ASSESSMENT OF KNOWLEDGE ON FACTORS INFLUENCING INCIDENCE OF

SEVERE ANAEMIA IN UNDER-FIVE YEARS MALARIA PATIENTS AMONG

CAREGIVERS IN NIGER STATE

BY

MUSTAPHA MUSA KALU

B/26/049/2015

DEPARTMENT OF COMMUNITY HEALTH, SCHOOL OF HEALTH

TECHNOLOGY MINNA, NIGER STATE

JULY, 2018

i
ASSESSMENT OF KNOWLEDGE ON FACTORS INFLUENCING INCIDENCE OF
SEVERE ANAEMIA IN UNDER-FIVE YEARS MALARIA PATIENTS AMONG
CAREGIVERS IN NIGER STATE

BY

MUSTAPHA MUSA KALU

B/26/049/2015

DEPARTMENT OF COMMUNITY HEALTH, SCHOOL OF HEALTH

TECHNOLOGY MINNA, NIGER STATE
IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF
DIPLOMA IN COMMUNITY HEALTH

JULY, 2018

ii
 Declaration

I Mustapha Musa Kalu hereby declare that this research work titled assessment of

knowledge on factors influencing incidence of severe anaemia in under-five year’s malaria

patients among caregivers in Niger State. It was written by me, in the department of

community Health, Niger State School of Health Technology, Minna. This work has not been

presented by anybody in anywhere in fulfillment for the award of diploma in Community

Health.

Mustapha Musa Kalu

__________________ __________________ __________________
Name Sign Date

iii
 Approval Page

This project has been read, reviewed and approved by the under listed in fulfilling the

requirement for the award of Diploma in Community Health as meeting the standard of

school of health technology, Minna, Niger State.

_____________________________ _______________________
Mal. Usman Mohammed Danlami Date
Project Supervisor

___________________________ _______________________
Mrs. Zullaihat M. Abdullahi Date
HOD Community Health

_________________________ ______________________
Mallam Abdullahi D. Bello Date
School Provost

iv
 Dedication

I dedicate this research work to Almighty Allah for giving me the wisdom and

guidance to underwent my educational pursuit successfully, to my beloved parents (Alh.

Etsu.Musa Kalu and MallamaAzatu Musa Kalu) who has always supported me with prayers,

words of advice, encouragement and financially, finally to the entire management team of

Niger State School of Health Technology, Minna.

v
 Acknowledgement

My profound gratitude and adoration to Almighty Allah for granting me the privilege,

wisdom and guidance to be in this unique profession and ensuring success in rounding up my

program with Niger State School of Health Technology Minna.

I specially appreciate my indefatigable, indomitable, highly esteem supervisor Mall.

Usman Mohammed Danlami for his tremendous effort to ensure that I put on the best in this

research work through his supervision, observation, and correction, more so, not only this

research work but throughout my stay in the above mentioned institution and even after my

program.

My special appreciation to the provost of the institution Mall.Abdullahi D. Bello,

Deputy Provost Admin Mrs. Deborah Aliyu, Deputy provost Academic Mall. Idris A.

Loguma,HOD, MrsZullaihat M. Abdullahi, Registrar Mall.Adamu B. Ndakatun, Dean

Student Affairs Mall.Musa Garba, The entire staff of the above mentioned institution,for their

quality leadership, ensuring that they bring out the best in me and the entire community

Health Students through their words of encouragement, discipline and prayers.

I humbly appreciate my irreplaceable parents (Alh. Etsu. Musa Kalu and

MallamaAzatu Musa Kalu) for their immense support, financially, spiritually (prayers),

encouragement and advice to ensure my success in Niger State School of Health Technology,

Minna. More so, to my entire family members, HajiyaMaimuna Musa Kalu, Zainab Musa

Kalu, Amina, Yakubu, Maryam, Fatima, Abdullahi, Hauwawu, Khadijat, Ramatu, Sadiq,

Iliyasu, Sakina, Sudais, Faruq, Firdausi, Na’ima, Jamila, Mohammed, Summaya,

ZuwairaKasim, Aunty Hauwa, GimbaEvuti, Mohamed saidu, ZainabSaidu, IsahSaidu, Fatima

saidu, Umar Yakubu, Aunty zainab.My appreciation to the former Chairman Abaji Area

CouncilAlh.Yahaya Musa, Gawu PHCC Staff, and Abaji Area Council at large, Finally my
vi
immense appreciation goes to JibrinIshaku, Yunusa MT Kutigi, Usman Mohammed Babagi,

Ahmad LawalSa’ad, Mohammed Baba Abdullahi, Joshua Shem, AbdulrahmanBobi, Gloria

Kolo, Judith Alamba, Gloria OdufaAseghemhe, HauwaAbdullahi, Ibrahim Abubakar, Farida

Auta, Hauwa Y. Garba, Safo, Gonagi, safiyaGata, Binta, Dayyabu, Gonagi, phillipNmadu,

joel Dare Ekundayo, Sunday Hosea, Madam Maryam, Madam AminaAbubakar, Madam

Maimuna Musa, Madam Rabi saniMuye, Madam Kulu, Madam AminaMatane, Madam

Josephine, ZainabKolo, JamiluBalarabe, Gideon Tella, Ayuba Dantani, Ismaila Musa,

Shamsudeen, Ibrahim MohammedAbubakarAbdullahi and many More.

vii
 Table of Content

Cover Page - - - - - - - - - - i
Title Page - - - - - - - - - - ii
Declaration - - - - - - - - - - iii
Approval Page- - - - - - - - - - iv
Dedication - - - - - - - - - - v
Acknowledgement - - - - - - - - - vi
Table of contents - - - - - - - - - viii
Abstract - - - - - - - - - - x

CHAPTER ONE
Background of the Study - - - - - - - - 1
Statement of the Problem - - - - - - - - 5
Purpose of the Study - - - - - - - - - 6
Research Hypotheses - - - - - - - - - 6
Research Questions - - - - - - - - - 6
Significance of the Study - - - - - - - - 7
Scope and Delimitation of the Study - - - - - - - 8
Operational Definition of Terms - - - - - - - 8

CHAPTER TWO
Review of Related Literature - - - - - - - - 10
Preamble - - - - - - - - - - 10
Concept of Anaemia - - - - - - - - - 10
Causes of Anaemia - - - - - - - - - 10
Signs and Symptoms of Anaemia - - - - - - - 13
Risk factors Associated with Anaemia - - - - -- - 13
Complication of Anaemia - - - - - - - - 14
Prevention of Anaemia - - - - - - - - 15
Anaemia in Malaria - - - - - - - - - 15
Causes of Anaemia in Malaria - - - - - - - 15
Factors Responsible for Incidence of Severe Anaemia - - - - 16
viii
CHAPTER THREE
Research Methodology - - - - - - - - 20
Preamble - - - - - - - - - - 20
Research Design - - - - - - - - - 20

Population of the Study - - - - - - - - 21

Sample and Sampling Technique - - - - - - - 21
Instrument for Data Collection - - - - - - - 23
Validity of Instrument- - - - - - - - - 24
Reliability of Instrument - - - - - - - - 24
Procedures for Data Collection - - - - - - - 25
Procedure of Data Analysis - - - - - - - - 25

CHAPTER FOUR
Preamble - - - - - - - - - - 26
Data Presentation and Analysis - - - - - - - 26

CHAPTER FIVE
Preamble - - - - - - - - - - 32
Summary - - - - - - - - - - - 32
Discussion of Findings - - - - - - - - 32
Conclusions - - - - - - - - - - 34
Recommendations - - - - - - - - - 35
Suggestion for Further Studies - - - - - - - - 36
References - - - - - - - - - - 36
Appendix - - - - - - - - - - 39

ix
 Abstract

This research work was carried out to assess the knowledge on factors influencing incidence
of severe anaemia in under-five year’s malaria patients among caregivers in Niger State. The
purpose of this study includesto investigate the level of caregivers awareness on delay care
as a predisposed factor to severe anemia in under-five years malaria patients; To examine
the caregivers knowledge on poor nutrition as a cause of severe anemia in under-five years
malaria patient; To find out the level of caregivers knowledge on the use of herbs as a
predisposed factor to severe anemia in under-five years’ malaria patients. Descriptive
research design of survey type was used, the instrument for data collection was close-ended
questionnaire using four (4) points likert scale format targeted on caregivers. The data was
collected and analyzed using frequency count and percentage. It was concluded that,the
majority of caregivers in Niger State have low level of awareness on delay care as a
predisposed factors to severe anaemia in under-five years’ malaria patients; the caregivers
in Niger State are fully aware of poor nutrition as a cause of severe anaemia in under-five
years’ malaria patients; the majority of the caregivers in Niger State have low level of
awareness on the use of herbs as a cause of severe anaemia in under-five years’ malaria
patients.However, it was recommended that,The caregivers should be enlighten during health
education sessions in order to create awareness on the implications of delay seeking health
care for a child suffering from malaria in order to encourage them to take the under-five
years malaria patient to the nearest health facility on time for prompt attention; there should
be a continue health education on adequate nutrition in order to maintain caregivers
knowledge on classes of food with their examples, the importance of nutrition on a sick child
suffering from any kind of illness which include malaria and also demonstrate how adequate
diet is prepared, Nutritional assessment should be carried out by health workers to ensure
the sick child is not anaemic;Caregivers should be health educated on the ill effect of
depending on use of herbs on a sick child and also encourage them to accept orthodox
medicine which has expiry date, adequate dosage for a specific age.

x
 CHAPTER ONE

INTRODUCTION

Background of the Study

Anaemia is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in

the blood or a lowered ability of the blood to carry oxygen. When anaemia comes on slowly,

the symptoms are often vague and may include feeling tired, weakness, shortness of breath or

a poor ability to exercise. Anemia that comes on quickly often has greater symptoms, which

may include confusion, feeling like one is going to pass out, loss of consciousness, or

increase thirst. Anemia must be significant before a person becomes noticeably pale.

Additional symptoms may occur depending on the underlying cause (U S Department of

Health & Human, 2016).

World Health Organization, (WHO, 2017) defined anaemia as a condition in which

the number of red blood cells or their oxygen-carrying capacity is insufficient to meet

physiological needs, which vary by age, sex, altitude, smoking and pregnancy status. Iron

deficiency is thought to be the most common cause of anaemia globally, although other

conditions, such as folate, vitamin B12 and Vitamin A deficiencies, chronic inflammation,

parasitic infections, and inherited disorders can all cause anaemia. Globally anaemia affects

between one-quarter and one-third of the world’s population, although some have estimated

that at risk populations indicating 50% to 80% incidence primarily due to iron deficiency. In

real numbers, the WHO suggests that approximately 800 million women and children are

affected globally (Evelyine et al, 2016).

According to the WHO (2017)anaemia in children age 0-59 months is defined as

hemoglobin (Hb) ranging between 100-109g/L (mild anaemia); 70-99g/L (moderate

anaemia); and <70g/L (severe anaemia). Causes of anaemia in children are having many

different aspect to be considered with 50% of the anaemia are as a result of iron deficiency.

1
Other causes of anemia in this subset of children are secondary to underlying risk factors,

such as malaria, sickle cell disease, and parasitic infections. Notwithstanding social

determinants of health such as food practices and taboos, cultural beliefs, knowledge and

socio-economic status influences incidence of anemia in children. The WHO (2017) reported

61% of children aged 0-59months in sub-saharan Africa have hemoglobin concentration of

<70g/L (95%). The findings resulted childhood anaemia being ranked as a severe public

health concern in sub-saharan Africa. The sub-saharan Africa demographic health survey

indicated that estimated prevalence of moderate to severe anaemia in children age 0-

59months is 6% overall, it is estimated that 72% of children aged 0-59months are anaemic,

with anaemia remaining among the top ten causes of hospitalization in children aged

According to World Health Organization (2017). Malaria is a life threatening disease

caused by parasites that are transmitted to people through the bites of infected female

anopheles mosquitoes. In 2016, there were an estimated 216 million cases of malaria in 91

countries, an increase of 5million cases over 2015. Malaria deaths reached 445,000 in 2016, a

similar number (446000) to 2015. The WHO African region carries a disproportionately high

share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and

91% of malaria deaths.

Despite the increase in control measures and reported 18% and 48% decrease in the

number of malaria cases and deaths respectively. Globally between 2000 and 2015, malaria

remains a major killer of children especially in sub-saharan Africa, Malaria is one of the

factors that contribute to the public health problem of anaemia in children, in almost all

countries in sub-saharanAfrica, and anaemia is a moderate or severe public health problem

causing significant morbidity and mortality (Sumbele, Samje,&Nkuo-Akenji, 2013).

Nutritional status of a person suffering from malaria is thought to be one of the

biggest factors of host resistance and recovery. Unfortunately, malaria is more present in

2
countries and regions where undernourishment and poverty levels are high, prolonging the

illness and increasing levels of malnourishment in the sufferer. Iron deficiency anaemia is

wide-spread in sub-saharan Africa and has a large impact socially and economically on

malaria endemic areas. In malaria pathogenesis, iron is essential for the vectors growth and

development in their life cycle. Severe malaria anemia is the biggest cause of child

hospitalization in sub-saharan Africa and is the cause of between 17% and 54% of malaria

related mortality in children under 5 years old (Gibney, 2009).

This changes in RBC functioning affects the level of iron within the body and the

body develops the signs of iron deficiency anaemia. By improving the iron status of the

sufferer along with treatment of the parasitic disease it is believed that the level of anaemia

will decrease and recovery from both the disease and deficiency will be more successful.

When anaemia is acute, levels of iron can be increased in the diet to help prevent against this

deficiency, good sources of iron are meat, fish, green leafy vegetables, legumes and fortified

grains. Increasing levels of these foods where possible can help to raise iron levels (Gibney,

2009).

WHO (as cited in Kassile, Lokinat, Mujinat, &Mmbandot, 2014) recognizes that early

diagnosis and prompt treatment within 24 hours of onset of symptoms, is an essential element

of malaria control.Espino (as cited in Kassile et al, 2014) this is primarily because early

medical care reduces the chance of progression of the illness to severe disease. Sharma (as

cited in Kassile et al, 2014).It has been noted that timely and appropriate treatment preferably

within 24 hours of onset of illness symptoms resulted into reduced severe anaemia as a

complication of malaria and probability of mortality among children under the age of five

years. In spite of this, evidence shows that most malaria related severe anaemia in malaria-

affected countries occur at home without receiving appropriate medical care, and when care

is sought, it is often delayed.

3
 Wisemen, Scott, Conteh,McElroy, Stevens (as cited in Kassile et al, 2014) observed

that a considerable proportion of severe anaemia among under-five children in sub-saharan

Africa occur in part because of delays in seeking medical care.Studies in malaria-endemic

areas have shown that caregivers with low level of education were more likely to delay in

seeking malaria treatment for children. Greenwald and colleagues argue that failure of

individuals to acknowledge that something is wrong or vulnerable to a disease may result into

delay in presentation to a healthcare provider.

Kassile et al, (2014) Caregivers often identify malaria as fever along with other

symptoms or signs. Studies have observed that caregivers perceive fever differently, mostly

as a mild or as a normal disease. Even in situations in which the cause of the fever was

believed to be malaria, caregivers still perceived their children’s illness as mild. It is

recognized that interventions which increase individuals’ participation in healthcare and

which promote greater knowledge of symptoms and outcomes will facilitate proper

healthcare seeking and services utilization. Nonetheless, previous studies, for example on

delay to seek healthcare for under-five children have considered the impact of the demand-

side, the supply-side, or both determinants of delay on a specific child’s febrile illness,

largely ignoring the influence of other symptoms or signs on the decision when to seek

healthcare for a particular symptom of interest. Studies have shown for example, that factors

including ease of access, satisfactions, as well as cost of services are associated with delay to

seek care.

Mafimisebi&Oguntade (as cited in Nwakwasi, Nwachukwu, Ifenkwa, Agwu, 2017)

many rural people do not trust western style medication preferring instead to use traditional

ways which is an alternative or non-conventional mode of treatment involving the use of

herbs in a non-orthodox manner, as well the process of consulting herbalists, mediums,

priests, witchdoctors, medicine men and various local deities.Okeoluwapo et al (as cited in

4
Nwakwasi et al, 2017) these treatments are usually incorrect or sub-optional since they are

most times administered without proper diagnosis.

Nwakwasi et al, (2017) In Nigeria, particularly in the rural areas, malaria are usually

first treated with herbal teas and baths prepared with neem, pawpaw, gwava and eucalyptus

leaves. Reliance on herbs as the first treatment action for malaria was also noted in

Nigeria.Nwakwasi et al, (2017) reported that people believes that herbal or traditional

treatments were safer and relatively more affordable than orthodox medicine, some believe

that traditional malaria treatment when administered takes care of all illness in addition to

malaria and also that a child with convulsion could die if given an injection. This cultural

belief result to severe anaemia in under-five malaria patient.

Statement of the Problem

Severe anemia is a major pediatric problem in Nigeria. It is associated with many

unwanted effects on the patient, one of which is congestive cardiac failure. Severe anemia

which is a life threatening condition is a common occurrence in children’s emergency units in

most hospitals in the developing countries (Muoneke&Chidilbekwe, 2011). Most anemia

related deaths encountered are usually due to severe anemia. It is a common blood disorder in

children and imposes an economic burden on parents/caregivers and the country as a whole.

In various African settings about 12 to 29% of hospitalized children have severe anemia with

the in-hospital case fatality rate ranging between 8 and 17% (Muoneke&Chidilbekwe, 2011).

it was observed personally by the researcher that most under-five years malaria patients

brought to the health facilities are diagnosed of been severely anaemic after checking their

packed cell volume (PCV) which as a result the children are transfused before the

commencement of treatment, this mostly occur during rainy season.

5
 Therefore the researcher deems it fit to investigate knowledge on factors influencing

incidence of severe anaemia in under-five year’s malaria patients among caregivers in Niger

State.

Purpose of the Study

 To investigate the level of caregivers awareness on delay care as a predisposed factor to

severe anemia in under-five years malaria patients.

 To examine the caregivers knowledge on poor nutrition as a cause of severe anemia in

under-five years malaria patient.

 To find out the level of caregivers knowledge on the use of herbs as a predisposed factor

to severe anemia in under-five years’ malaria patient.

Research Hypotheses

 There is no significant relationship between knowledge of caregivers’ on delay care and

severe anemia in under-five years’ malaria patient in Niger State.

 There is no significant relationship between caregivers’ knowledge on poor nutrition and

severe anemia in under-five malaria patient in Niger state.

 There is no significant relationship between caregiver’s knowledge on the use of herbs

and severe anemia in under-five malaria patient in Niger State.

Research Questions

 Are caregivers aware of delay care as a predisposed factor to severe anemia in under-five

years’ malaria patient?

 Are caregivers aware that poor nutrition of under-five years’ malaria patient leads to

severe anemia?

 What is the level of knowledge of caregivers on the use of herbs as predisposing factor to

severe anemia in under-five years’ malaria patient?

6
Significance of the Study

It is apparent that the importance connected to this study cannot be over emphasized

as it will bring awareness and broaden the knowledge of the caregivers in Niger State on

factors influencing incidence of severe anaemia in under-five malaria patient, this will inform

the caregivers that delay in seeking care, poor nutrition, and use of herbs in the treatment of

malaria leads to severe anemia in under-five years malaria patient, as such haven know this

the caregivers will take possible measures to get rid of such practices.

The end result of this study will serve as a reference material to future researchers in

related study. The outcome of this study will also help the community health students to be

aware of factors influencing incidence of severe anaemia in under-five malaria patients and

also serve as a guide when they embark on their own research.

This study will also have a great impact to the community at large in the sense that the

entire community will be aware of factors which includes delay in seeking care, poor

nutrition, cultural practices that influence incidence of severe anaemia in malaria patient as a

result it will encourage them to quickly find their way to the health facility in seeking

treatment for their under-five malaria patient, by so doing incidence of severe anaemia in

malaria patient will be minimized.

Furthermore, this study will also be vital to community Health workers and other

medical practitioners to be aware of these factors that influence incidence of severe anaemia

in under-five malaria patient in order to strengthen health talk in their health facilities, this

will help the caregivers to take the rightful decision in management of malaria and prevention

of severe anaemia in under-five malaria patient.

Furthermore, the study will serve as a tool in drawing the attention of the Government

and concern agencies to take an everlasting measures to get rid of severe anemia in under-

five malaria patients by reinforcing health talk as an intervention to caregivers. The study

7
also assist in increasing knowledge to existing one on the topic especially in respect to, with

little or no knowledge of factors influencing incidence of severe anemia.

Scope and Delimitation of the Study

This research work focused on assessment of knowledge on factors influencing

incidence of severe anaemia in under-five malaria patients among caregivers in Niger State.

The study is descriptive in nature and targeted on caregivers. The research sample is

composed of one hundred and seventy (170) caregivers out of one million andnineteen

thousand four hundred and seventy three (1,019,473) caregivers which was taken from total

population of people in Niger state estimated to be three million nine hundred and fifty four

thousand seven hundred and seventy two (3,954,772) base on the population census of 2006.

The primary data gathering method used is questionnaire to determine the caregiver’s

knowledge on the factors influencing incidence of severe anaemia in under-five malaria

patient. The researcher used cluster sampling or multi-stage sampling techniques in which an

equal representation for caregivers among the respondents is applied. The gathered data was

analyzed using descriptive statistics (frequency count and percentage) for both

demographicdata and the variables.

The research method of data collectionwas based on use of questionnairedistributed to

caregivers in Niger State. It focus on knowledge of caregivers on the factors influencing

incidence of severe anaemia in under-five malaria patient

The study is delimited to caregivers in selected communities in Niger state who

provide welfare to under-five year’s children.

Operational Definition of Terms

Anemia: Is a condition in which the number of red blood cells or their oxygen-carrying

capacity is insufficient to meet physiological needs.

8
Malaria: Is a life-threatening disease caused by parasites that are transmitted to people

through the bites of infected female anopheles mosquitoes.

Severe Anaemia: Severe anemia is considered for hemoglobin concentrations below 8.0

g/dL of an under-five malaria patient.

Under-five: This implies children of 0-59months of age of life.

Patient: Is an under-five malaria patient suffering from severe anaemia and he/she is under

medical treatment and care.

Caregivers: A caregiver is an unpaid or paid member of a person’s social network who helps

them with activities of daily living.

Incidence: The occurrence, rate, or frequency of severe anaemia in under-five malaria

patient.

Influence: The capacity of some factors (delay care, poor nutrition, cultural beliefs) to have

an effect on under-five year’s malaria patients which result to a complication of severe

anaemia.

Hemoglobin: Is the iron-containing oxygen-transport metalloprotein in the red blood cells of

all vertebrates as well as the tissues of some invertebrates.

Iron-deficiency: A condition of too little iron in the body of under-five malaria patients

Packed cell volume (PCV): Is the percentage of red blood cells in circulating blood.

Culture: The ideas, customs and social behavior of a particular people or society.

Herbs: Are plants with savory or aromatic properties that are used for flavoring food, in

medicine, or as fragrances.

Delay Care: Is when under-five years patient does not get treatment at the right time.

Predisposing Factors: To give an inclination or tendency to beforehand; make susceptible.

9
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

Preamble

This chapter reviews the relevant literature under the following sub-headings;

 Concept of anaemia

 Causes of anaemia

 Signs and symptoms of anaemia

 Risk factors associated with anaemia

 Complication of anaemia

 Prevention of anaemia

 Anaemia in malaria

 Causes of anaemia in malaria

 Factors responsible for incidence of severe anaemia

Concept of Anaemia

Laura & Martin (2016), Anaemia is a condition that develops when the blood lacks

enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells

and binds oxygen. If there is too few or abnormal red blood cells, or the hemoglobin of one is

abnormal or low, the cells in the body will not get enough oxygen. The symptoms as a result

of this will be fatigue which occurs because organs aren’t getting what they need to function

properly. Anaemia is the most common blood condition in the world. Women, young

children and people with chronic diseases are at increased risk of anaemia.

Causes of Anaemia

There are more than 400 types of anaemia, which are divided into three groups:

1. Anaemia caused by blood loss

2. Anaemia caused by decreased or faulty red blood cell production

10
 3. Anaemia caused by destruction of red blood cell

Anaemia Caused by Blood Loss

Red blood cells can be lost through bleeding, which often can occur slowly over a

long period of time, and can go undetected. This kind of chronic bleeding commonly results

from the following:

 Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the

stomach), and cancer.

 Use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,

which can cause ulcers and gastritis.

 Menstruation and childbirth in women, especially of menstrual bleeding is excessive and

if there are multiple pregnancies.

Anaemia Caused by Decreased or Faulty Red Blood Cell Production.

With this type of anaemia, the body may produce too few blood cells or the blood

cells may not function correctly. In either case, anaemia can result. Red blood cells maybe

faulty or decreased due to abnormal red blood cells or a lack of minerals and vitamins needed

for red blood cells to work properly. Conditions associated with these causes of anaemia

include the following:

 Iron-deficiency anaemia

 Sickle cell anaemia

 Vitamin deficiency

 Bone marrow and stem cell problems

 Other health conditions

Iron-deficiency anaemia:- occurs because of the lack of the mineral iron in the body. Bone

marrow in the center of the bone needs iron to make hemoglobin, the part of the red blood

that transports oxygen to the body’s organs. Without adequate iron, the body cannot produce
11
enough hemoglobin for red blood cells. The result is iron-deficiency anaemia. This type of

anaemia can be caused by.

 An iron-poor diet, especially in infants, children, teen’s vegans, and vegetarians.

 The metabolic demands of pregnancy and breastfeeding that deplete a woman’s iron

stores

 Menstruation

 Frequent blood donation

 Certain drugs, food, and caffeinated drinks

Sickle cell anaemia:- Is an inherited disorder. Red blood cells become crescent-shaped

because of a genetic defect. They breakdown rapidly, so oxygen does not get to the body’s

organs, causing anaemia. The crescent-shaped red blood cells can also get stuck in tiny blood

vessels, causing pain.

Anaemia Caused by Destruction of Red Blood Cells.

When red blood cells are fragile and cannot withstand the routine stress of the

circulatory system, they may rupture prematurely, causing hemolytic anaemia. Hemolytic

anaemia can be present at birth or develop later. Sometimes there is no known cause. Known

causes of hemolytic anemia may include:-

 Inherited conditions, such as sickle cell anaemia and thalassemia.

 Stressors such as infections, drugs, snake or spider venom or certain foods.

 Inappropriate attack by the immune system (called hemolytic disease of the newborn

when it occurs in the fetus of a pregnant woman).

Inoue (2017), pediatric anaemia refers to a hemoglobin or hematocrit level lower than

the age adjusted reference range for healthy children. Physiologically, anaemia is a condition

in which reduced hematocrit or hemoglobin levels lead to diminished oxygen-carrying

capacity that does not optimally meet the metabolic demands of the body. Anaemia is not a
12
specific disease entity but is a condition caused by various underlying pathologic processes. It

may be acute or chronic. The clinical effects of anaemia depend on its duration and severity.

When anaemia is acute, the body does not have enough time to make the necessary

physiologic adjustments, and the symptoms are more likely to be pronounced and dramatic.

Signs and Symptoms of Anaemia

Mayo foundation for medical education and research (2017), Anaemia signs and

symptoms vary depending on the cause of anaemia, this includes:

 Fatigue

 Weakness

 Pale or yellowish skin

 Irregular heartbeats

 Shortness of breath

 Dizziness or lightheadedness

 Chest pain

 Cold hands and feet

 Headache.

At first anaemia can be so mild that it goes unnoticed. But symptoms worsen as

anaemia worsens.

Risk Factors Associated with Anaemia

These factors place one at increased risk of anaemia:

 A diet lacking in certain vitamins: Having a diet that is consistently low in iron, vitamin

B-12 and folate increases the risk of anaemia.

 Intestinal disorders: Having an intestinal disorder that affects the absorption of nutrients

in your small intestine- such as crohn’s disease and celiac disease- puts one at risk of

anaemia.
13
 Menstruation: In general, women who haven’t experienced menopause have a greater

risk of iron deficiency anaemia than do men and postmenopausal women. That’s because

menstruation causes the loss of red blood cells.

 Pregnancy: If you’re pregnant and aren’t taking a multivitamin with folic acid, you’re at

an increased risk of anaemia.

 Chronic conditions: If one has cancer, kidney failure or another chronic condition, the

person may be at risk of anaemia of chronic disease. These conditions can lead to a

shortage of red blood cells.Slow, chronic blood loss from an ulcer or other source within

your body can deplete your body’s store of iron, leading to iron deficiency anaemia.

 Family history: If your family has a history of an inherited anaemia, such as sickle cell

anaemia, you also may be at increased risk of the condition.

 Other factors: A history of certain infections, blood diseases and autoimmune disorders,

alcoholism, exposure to toxic chemicals, and the use of some medications can affect red

blood cell production and lead to anaemia.

 Age: People over age of 65 are at increased risk of anaemia.

Complication of Anaemia

Inoue (2017) acute and severe anaemia can result in cardiovascular compromise.

Moreover, if individuals with acute anaemia are not treated immediately and appropriately,

the resulting hypoxemia and hypovolemia can lead to brain damage, multiorgan failure, and

death. Other complications can include congestive heart failure, hypoxia, hypovolemia,

shock, seizure, and acute silent cerebral ischemic event.

Lundblad, Rosenberg, Mangurten and Angst (2016), For many years, iron-deficiency

anaemia in infants and young children has received considerable attention in the pediatric

community because of relatively high prevalence and known detrimental effects on

neurological development, cognitive function, exercise tolerance, immune function, in

14
addition to the known long-term consequences of IDA, some children will experience acute

life-threatening clinical events, including tachycardia, tachypnea, hypotension, respiratory

distress, and congestive heart failure. Children with these findings will often present to

emergency departments rather than to offices or clinics of their primary care pediatricians.

The presence of one or more of these findings will prompt, appropriately, admission to

inpatient pediatric units.

Prevention of Anaemia

Eat a vitamin-rich diet:-Many types of anaemia can be prevented. But iron deficiency

anaemia and vitamin deficiency anaemias can be avoided by having a diet that includes a

variety of vitamins and nutrients, including; iron, folate, vitamin B-12, vitamin C.

Consider a genetic counseling:- If you have a family history of an inherited anaemia, such

as sickle cell anaemia or thalassemia, talk to your doctor and possibly a genetic counselor

about your risk and what risks you may pass on to your children.

Prevent malaria:-Anaemia can be a complication of malaria. If you plan on traveling to a

place where malaria is common, talk to your doctor beforehand about taking preventive

drugs. In areas where malaria is common, prevention involves reducing exposure to

mosquitoes, for example, bed nets treated with insecticide.

Anaemia in Malaria

Hemocue (2017), explain that about 3.2 billion people, almost half of the world’s

population are at risk of malaria. Young children and pregnant women are particularly

vulnerable to the disease when they become infected. Malaria is an acute febrile illness.

Symptoms appear 7 days or more after the infective mosquito bite. The first symptoms; fever,

headache, chills and vomiting may be mild. If not treated within 24 hours, plasmodium

falciparum malaria can progress to severe illness, often leading to death. Children with severe

15
malaria frequently develop one or more of the following symptoms: severe anaemia,

respiratory distress in relation to metabolic acidosis, or cerebral malaria.

Causes of Anaemia in Malaria

Hemocue (2017), explain that the malaria parasites, entering the blood after an

infective mosquito bite, infect red blood cells. At the end of the infection cycle, red blood cell

rupturs, this process lowers the amount of red blood cells and can in a severe stage cause

severe anaemia.Kakkilaya (2015), the causes of anaemia in malaria include obligatory

destruction of red blood cells at merogony, accelerated destruction of non-parasitized red

cells (major contributor in anaemia of severe malaria), bone marrow dysfunction that can

persist for weeks, shortened red cell survival and increased splenic clearance.

Factors Responsible for Incidence of Severe Anaemia

Delay in Seeking Health Care and Severe Anaemia in Under-five Years Malaria

Patients

MitikuandAssefa (2017), early diagnosis and prompt malaria treatment are essential

to reduce progression of the illness to severe disease and, therefore, decrease high death rate

most especially among children under-five years of age. Malaria remains a major killer of

children particularly in sub-saharan Africa, taking the life of children. According to the latest

estimates, 214 million cases of malaria occurred globally in 2015 and the disease led to

438,000 deaths. It is one of the major disease of poor people in developing countries and one

of the leading causes of avoidable death, especially in children and pregnant women. In 2015,

malaria was the fourth highest cause of death, accounting for 10% of child deaths in sub-

saharan Africa.

According to World Health Organization (WHO, 2017), recognizes that early

diagnosis and prompt treatment, within 24hours of onset of symptoms, is an essential element

of malaria control. Evidences show that timely and appropriate treatment has resulted into

16
reduced severe morbidity and mortality among children under the age of 5 years. Despite this,

only a small proportion of malaria patients, including children, receive prompt and effective

treatment.

Ahmed et al (2017), a study carried out in rural area of northern Nigeria showed that

caregivers had a good knowledge of both the cause and the measures of prevention of

malaria, but the knowledge of proper administration of anti-malaria drugs were limited.

Similar findings were also reported in an urban community in south west Nigeria. The

caregivers and the patent medicine sellers lack effective knowledge about medical treatment

and unfortunately, caregivers prefer seeking medicine vendors as the place to receive

treatment, because they are easily accessible and available, despite the fact that a real

knowledge of medicine calls for treating the disease’s causes and not its symptoms. As a

consequence, due to a wrong home management of fever, many children sampled were

admitted to the hospital with a diagnosis of anaemia. Indeed, malaria fever is often associated

with non-specific symptoms or severe complications, as past studies has showed, especially if

the correct medical treatment is not promptly started within 24 hours. Therefore, poor

knowledge of correct management at home, and the role played by patent medicine sellers

might have accounted for the widespread inappropriate home management of fever observed.

Ahmad et al (2017), the accessibility to health care services is very important for good

management of malaria. Increasing access to health care services is considered pivotal to

improving the health of populations. According to a recent review of literature, key factors

include costs, proximity, timelines, supplies, as well as the importance of health worker

personalities and relationships with patients. In sub-saharan African countries like Nigeria,

conversely, poverty, negative attitude, poor access roads and transport system, are important

challenges to access health facility services.

17
Poor Nutrition and Severe Anaemia in Under-five Years Malaria Patients

Simbauranga,Kamugisha, Hokororo, Kidenya, and Makani (2015), unemployment

and low level of education might lead to poor socio-economic status. This suggests that better

socio-demographic conditions increases access to better nutrition and health care and as a

result lower the risk of anaemia, it was noted that lower level of education was associated

with increased risk of anaemia. Anaemic children had caretakers who did not complete or

attend primary education. The relationship between education and anaemiamay be due to the

capacity ofcaretakers to grasp the knowledge needed for adequate healthcare and nutrition for

children.

Kateera et al (2015), Malaria, anaemia and under-nutrition are each associated with

significant morbidity and mortality, particularly among children in sub-saharan Africa.

Globally, malaria is responsible for over 450,000 deaths among children under 5 years;

Anaemiais prevalent in 273 million (43%) of children age 0-59 months; and severe under-

nutrition affects about 20 million pre-school aged children living in sub-sharan Africa. In the

majority of the affected children, all three conditions frequently co-exist and have been

associated with complications, including physical and cognitive development. Studies

elucidating associations between malaria and under-nutrition yield conflicting results; with

some suggesting that under-nutrition is associated with higher malaria morbidity and all-

cause mortality outcomes, while others show no effect of under-nutrition on malaria.

Conversely, some studies have associated malaria with increased risk of under-nutrition.

Use of Traditional Medicine in Home Management of Malaria and Severe Anaemia in

Under-five Years Malaria Patients

Eseigbe, Anyiam, Ogunrinde, Wammanda, and Zoaka (2012), the allure for home

treatment includes its apparent time saving characteristics and cheaper cost. However it is

inadequate. The use of herbal mixtures is founded in the belief that herbs are efficacious in

18
the management of malaria. In Nigeria, it is observed that 28.3% of parents believe that the

best treatment for febrile fever is traditional medicine. Furthermore, the ingredients are

readily available and affordable, but unhygienic preparations and potentially harmful

combinations coupled with unconventional prescriptions make the use of herbal concoctions

hazardous or very harmful to malaria patients.

Duru et al (2016), the use of traditional medicine among Nigerians has been on the

upward trend and varies greatly depending on several factors which span from socio-

demographic, economic to pattern, duration and severity of the disease. Also in Nigeria, in a

country wide survey reported a prevalence of herbal use of 41% with 31% combination of

orthodox and traditional medicine. In many developed countries popular use of

complementary and alternative medicine is fuelled by concern about the adverse effects of

chemical drugs, questioning of the approaches and assumptions of allopathic medicine and

greater public access to health, while in developing countries, broad use of traditional

medicine is often attributed to its accessibility and affordability. Herbs are thought to be safe

because they are “natural”, yet herbs may contain hundreds of components that can cause ill

effects directly or through interaction with orthodox drugs. The WHO, noted that

inappropriate use of traditional medicines or practices can have negative or dangerous effects.

The use of this combination could have dangerous consequences arising from complex

reactions between herbal and synthetic drugs and this might have contributed immensely to

this high rate of infant mortality.

19
 CHAPTER THREE

RESEARCH METHODOLOGY

Preamble

This chapter has to do with the methodology for gathering information. The respond

to each question forwarded will be properly and carefully analyzed and will be identified

under the following sub-headings:-

 Research Design

 Population of the Study

 Sample and sampling technique

 Research instrument

 Validity of the instrument

 Reliability of instrument

 Procedure for data collection

 Procedure for data analysis

Research Design

The objective of this research work is to examine and assess the level of awareness of

caregivers on factors influencing incidence of severe anaemia in under-five years’ malaria

patient in Niger State. Descriptive research design of survey type was adopted for this study.

This method is aimed at collecting; analyzing and interpreting data as it exist in the study

area.

Shields, Patricia & Rangarajan (2013), explained descriptive research design as a

method used to describe the characteristics of a population or phenomenon being studied. It

does not answer questions about how/when/why the characteristics occurred. Rather it

addresses the “what” question (what are the characteristics of the population or situation

being studied?) the characteristics used to describe the situation or population are usually
20
some kind of categorical scheme also known as descriptive categories. Here the researcher

does not consciously manipulate the variables so as to observe the effect rather he is only

describing or explaining what he has found to be already in existence (Adaeze, 2004). The

choice of this design is justified because the researcher is interested in the knowledge on

factors influencing incidence of severe anaemia in under-five year’s malaria patients among

caregivers in Niger State.

Population of the Study

Explorable (2018), explain a research population as a large collection of individuals

or objects that is the main focus of a scientific query. A research population is also known as

a well-defined collection of individuals or objects known to have similar characteristics. All

individuals or objects within a certain population usually have a common, binding

characteristics or trait. The population of this study is made up of all caregivers in Niger

State. The caregivers in Niger State have a population of 1,019,473 out of the total population

of 3,954,772 (2006 population census).

Sample and Sampling Technique

Merriam (2018), sample is a finite part of a statistical population whose properties are

studied to gain information about the whole. A representative part or a single item from a

larger whole or group especially when presented for inspection or shown as evidence of

quality.

Lance & Hattori (2016), sampling is the selection of a subset of individuals from

within a statistical population to estimate characteristics of the whole population. The

researcher employed the use of multistage sampling techniques as follows; Cluster sampling

technique was adopted in selecting one senatorial district from the three senatorial districts in

Niger State. Brown (2010) defined cluster sampling as a sampling plan used when mutually

homogeneous yet internally heterogeneous grouping are evident in a statistical population. In

21
this sampling plan, the total population will be grouped into three senatorial districts (zone

“A” [Niger South], zone “B” [Niger East], zone “C” [Niger North]), each zone represents a

cluster, and simple random sampling was used to select one senatorial district from the three

senatorial districts. Thus; for this research three senatorial districts with the total population

of 1,019,473 caregivers based on age distribution of 2006 population census which was

picked ranging from 30-80 years of age and above.

Secondly, two-stage cluster sampling was used to select two (2) LGA from the

selected one senatorial district with nine (9) LGA using simple random sampling.

Encyclopedia Britanica (2018) explained two-stage cluster sampling as a simple random

sample of clusters are selected from the units in each sample cluster. Simple random

sampling was used to select five (5) PHCC from the two (2) selected LGA.

Thirdly, purposive sampling technique was adopted to pick 5% across the five

selected clinics based on the total number of registered caregivers who brought their children

for immunization between the month of January and June 2018. Crossman (2018), explain

purposive sample as a non-probability sample that is selected based on characteristics of

population and the objective of the study. Hence, the selection of 5% respondents from the

five PHCC gave enough samples that will make the result of the research scientific.

Simple random sampling was used in selecting the 5% samples from each of the

selected PHCC making the total sample of one hundred and seventy (170) caregivers as

shown in the table below. According to Yates, Daniel, Moore and Starnes (2008), explain

simple random sampling as a subset of individuals (a sample) chosen from a larger set (a

population) by a random process. Using either a random number generator or a random

number table so that each person remaining in the population has the same probability of

being selected. To achieve this, the register for immunization services in each of the five (5)

selected PHCC was used to list out the caregivers who brought their children for

22
immunization services; thereafter using lucky dip method by picking the numbers at random

until the sample size for the clinic is reached as shown in the table 1 below.

Table1.0: Record of Children’s Surname (caregivers) Registered for RI as From

January-June 2018

S/N Name Of Clinics No. Of Caregivers Expected Sample Size

Registered From
January-June, 2018
1 Gwari Road Clinic 680 34

2 Old Airport Road clinic 629 31

3 FSP Clinic 629 32

4 Bosso clinic 675 33

5 Beji clinic 805 40

TOTAL 3419 170

Source: Immunization Registers of the Above Mentioned PHCC

Instrument for Data Collection

Des Moines University (2018), research instruments are measurement tools (for

example, questionnaires or scales) designed to obtain data on a topic of interest from research

subjects. The instrument adopted in collecting data for this study is questionnaire.

Merriam (2018), Questionnaire is a set of questions for obtaining statistically useful

or personal information from individuals. Written and printed questionnaires are made up

with spaces for answers. The questionnaire was constructed by the researcher. The

questionnaire is to evoke some responses on level of knowledge on factors influencing

incidence of severe anaemia in under-five year’s malaria patients among caregivers in Niger

State and was developed base on the hypothesis of this research. The questionnaire consists

of two sections, ‘A’ and ‘B’, section ‘A’ deals with personal information of the respondents

such as age; gender, marital status, occupation, and level of education, while section ‘B’

sought information on the variable selected for the study in the questionnaire. The close
23
ended type of questionnaire of four points modified likert scale format of SA-Strongly Agree,

A-Agree, D-Disagree, SD-Strongly Disagree was used, each respondent reacted to the

statement by ticking it.

Validity of the Instrument

Carole and Almut (2008) defined validity as the extent to which an instrument

measures what it purports to measure. The developed structured questionnaire by the

researcher was given to the supervisor and three experts in the department of Community

Health, Niger State School of health technology Minna who are well experienced in

community health, have extensive knowledge on factors influencing severe anaemia in

malaria patients in the community. They went through the questionnaire items and remove

ambiguous statement which forms the basis for making necessary correction on the

questionnaire items. The questionnaire was designed in such a way that they will be

presented in a close ended format.

Reliability of Instrument

Trochim (2006), reliability has to do with the quality of measurement in its everyday

sense. Reliability is the “consistency” or “repeatability” of your measures. A measuring

instrument is said to have a high reliability if it produces the same result under consistence

conditions. Therefore the test, re-test method was employed to find the reliability of the

instruments using caregivers from a LGA in Niger State different from the 2 sample LGA.

The instrument was administered to 30 caregivers from the LGA and the first and second

administration was correlated using the person product moment correlation coefficient to

determine the reliability level and coefficient of 0.86 is expected to be recorded which will

make the instrument reliable enough for the study.

24
Procedure for Data Collection

The researcher was personally involved in the distribution of the questionnaire to the

respondents. This was done by taking the questionnaire to the one hundred and seventy (170 )

caregivers sample from the entire caregivers in the two (2) LGA selected during the

immunization services, the questionnaire was collected as soon as they are complete to make

sure that increased rate and degree of return is achieved. The researcher gave the respondents

explanation on how to complete the questionnaire. The responses of the samples to items in

the questionnaire formed the data base for this research work, upon which data was analyzed.

Procedure for Data Analysis

In order to test the hypothesis formulated, descriptive statistics of frequency count and

simple percentage analysis was used to determine the level of knowledge on factors

influencing incidence of severe anaemia in under-five years’ malaria patient among

caregivers. The items in section A: (Demographic data) is also subjected to descriptive

statistics of frequency count and simple percentage.

25
 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

Preamble

This chapter deals with the presentation and analysis of data collected from the

respondents with the use of questionnaire. The information was obtained from caregivers in

the selected LGA in Niger State. This will be presented using descriptive statistic of

frequency count and percentage.

26
Table 2.0: Personal Data of the Respondents

S/N Respondents Bio-Data Responses Percentage

1 Age of respondents
15-25years 37 22%
26-35 years 77 45%
36-45 years 35 21%
46 years and above 21 12%
Total 170 100%
2 Sex of respondents
Mala 42 25%
Female 128 75%
Total 170 100%
3 Marital status of the respondents
Single 24 14%
Married 128 75%
Divorce 11 7%
Widow 7 4%
Total 170 100%
4 Educational qualification of the
respondents
Primary school certificate 41 24%
Secondary school certificate 59 35%
Tertiary education certificate 56 33%
Others 14 8%
Total 170 100%
5 Occupation of the respondents
Civil Servant 52 30%
Farming 71 42%
Others 47 28%
Total 170 100%
Source: Researcher’s Field Work, 2018

27
From the above table, it shows that 22% of the respondents are 15-25 years of age, 45% are

26-35 years, 21% are 36-45 years, while 12% are 46 years and above. 25% respondents are

male, while 75% are female. 14% of the respondents are single, 75% are married, 7% are

divorced, while, 4% are widow. 24% respondents are primary school certificate holders, 35%

are secondary school certificate holders, 33% are tertiary education certificate holders, while,

8% belong to other qualifications. 30% of respondents are civil servants, 42% are farmers,

while 28% belongs to other occupation.

28
 Table 3.0: Knowledge on delay care and severe anaemia in under-five years’ malaria
patient.
S/N Statement Responses
Positive Negative
(SA & A) (D & SD)
1 Caregivers find it so difficult to access health facility with their sick child 58 112
due to lack of clinic around them which as a result there is delay in seeking
health care
2 The cost of treatment in the health facility is always not affordable by 90 80
caregivers which discourages them from taking their sick child to the health
facility early
3 Caregivers tend to delay seeking health care for their children suffering from 70 100
malaria as a result of negative attitudes from health workers which includes
harshness, insulting, neglecting, and charging patients unnecessarily
4 Caregivers desire to purchase drugs from patent medicine sellers because they 74 96
feel it’s cheap and can get the child well which result to delay in seeking
health care
5 Caregivers feel when the condition is critical or out of hand that is when they 55 115
will take the child to the health facility for treatment
6 Caregivers have no knowledge of clear signs and symptoms of malaria 111 59
making them to keep the sick child at home for too long without going to the
clinic
7 Caregivers perceive child illness as mild because the child is playing and not 114 56
lying down which delay in taking the child to clinic.
8 Seeking health care is delayed because caregivers feel fever is a normal 78 92
disease which just requires paracetamol tablet or syrup only and the child get
well
9 Lack of skillful health workers in the health facility close to caregivers 63 107
discourages them from taking their sick children suffering from malaria to the
clinic for early treatment
10 The health workers are not always available in the health facilities which 46 124
result in keeping the child at home before the presence of health workers
Total 759 941
Percentage 45% 55%
Source: Researcher’s Field Work, 2018

29
 From the above table, it shows that 759 responses that is 45% agreed to the above

items as reasons for delay care as a factor to severe anaemia in under-five years malaria

patients, while, 941 responses that is 55% disagreed to the above items.

Table 4.0: Knowledge on Poor Nutrition and Severe Anaemia in Under-five Years’
Malaria Patient.
S/N Statements Responses

Positive Negative
(SA & A) (D & SD)
1 Lack of enough income lead to insufficient supply of 144 26
diet to the sick child which increases the level of
anaemia
2 The child doesn’t have strength to eat enough when 147 23
he/she is sick with malaria, this lead to very low
blood level in the child
3 Caregiver do not have the knowledge on how to 131 39
prepare adequate diets that will increase the blood
level of the sick child which result to severe anaemia
4 Sick children are deprived of some foods with the 109 61
assumption that the child will not be able to eat those
foods
5 Sick children tends to vomit if given food to eat 139 31
which may increases incidence of severe anaemia
Total 670 180
Percentage 79% 21%
Source: Researcher’s Field Work, 2018.

From the above table, it shows that 670 responses that is 79% agreed to the above

items as factors to severe anaemia in under-five years malaria patients, while, 180 responses

that is 21% disagreed to the above items.

30
Table 5.0: Knowledge on Use of Herbs and Severe Anaemiain Under-Five Years
Malaria Patients.
S/N Statement Responses

Positive Negative
(SA & A) (D & SD)
1 Caregivers believe that consulting herbalists, local deities 100 70
and use of herbs for the treatment of malaria is more
cheaper and easily accessible
2 Caregivers believe malaria is first treated with herbal teas 111 59
and baths prepared with neem, pawpaw, guava and
eucaplyptus leaves which are also more effective in
managing the condition.
3 Herbal or traditional treatment of malaria is safer and more 64 106
affordable than the drugs given in the health facility as
believed by caregivers
4 Taking of herbal medicine take care of all illness including 49 121
malaria which we prefer than taking the child to the clinic
5 Herbs has been in use before now in the treatment of 95 75
malaria which is part of us and that is why we don’t treat
malaria in the clinic
Total 419 431
Percentage 49% 51%
Source: Researcher’s Field Work, 2018

From the above table, it shows that 419 responses that is 49% agreed to the items on

use of herbs as a predisposed factor to severe anaemia in under-five years’ malaria patient,

while 431 responses that is 51% disagreed to the above items.

31
 CHAPTER FIVE

SUMMARY, DISCUSSION OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS
Preamble

This chapter deals with the summary, discussion of findings, conclusions and

recommendations of the study;

Summary

The objective of this research work was to assess the knowledge on factors

influencing incidence of severe anaemia in under-five year’s malaria patients among

caregivers in Niger State. The areas examined involved knowledge or awareness on delay

care as a predisposed factor to severe anaemia in under-five years’ malaria patients,

knowledge on poor nutrition as a cause of severe anaemia in under-five years’ malaria patient

and knowledge on the use of herbs as a predisposed factor to severe anaemia in under-five

years’ malaria patient. A descriptive research of survey type was used and a self-structured

questionnaire consisted of two sections (A and B) to gather information for the research work

on the identified variables was adopted.

The results were analyzed using frequency table and percentage counts to bring out

the agreement or disagreement of the respondents on the presented statements.

Recommendations were made based on the findings of the research work.

Discussion of Findings

Research Hypothesis1: there is no significant relationship between knowledge of

caregivers on delay care and severe anaemia in under-five year’s malaria patients in Niger

State. Therefore, the above null hypothesis was accepted considering the analysis from table

3.0 of this research work where majority of responses shows agreement to the items on

knowledge on delay care as a predisposed factor to severe anaemia in under-five year’s

malaria patients.
32
 The above findings of this study is inline with the reports of Wisemen, Scott, Conteh,

Mcelroy, and Stevens (as cited in kassile et al, 2014) that caregivers with low level of

education were more likely to delay in seeking malaria treatment for children; caregivers

often identify malaria as fever along with other symptoms or signs; they perceive children

illness as mild; cost of services are associated with delay to seek care. Ahmad et al (2017)

also reported that in sub-saharan African countries like Nigeria, poverty is important

challenges to access health facility services. From the result of this research, it shows that the

majority of the caregivers have low level of awareness on delay care because they have not

been exposed to health education on causes of delay care as a predisposed factor to severe

anaemia in under-five year’s malaria patients.

Research Hypothesis 2: There is no significant relationship between caregivers’

knowledge on poor nutrition and severe anaemia in under-five year’s malaria patients in

Niger State. Therefore, the null hypothesis was not accepted considering the analysis from

table 4.0 of this research work where majority of responses shows agreement to the items on

knowledge on poor nutrition as a cause of severe anaemia in under-five year’s malaria

patients.

The above findings of this study is in contrary to the report of Simbauranga et al

(2015) who reported that unemployment and low level of education might lead to poor socio-

economic status, it was noted that lower level of education was associated with increased risk

of anaemia. Anaemic children had caretakers who did not complete or attended primary

education. The relationship between education and anaemia may be due to the capacity of

caregivers to grasp the knowledge needed for adequate nutrition for children. From the result

of this research, it shows that the caregivers have knowledge of poor nutrition as a

predisposed factor to severe anaemia in under-five year’s malaria patients because they feel

nutrition is an aspect of promoting good health.

33
 Research Hypothesis 3: There is no significant relationship between caregivers’

knowledge on the use of herbs and severe anaemia in under-five year’s malaria patients.

Therefore, the above null hypothesis was accepted considering the analysis from table 5.0 of

this research work where majority of responses shows disagreement to the items on

knowledge on use of herbs as a predisposed factor to severe anaemia in under-five year’s

malaria patients.

The above findings of this study is in line with the reports of Eseigbe et al (2012) that

the use of herbal mixtures is founded in the belief that herbs are efficacious in the

management of malaria. Also supported by Nwakwasi et al (2017) many rural people do not

trust western style medication preferring instead to use traditional ways which is an

alternative or non-conventional mode of treatment involving the use of herbs in a non-

orthodox manner, as well the process of consulting herbalists, mediums, priests,

witchdoctors, medicine men and various deities. In Nigeria, particularly rural areas, malaria

are usually first treated with herbal teas and baths prepared with neem, pawpaw, guava and

eucalyptus leaves. From the result of this research, shows that majority of caregivers have

low level of knowledge on depending on use of herbs in the treatment of malaria as a

predisposed factor to severe anaemia because they have not been exposed to the implications

of depending on use of herbs.

Conclusions

Based on the findings of this research work, the researcher therefore made the

following conclusions that;

 the majority of caregivers in Niger State have low level of awareness on delay care as

a predisposed factors to severe anaemia in under-five years’ malaria patients.

 the caregivers in Niger State are fully aware of poor nutrition as a cause of severe

anaemia in under-five years’ malaria patients.

34
  the majority of caregivers in Niger State have low level of awareness on the use of

herbs as a cause of severe anaemia in under-five years’ malaria patients.

Recommendations

Considering the conclusions above, the researcher made the following

recommendations
 The caregivers should be enlighten during health education sessions in order to create

awareness on the implications of delay seeking health care for a child suffering from

malaria in order to encourage them to take the under-five years malaria patient to the

nearest health facility on time for prompt attention.

 There should be a continue health education on adequate nutrition in order to maintain

caregivers knowledge on classes of food with their examples, the importance of

nutrition on a sick child suffering from any kind of illness which include malaria and

also demonstrate how adequate diet is prepared. Nutritional assessment should be

carried out by health workers to ensure the sick child is not anaemic.

 Caregivers should be health educated on the ill effect of depending on use of herbs on

a sick child and also encourage them to accept orthodox medicine which has expiry

date, adequate dosage for a specific age.

Suggestions for Further Studies

Considering the limitation of this study the researcher therefore suggest the
followings for further studies;
 Assessment of knowledge on interventions in overcoming severe anaemia in children

among health care providers.

 Assessment of attitude and practice of interventions in overcoming severe anaemia in

children

35
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38
 APPENDIX

QUESTIONNAIRE

NIGER STATE SCHOOL OF HEALTH TECHNOLOGY P.O.BOX, 137

MINNA.ASSESSMENT OF KNOWLEDGE ON FACTORS INFLUENCING INCIDENCE

OF SEVERE ANAEMIA IN UNDER-FIVE YEARS MALARIA PATIENTS

AMONGCAREGIVERS IN NIGER STATE.

Dear Respondent,

This questionnaire is designed to collect data for the above study. It will be

appreciated if you respond to each item objectively. All responses will be treated

confidentially and will only be used for the purpose of this study.

In order to maintain anonymity and confidentiality, do not indicate your name.

Thank you.

Yours faithfully

Mustapha Musa Kalu

B/26/049/2015

Consent section: (please tick [√]

 I wish to participate in this research [ ]

 I am not interested in this research [ ]

39
SECTION A: Personal Data

Instruction: (please tick [√]) as appropriate, the option provided. Only one response is valid

for a question.

1. Age of respondents

a. 15-25Age years

b. 26-35 years

c. 36-45 years

d. 46 years and above

2. Sex of respondents

a. Male

b. Female

3. Marital status

a. Single

b. Married

c. Divorce

d. Widow

4. Educational qualification of respondents

a. Primary school certificate

b. Secondary school certificate

c. Tertiary education certificate

d. Others

5. Occupation of respondents

a. Civil servant

b. Farming

c. Others

40
 SECTION B:

Instruction: (please tick [√]) as appropriate considering the keys below.

SA- Strongly Agreed D- Disagreed

A- Agreed SD- Strongly Disagreed

S/N Knowledge on Delay Care SA A D SD

1. I find it so difficult to access health facility with my sick

child due to lack of clinic around us which as a result there is

delay in seeking health care

2 The cost of treatment in the health facility is always not

affordable by me which discourages me from taking my sick

child to the health facility early

3 I tend to delay seeking health care for my child suffering from

malaria as a result of negative attitudes from health workers

which includes harshness, insulting, neglecting, and charging

patients unnecessarily

4 I desire to purchase drugs from patent medicine sellers

because i feel it’s cheap and can get the child well which

result to delay in seeking health care

5 I feel when the condition is critical or out of hand that is when

I will take the child to the health facility for treatment

6 I have no knowledge of clear signs and symptoms of malaria

making me to keep my child at home for too long without

going to the clinic

7 I perceive child illness as mild because the child is playing

and not lying down which delay in taking the child to clinic.

41
8 Seeking health care is delayed because I feel fever is a normal

disease which just requires paracetamol tablet or syrup only

and the child get well

9 Lack of skillful health workers in the health facility close to

me discourages me from taking my sick children suffering

from malaria to the clinic for early treatment

10 The health workers are not always available in the health

facilities which result in keeping the child at home before the

presence of health workers

Knowledge on poor nutrition and severe anaemia in SA A D SD

under-five years malaria patient

1 Lack of enough income lead to insufficient supply of diet to

the sick child which increases the level of anaemia

2 The child doesn’t have strength to eat enough when he/she is

sick with malaria, this lead to very low blood level in the

child

3 I do not have the knowledge on how to prepare adequate diets

that will increase the blood level of the sick child which result

to severe anaemia

4 Sick children are deprived of some foods with the assumption

that the child will not be able to eat those foods

5 Sick children tends to vomit if given food to eat which may

increases incidence of severe anaemia

Knowledge on use of herbs and severe anaemia in under- SA A D SD

42
 five years malaria patient

1 I believe that consulting herbalists, local deities and use of

herbs for the treatment of malaria is more cheaper and easily

accessible

2 I believe malaria is first treated with herbal teas and baths

prepared with neem, pawpaw, gwava and eucaplyptusleaves

which is also more effective in managing the condition.

3 Herbal or traditional treatment of malaria is safer and more

affordable than the drugs given in the health facility as

believed by me

4 Taking of herbal medicine take care of all illness including

malaria which we prefer instead to take the child to the clinic

5 Herbs has been in use before now in the treatment of malaria

which is part of us and that is why we don’t treat malaria in

the clinic

43