Discussion
malaria, MPE
MALARIA
In our study, bed net utilization among children in the intervention arm increased substantially from 7.9–55.1%% due to a bed net distribution and this rise was similar in both arms (p value:0.92). The MPE did not significantly affected both bed net ownership and its utilization. However, bed net utilization by SAC was associated with adequate access to bed net in the household (i.e., household size to bed net ratio ≤ 2) and with a reported malaria attack in the last 12 months. Cumulative incidence of malaria by consequence was also similar, 16.2% and 18.2% in MPE and control groups respectively. Bed net use was affected by an altitude of the residence place, wealth of the household, adequate access to the bed nets and the use of bed net by the study SAC at baseline of the study. Seeking treatment from a health facility as the 1st choice for malaria in the MPE group was 81.5% compared to 71.9% in control group.Bed net utilization is one of the effective malaria prevention measures in SSA. SAC who slept under a bed net the previous night before data collection are 22% less likely to be infected by malaria in SSA [Apart from the MPE, bed net utilization among SAC was affected by using bed net at bassline survey, household size to bed net ratio equal or less than 2 and reported that the children suffered from malaria. It was also observed in Dar es Salaam [The MPE given by science teachers in the current study did not show significant effect on the cumulative incidence of reported malaria. This reported cumulative incidence of malaria could be overestimated and which may vary between intervention arms. Thus, future studies would consider ecological studies or analysis at cluster level to see the effect of such interventions on laboratory confirmed malaria. Unlike the finding of this study, teachers- lead participatory education given to schoolchildren in Mali significantly affected the point prevalence of malaria in the intervention arm as compared to those in the control arm [The percentage of children who sought treatment from a health facility as the 1st choice was not different between arms. The low number of parents attended MPE, health facility problem and poverty could be the reason for the insignificant effect of the intervention on treatment seeking from a health facility. MPE implementation research should be conducted after ensuring the problems hampering seeking treatment from a health facility are removed. In Indonesia, poor understanding of seeking medical care from a health facility was associated with economy and educational status [One of the limitations of our study was the MPE being given only once, a year before the evaluation of its effectiveness. This might be presumptive reason for the insignificant effect of the intervention on the outcome variables considered. The 2nd limitation of the study was failure to include SAC not enrolled to a school. These children may differ in certain aspects affecting the use of malaria prevention measures. The third limitation was low number of parents attended the MPE. The other limitation was that bed net coverage was very low in the study area at the baseline of the study which might underestimate the true effect on the reported cumulative incidence of malaria. The strength of this study was that it is a large study that involved children from both urban and rural areas of hard-to reach settings.