Evaluation of household knowledge, attitudes and practices concerning malaria in the city of Djibouti

This study presents the first Knowledge Attitudes, and Practices (KAP) survey on malaria in Djibouti City. It was conducted among 1,344 household heads across nine neighbourhoods in Djibouti City. Composite scores were calculated for each KAP dimension. Analysis of variance and multinomial logistic regression identified socio-demographic predictors and Local Indicators of Spatial Association (LISA) characterised the spatial clustering of the KAP scores. No significant association was found between sociodemographic or economic factors and malaria knowledge. Prevention practices varied notably across neighbourhoods, driven by place of residence, mother tongue, and education-underlining the primacy of spatial determinants. Attitudes were found to be linked to gender and income. Despite high disease awareness, 60% of respondents misidentified transmission routes, nearly two-thirds of respondents failed to adopt effective preventive behaviours, while Long-Lasting Insecticidal Net (LLIN) ownership far exceeded correct use. The gap between awareness and practice suggests that information-deficit approaches have reached their limits; future interventions should target motivational norm-based determinants of behaviour, spatially concentrated in the highest-risk neighbourhoods. Language and cultural barriers require tailored communication strategies beyond standard broadcast campaigns. Strengthened vector control and active surveillance remain essential complements to any behavioural intervention.