| 1. |
Tribal knowledge about malaria is poor |
1. Culturally inappropriate health education material2. CHWs do not understand or speak tribal language |
1. Lack of access to education due to poverty predisposes to poor knowledge about malaria |
1. Residence in remote locations prevents access to schools2. CHWs may not be able to reach villages on a regular basis and provide health education |
| 2. |
Heavy reliance on traditional healers and informal providers for evaluation of fevers |
1. Belief in spiritual cause of physical symptoms2. Prior experience of rapid symptomatic relief with treatments from informal providers3. Prior experience of physicians not being present at the PHCs |
1. Lack of mechanized transport due to poverty creates difficulties in accessing the PHCs or other formal providers |
1. Difficulty accessing the PHCs due to remote area of residence |
| 3. |
Surveillance and diagnosis of malaria is inadequate |
1. Delays in malaria diagnosis due to treatments from traditional healers first2. Vacant posts of NVBDCP officials due to insurgency factors in the district |
1. Preferring locally available treatments to save costs of travel and lost wages |
1. Health workers cannot make timely visits for surveillance especially during rainy seasons2. Delays in the diagnosis of malaria due to longer time needed to transport slides to a laboratory and get the results3. Stock-outs or other supply chain difficulties create medication shortages in rural areas |
| 4. |
Adherence to antimalarial medications is poor |
1. Practice of stopping anti-malarials as soon as there is symptomatic relief2. Counseling by traditional healers not to take anti-malarials3. Oral medications are perceived as ineffective |
1. Lack of education due to poverty predisposes to illiteracy, poor knowledge about malaria and poor adherence to medications |
|
| 5. |
Malaria prevention with ITNs and IRS is inadequate |
1. ITN use affected by cultural practices e.g. only males using ITNs due to their higher social status2. Use of ITNs for other purposes such as fishing3. Reluctance to IRS due to concern for contamination of belongings4. Not allowing IRS in rooms where household altars or deities are located |
1. Poor purchasing capacity due to poverty decreases use of ITNs |
1. Need to travel longer to purchase ITNs as they are not easily available in local markets |
