Objective  To examine interactions among the knowledge, attitude and practice (KAP) about malaria prevention and control among community residents in rural China.

  Methods  Using four-stage stratified random sampling, we conducted a cross-sectional survey in four malaria endemic regions (Guangxi Zhuang Autonomous Region, Chongqing Municipality, and Anhui and Hubei province) between September 2016 and March 2017. We first classified all counties in the four regions into three categories based on malaria prevalence level and selected 3 counties from all counties in each of the three categories. Then, we sequentially selected 3 townships from each of the county and 3 villages from each of the township. Finally we randomly recruited 1 358 adult residents in totally 81 villages of 27 townships in 9 counties for a household interview with a self-designed questionnaire on demographics and KAP about malaria. We performed quantifications on information collected and adopted multiple structural equation model (SEM) in data analysis.

  Results  Valid information were collected from a total 1 321 residents (averagely aged 44.78 ±1 7.46 years for 645 males and 676 females) and the response rate was 97.3%. For all the respondents, the scores for malaria-related KAP were 0.47 ± 0.22 for knowledge, 0.61 ± 0.32 for attitude, and 0.63 ± 0.25 for behavior, respectively. The established SEM model revealed that the score for total effect of malaria knowledge on behavior is 0.443 9 and the score of total effect of attitude towards malaria on behavior is 0.19, indicating a much greater influence of knowledge than that of attitude on behavior. The parameters of established SEM model for interaction between malaria-related KAP components varied based on the data collected from different counties (α = 0.05).

  Conclusion  Health education on malaria prevention and control needs to be promoted among residents in remote rural areas to improve KAP among the population for control malaria epidemic in China.