Malaria in East Nusa Tenggara Province (Indonesia): Protocol for a Cross-sectional Study (Preprint)
BACKGROUND Malaria is a global pandemic resulting in approximately 228 million cases globally, and 3.5 % of these is in South-East Asian countries including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the Eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still suffers from a disproportionately higher rate of malaria. OBJECTIVE The purposes of this cross-sectional study are to: (1) Determine the awareness, knowledge, attitudes, and practices (KAP) towards various aspects of malaria among rural adults and their associated factors including socio-demographic factors and ethnicities; (2) Assess the gap between coverage, access, and use of long-lasting insecticide-treated bed nets (LLINs) among the households; (3) Estimate the prevalence of, and factors associated with, malaria in rural adults; and (4) Develop a risk prediction model of malaria. METHODS A three-stage cluster sampling procedure with a systematic random sampling procedure at cluster level 3 had been applied to recruit 1,470 adults aged 18 years or over from ENTP. Each participant participated in a face-to-face interview to assess their awareness and KAP of malaria, practices of sleeping under LLINs, and malaria history. Information on socio-demographic, environmental, and lifestyle factors was documented. The proportion of malaria KAP and their variations across different socio-demographic and ethnicities will be analysed using descriptive statistics and Chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendation. Malaria risk factors will be analysed using a logistic regression method. Multilevel logistic regression will be applied to estimate the risk score of malaria. RESULTS In total, we interviewed 1495 rural adults from 49 villages in the ENTP from October to December 2019. The study results are expected to publish in September 2020. CONCLUSIONS The best malaria risk prediction model will be developed by this study.We believe that the protocol paper has developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030.