In MalariaWorld this week the study ‘Knowledge, attitudes, and practices regarding malaria in rural Uganda: a cross-sectional study’ by Cathorall et al is featured. In four villages in rural Uganda 106 adults, heads of household, were questions about a variety of issues related to malaria and, in particular, bed net use.
The major findings from this study indicate high rates of net ownership and self-reported use within the rural areas. Perceived susceptibility and barriers were greater among those with a recent diagnosis of malaria within the household. The positive association remained significant after controlling for household size.
Net usage is reported as high. It is difficult to know if the respondents told the truth or what the researcher wanted to hear. However, for comfort why not sleep under a bed net if one is available? I know from experience living in Lodwar, Kenya, and often sleeping outside or with windows open because of the heat that accumulates in houses during the day, that mosquitos will bite exposed skin at night if not excluded by a net. And the bites are uncomfortable.
However, an observation in the study caught my attention. They stated ‘However, only 63 (60%) correctly identified that a mosquito bite was the only way to contract malaria’. I am tempted to ask the corresponding author how they ‘know that’, but I suspect this question is a question of faith analogous to asking a priest or Imam how he knows God exists.
What is curious is the other answers given to these questions by people who live with the disease, showing that some are not convinced by the mosquito tale of the educated westerners. In March 2025 I reported that Chinese expatriates are not convinced either. In the study 42% indicated factors like eating mangos, other foods or bad water as a cause of malaria. Even if they indicated mosquito bites as a risk, they were unsure of the actual route of transmission. The mango theory could be because malaria transmission is seasonal in this region, increasing at the end of the rainy season and coinciding with mango ripening.
The authors suggest that this knowledge gap must be addressed. In surveys in Guinea-Bissau (85%) and Eswatini (99.7%) higher levels of belief in the mosquito transmission hypothesis were measured. I would love to know how they try to convince people of the mosquito hypothesis. I have investigated this topic for years and have found no convincing evidence. Yes, mosquito bites are annoying and uncomfortable, but what is the actual evidence of disease transmission?