A Formative Cross-Sectional Study to Assess the Knowledge, Attitude, and Practices of Caregivers of Children Under Five Towards Malaria Control in the Buea Health District of Cameroon.

Background: Malaria is a major public health problem in Cameroon, disproportionately affecting children under five. The success of prevention and control programmes depends on caregivers' knowledge, attitudes, and practices (KAP). Assessing these domains and their determinants could provide evidence for targeted interventions. The study set out to determine the levels of KAP towards malaria prevention and identify associated factors among caregivers of children under five in the Buea Health District in Cameroon. Methods: A community-based cross-sectional study was conducted among 394 caregivers in peri-urban and rural communities of the Buea Health District. The survey was conducted from April 3 to July 12, 2024. Participants were interviewed using a structured questionnaire which captured the KAP of caregivers of under-five children. Association between variables and community setting was measured using chi square test, and a multivariate logistic regression model was fitted to identify factors associated with adequate knowledge, positive attitudes, and good practices on malaria prevention. Results: Most respondents were female (85.3%), parents of the child (88.6%), and self-employed (78.2%). Overall, 58.4% (95% CI: 53.5%-63.0%) had adequate knowledge, 42.9% (95% CI: 38.0%-47.8%) demonstrated positive attitudes, and 54.1% (95% CI: 49.2%-59.0%) reported good practices towards malaria prevention. Adequate knowledge was associated with being a caregiver rather than household head (AOR = 2.23, 95% CI: 1.10-4.49), employed (AOR = 8.12, 95% CI: 1.86-35.28), and living in brick houses (AOR = 1.88, 95% CI: 1.20-2.95).Positive attitudes were more likely among caregivers in peri-urban areas (AOR = 1.72, 95% CI: 1.12-2.65), those with secondary (AOR = 2.21, 95% CI: 1.04-4.67) or tertiary education (AOR = 3.18, 95% CI: 1.16-8.71), and those with better living standards (e.g., owned a television set, radio, or phone [AOR = 2.16, 95% CI: 1.29-3.63]). Good practices were associated with peri-urban residence (AOR = 1.73, 95% CI: 1.12-2.67), adequate knowledge (AOR = 2.06, 95% CI: 1.37-3.09), positive attitudes (AOR = 1.84, 95% CI: 1.23-2.77), higher maternal education (secondary: AOR = 1.90, 95% CI: 1.01-3.58), and requesting malaria testing before treatment (AOR = 3.15, 95% CI: 2.01-4.94). Conclusion: Over half of caregivers had adequate knowledge and good practices, but fewer demonstrated positive attitudes, with rural caregivers showing significant gaps. KAP were influenced by sociodemographic, socioeconomic, and behavioural factors. Targeted health education, particularly for rural caregivers and those with lower education or fewer assets, could improve malaria prevention behaviours and reduce disease burden among children under five.