Knowledge and practices for preventing severe malaria in Yemen: the importance of gender in planning policy

[[[ Objective: ]]] In Yemen, morbidity and mortality due to malaria is high. We explored malaria-related treatment seeking, prevention practices and knowledge of transmission amongst parents in order to inform health education strategies. Yemen is culturally very distinct from most malaria-endemic countries. We aimed to identify beliefs which may be barriers to malaria prevention and treatment, and hypothesized that household gender relationships might impact on practice. [[[ Methods: ]]] Focus group discussions amongst women and men in urban, semi-urban and rural areas, followed by questionnaire interviews with parents or guardians of children with severe malaria, mild malaria, and healthy children from the community. [[[ Findings: ]]] Recognition of malarial symptoms was good but delays in seeking medical treatment after symptom onset were common, with 78% of parents reporting delay. Delays primarily related to financial constraints, but also to difficulties with treatment seeking when male family members were not available. When contact with a health worker occurred prior to admission to the hospital, the treatment was potentially inappropriate in 29% and ineffective in 57%. There were distinct differences between men and women in their perspective on malaria. Knowledge of malaria transmission was vague and mosquitoes were not emphasized, particularly amongst mothers. Bednets were reported to be used rarely and without insecticide treatment, and some beliefs such as that malaria is transmitted by breastfeeding were potentially harmful. [[[ Conclusions: ]]] Some beliefs were potential barriers to malaria prevention strategies. The different beliefs and roles identified between men and women need to be taken into account in health promotion messages.