Knowledge, perception and practices about malaria, climate change, livelihoods and food security among rural communities of central Tanzania

Socio-demographic characteristics of the respondents

A total of 399 individuals were interviewed. The age of respondents varied between
16 and 98 years with mean of 39.8 (SD?=?15.5). Of these, females accounted for three
quarters of the respondents. Most (62.41%) of the respondents had attained primary
school education. Majority (91.23%) were involved in farming activities as the main
occupation (Table 1).

Table 1. Socio-demographic characteristic of respondents (N?=?399)

Knowledge of malaria

Awareness of the existence of malaria in the sample population was high. Majority
(97.5%) of the respondents indicated to have heard of malaria. Three quarters (73%)
reported that most people get sick from malaria during the rainy season. Nearly all
(94.7%) knew that malaria is acquired through a mosquito bite, and virtually all (99.5%)
confirmed that mosquitoes were present in their homes and in the surroundings. About
50% of the respondents felt that malaria had decreased in their village during the
last 10 years, presumably leaving the other half unimpressed by malaria changes and
mosquito abundance. The most commonly known symptom of malaria was fever (66.7%),
followed by headache (44.4%), joint pains (43.6%), and nausea/vomiting (40.9%). Poorly
known symptoms were diarrhoea (18.8%), convulsions (2.0%), and anaemia (1.5%).

Nearly all (95.5%) respondents mentioned the use of insecticide treated mosquito nets
(ITN) as the main method of malaria prevention. Only a small proportion of the respondents
mentioned other vector control methods including use of mosquito coils (4.8%); indoor
residual spraying (6.8%); and larviciding (0.8%). Majority (78.7%) of the respondents
believed that mosquito nets were the most effective method for preventing malaria.
Environmental management of malaria was poorly known by the respondents. For instance,
cleaning the environment around the homes was mentioned by 23.3% of the respondents
while clearing grass and bushes around homes was mentioned by 12.5%. A large proportion
(85.2%) of the respondents was of the opinion that reducing the population of mosquitoes
would reduce malaria incidents.

Reported availability of ITN in the households was very high (98.90%), with an average
of at least 2 nets per household. Almost all (96.0%) reported to have slept under
a mosquito net the previous night. However, 17.0% of the respondents said there were
some nights they did not sleep under a mosquito net. About 87.0% reported receiving
at least one ITN for free from a government source, and 12% had received a subsidized
net from the national voucher scheme. Slightly over a quarter (26.9%) reported to
have bought at least one ITN, indicating that nets were a priority for these households.
The majority (98%) of the respondents reported that they sought health care from government
health facility when a household member fell sick. However, among them, 12.0% mentioned
to seek care from drug stores. A few respondents (18.3%) admitted that sometimes they
do not seek treatment from health facilities when someone in the household suffers
from malaria. Of these, 4.8% reported not seeking treatment from health facilities
because of the high cost.

Livelihoods and malaria risk

Standing water (57.9%) and environmental factors including presence of grasses (42.9%)
were the most frequently mentioned factors affecting mosquito abundance in and around
homes. Climatic factors were not as commonly associated with malaria risk: only 35.8%
mentioned amount of rainfall, 11.3% temperature, and 2.0% relative humidity. Although
the respondents apparently knew that the state of the environment around the village
contributes to mosquito breeding, they did not connect that standing water and grass
growth are influenced by climatic events. Some 40.0% of the respondents did not know
the linkages between crop farming and malaria prevalence. However, 30% of the respondents
believed that rice farming contributed to malaria, and only 11% mentioned maize farming,
which is the dominant occupation among the community members.

Over one-third of the respondents had outdoor activities starting before 5 am in the
morning. Majority (92%) of the respondents admitted to wake up early in the morning
to travel to their farms where they worked for the whole day. Travel time from homes
to farms was approximated to take between one and three hours (~4-10 km). Over half
(55.0%) of the respondents reported that there are times when they stay overnight
in their farms, mostly during harvesting season. Staying overnight in the farms was
described as necessary to reduce travel time to and from the farm, protecting crops
from domestic and wild grazing animals as well as protecting crops from birds and
insect pests. Encouragingly, 82.0% reported that they brought mosquito nets to protect
themselves from mosquito bites while sleeping in the farms.

Knowledge and perceptions on climate change

Only one in four understood the official Kiswahili term for climate change known as
Mabadiliko ya Tabia Nchi. However, there was a general understanding that the rain patterns have changed in
the past 10 years (less than 5% said there were no changes). There were a range of
descriptions for this change: 35.0% said the rains begin earlier, while 21.0% said
rains begin late; 22.0% said that there is more total rain than ever before, but 10%
said there is less total rain; 38.0% described the rains as being more unpredictable.

Most of the respondents who described that the rain pattern was unpredictable adopted
irrigation practices (60%) and about half (46%) initiated use of agricultural inputs
and equipment, while 40% changed crop type and variety. The perception that rain began
earlier was associated with changing crop type or variety. These differences were
described more by male than female respondents (test of proportion, p-value??0.001)
(Figure 2).

Figure 2. Community perception on rainfall pattern for the past 10 years and resilience in the
farming practices.

There was more agreement on temperature change, with 62.0% believing that the temperature
has increased in the last 10 years (19.0% said there had been a decrease in temperature
while 18.0% said there was no change). Most of the respondents who perceived that
the temperature has increased changed crop type and/or variety (63%) while 56% started
to use more agricultural inputs and equipment and 40% moved to irrigation practice.
Similar to the changes in rainfall pattern, the impact of temperature changes was
described more frequently by male than female respondents (test of proportion, p-value??0.001)
(Figure 3).

Figure 3. Community perception on temperature pattern for the past 10 years and resilience in
the farming practices.

Respondents with primary education were more likely to perceive temperature increases
than those with secondary or higher education, while those with secondary or higher
education were more likely to be concerned with unpredictable rain patterns (Chi-square
test, p-value 0.001). Older individuals (45 years) were also more concerned with
the impact of change in temperature and rain on the farm productivity than younger
individuals (p-value 0.001). There was a tendency of families with large number of
children to change their farming practice due to unpredictable rain or increase in
temperature (p-value 0.01) (Table 2).

Table 2. Proportion of respondents adopting changing in farming practices due to climate change
by different socio-demographic characteristics

Majority (86.0%) of the respondents reported to rely on weather patterns to determine
planting time for their crops. Only about half of the respondents thought that the
weather forecast by the Tanzania Meteorological Agency as provided through radio and
television is useful in helping them to determine planting time.

It was observed that respondents who were relying on rain-fed crop production, employed
different strategies to cope with extreme climate events such as drought. These included
switching to more pest-resistant maize varieties, changing cultivars, seeking temporary
jobs in urban areas or renting their fields. These were more reported as adaptation
farming practices, indicating resilience to climate change. One in three had changed
their crop variety in the last 10 years. About 16% had changed crop type and 11% had
gained use of equipment (Figure 2). However, inputs and irrigation practices remained mostly unchanged (less than 5%
reported the change). When asked about the impact of the 2009/2010 floods in Kilosa,
77% of the respondents reported their households to be affected. Some 30% reported
to have been displaced from their homes, with others reporting being still displaced
for the past two years. Farmland was heavily affected with 45% of the respondents
reporting a permanent loss of part of their land.

Food insecurity

Food insecurity was described by the majority of respondents to be a common problem
across the study area. Three quarters of the respondents reported that they had no
sufficient production from their own farms to guarantee food security in their household
for the year. Three quarters (73.0%) reported to having food shortages in their household
in the past five years. About half said they most often experienced severe food shortage
during the rainy season – the season when most households experience several bouts
of febrile illnesses including malaria (Figure 4). This is also the planting season, when farmers need to put much of their energy
in farming to ensure high productivity. Maize was as staple food for almost all (98.35%)
respondents, meaning their household would be upset by poor maize harvests. About
a quarter (26%) had less than two meals a day.

Figure 4. The proportion of respondents on the season when they experience most malaria and
food shortage.