Human Behaviour and Perceptions as Drivers for Persistent Malaria Transmission in Mudzi District, Zimbabwe: Results from Focus Group Discussions.

ObjectivesThis study aims to establish knowledge, perceptions, attitudes, and practices on malaria in Mudzi district, Zimbabwe, where there is persistent malaria transmission despite high indoor residual spraying coverage. DesignA qualitative study employing focused group discussions (FGDs) was used to establish knowledge, perceptions, and practices on malaria among the local population. NVIVO version 13 was used for content analysis. SettingThe study was conducted in a rural district located on the Zimbabwe and Mozambique border region. ParticipantsParticipants were residents of six (6) randomly selected villages in Mudzi district, Zimbabwe, aged 15 years and above. ResultsEighteen (18) FGDs were conducted with 148 individuals participating. The majority of participants were unemployed, 102 (69.9%), and had attained secondary level education, 138(94.5%). Participants showed good knowledge of malaria, but misconceptions were also reported. Participants reported high community participation in night outdoor activities, prolonged outdoor religious activities, and artisanal gold mining with minimal malaria preventative measures. Long queues at health facilities, negative attitudes of the healthcare staff, inadequate community health workers (CHWs) coverage, malaria diagnostics, and medicine stockouts were reported by participants as key hindrances to accessing malaria treatment. Indoor residual spraying (IRS) was accepted by participants as an effective malaria control intervention; however, some participants viewed IRS chemicals currently in use as less effective compared to previous ones. This perception may likely result in low IRS uptake; hence, effective education is required by program managers and spray operators. ConclusionThe study revealed complex intertwined human, economic, and social behavioural practices and perceptions that minimise the protective effect of IRS. Intensifying integrated targeted social behaviour change intervention towards key groups may reduce night outdoor activities, improve risk perception, and increase uptake of personal protective measures. Critical investment should be made in expanding human resources for health and reducing access to care bottlenecks. Strengths and limitations of this studyO_LIThis study involved focus group discussions separated by gender and age. This allowed full expression of views from all groups without hindrance from cultural and social impediments. C_LIO_LIData collection was done in multiple sites of the districts. This ensured that representatives and may improve the generalisability of the results. C_LIO_LIThe study was carried out in two majorly rural districts, and results may not be generalizable to different settings. C_LIO_LIThe selection of knowledge-rich individuals introduced bias as willing, hesitant individuals who could have been knowledgeable may have been excluded, thus depriving the FGDs of diverse views. C_LI