Publication: Development and validation of malaria knowledge questionnaire and the level of malaria knowledge among population in Kuala Krai and Gua Musang, Kelantan
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Date
2024-06
Authors
Ismail, Mohd Hafiz Che
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Abstract
Background: Malaysia has made significant progress in reducing malaria cases, achieving zero local transmission in 2018. However, imported cases continue to pose risks of reintroduction. Assessing local knowledge is vital for targeted education as it empowers communities with the information necessary to take appropriate actions to prevent malaria transmission, thereby reducing the risk of transmission and contributing to the overall goal of malaria elimination.
Objective: This study aimed to develop and validate a questionnaire assessing local communities' malaria knowledge and compare this knowledge among residents in low, medium, and high-risk areas in Kelantan, Malaysia.
Methodology: The study was conducted from June 2023 to February 2024. It is comprised of two phases. Phase 1 focused on developing a new questionnaire and validating it. A draft of the questionnaire was established from a literature review and expert input via the Nominal Group Technique. Then, the questionnaire was validated using content validity, face validity and construct validity. Content validity was conducted among experts in public health, and face validity among local communities. Construct validity was analysed using a two-parameter item response theory, involving 300 participants. Subsequently, Phase 2 involved a cross-sectional study involving 159 participants assessing the knowledge on malaria among residents in low, medium, and high-risk areas in Kuala Krai and Gua Musang districts, Kelantan. The newly validated self-administered questionnaire from Phase 1 was utilised. The data was then subjected to descriptive analysis and two-way ANOVA analysis.
Result: The new questionnaire comprised of 53 items across the seven domains. The domains are transmission, risk of malaria infection, vector, symptoms, complications, treatment and management, and prevention measures. The questionnaire demonstrated good content (S-CVI/Ave = 0.99, S-CVI/UA = 0.92) and face validity (S-FVI = 1.0, S-FVI/UA = 0.99). The 2-PL IRT analysis show that the questionnaire has good model fitness and acceptable difficulties and discrimination parameters, with reliability of the domains ranges from 0.62 to 0.83. The ANOVA analysis revealed that residents in high-risk areas had the highest estimated marginal mean knowledge score of 35.0 (95% CI: 32.8, 37.2), followed by those in medium-risk areas, 34.4 (95% CI: 32.2, 36.6), with the lowest scores in low-risk areas, 29.0 (95% CI: 26.8, 37.2). The high and medium-risk area residents had significantly higher knowledge scores than low-risk residents (p < 0.001), however there is no significant difference between high-risk area residents and medium-risk residents (p = 0.927).
Conclusion: The developed questionnaire is reliable for assessing malaria knowledge in the context of the local community in Malaysia. Residents in low-risk areas exhibited a more significant knowledge deficit compared to those in medium- and high-risk areas. Comprehensive community health education, including in low-risk areas, should be continued given the potential risk of malaria transmission.
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Keywords
malaria , knowledge