Report on Malaria Baseline Survey in Two Woredas of Zone 5 in Afar Region, Northeast Ethiopia AMREF in Ethiopia June 2008 Addis Ababa, Ethiopia Acknowledgements This baseline survey was funded by the AMREF in Ethiopia. We give special thanks to Mr. Samuel Hailu, Mr. Berhane Hailesellassie, and Mr. Tilahun Negatu, all from AMREF in Ethiopia, for their technical assistance throughout the design, questionnaire development, and data collection fieldwork. We are also grateful to Dr. Alemayehu Seifu, Head of Health Programs at AMREF in Ethiopia, for his leadership during all stages of the survey implementation. We also owe a debit of gratitude for the supervisors, data collectors and above all, to the respondents for their participation in this study. We are also grateful to Dr. Wakgari Deressa, from the School of Public Health at Addis Ababa University in Ethiopia, who participated in the design and development of data collection tools, fieldwork data collection, analyzed the data and prepared the draft report of the baseline survey on malaria prevention and control in Zone 5 of Afar Region. AMREF in Ethiopia Draft Report June 2008 i Abbreviations ACTs Artemisinin-based Combination Therapies AIDS Acquired Immuno-Deficiency Syndrome AMREF African Medical and Research Foundation BCC Behaviour Change Communication CHWs Community Health Workers DDT Dichloro-Diphenyl-Trichloroethane DHS Demographic and Health Survey GFATM Global Find to Fight AIDS, Tuberculosis and Malaria HEW Health Extension Worker HH Household HIV Human Immuno-deficiency Virus HMM Home-based Management of Malaria IEC Information, Education and Communication IRS Indoor Residual Spraying ITNs Insecticide Treated Nets LLINs Long Lasting Insecticidal Nets MDGs Millennium Development Goals MOH Ministry of Health NGOs Non-Governmental Organizations PMPT Participatory Malaria Prevention and Treatment RBM Roll Back Malaria RDTs Rapid Diagnostic Tests SD Standard Deviation SPSS Statistical Package for Social Sciences WHO Woreda Health Office AMREF in Ethiopia Draft Report June 2008 ii Table of Contents Page Acknowledgements .............................................................................................................. i Abbreviations ...................................................................................................................... ii Table of Contents .............................................................................................................. iii List of Tables ...................................................................................................................... v Executive summary .......................................................................................................... vii 1. Introduction ................................................................................................................... 1 1.1 Country profile ......................................................................................................... 1 1.2 Malaria situation in Ethiopia .................................................................................. 1 1.3 Afar Region .............................................................................................................. 3 1.4 AMREF in Ethiopia ................................................................................................. 4 2. Objectives of the baseline survey ................................................................................... 7 3. Methodology ................................................................................................................... 7 3.1 Study areas ............................................................................................................... 7 3.2 Study design.............................................................................................................. 8 3.3 Study population ...................................................................................................... 8 3.4 Sample size calculations .......................................................................................... 8 3.5 Sampling strategy ..................................................................................................... 9 3.6 Questionnaire development ................................................................................... 10 3.7 Training of field personnel and data collection .................................................... 11 3.8 Data analysis and presentation.............................................................................. 13 4. Ethical considerations ................................................................................................. 13 5. Findings ........................................................................................................................ 14 5.1 Qualitative findings ................................................................................................ 14 5.2 Quantitative findings.............................................................................................. 19 5.2.1 Population characteristics ............................................................................... 19 5.2.2 Household size ................................................................................................. 23 5.2.3 Households ownership of basic durables ........................................................ 24 5.2.4 Household’s source of drinking water and sanitation facilities ...................... 25 5.2.5 Household’s sleeping area arrangements ....................................................... 26 AMREF in Ethiopia Draft Report June 2008 iii 5.2.6 Exposure to mass media and sources of information about malaria............... 27 5.2.7 Respondent’s perceived major health problems .............................................. 28 5.2.8 Respondent’s knowledge about transmission and causes of malaria .............. 29 5.2.9 Respondent’s knowledge about mosquito biting time ...................................... 31 5.2.10 Respondent’s knowledge about malaria symptoms ....................................... 32 5.2.11 Respondent’s perceived severity of malaria .................................................. 33 5.2.12 Respondent’s knowledge about malaria treatment and antimalarial drugs .. 34 5.2.13 Respondent’s knowledge and practices about malaria prevention ............... 35 5.2.14 Treatment seeking behaviour for malaria...................................................... 36 5.2.15 Current ITNs ownership and use ................................................................... 39 6. Discussion and conclusions ........................................................................................ 52 7. Recommendations ....................................................................................................... 54 8. Annexes ........................................................................................................................ 55 AMREF in Ethiopia Draft Report June 2008 iv List of Tables Page Table 1: Type of health facilities and health personnel category by woreda, May 2008 ..15 Table 2: Socio-demographic characteristics of the respondents by woreda, May 2008....20 Table 3: Marital status of the respondents by woreda, May 2008 .....................................21 Table 4: Educational status and literacy of the respondents by woreda, May 2008 ..........22 Table 5: Occupational status of the respondents by woreda, May 2008 ...........................23 Table 6: Household size of the respondents by woreda, May 2008 ..................................24 Table 7: Households ownership of basic durables by woreda, May 2008 ........................25 Table 8: Main source of drinking water and latrine possession for survey households by woreda, May 2008 ..................................................................... 26 Table 9: Sleeping area arrangements of household members by woreda, May 2008 .......27 Table 10: Respondent’s media exposure by woreda, May 2008 ......................................27 Table 11: Respondent’s exposure to sources of information in the last three months by woreda, May 2008 .......................................................................... 28 Table 12: Respondent’s perceived major health problems by woreda, May 2008 ............29 Table 13: Respondent’s knowledge about transmission and causes of malaria by woreda, May 2008 ....................................................................................... 30 Table 14: Respondent’s knowledge about transmission and causes of malaria by sex and residence, May 2008 ....................................................................... 31 Table 15: Respondent’s knowledge about mosquito biting time by woreda, May 2008...31 Table 16: Respondent’s knowledge about malaria symptoms by woreda, May 2008 ......32 Table 17: Respondent’s perceived severity of malaria to different population groups by woreda, May 2008............................................................................ 33 Table 18: Respondent’s perception about malaria treatment and antimalarial drugs by woreda, May 2008.............................................................................. 34 Table 19: Respondent’s perception and household’s practice about malaria prevention by woreda, May 2008 .................................................................... 35 Table 20: Preferred source of initial visit for malaria treatment by woreda, May 2008 ........................................................................................................