approved by the
39
Education Level
those who left before completing the interview or failed to
the different groups. The value of p < 0.05 was considered as
SD
Gender
Sinderut, Kampung Cherong, Kampung Tidol, Kampung
The study tool was a pre-tested structured questionnaire which
Mean
characteristics
pipe water, electricity or proper toilets. The main economic
activity is farming which they depend on for their livelihood.
n=202
Family members
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INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015
E-ISSN: 2349-7610
about mosquito nets (p=0.027) and drying stagnant water
Monthly income (Ringgit
Malaysia, RM)
(p=0.029) compared to those above 30 years of age.
<200
199
98.5
>200
3
1.5
113
±103.8
Respondents with formal education had significantly higher
knowledge about mosquito nets (p=0.004) and drying stagnant
Table 1: Socio-demographic characteristics of respondents (n
water (p<0.05) compared to those without formal education.
There was an unexpected significant finding of more
= 202)
Table 2 shows the cross tabulation of socio-demographic data
against knowledge, attitude and practice. In the knowledge
domain for symptoms, it was found that there was no
significant difference between females and males for all the
knowledge on symptoms except for dizziness where the male
subjects knowledge was significantly higher than female
subjects (p=0.007). Respondents with formal education had
respondents who were in other occupation knowing about
drying stagnant water compared to those working in jungle –
related occupation (p<0.05). It was also found that respondents
with previous history of malaria had significantly more
knowledge on using mosquito nets as a control measure
(p=0.001) compared to those who had never been infected by
malaria.
significantly higher knowledge about fever (p=0.0028) and
4. DISCUSSION
chills (p=0.0018) compared to those without formal education.
Respondents who were working in jungle–related occupation
had significantly higher knowledge of the symptoms of
dizziness (p=0.010), headache (p=0.006) and loss of appetite
(p=0.018) compared to those with other forms of occupation.
Respondents with previous history of malaria had significantly
more knowledge on all symptoms of fever, chills, dizziness,
headache and loss of appetite (all p<0.05) compared to those
Local community knowledge, attitudes and practices of
malaria and it’s prevention measures is an integral part of the
planned malaria elimination strategy. In Malaysia, various
malaria control activities as part of the control program have
been carried out and have managed to reduce malaria with
cases falling from 60,000 in 1995 to 6,650 in 2010 [3].
Although these malaria control programs are quite impressive,
the assessment of KAP has a very important role to indicate
who had never been infected by malaria.
the true meaning of a successful malaria control program [4].
For knowledge on route of transmission it was found that there
was significant difference in gender whereby males had more
knowledge than females on the route of transmission of
mosquito
(p=0.013).
bite
(p<0.05)
Respondents
and
with
unhygienic
formal
This study mainly focused on knowledge domain regarding
malaria infection among the Orang Asli who live in the
malaria endemic area in Peninsular Malaysia.
surroundings
education
had
significantly higher knowledge about mosquito bite (p=0.001)
and unhygienic surroundings (p=0.002) compared to those
without formal education. It was found that respondents with
previous history of malaria had significantly more knowledge
on mosquito bite (p<0.05) and unhygienic surroundings
(p=0.03) compared to those who had never been infected by
malaria.
For knowledge on control measures it was found that there
was no significant difference between females and males for
all the knowledge on control measures except for mosquito net
where the males knowledge was significantly higher than
females (p<0.05). As for age groups, there was significant
difference, whereby more of those aged between 13-30 knew
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INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015
Characteristics
Sex
Male
Female
(n=73)
(n=129)
Fever
52.1
42.6
Chills
53.4
41.5
Dizziness
46.6
Headache
Loss of appetite
Age (years)
13-30
>30
(n=93)
(n=109)
0.197
44.1
47.7
0.14
44.1
48.6
27.9
0.007*
32.3
37
24.8
0.067
32.9
21.7
0.081
p
value
E-ISSN: 2349-7610
Education level
Informal
Formal
(n=125)
(n=77)
0.607
40
55.8
0.519
40
57.1
36.7
0.509
29.6
29
29.4
0.96
23.7
27.5
0.531
p
value
Previous history of
Occupation
p
value
Junglerelated
Others
malaria infection
p
value
Yes
No
(n=69)
(n=133)
p
value
(n=132)
(n=70)
0.028*
50
38.6
0.121
85.5
25.6
0.000*
0.018*
50.8
38.6
0.098
87
25.6
0.000*
42.9
0.054
40.9
22.9
0.010*
73.9
14.3
0.000*
26.4
33.8
0.263
35.6
17.1
0.006*
62.3
12
0.000*
23.2
29.9
0.292
31.1
15.7
0.018*
52.2
12
0.000*
Symptoms
Mean % of knowledge for symptoms
37.9
Route of transmission
Mosquito bite
64.4
37.2
0.000*
49.5
45
0.522
37.6
62.3
0.001*
46.2
48.6
0.749
65.2
37.6
0.000*
Unhygienic surroundings
34.2
18.6
0.013*
24.7
23.9
0.885
16.8
36.4
0.002*
22
28.6
0.298
33.3
19.5
0.030*
Polluted food
86.3
89.9
0.436
84.9
91.7
0.13
92
83.1
0.054
90.2
85.7
0.345
87
89.6
0.593
Mean % of knowledge for route of transmission
52.9
Control measures
Mosquito net
97.3
76.7
0.000*
90.3
78.9
0.027*
78.4
93.5
0.004*
83.3
85.7
0.659
95.7
78.2
0.001*
Drying stagnant water
37
37.2
0.975
45.2
30.3
0.029*
27.2
53.2
0.000*
28
54.3
0.000*
43.5
33.8
0.179
Using insecticides
45.2
39.5
0.432
43
40.4
0.704
42.4
40.3
0.764
43.9
37.1
0.351
46.4
39.1
0.32
Mean % of knowledge for control measures
55.5
Mean % of knowledge domains
49.4
*p<0.05
Table 2: Socio-demographic data against knowledge domains (n = 202)
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E-ISSN: 2349-7610
From the survey, we found that only 38.1% of the subjects had
or other means of personal protection, would raise the risk of
formal education and male subjects had better education than
getting malaria by 5 times (Hanafi-Bojd et al, 2011). In our
female subjects (52.1% and 30.2% respectively, p<0.05).
study we found that there is a significant correlation between
Indirectly, this low literacy rate had affected the way the
gender, age group, education level and history of malaria
subjects could understand and answer the questionnaires. This
infection with using of mosquito nets (p<0.05).
shows that literacy rate is an important protective factor
District Department had distributed mosquito nets and gave
against malaria morbidity as shown by a previous study [5]. A
indoor residual spray (IRS) in this community according to
study in Iran had found that education level showed a
their schedule. But in our observation, the use of mosquito
significant role in using bed nets and those who had better
nets and IRS were not enough to control malaria because of
education level had more interest to participate as volunteers.
their sleeping habit and in fact most of them are dependent on
[4]. The level of knowledge is also better among the group
intervention by Health District Department. In this case,
with age range of 13–30 because 63.4% of them had an
education program is needed to encourage people in this
opportunity to get formal education compared to only 16.5%
community to use mosquito nets.
Health
subjects that had formal education in age group of 30 years
and above (p<0.05). Subjects who were involved in jungle-
Overall, we found that the knowledge regarding malaria
related occupation also had better knowledge even though
among Orang Asli at Pos Sinderut against malaria was
68.9% had no formal education (p<0.05). Among them, 78.3%
inadequate. Authorities should institute measures to improve
(p<0.05) had previous history of malaria infection. It could be
the KAP among Orang Asli community in an effort to control
concluded that they could have the knowledge about malaria
malaria. Within the Orang Asli community in Pos Sinderut,
through their personal experience with malaria infection.
health education must be emphasized and followed by an
effective communication process to increase the knowledge
Regarding the knowledge on signs and symptoms, fever and
concerning malaria, especially among women, those who aged
chills are the most commonly mentioned by the subjects since
30 years and above and those who do not have formal
these two symptoms are very obvious in a person who is
education. Awareness campaigns need to be increased with
infected with malaria parasites. This findings is in accordance
augmentations on the importance of practice to prevent
to a study conducted in Swaziland where more than 70% of
malaria infection.
the subjects noticed fever and chills as the signs and
symptoms of malaria [6]. Similar trends were also observed in
5. CONCLUSIONS
other studies whereby fever and chills became the most
In conclusion, there are still deficits in the knowledge on
frequently mentioned signs and symptoms (more than 50%)
malaria symptoms and transmission among Orang Asli
such as studies conducted in Pos Betau [7], rural Tigray,
community in Pos Sinderut. Health education should be
Ethiopia [8] and in Jamnagar District, India [9].
focusing more on women, those aged above 30 years and
those who do not have formal education. In order to improve
Observation regarding preventive measures showed that most
knowledge
of the subjects (84.2%) believed that regular use of mosquito
Department need to strategize an effective way to deliver
nets could prevent mosquito bites and malaria. Similar
information about malaria through primary health centre and
findings were also noted in the previous study in Pos Betau
also through community leaders. Most importantly different
[7], Vietnam [10] and in Tanzania [11] which demonstrated
target groups need different educational strategies when
that most of the subjects could associate malaria with
delivering health information regarding malaria. It is hoped
mosquito bites. Awareness about various methods of
that by strengthening the strategic approach, the national goal
preventing malaria such as drying stagnant water and using
of eliminating malaria by the year 2020 would be achieved
insecticide spray were also demonstrated in this study.
and the political, economic, administrative and technical
Previous study in Iran found that by not using mosquito nets
issues would be addressed.
VOLUME-2, ISSUE-3, MARCH-2015
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among
this
community,
Health
District
121
INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015
[8]
ACKNOWLEDGMENT
E-ISSN: 2349-7610
J. Paulander, H. Olsson, H. Lemma, A. Getachew, and
This work was supported by Universiti Kebangsaan Malaysia
M. San Sebastian, “Knowledge, attitudes and practice
Fundamental Research Grants (FF-408-2012). This study is
about malaria in rural Tigray, Ethiopia,” Glob Health
part of MMedSc. dissertation of the first author, Universiti
Action 2, 2009.
Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
[9]
K. M. Dhaduk, K. M. Gandha, B. N. Vadera, J. P.
Mehta, D. V. Parmar and S. B. Yadav, “A Community
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