The variation of malaria prevention measures knowledge and their associated factors: A cross-sectional study in East Nusa Tenggara Province Indonesia

Objective Malaria is one of the major public health problems in African and Southeast Asian countries including Indonesia. However, knowledge of malaria prevention measures (MPM) is not well studied, particularly in Indonesia. This study aimed to investigate the level of MPM knowledge and associated factors among rural adults in high, moderate and low endemic settings of East Nusa Tenggara Province (ENTP) Indonesia. Methods A community-based cross-sectional study was conducted among a randomly selected 1495 households at rural ENTP. Multistage sampling technique was employed to recruit participants. Univariate and multivariable logistic regression model was used to assess factors affecting knowledge of MPM. Results The level of MPM knowledge in low, moderate, and high endemic settings differs significantly with the highest in low settings (57%, 95% CI: 50.5 – 63.5 and the lowest in high settings (19.3%, 95% CI: 11.1 – 27.5). In all settings, good level of MPM knowledge was significantly higher for adults with high SES (Adjusted odds ratio (AOR) = 2.52, 95% CI: 1.20 – 5.30; AOR=20.5,95%CI: 4.64-90.8, AOR=3.31,95%CI: 1.34-8.15 respectively) compared to those having low SES. In high and moderate settings, the likelihood of good MPM knowledge was considerately higher for adults with at least secondary (AOR=2.35, 95% CI= 1.29 – 4.36, AOR=2.66, 95% CI=1.32-5.39 respectively) than those with primary or no education level. Conclusions The good level of MPM knowledge was very low in three different malaria endemic settings. Higher level of education and high SES were significantly associated with the good level. Therefore, health education promotion on MPM knowledge is critical to support malaria elimination program in the province. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was funded by Mathematics Study Program Faculty of Science and Engineering Nusa Cendana University Kupang NTT Indonesia. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was accepted by Human Ethics Committee of the Swinburne University of Technology (reference number 20191428-1490) and the Indonesian Ministry of Health (reference letter: 164 LB.02.01/2/KE.418/2019). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors