Knowledge, Attitudes, and Practices Regarding Malaria Prevention in District Khyber, Khyber Pakhtunkhwa, Pakistan: A Cross-Sectional Study

Abstract

Background: Malaria remains a significant public health challenge in Pakistan, particularly in Khyber Pakhtunkhwa (KP) province, where transmission patterns vary across districts. District Khyber, a former tribal agency with unique socio-demographic characteristics, lacks comprehensive data on community awareness and preventive practices regarding malaria. This study aims to assess the knowledge, attitudes, and practices (KAP) regarding malaria prevention and identify associated factors in District Khyber. Methods: A community-based cross-sectional study was conducted in District Khyber from [Month, Year] to [Month, Year]. A multi-stage stratified random sampling technique was used to recruit 384 households. Data were collected using a pre-tested structured questionnaire assessing socio-demographic characteristics, knowledge of malaria transmission and symptoms, attitudes toward prevention, and actual preventive practices. Malaria infection status was confirmed using rapid diagnostic tests (RDTs). Multivariate logistic regression analysis was performed to identify predictors of good knowledge and preventive practices. Results: A total of 384 participants were enrolled (response rate: 96%). The overall malaria prevalence was 22.4% (n=86), consistent with recent KP-wide estimates of 24.5% (Suleman et al. 2026). Regarding knowledge, only 41.2% knew that mosquitoes transmit malaria, 38.5% could identify fever as a primary symptom, and 28.9% recognized the importance of sleeping under insecticide-treated nets (ITNs). Good knowledge was significantly associated with higher education (AOR: 3.8; 95% CI: 2.1-6.7) and urban residence (AOR: 2.4; 95% CI: 1.4-4.1). Preventive practices were poor: only 31.5% reported regular ITN use, 24.2% used mosquito repellents, and 18.5% eliminated stagnant water around homes. Independent predictors of malaria infection included non-use of bed nets (AOR: 4.2; 95% CI: 2.3-7.8), poor housing conditions (AOR: 3.6; 95% CI: 1.9-6.8), and distance to health facility >5 km (AOR: 2.9; 95% CI: 1.6-.3). Conclusion: This study reveals significant gaps in malaria awareness and preventive practices in District Khyber, contributing to high disease burden. Targeted health education campaigns, distribution of ITNs, and improved access to healthcare facilities are urgently needed. These findings support provincial and national malaria control goals, including Pakistan's commitment to the Global Fund malaria elimination targets