Knowledge of Malaria Transmission, Treatment Adherence, and Antimalarial Drug Resistance Awareness among Adults in Osun State, Nigeria: A Cross-Sectional Study

Malaria remains a major public health burden in Nigeria, driven by biological and modifiable human factors. This study assessed knowledge, attitudes, and perceptions of malaria transmission, treatment, and drug resistance among adults in Osun State, Nigeria, and examined associations between cognitive gaps and preventive/treatment-seeking behaviors using the Health Belief Model. A cross-sectional study was conducted among 1,500 adults (≥18 years) in Osun State between June and August 2023 using a pre-tested questionnaire. Descriptive statistics, chi-square tests, and multivariable logistic regression were used. Key gaps: 49.5% were unaware of the primary transmission route, and only 27.5% recognized antimalarial drug resistance. Among 712 participants who used antimalarial drugs in the past two weeks, 70.5% completed treatment. Awareness of drug resistance was independently associated with treatment completion (aOR=1.68; 95% CI:1.25–2.25; p<0.001), formal healthcare use (aOR=1.45; 95% CI:1.12–1.88; p=0.005), and lower herbal medicine use (aOR=0.65; 95% CI:0.50–0.85; p=0.002). Female gender predicted insecticide-treated net use (aOR=2.15; 95% CI:1.65–2.80; p<0.001) but was inversely associated with drug resistance awareness (aOR=0.62; 95% CI:0.46–0.83; p=0.001). Knowledge deficits, especially regarding drug resistance, are linked to less favourable preventive and treatment-seeking behaviours. Targeted behavioral change communication, vendor education, and healthcare worker engagement are imperative to improve treatment adherence and curb drug resistance.