Qualitative research and cross-sectional survey methods were used in a study conducted in rural and urban areas of the Greater Accra Region, Ghana, to explore people's understanding of the cause of malaria and patterns of mosquito avoidance, in particular bed net ownership and use. The study indicated far higher bed net ownership and use in rural than urban areas, which was related partly to perceived affordability and partly to the different contexts of and reasons for avoiding mosquitoes. Knowledge of an association between mosquitoes and malaria, the most common cause of illness in both areas, was related to residence but not to literacy or formal education, and this knowledge did not predict bed net use. The paper points to the complexity of social and personal factors implicated in behavioural interventions for malaria control, and questions behavioural models that assume a linear relationship between knowledge and practice.
PIP: In the absence of a vaccine or effective and sustainable means of vector control, public health interventions remain the main means of reducing the incidence of malaria. The most promising current intervention which both limits mosquito bites and kills the vector is the use of insecticide-impregnated bed nets and/or curtains. This paper reports data collected during field trials for the development of the Malaria Manual, conducted in August-September 1992. Qualitative research and cross-sectional survey methods were used in a study conducted in rural and urban areas of the Greater Accra Region, Ghana, to explore people's understanding of the cause of malaria and patterns of mosquito avoidance, especially bed net ownership and use. The level of bed net ownership and use was far higher in rural than urban areas. That difference was partly related to perceptions of affordability and partly to the different contexts of and reasons for avoiding mosquitoes. Knowledge of the existence of an association between mosquitoes and malaria, the most common cause of illness in both areas, was related to residence but not to literacy or formal education. That knowledge, however, did not predict bed net use. Different social and personal factors must be considered when behavioral interventions for malaria control are designed and implemented. Behavioral models which assume a linear relationship between knowledge and practice should be regarded with caution.