KAP surveys allow us to understand the context of quantitative research numbers and epidemiological indexes [12, 15]. This study was conducted to identify the KAP related to malaria in a vulnerable municipality of Colombia, a community with a long history of social segregation and poverty.
The sociodemographic characteristics showed that in terms of house structure, zinc roofs followed by wood walls were the most prevalent materials types of houses. Similar results were observed in houses of communities in Quibdo (Colombia) [15], in Swaziland (Africa) [16] and Chiapas (México) [17], showing some environmental characteristics similar to other endemic malaria countries.
There remain some equity issues regarding education, such as 9.85% of the surveyed people being illiterate, mostly women (69.2%). However, these results were lower than those observed in other studies in which the level of the population with no education is higher, 16.2% in Swaziland (Africa) [16], 23.6% in Muleba (Africa) [18], 29.2% in Rural Northwest Tanzania (Africa) [19], and 16.6% in Chiapas (México) [17].
When analyzing the family environment of the respondents, the majority of their household members were adolescents (55.73%) and children (24.89%), a condition that is reflected with a childhood index of 38.6 under 15 years old for every 100 people. Similarly, there was a significant percentage of eldery (16.09%); however, the old age index for the population is 3.56 people over 65 years old for every 100 people [14]. This could affect the municipality’s economy, resulting in a small workforce or people forced to work from very early to very advanced ages.
Public services are absent or deficient, especially drinking water supplies (33.58%) and garbage (65.67%) and sewage disposal (8.21%). These findings are similar to those found in Calcutta in India [20].
All those points above listed, combine with focal points of inequality in the social structure, such as the low-income social class with few basic needs met, socioeconomic position, gender with great inequalities for women and an ethnic group that marks a whole territory of inequality, where Afro-Colombian mixes with the high rurality full of oversight and poverty [15].
The knowledge of this community about malaria, evidenced that they know that malaria is a disease transmitted by a mosquito and that the responsibility to prevent it falls not only on government entities such as the Department of Health but also on every individual and the community. These results are in line with studies conducted in Tumaco and Buenaventura, nearby municipalities similar to Olaya Herrera in culture and ethnicity, where between 79.2% and 86.9% of the respondents knew that malaria transmission occurs through the bite of an infected mosquito [21]. These levels of knowledge are not only seen in Colombian communities. In other populations like in the northern coast of Ecuador between 50 and 75% of the surveyed people in the communities declared to know how malaria is transmitted and 90–100% knew that a mosquito is responsible for malaria transmission [22]. The majority of the respondents also associated mosquito bites with malaria transmission, in Zambia (Africa) [23], Swaziland (Africa) [16], in Muleba (Africa) [18]. This leads us to believe that the problem lies not in what populations know about malaria, but in the disconnection between them and the disease control plans taught by Departments of Health and other government entities [24, 25].
The knowledge of signs and symptoms showed that over 76% of the respondents identified fever, headache, and chills as the most common ones. This is in line with the observations of most studies in endemic settings from Colombia, as in Antioquia and Choco where 80% of knowledge was found on the main symptoms of malaria [26], and in other contexts like Swaziland (Africa) [16], Muleba (Africa) [18] and Rural Northwest Tanzania (Africa) [19].
The population’s attitudes about malaria control observed in this study are similar to the population of Chiapas (Mexico) [17], more than 96% of the respondents agreed with the use of insecticides at home as a strategy to protect their homes from mosquito bites in the future.
Regarding practices to prevent malaria, the health system performs community education, and is making efforts to spread awareness regarding the risks posed by vectors; the population accepts these trainings and the level of knowledge is acceptable. However, such methods will not resolve problems regarding the environment, homes located near vegetation and the river, scarcity of drinking water, and the lack of garbage disposal, which are breeding grounds for high-risk conditions for the population’s health. There is a health center with first level basic care focused on treatment and rehabilitation with few resources allocated to activities promoting health and preventing diseases. Accessing levels of greater complexity is very difficult due to economic, geographic, and communication barriers, without dismissing the violent actors that are part of daily life.
The KAP survey results suggest that this prolonged process of coexisting with malaria and prevention and control campaigns could be reflected in the homogeneity of the responses among all the participants regarding their perception of the disease as one of the main health problems (75.37%). Some of the field observations showed the lack of control measures and stagnant water, and the use of insecticides and mosquito nets as the most important control measures in this community, being the same reported by Fernández-Niño (2014) [27] and Osorio (2006) [28] in similar populations like the northern coast of Ecuador [22], in Iquitos (Perú) [29], Chiapas (México) [17], and others populations like Swaziland (Africa) [16], in Rural Northwest Tanzania (Africa) [19].
The perception of the population about preventive activities to control malaria in Olaya Herrera is not the best one; because more than 40% said that the Health Department doesn’t do any control activities. Similarly, a low perception of the benefit of preventive activities has been reported as a result of the lack of concerted action between the health services and the community en Lima–Perú [30].