Community and healthcare worker contributions to malaria prevention: a culturally tailored behaviour change approach in Jozini, South Africa

Abstract Background According to the national strategic plan, South Africa aims to eliminate malaria by 2030. Only three out of 9 provinces are malaria endemic. These are Mpumalanga, Limpopo and the north–eastern parts of KwaZulu-Natal provinces. It is important to investigate community and healthcare worker perceptions regarding malaria prevention, control and elimination interventions to enable development of a Social Behavioural Change Communication (SBCC) strategy for Jozini local municipality to complement the National Strategic Plan 2025–2030. Methods A cross-sectional mixed-method study was conducted in six communities and their respective healthcare facilities in Jozini local municipality, KwaZulu-Natal, during 2025. A structured questionnaire was administered to 384 community participants using a systematic household sampling. In addition, semi-structured interviews were conducted with 15 healthcare workers selected purposively. Quantitative data were analysed using descriptive statistics, Chi-square (χ 2 ) tests (p < 0.05) and Fisher’s exact test (p < 0.05) where expected cell counts were less than 5, while qualitative responses were analysed thematically. Results Three hundred and eighty-four community members and 15 healthcare workers were interviewed. Community respondents (median age 36 years; 72% female) showed high malaria awareness (96%), with 92% correctly identifying mosquito bites as the main transmission route. Overall, 97% had high knowledge, 79% positive attitudes, and 64% good practices. Knowledge was significantly associated with age (χ 2 = 9.61, p = 0.01) but not with gender, education, employment status, or residence duration, and knowledge level was not significantly associated with attitudes or practices (p > 0.05). Healthcare workers showed strong technical knowledge of malaria transmission and prevention, and most reported involvement in diagnosis, treatment, and community outreach activities. However, qualitative findings highlight challenges related to irregular training, staffing gaps, and shortages of diagnostic tools and commodities. Conclusions The study found that although awareness of malaria is generally high in Jozini local municipality, misconceptions and inconsistent prevention practices remain. Community health workers are key information sources, but barriers such as poverty, cultural beliefs, and limited resources affect prevention efforts. Healthcare providers are knowledgeable but face operational challenges. These findings underscore the need for targeted SBCC interventions to support malaria control under South Africa’s NSP 2025–2030.