Intersectional gender inequalities in access to information, knowledge, and attitudes toward malaria prevention services in Ethiopia: A Mixed- methods study

Abstract Background Malaria remains a significant public health issue in Ethiopia, particularly for vulnerable populations like women and children. Gender-based inequalities in malaria knowledge, attitudes, and access to information persist, intersected by socio-economic and cultural factors. This study explores these intersectional gender inequalities in malaria information access and attitudes toward preventive services in the Jimma Zone, Oromia Region, Ethiopia. Methods A mixed-methods study was conducted from August 28 to September 9, 2023, in malaria-endemic districts of Jimma Zone, Oromia Region, Ethiopia. Qualitative data included 12 focus group discussions (FGDs), 2 in-depth interviews (IDIs), and 11 key informant interviews (KIIs) to explore gender inequalities. Quantitative data comprised a community-based cross-sectional survey of 2,201 respondents (1,086 females and 1,112 males) to assess sex disparities. Qualitative data were analyzed using thematic analysis (ATLAS.ti), while quantitative data were analyzed with SPSS. Comprehensive malaria knowledge was scored based on responses to 17 items, and attitudes towards services were evaluated from 31 items across five constructs. Statistical significance was determined via ANOVA and Chi-square tests. Results Findings revealed comparable overall exposure to malaria messages for both sexes, with 51.7% of females and 52.2% of males reporting exposure to malaria information within the last 12 months. However, significant differences were observed in the sources of malaria information between the sexes. Males reported greater exposure to messages on insecticide-treated nets (54.0% vs. 47.1%) and sanitation (46.7% vs. 40.6%). Qualitative findings highlighted societal expectations that often confine females to domestic roles, limiting their access to malaria information. Males exhibited slightly higher comprehensive malaria knowledge, with a mean score of 10.89 compared to 10.31 for females. While attitudes towards malaria services were generally positive across both sexes, males demonstrated greater confidence in accessing preventive care (mean = 7.15 vs. 6.61, p = 0.000).Intersectional factors such as age, education, residence, and weal were found to significantly influence malaria knowledge and attitudes. Conclusion This study revealed the impact of gender intersecting with other factors on malaria information access, knowledge, and attitudes toward malaria prevention services, emphasizing the need for gender-sensitive interventions to empower women and girls in malaria prevention and control.