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. VOLUME-2, ISSUE-3, MARCH-2015 COPYRIGHT © 2015 IJREST, ALL RIGHT RESERVED 117 INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015 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 COPYRIGHT © 2015 IJREST, ALL RIGHT RESERVED 6 118 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 VOLUME-2, ISSUE-3, MARCH-2015 COPYRIGHT © 2015 IJREST, ALL RIGHT RESERVED 119 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) VOLUME-2, ISSUE-3, MARCH-2015 COPYRIGHT © 2015 IJREST, ALL RIGHT RESERVED 120 INTERNATIONAL JOURNAL FOR RESEARCH IN EMERGING SCIENCE AND TECHNOLOGY, VOLUME-2, ISSUE-3, MARCH-2015 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 COPYRIGHT © 2015 IJREST, ALL RIGHT RESERVED 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 REFERENCES [1] level KAP study on mosquito control in Jamnagar G. Kaur, “Prevalence of clinical malaria among an district,” Natl J Community Med, vol 4(2), page 321- Orang Asli community in Malaysia,” Southeast Asian J 328, 2013. Trop Med Public Health, vol 40(4), page 665-73, 2009. [2] R. E. Klein, S. C. Weller, R. Zeissig, F. O. Richards and T. K. Ruebush, “Knowledge, beliefs, and practices in relation to malaria transmission and vector control in Guatemala,” Am J Trop Med Hyg, vol 52(5), page 383- Caruana, B. A. Biggs and M. 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