This paper presents findings from a study conducted in Heping Town, Qiongzhong County, Hainan Province, China. The study, conducted in 1992, used qualitative as well as quantitative methods to gather social, cultural and behavioural data associated with the acquisition, transmission and prevention of malaria, and the diagnosis and treatment of disease. These methods included focus groups, key informant and other in-depth interviews, and observations, a household survey and tests of school children of knowledge of malaria. The study is among the first to our knowledge that has utilized this broad mix of methods for tropical disease research in China.
PIP: Malaria continues to be a major public health problem worldwide. Although there is only a low level of malaria endemicity in China, Hainan Island is endemic for malaria. Qiongzhong County was long hyperendemic for malaria. The authors used focus groups, key informant and other in-depth interviews, observations, a household survey, and tests of school children knowledge of malaria to gather social, cultural, and behavioral data associated with the acquisition, transmission, and prevention of malaria, and the diagnosis and treatment of disease in six villages of Heping Town and three production teams of Chengpo Farm, Qiongzhong County. This 1992 study is groundbreaking in its use of such a broad array of methods to research tropical disease in China. Findings are based upon the input of 1100 persons in 226 households. The open walls of the bamboo-slat houses allow easy mosquito access, but the cost of more substantial, and protective, housing is beyond the means of most villagers. The study found no statistically significant association between literacy and bed net use, while income was neither predictive of nor related to bed net use. Some malaria knowledge and being younger than ten years old were, however, predictive of bed net use. Residents tend to use bed nets without understanding the rationale for such behavior. They do so in adherence to the general message that bed nets will prevent mosquito bites. The authors note the need to address the odor and heat discomfort from sleeping under bed nets, the lack of association among villagers between net use and disease prevention, the lack of understanding that mosquitoes are the vector of malaria, confusion between general health status and vulnerability to malaria infection, the nature of sleeping patterns by sex, and the lack of understanding that one bite suffices to transmit disease.