Focus Group Discussions
In all the FGD groups, only few participants stated that mosquito bite could lead to the occurrence of malaria. Many participants were of the view that malaria was caused by eating contaminated food, drinking of dirty water and staying long in the sun. Majority of the participants stated correctly that malaria could lead to death and that the disease was a serious illness that needs to be treated promptly.
The prevailing malaria treatment seeking behaviour in the two study communities were discussed and most FGD participants disclosed that use of local herbs was usually the first treatment action for malaria episodes. It was revealed further that use of local herbs could be followed by use of modern anti-malaria drugs such as chloroquine and fansider. Most FGD participants noted that people visit formal health care facilities such as clinics or hospital for care only when home management practices failed.
In response to a general question which focused on where mosquitoes breed, majority of the FGD participants stated correctly that mosquitoes could breed on the surface of stagnant water as well as on large leaves which hold water in bushy environments. It was suggested by discussants that in other to control or prevent mosquito breeding, farmers should always remove empty containers which can hold water and clear off stagnant water in the surroundings.
Another suggestion by most FGD participants which is not tied specifically to mosquito breeding but could also help in the control of mosquitoes' abundance was that the Nigerian government needs to enforce health policies and laws by deploying sanitary inspectors to communities to promote environmental sanitation
A question which focused on the cause of malaria in the community was broadly asked with a view to determining whether FGD participants would be able to link some of their agricultural practices to mosquito breeding and the prevalence of malaria. A clear difference in perception of the cause of malaria by chorological age was noted. Nine of the participants in both communities directly linked agricultural practices with mosquito breeding. A majority of the FGD participants aged 20 to 40 years irrespective of gender differences were however able to associate mosquito bites with the occurrence of malaria. The view that malaria is caused by working too hard in the heat of the sun cuts across both sexes among those aged 41 years and above with only few associating malaria occurrence with the bite of mosquitoes.
The mean age of respondents was 38.7 ± 16.2 years. Majority (81.7%) of respondents were of the Yoruba ethnic group, 60.0% males, 67.2% married and 50.3% had secondary school education. Many (45.2%) of the farmers engaged in crop farming and were in the low wealth-quintile (48.1%). Nearly half (49.0%) obtained domestic water supply from rivers or streams (See table 1 for details of the socio-demographic characteristics).
Knowledge of Malaria
The semi-structured questionnaire used contained a 15-point knowledge scale for the assessment of the following malaria related knowledge issues: cure; signs and symptoms, prevention; consequences; treatment; and practices which promote and prevent the breeding of mosquitoes. Respondent's overall mean knowledge score was 9.1 ± 2.8 while the mean knowledge score for Fasola and Soku were 9.1 and 9.0 respectively with no significant differences when t-test was used to compare them.
Knowledge scores ranging from 0-5, 6-10 and 11-15 points were described as low, average and high respectively. Overall, majority (68.2%) had average knowledge scores. Few (6.8%) had low scores while 25.1% had high knowledge scores. These scores are indicative of the urgent challenges for health education in the study communities.
The respondents' perceived causes of malaria are shown in table 2. Most of the listed causes are misperceived. Consumption of contaminated food or water (35.4%) topped the list of such misconception followed by "staying for a long time in the sun" (20.0%). Only 12.4% could correctly link mosquito with the possible occurrence of malaria. Clearly, respondents' knowledge of the cause of the disease in the scientific par lance is abysmally low.
Few respondents could correctly outline the signs and symptoms used for recognizing a case of malaria (See table 3). The correctly listed possible signs and symptoms of malaria included high body temperature (13.8%); body pains (12.9%) headaches (8.3%), body weakness (7.7%) and cold (4.1%). The appropriate treatment seeking behaviour in terms of the time when treatment action should be initiated was sought. Most farmers in Fasola (95.0%) and Soku (89.7%) stated correctly that an episode of malaria should be treated promptly once signs/symptoms of the disease appear. Awareness of the preventable nature of malaria was also high among respondents in Fasola (88.9%) and Soku (86.7%). Farmers' relative vulnerability to malaria was determined. Overall, majority of the farmers in Fasola (95.0%) and Soku (87.2%) were of the perception that farmers are more susceptible to malaria compared with other people.
Practices related to Malaria prevention
The determination of respondents' practices for preventing mosquito breeding revealed that the clearing bushes around dwelling units with a view to eliminating hiding places for mosquitoes and removal of large leaves that can hold water were more practiced in Fasola (64.1%) than Soku (47.3%). Equal proportions of respondents in both communities (62.3%) removed heaps of cassava tuber peelings that can facilitate the collection of pools of water in the farms. A few respondents in Fasola (29.1%) and Soku (37.3%) cleared the ditches in their farms regularly with a view to interrupting mosquito breeding.
The methods used in homes to prevent mosquito bites are highlighted in table 4. The adoption of Insecticide Treated Nets (ITNs), a technology promoted through the Roll Back Malaria initiative in Nigeria, was low in both communities as only 6.1% of respondent in Fasola and 3.8% of their counterpart in Soku used ITNs. The other methods adopted by some respondents included use of the following: brooms for the physical killing of mosquitoes (25.3%), mosquito coils (25.9%); electric fan (18.7%); and insecticide sprays (11.9%). The other details are shown in the table 4.
The observed agricultural practices that favour mosquito breeding in the farms are depicted in table 5. Overall, the practice of dumping cassava tuber peeling was observed in 10 farms (50.0%) in each community. The practice of soaking peeled cassava tubers in water in large uncovered plastic containers was observed in 11 farms (55.0%) in Fasola and nine (45.0%) in Soku. The two aforementioned practices constituted the leading factors that promote mosquito breeding in the farms. Dug trenches were observed in 7 farms each in Fasola and Soku. The observed minor environmental factors with potential for promoting mosquito breeding was the presence of three dams in Fasola and one in Soku.
Some other environmental conditions which favour mosquito breeding included presence of heaps of large dry leaves which hold water during the rainy season in both Fasola (65.5%) and Soku (40.0%), presence of run-off water from cassava fermentation spots in nine farms each in Fasola and Soku, uncleared stagnant water (Fasola, 35.0%; Soku, 55.0%), swampy environments (Fasola, 45.0%; Soku 30.0%) and presence of stored water for domestic use in uncovered tanks (Fasola, 20.0%; Soku, 55.0%).