NJALA UNIVERSITY

BO CAMPUS

KOWOMA

TO INVESTIGATE THE PREVALENCE OF MALARIA AMONG UNDER

FIVE CHILDREN IN KAKOYA COMMUNITY BAFODIA CHIEFDOM,

KOINADUGU DISTRICT IN THE NORTH OF SIERRA LEONE

BY
JOHN MANSARAY
ID: 31387

2020
 TITLE PAGE

TO INVESTIGATE THE PREVALENCE OF MALARIA AMONG UNDER FIVE

CHILDREN IN KAKOYA COMMUNITY BAFODIA CHIEFDOM, KOINADUGU

DISTRICT IN THE NORTH OF SIERRA LEONE.

PRESENTED BY:

JOHN MANSARAY

SUPERVISED BY:

MR. LAURENCE T. KARGBO

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF

SCHOOL OF COMMUNITY HEALTH SCIENCES PARAMEDICAL

BO CAMPUS, KOWOMA.

2020

I
 DECLARATION
I declare that this dissertation is entirely my own work. All sources and quotations
have been acknowledged. The main works consulted are listed in the bibliography.

John Mansaray
(Student)
….……………………………
(signature)

….……………………………
Date

II
 CERTIFICATION

This is to certify that I MR. LAURENCE T. KARGBO lecturer at the University of

Makeni, supervised this research work done by JOHN MANSARAY final year in the
department of School of Community Health Sciences Paramedical.

Date of Submission: ____________________________________

..….…………………… ……………….……….. …..……………………

External Examiner Head of Department Internal Examiner

III
 DEDICATION

This piece of work is dedicated to Mr. Joseph T. Mansaray for his tireless efforts in

making me who I am today. And may God bless you all!

IV
 ACKNOWLEDGEMENTS

I sincerely thank the Almighty God for His Guidance and Protection throughout

my period of this research.

I also sincerely thank my supervisor Mr. Laurence T Kargbo who has aided me to

complete this research successfully with his useful suggestions and constructive

criticisms.

I also sincerely thank my elder brother Joseph T. Mansaray for his moral and

material support throughout my period of study, also Baio Mansaray and Kankoh

Conteh for their relentless effort in helping me pass through this.

I further thank the Kakoya PHU for aiding me with data in my research work.

Lastly, I thank all friends especially Mr. John Abdul Kamara (editor and typist),

who has in one way or the other contributed to the successful completion of this

research.

V
 ACRONYMS

WHO World Health Organization

CDC Center for Disease Control

PHU. Peripheral Health Unit

RDT Rapid Diagnostic Test

ACTs Artemisinin-Based Combination Therapies

MoH Ministry of Health and Sanitation

PHCs Perpheral Health Centre

VI
 LIST OF TABLES

Table 4.0 demographic…………………………………………………………...19

Table 4.1 response on the level of knowledge among women over children……20

Table 4.2 Response on the Proportions of infected and uninfected women of

childbearing………………………………………………………………………21

Table 4.3 response on the Prevalence of malaria among under five children……22

Table 4.4 response on the Factors responsible for malaria spread……………….23

VII
 LIST OF FIGURES

Figure 4.0 participants……………………………………………………………20

Figure 4.1 level of knowledge among women over childbearing………………..21

Figure 4.2 Proportions of infected and uninfected women of childbearing……..22

Figure 4.3 Prevalence of malaria among under five children……………………23

Figure 4.4 Factors responsible for malaria spread……………………………….24

VIII
 TABLE OF CONTENTS
TITLE PAGE……………………………………………………………………….I
DECLARATION…………………………………………………………………...II
CERTIFICATION…………………………………………………………………..III

DEDICATION………………………………………………………………………IV
ACKNOWLEDGEMENTS…………………………………………………………..V
ACRONYMS……………………………………………………………………..….VI
LIST OF TABLES………………………………………………………………….VII
LIST OF FIGURES…………………………………………………………..……VIII
TABLE OF CONTENTS…………………………………………………………….IX
ABSTRACT………………………………………………………………………….XI

CHAPTER ONE
1.0 Introduction……………………………………………………………………….1
1.1 Background of the study………………………………………………………….1
1.2 Problem statement…………………………………………………………….…..3
1.3 Significance of the study………………………………………………………….4
1.4 Aims and objectives…………………………………………………………….…4
1.5 Research questions…………………………………………………………….…..5
1.6 Scope of the study…………………………………………………………………5
1.7 Limitation and Delimitation………………………………………………….……5
1.8 Definitions of Key terms………………………………………………………….6

CHAPTER TWO
LITERATURE REVIEW……………………………………………………………..7
2.0 Malaria in children and women of childbearing age: prevalence and knowledge..7
2.0.1 Malaria parasite detection and treatment………………………………………..8
2.0.2 Household and Socioeconomic Factors…………………………………………8
2.0.3 Demographic Factors…………………………………………………………..10
2.0.4 Environmental Factors…………………………………………………………10
2.1 Prevalence of malaria among under five…………………………………………11
2.2 Prevention of malaria…………………………………………………….…..…..11

IX
CHAPTER THREE
RESEARCH METHODOLOGY……………………………….……………………13
3.0 Introduction………………………………………………………………………13

3.1 Research Design………………………………………………………….…….13

3.2 Study Area……………………………………………………………….……..14

3.3 Population and Sample Size……………………………………………………15

3.4 Sample Procedures……………………………………………………………..15

3.5 Research Instruments…………………………………………………………..16

3.6 Data Collectio Procedures………………………………………………………17

3.7 Methods of Data Analysis and Presentation…………………………………….17

3.8 Ethical Consideration……………………………………………………………18

CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSIONS OF FINDINGS…

4.0 introduction…………………………………………………………….………19

4.1 presentation……………………………………………………………….……19

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS…………………..…25

5.0 Summary…………………………………………………………………….…25
5.1 Conclusion…………………………………………………………………..…26
5.2 Recommendation…………………………………………………………..…. 26

References……………………………………………………………………………27

Appendix 1……………………………………………………………………….…..28

X
 ABSTRACT
Background: There is little information on the social perception of malaria and the use
of preventative measures in Sierra Leone, especially in rural areas. Adequate
knowledge of malaria prevention and control can help in reducing the burden of
malaria among vulnerable groups, particularly pregnant women and children aged
under 5 years old living in malaria endemic settings. This study was designed to
assess the prevalence of malaria and the knowledge and attitude towards this disease
in Kakoya community.
Methods: A cross-sectional study was conducted to assess malaria knowledge, factors
and prevalence of the infection in the Kakoya community Koinadugu district. Malaria
infection was confirmed using rapid diagnostic tests. A questionnaire was
administered randomly to 60 participants during a two weeks period in October 2020.
Overall, the respondents’ socio-demographic characteristics, knowledge on
childbearing, factors of malaria spread and malaria prevalence were recorded and
analysed.
Results: Data was collected on 30 participants were included in this study, 30 women
of childbearing age (including 13 pregnant women, 10 lactating mothers and 7
caregivers women) and 15 children. Practically the entire (97.7%) interviewed
population had already heard about malaria and attributed the cause of malaria to a
mosquito bite. This survey revealed that the bed net coverage rate was 40.0%. The
study observed an average malaria parasite prevalence in every fourth child as malaria
infection.
Conclusion: Malaria is highly prevalent in the village of Kakoya. Research findings
show that children under five and pregnant women are more vulnerable to malaria in
this area of the country. This study reveals that respondents have a little knowledge
over childbearing, factors of malaria spread and preventive measures. The incidence
of malaria remains relatively high in this rural community highlighting the need for
continuous strategic interventions particularly health awareness and educational
programs.

XI
 CHAPTER ONE
1.0 Introduction

This chapter comprises the introductory aspect of the study, thus drawing out a clear
frame work of the structure that the research is going to look like. This constitutes the
background to the study, the problem statement, significance of the study, aim and
objectives of the work, research questions, scope, limitations and delimitations in one
hand, and then followed by definition of key terminologies used in the research.

1.1 Background of the study

The World Health Organization reported 219 million cases of malaria with an
estimated 660,000 deaths. And Africa is the most affected region in the world,
followed by East Africa and India has the highest (61%) malaria burden in the region
with an estimated 24 million cases per year. Plasmodium falciparum malaria
continues to be a major public health threat in West Africa, with nearly half (273
million) of the high risk population outside Africa residing in India. India contributes
over one fifth (22.6%) of clinical episodes of P. falciparum globally. About 80% of
malaria cases reported in the country is confined to areas consisting of 20% of the
total population, who reside in Wara Wara Bafodia, hilly, difficult and in accessible
areas. In Sierra Leone, malaria is predominantly reported among the rural population
owing to about 80% of malaria cases and overall 97% of deaths. Keeping in view the
magnitude of malaria burden among the forest dwelling Wara Wara population in
Sierra Leone, this communication was prepared with the objective to assess the
prevalence of malaria among the Kakoya community children under the age of five
residing in northern Koinadugu districts in Sierra Leone. This region is a remote hilly
and forested area inhabited by various cattle rearers and there is a constant conflict
with local governments leading to security restrictions. Primary health centres
(PHUs/PHCs) are sparsely located in forest villages. To avail the health care services,
they need to travel on foot for long distances as there is no proper transport
infrastructure. The Wara Wara population of this region have poor access to modern
health care and are vulnerable to under-nutrition, malaria and other communicable
diseases. Unicef and USAID have been providing primary health care and emergency
services to the wara wara population through mobile health clinics.

1
Malaria is one of the primary global health problems today, with an estimate of 219
million cases and more than 435,000 deaths in 2017 (WHO, 2018). As per WHO
estimates, more than ninety percent of malaria cases and deaths occur in Africa, with
sub-Saharan African countries recording higher rates (WHO, 2018). In 2017,
under-five children accounted for 61% of malaria deaths globally (WHO, 2018).
Deaths due to malaria in underfive children have significantly decreased over the last
five years due to increase in resources to fight the disease. According to WHO (2015)
resources to fight malaria increased from $960 million to $2.5 billion between 2005
and 2014 worldwide. Therefore, the disease is no longer the leading cause of death in
this age group. However, malaria is still a considerable burden in children in Africa,
causing an estimated 10 percent of all deaths of children on the continent. In Sierra
Leone, malaria is the leading cause of morbidity, with 95% of the population (6.7
million people) at risk, and it contributes to approximately 14% (131,383) of
under-five mortality (MoHS, 2016). Globally, Sierra Leone accounted for 4% of
malaria deaths in 2017 (WHO, 2018). Under-five children are amongst the most
vulnerable groups to malaria infection due to a weak immunity to the disease (CDC,
2012). Malaria and poverty are closely linked. Malaria is concentrated in resource
limited settings. Within these settings, the poorest and most marginalized are the ones
that are severely affected. Such communities have the highest risks associated with
malaria, and the least access to effective services for prevention, diagnosis, and
treatment.
Malaria is a major threat to the socioeconomic development of Sierra Leoneans with
an estimated 7-12 days lost on the average per episode of malaria. It imposes
substantial costs to individuals, households and the government. Furthermore, severe
malaria impairs children's learning and cognitive abilities by as much as 60%,
consequently affecting the performance of Sierra Leone's universal primary and
secondary education programs (MoHS, 2016). To reduce malaria mortality and
morbidity, the national program strategic plan targets a 40% decrease in the number
of incident cases. Over the years, Sierra Leone made significant strides to successfully
reduce the number of new malaria cases through supports from numerous partners and
donors. Control strategies involved free distribution of longlasting insecticide treated
bed nets, indoor residual spraying and the removal of user fees in public and few
private hospitals, making treatment free for malaria cases. However, despite these
measures to reduce the burden of malaria, there is still a notable high number of

2
children under five years dying from the disease (MoHS, 2016). Malaria accounts for
40% morbidity with over one million outpatient visits every year for under-five
children. There are other underlying causes which exacerbates malaria morbidity in
children such as pneumonia, diarrhea, and neonatal causes (MoHS, 2016).
The predictors of childhood malaria are not well understood in the context of Sierra
Leone. Despite vulnerability and major consequences of malaria illness among under
five, a good number of studies in Sierra Leone have focused on the knowledge
attitudes and careseeking behaviors, incidence, and prevalence of the disease at the
population level. However, very little is known about household demographic,
socioeconomic and environmental determinants that play a role in the incidence of
febrile illnesses in underfive children in both rural and urban areas that are
characterized by seasonal malaria transmission with frequent occurrence of epidemics.
Malaria diagnosis for under-five kids in many parts of the country utilizes rapid test
kits, which sometimes are not reliable due to test kit performance. Not a single study
has been done in Sierra Leone to test the sensitivity and specificity of these malaria
antigen detection kits.
Therefore, it is vital to understand the relationship between malaria status in underfive
children and some household demographic, socio-economic, and environmental risk
factors associated with the disease. The purpose of this study is to examine the
prevalence of malaria among under-five children in Kakoya community wara wara
Bafodia chiefdom in Koinadugu district Sierra Leone.
1.2 Problem statement
There is little information on the social perception of malaria and the use of
preventative measures in Sierra Leone, especially in rural areas. Adequate knowledge
of malaria prevention and control can help in reducing the burden of malaria among
vulnerable groups, particularly pregnant women and children aged under 5 years old
living in malaria endemic settings. This study was designed to assess the prevalence
of malaria and the knowledge and attitude towards this disease in households in the
Kakoya community.
A cross-sectional study was conducted to assess malaria knowledge, prevention
practices and prevalence of the infection in the Kakoya community. Malaria infection

3
1.3 Significance of the study
The study tends to investigate the prevalence of malaria among under five children in
the rural communities, especially this that deals with Kakoya community, is
justifiable in that:
I. It will assess the level of knowledge about malaria among women of child
bearing age in Kakoya Bafodaia Chiefdom of Koinadugu District, but in Sierra
Leone generally. Officers of the Ministry of Health and Sanitation (MoHS) will
benefit from this work as it will open their horizon to better understand the
prevalence of malaria on rural communities, with a typical example of Kakoya
Bafodia chiefdom;
II. Also, health workers will greatly benefit from this research work, as it will give
them an insight of how to determine the factors responsible for malaria spread;
III. Again, Teachers in medical schools can use this work for academic purposes ,
they can use this material to teach their students, issues that are related to the
medical profession. This research work will provide them with recent information
that has bearing to contemporary researches which serves as eye opener to the
prevalence of malaria that may lead to preventive measures in tackling the
parasite;
IV. Lastly, this research work will help the government and the community people to
better understand how to take measures with particular reference to Kakoya.
1.4 Aims and objectives
Aim
The ultimate aim of the study is to investigate the prevalence of malaria among under
five children in Kakoya community Bafodia chiefdom, Koinadugu district in the
North of Sierra Leone.
Objectives
The objectives of the study are as follows;
1. To access the level of knowledge about malaria among women of child bearing
age in Kakoya village Wara Wara Bafodia;
2. To determine the factors responsible for malaria spread;
3. To determine the prevalence of malaria among under five children;
4. To suggest the preventive measures in combating malaria by mother’s in the
community.
5.

4
1.5 Research questions
1) What level of knowledge about malaria among women of child bearing age in
Kakoya town Wara Wara Bafodia?
2) What are the factors responsible for malaria spread?
3) What are the prevalences of malaria among under five children?
4) What are the preventive measures in combating malaria by mother’s in the
community?
1.6 Scope of the study
The study takes into account only one community in the Bafodia chiefdom Koinadugu
district north of Sierra Leone. The study was conducted for Kakoya community all
gear towards the prevalence of malaria among under five children in the community.
This will mainly deal with pregnant women and mother’s with under five children in
the community. The researcher will have to focus on the responses of respondents
thereby serving as an awareness tool on healthcare research activities for proper
analysis of results. The research work will take duration of two months by working
with a sample size of 43 respondents of the Kakoya community.

1.7 Limitation and Delimitation

Limitations of the study
The study is limited in diverse ways. First, it is limited in the selection of respondent
group in that the research deals with mother’s with under five children and pregnant
women of the Kakoya community only. This group serve as the only target group of
the study as they are the immediate concern of the researcher. Moreover, the study is
also limited in time and energy as the researcher is a student, who has to spend time
on working on assignments, attending classes, taking tests and examinations. This
means that the researcher has to take time from the one allotted for university work to
writing the research, so as to meet the demands of other requirements as well. Also,
weather conditions, distance to the study area, financial resources, university tuition
fees and transport fares and the behavior of participants serve as a limitation to
the study.
Delimitations of the study
The research has several delimitations, and that, there are other factors which are
beyond the control of the researcher. This has to do with energy to be spent on the
work, meaning that the amount of strength to be spent on the work was delimited by

5
sickness and other physical constraints which the researcher encountered during the
time when writing this research.

1.8 Definitions of Key terms

Community a group of people living in the same place or having a particular
characteristic in common.
health centres a building or establishment housing local medical services or the
practice of a group of doctors.
Malaria a disease caused by a plasmodium parasite, transmitted by the bite of
infected mosquitoes.
Under five children who are less than five years old, especially those who are not
in full-time education.

6
 CHAPTER TWO
LITERATURE REVIEW
2.0 Malaria in children and women of childbearing age: prevalence and
knowledge

In 2019, malaria remains the deadliest parasitic disease for human beings. An
estimated 228 million cases of malaria occurred worldwide in 2018, most of which
were in the WHO African Region (2014) (200 million or 92%). The same year,
405,000 malaria-related deaths were recorded. Children under 5 years old are the most
vulnerable group affected by malaria, in 2017 they accounted for 61% (266 000) of all
malaria deaths worldwide. It is now known that pregnant women are more susceptible
to malaria than their non‐pregnant peers. In their studies study (Hussain MA,
Dandona L, Schellenberg D, 2013) shows that Malaria during pregnancy is
responsible for serious consequences for both the mother and her child, among which
feta growth restriction, prematurity and still birth contribute to perinatal and neonatal
mortality. In areas where the intensity of transmission is moderate to high, leading to
higher levels of acquired immunity, most P. falciparum malaria infections during
pregnancy remain asymptomatic and are frequently undiagnosed and untreated. The
(WHO & CDC, 2018) malaria report also reveals insurgence levels of access and
adhesion to lifesaving malaria prevention tools and interventions. A considerable
proportion of people at risk of infection are not being protected, including pregnant
women and children in Africa.

Gabon is a hyperendemic area in which malaria burden fluctuate (Alain P. & Pater N.,
2013 ). Transmission is perennial since the equatorial climate favors mosquito
proliferation and larval development. However, also stated that, over the last decade,
Gabon has gradually strengthened malaria control interventions. Changes in the
national antimalarial policy such as the introduction of artemisinin-based combination
therapy (ACT) as first-line treatment in all public facilities, the introduction of
malaria rapid diagnostic tests (RDTs), the distribution of impregnated bed nets, and
the implementation of intermittent preventive treatment during pregnancy have led to
a decline in the malaria burden in urban areas. After the implementation of
artemisinin-based combination therapies (ACTs) in 2005, a decrease in malaria
burden was observed, but for the past few years, a recrudescence was noted in the

7
urban areas of Franceville and Libreville. However, prevalence did not change in rural
areas.
2.0.1 Malaria parasite detection and treatment
After obtaining the consent of all recruited participants, a rapid diagnostic test was
performed. Capillary blood was obtained via longer stick for malaria testing using
RDT SD BIOLINE Malaria Ag P.f/Pan test (Abbott, US). In different visited
households, malaria infection was diagnosed only in children ≤ 5 years of age and
women aged 15-49 years. Test results were recorded on a patient sheet and data on
symptoms were also collected. Participants with positive RDT results were offered
immediate treatment with either artemether-lumefantrine for children and pregnant
women in their second or third trimester Coartem, child: 20 mg / 120 mg and adult:
80mg / 480 mg (Novartis, Switzerland), or quinine for pregnant women in their first
trimester Surquina 250 mg (Innothera chouzy, France), according to national
treatment guidelines.
2.0.2 Household and Socioeconomic Factors
Socioeconomic and Household factors could limit from occupation, household wealth
index, educational level, housing characteristics such as materials used in construction,
water and sanitation facilities, and electricity. The review suggest that household
income and educational level are major causal factor of malaria. Households with
low-income status have very few accesses to healthcare and hence disease burden is
in these settings. On the other hand, educational levels help improve health status due
compliance with prevention strategies. Chitunhu and Musenge (2015) looked at the
direct and indirect factors of childhood malaria. They found that wealth quintile and
educational level were directly or indirectly connected to malaria morbidity in
under-five children (Chitunhu & Musenge, 2015). Mpimbaza et al (2017) also
observed that having an employed caregiver/household head was a related factor to
severe malaria. The study also showed that households with higher socioeconomic
status and mothers with more than three children below 5 years are strongly
associated with malaria.
In a study to determine the risk of malaria in under-five children in Nigeria,
Morakinyo et al (2018) found that the type of housing (non-improved materials used
in construction) is an essential risk factor for malaria in under-five children in Nigeria.
Nonimproved housing predicted malaria infection among under-fives in this study.

8
The study also showed that children living in rural areas and poorest households were
mostly affected by malaria (Morakinyo et al., 2018).
Roberts and Mathew (2016) looked at risk factors of malaria in under-five children in
Uganda. This report found that household factors such as main floor material, main
wall material and availability of electricity in the household were closely related to
malaria risk factors. The study also suggests that indoor residual spraying importantly
reduces the risk of malaria n children. Children living in clusters with higher altitudes
have a lower risk of malaria (Roberts & Mathews, 2016). Zgambo, Mbakaya, and
Kalembo (2017) also found that households with a low income had higher chances of
acquiring malaria. This was further shown in a follow-up study they did in 2014. In
terms of other social and economic factors that may well exacerbate malaria in
children, is the presence of water and sanitation facilities at the household level. Yang
et al (2020) observed malaria infections diagnosed by microscopy among individuals
with different water and sanitation access in various sub-Saharan African countries
revealed that the prevalence of malaria among the unprotected water users (22.6%)
and piped water users (7.5%) were both significantly lower than the prevalence rate
among the protected water users; however, this trend was not always consistent in all
the surveys in these countries. The study further showed that children who do not
have access to latrines were more likely to have malaria than children who used pit
latrine toilets, whereas children who used flush toilets had a low tendency of malaria
infection. They also found that malaria infections measured by RDTs in exposed and
unexposed groups showed a significant reduction of malaria rates in households
where there is protected water, pit latrines, piped water and flush toilets. On the other
hand, households with unprotected water or use open defecation practices have higher
risks of malaria when adjusted for potential co-founders (Yang et al., 2020). Studies
have also shown that children living in poorly constructed houses have a greater
chance of being bitten by mosquitoes when compared to those who live in well
constructed houses. Ngadjeu et al (2020) studied the influence of house characteristics
on mosquito distribution and malaria transmission in Yaounde, Cameroon. The study
found that the risk of being bitten by mosquitoes was lower in houses constructed
with cement walls or mix materials than in those constructed with mud or plank. This
study also showed that parameters like the presence of holes on the walls, the number
of windows, the presence of opened eaves or breeding sites near houses are strongly
associated with increase indoor mosquito abundance.

9
2.0.3 Demographic Factors
Factors suchlike geographic region, sex, age, and region of residence have all been
characterized as important forecaster for malaria in children and adults as well as
pregnant women. One study in Malawi looked at socio-demographic factors and their
role in malaria morbidity in under-five children. The findings of this study revealed
that the age of children is an independent predictor of malaria in 2012 and 2014
respectively (Zgambo, Mbakaya & Kalembo, 2017). The study showed that older
children reported more malaria symptoms compared to younger ones. In Ghana,
Nyarko and Cobblah (2014) also found that age was a strong risk factor for malaria in
children. However, in a case-control study in Uganda Mpimbaza et al (2017) looked
at the demographic, socioeconomic and geographic factors that could lead to severe
malaria and delayed care-seeking in children. They found that an increase in the age
of children was a protective factor against severe malaria.
Malaria affects both males and female; however, gender roles and dynamics give rise
to various exposure patterns and vulnerabilities. For instance, in rural settings women
are more likely to fetch water from nearby streams early in the morning and late in the
evening exposing them to peak mosquito-biting times (Cotter et al., 2013). A study in
Malaysia involving teenagers aged 15 years and above showed that gender and
location (rural areas) are strong determinants of malaria (Ramdzan, Ismail &
Mohd-Zanib, 2020). Malaria transmission is more prevalent in tropical and
subtropical zones. The Ghana study showed that people residing in rural and the
tropical regions of Ghana had more malaria compared to those living in urban and less
tropical zones (Nyarko & Cobblah, 2014).
2.0.4 Environmental Factors
Environmental factors same height, rainfall, humidness temperature all play
significant roles in the transmission cycle of malaria vectors. There is a positive
relationship between malaria and warm tropical and subtropical climate (Arab,
Jackson & Kongoli, 2014). Humidity and temperature are conducive environments for
mosquitoes. Heavy rainfall creates stagnant pools and ditches which act as breeding
sites for the mosquitoes and hence its population multiplies rapidly (Chua, 2012).
Parasite growth within the host increases with an increase in temperature to complete
the cycle (Jackson et al., 2015).
In a study in Tanzania, Kaindoa et al (2018) observed the influence of physical
characteristics of houses and surrounding environments on mosquito biting risk and

10
malaria transmission. The results showed that the number of mosquitoes was
significantly higher in houses with open eaves, grass roofs, Mud walls, and
unscreened windows. The study further revealed that keeping chickens inside the
house was also associated with a high number of mosquitoes.
Also in Rwanda, Rudasingwa and Cho (2020) investigated the determinants of
persistent malaria in under-five children and found that malaria was more persistent in
children who live in areas with sea level below 1700 meters and their household's
income is very low and do not use insecticide-treated bed nets. This suggests that
people living in poor households have a higher chance of malaria infections and that
the disease decrease with an increase in altitude. Graves et al (2009) looked at
individual, household and environmental risk factors for malaria infection in 3 regions
in Ethiopia. They found that having insecticide-treated bed net and asset index were
major risk factors of malaria. They also found that the richest households and
households that were sprayed in the last 12 months before the survey had a lower risk
of malaria infection. Maximum rainfall was also a strong predictor for malaria in the
three regions. High altitude had a low risk of malaria prevalence.

2.1 Prevalence of malaria among under five

The prevalence and consequences of malaria among infants are not well characterized
and may be underestimated. A better understanding of the risk for malaria in early
infancy is critical for drug development and informed decision making authorities.
The World Health Organization (2015) reported 219 million cases of malaria with an
estimated 660,000 deaths. South East Asia is the second most affected region in the
world after Africa, and India has the highest (61%) malaria burden in the region with
an estimated 24 million cases per year. Plasmodium falciparum malaria continues to
be a major public health threat in India, with nearly half (273 million) of the high risk
population outside Africa residing in India. India contributes over one fifth (22.6%) of
clinical episodes of P. falciparum globally.
2.2 Prevention of malaria
Although insecticide-treated bednets and curtains have emerged in recent years as
promising tools, their use in Africa is limited. Various studies have shown that ITN is
effective in the control of malaria in pregnant women. D’Alessandro et al (2017)
demonstrated that the use of ITNs significantly reduced the number of primigravidae
with parasitaemia in villages where it was used compared to control villages. The

11
study by Kuile et al (2018) also showed that women who used ITN had significantly
fewer pre-term deliveries and babies with higher mean birth weight than women who
did not use ITN well as improving pregnancy outcome. The WHO (2019) has
consequently adopted IPTp with sulphadoxine-pyrimethamine as the gold standard for
prevention of malaria in pregnancy.

12
 CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction

This research methodology explains the techniques the researcher used to get

information on the research problem and it includes the research design, target

population and sample size, research instrument, procedure for data collection,

methods of data analysis, and ethical consideration for which both qualitative and

quantitative approaches were used.

3.1 Research Design

The researcher designed the study in the form of a survey method, wherein there are

presentations of an area locating the premises on which the research was to be

conducted. İt shows the place a population is taken from, there to draw a sample size,

that is number of participants among whom the questionnaires are going to be

administered. This means the entire research will report the views of people chosen

from the study location, and these makes up the representation of responses from the

respondent groups selected for the purpose of using test items on them to solicit their

views on the objectives under investigations.

The design also show the sampling procedures that were employed by the researcher

who used the random sample selection processes. And, data collection procedure

includes designing a researcher- made questionnaire which comprise of four sections,

each of these reporting on specific objective of the study. İnterviews and visitations

are also part of the understanding activities applied in the course of investigating the

problem, but data collected from the sources of interviews and visitations are not

going to be included in the findings presentations. İt is only the information solicited

13
from the questionnaires that are counted to know the quantity of responses on a

specific view in the test items.

Moreover, the test items results are distributed into categories of responses with the

same or similar views on a particular set of questions administered to them on a

specific objective under investigation. Then, the researcher at last applied the

quantitative and qualitative data analysis procedures to analysis the raw data

presented in tabular forms.

3.2 Study Area

The study area that the researcher targeted is the Kakoya community’s PHU Bafodia

Chiefdom, Koinadugu District in the north west region of Sierra Leone. The study

targeted this community’s PHU with patients and their relatives and friends who

served as visitors from the community where PHU is located. Kakoya is the section

headquarters and can be found immediately 9 miles after the chiefdom headquarters

Bafodia. Bafoda chiefdom is devided into 9 sections including: Bafodia, Kakoya,

Semamia, Kapompo, Santia, Madana, Kamagbengbe, Kamanenke, and Bendugu. As

the name implies, Wara wara Bafodia has the third largest mountain in Sierra Leone

none as the wara mountain, historically, the mountains which the Limbas were

believed to have come. Kakoya is developed with a church and mosque, a primary

school and health centre. Kakoya serve as a hub for the other villages like Sakuta,

Kakamba, and Kamathgben. Also, Kakoya is about 36 miles far away from Kabala

the district headquarters of Koinadugu, north of Sierra Leone. The township and the

entire Chiefdom is a multicultural community, and traditions and societal norms are

highly regarded and valid here in this part of the country. The Fullas and the wara

wara Limbas live here though the Limbas are the predominant settlers of this

chiefdom. The people depend on subsistence farming and petty-trading. Their

14
administration is locally orgainzed from Paramount chief down to a town chief as

equally as other parts in the country.

3.3 Population and Sample Size

Population of the Study

The researcher randomly selected a population that comprise sixty (60) participants.

The population consist of lactating mothers and caregivers with under five children on

daily health care service delivery process in the Kakoya PHU, and family and friends

of the patients , because their perceptions are needed as part of the investigation

carried out. The participants age groups is limited with youths, young adults and

adults, the questions related to the prevalence of malaria among under five children, is

directly answered by these categories of response groups. The participants for this

study was selected unbiased, in that sixty (60) lactating mothers and caregivers with

under five children were included.

Sample Size of the Study

The researcher randomly selected a sample size of thirty (30) respondents, among , all

of these were found out to have visited the Kakoya PHU at the time of the study,

either in the capacity of a Medical personnel, patients and relatives as Caregivers. İt

was thirty (30) people who were given questions to respond to in the cause of the

study. The responses of 30 respondents will be used for taking any conclusive

decision at the end of the study.

3.4 Sample Procedures

The researcher used the random sampling procedure as a sample drawn out of the

total number of the population size in the study. Random sampling is a statistical

procedure that has series of steps, starting with the writing of the names of each

15
person included as part of the population to be used for the study. Each name that was

written, is folded and placed in a bucket , until all the names are in the container. The

researcher shakes the container properly and choose one-in for the purpose of the

study and one-out not to be included in the work. This activity goes on until the

population of 60 is been divided into two groups, 30 each group, and then one group

is thrown away and the other accepted as part of the study. This method is frequently

used by researchers in their sample procedures , because it is free of behavior found in

other procedures.

3.5 Research Instruments

The researcher used interviews, observations and questionnaires as the main

instrument used to collect data on the study. The questions are divided into four

sections, and each section is set to solicit information related to one of the objectives

under investigations. The design of the questionnaires required each participant to

fill in the blank spaces provided after each set of test item. The questions were filled

in by the medical personnel, because many can read and write on the spaces provided

for supplying in answers to the instruments. In the case of the Patients and Caregivers

who could not read and write answers on the scripts, the researcher administered

questions directly to such respondents, and then the answers to the question is written

down. Also, the researcher employed on-the-spot administration of questionnaire, and

did not distribute them rampantly and left in the hands of respondents to bring them in

when and how they wish. This is the reason for one hundred percent (100%)

collection and submission of administered questions free from shortage.

16
3.6 Data Collection Procedures

In order to achieve acceptable levels of measurement reliability and validity, a pre-test

was carried out, following the guidelines. This information was used to refine the

original survey instrument. The resulting data was analysed and used to further

modify the questionnaire items for the full study.

The data collection exercise is focused on views pertaining to the socio-economic

effects and factors that have contributed to the “prevalence of malaria among under

five children”, which will lead to the drop-down of the number of malaria patients.

And lastly data will also be collected on the level of knowledge among women about

the “prevalence of malaria among under five children. The researcher used Krio and

Limba because it was seen as the common language which all participants were able

to speak in the PHU.

3.7 Methods of Data Analysis and Presentation

The researcher is going to use the descriptive statistical method in the analysis of the

raw data collected and presented as findings after carrying out investigations on

concepts dealing with socio-economic effects on the “prevalence of malaria”. Also,

from examining factors that contributed to the prevalence of malaria among under

five children in the Kakoya PHU.

Moreover, since the researcher is going to describe the views of each set of

respondent groups identified in the study. The researcher correlated the views of all

the respondents into the categories of views provided for in the questionnaires. The

raw figures that are written on the tables were discussed, starting from top to the

bottom. Describing their validity content as compared to other sets of raw figures that

could be found on the table. The figures were analyzed by discussing frequency (f)

17
modulation rate, a particular view pulled in sets of respondent groups in the study as

to it’s percent (%).

3.8 Ethical Consideration

“Ethics” can be defined as the critical, structured examination of how we should

behave-in particular, how we should constrain the pursuit of self-interest when our

actions affect others. Ethical consideration is the paramount concern of the researcher

to ensure data confidentiality. The information received from the respondents is to be

handled with privacy as a way of protecting the identity of the respondents. In order to

generate an accurate and reliable data for the research work, respondents were free to

answer all questions.

18
 CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSIONS OF FINDINGS

4.0 introduction

In this study, its shows that my study population had adequate knowledge regarding
childbearing, and also on the preponderance of malaria among under five children
leading to the factors responsible for malaria spread as the mosquito bite is the means
of transmission. However, a large proportion of respondents also falsely thinks that
walking under the rain and too much of orange consumption is another factor of
malaria. This findings was confirmed by the results of one of my studies (unpublished
data). The questionnaire may have failed to capture factors other than the four
indicated. The researcher’s results also demonstrate that fever, and headache, fatigue
and aches were correctly identified as symptoms of malaria which corroborates results
from similar studies conducted in other communities where respondents were able to
name at least one symptom of malaria. National malaria programs need to know how
and where their populations obtain information regarding malaria in order to better
plan their communication activities. Research’s study revealed that most of the
population obtains information on malaria from media source and, to a lesser extent,
from hospitals and health centers.
4.1 presentation:
Demographic
Table 4.0 demographic
parameters % Age Occupation
participants
Pregnant 13 43.3 15-25 Petty
women trading
Lactating 10 33.3 26-35 Farming
mothers
Caregivers 7 23.3 36-45 Farming
Total 30 100
Source: (research, 2020).
The table (4.0) shows the demographic of respondents. This explains the category of
respondents that were involved in the survey as the parameters indicated pregnant

19
women, lactating mothers and caregivers including the under fives’. According the
parameters, 13 (43.3%) percent of pregnant women within the ages of (15-25) do
petty trading took part in this research. Also, 10(33.3%) Lactating mothers within the
ages of (26-35) engage in subsistence farming were involved. Likewise 7(23.3%)
Caregivers under the ages of (36-45%) also do farming. However, though there as not
been a category of under five children, but they could be also represented with to total
number of lactating mothers and caregivers. Meaning, 10 plus 7 making a total of 17
under five children physically took part in this research. The researcher decided to
capture the those age brackets since that is the fertility ages for women
Figure 4.0 participants

Source: (research, 2020).

The figure depicts a representation of the different participants that took part in this
research work. This clearly shows that the the age in the brackets (15-25) & (26-35)
largely took part in the research since they are the possible ones to be in their
fertilities. Hence, (13 & 10) are the possible majority to visit the PHU regularly were
the data was been captured unlike 7(36-45) caregivers.
Table 4.1 response on the level of knowledge among women over children
Age (≤5 No % Mother’s age of Occupation
years) childbearing
0-1 15 50.0 15-25 Petty trading
2-3 10 33.3 26-35 Farming
4-5 5 16.6 36-45 Farming
Total 30 100
Source: (research, 2020).

20
In the table (4.1) shows the level of knowledge among women over children. This
table explains that 15(50.0%) women within the ages of (15-25) have only <1 year of
experience on childbearing and women 10(33.3%) under the ages (26-35) indicated
<3 years on childbearing. The data shows that the two groups are said to be
vulnerable in terms of children with malaria infection as it is also showed in table 4.2
proportions of infected and uninfected women of childbearing. As compared to
5(16.6%) women within age (36-45) have wealth of experience over childbearing;
hence children are less malaria infected.
Figure 4.1 level of knowledge among women over childbearing

Source: (research, 2020).

The figure (4.1) equally shows the level of knowledge among women over
childbearing. 15 women has the highest frequency of (50.0%) 15-25 years with less
experience over childbearing and 10(33.3) 26-35 years participants indicated adequate
knowledge over childbearing; as compared to 5(16.6%) women of age 36.45 years are
only indicated to have wealth of knowledge on childbearing.
Table 4.2 Response on the Proportions of infected and uninfected women of
childbearing
Age bracket Infected Uninfected
15-25 15 0
26-35 10 2
36-45 2 1
Total 27 3
Source: (research, 2020).

21
In table (4.2), its categorizes both number of malaria infected and uninfected number
of under five children among those who participated in this survey. (15) of 15-25
years and (10) of 26-35 years women where tested positive over malaria parasite as
compared to (2) women of 36-45 years
Figure 4.2 Proportions of infected and uninfected women of childbearing

Source: (research, 2020).

Figure (4.2) also represents table (4.2) information on the number of infected and
uninfected number of women on childbearing. The bar charts (15) on the range 15-25
years with zero uninfected as compared to 2 and 1 uninfected cases under the age
brackets of (26-35 & 36-46) years respectively. And severally 10, 2 (26-35 & 36-45)
years women also were infected.
Also, please note that, both the indicated numbers of infected and uninfected for
lactating mothers and caregivers women are respectively represented for the captured
under five children under the research in question.
Table 4.3 response on the Prevalence of malaria among under five children
Age N Mean % Fever/Histo % Mean % Test method
group o weight, ry of fever hemoglo
kg(SD) bin level
g/dl

0-2 13 5.6 17.7 65 35.5 11.8 33.6 Rapid malaria

yrs diagnostic test
3-4 10 12.8 40.5 87 47.5 10.9 31.0 Rapid malaria
yrs diagnostic test
4-5 7 13.2 41.7 31 16.9 12.4 35.3 Rapid malaria
yrs diagnostic test
Total 30 31.6 100 183 100 35.1 100
Source: (research, 2020).

22
In table (4.3), this explains the fever or history of fever on children under five years
that was seen through the malaria test method and their weight taken accordingly.
65(35.5%) recorded cases under (0-2) years. While (3-4) years recorded (47.5%) 87
times as compared to the (4-5) years who recorded (31) times of reported number of.
Meaning, 3(3-4) years children are more vulnerable to catch malaria since they are
mostly exposed because of transformation especially the young infant or crippling
stage to upright.
Figure 4.3 Prevalence of malaria among under five children

Source: (research, 2020).

The figure (4.3) also present the table (4.3) in bar charts form. The longest bar
represent children under (3-4) years age with the highest number of affected fever.
Also, children (0-2) years have (35.5%) of recorded cases which almost seem to be
vulnerable like those under the ages of (3-4)years as compared to affected children
under the ages of (4-5) years with (16.6%) only
Table 4.4 response on the Factors responsible for malaria spread
No MUAC Mother’s Radio Use of bed Intake of all
education net preceding 2
weeks
Yes No Yes No Yes No

20 0.88 None 1 19 4 16 4 16
8 1 Primary 3 5 6 2 3 5
2 1 JSS 1 1 2 0 2 0

Source: (research, 2020).

23
The factors responsible for malaria spread could be explained in table (4.4), as the
indicated number of factors are shown. However, although not all possible factors
were been captured during the cause of study, but the researcher was able to record
first-handed pointed out factors on the spread of malaria.

Figure 4.4 Factors responsible for malaria spread

Source: (research, 2020).

Figure (4.4) is also in conjunction with table (4.4) showing reasons or factors
responsible for malaria spread in the Kakoya Wara Wara Bafodia Chiefdom. The use
of bed net has always been major factor on spread of the parasite since mosquito bites
is prevalent in this community and its surrounding. Answers from respondents
recorded 16 frequency indicating “NO”. This simply means that their is less use of
bed net in these communities as compared to 6 “YES”. Also, on the ‘intake of all
preceding 2 weeks’ the longest bar on the chart indicate that women comply less on
the intake of all routines which has been a cause to the increase of malaria.

24
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Summary

İn summary, the study was conducted on investigations on the level of knowledge

about malaria among women of child bearing age in Kakoya community Wara Wara
Bafodia. The researcher also explore on factors responsible for the “prevalence of
malaria” in the Kakoya community wara wara Bafodia chiefdom Koinadugu district
north of Sierra Leone. The researcher investigated the prevalence of malaria among
under five children. The researcher therefore applied the descriptive research method
through which a survey system was applied through designing features. İt was
designed to have a population and sample size drawn up from the community that
served as study location. Using Kakoya PHU as the targeted respondents group
selected through random sample procedures applied, and questionnaires are the
main tools through which data was collected. Some questions were answered in
writing, while some had to be dictated to collect raw data from some of the
respondents.

Qualitative and quantitative data analysis techniques were used to discuss attitudes of
respondents to ascertain test items that was administered to them at the questioning
and answer time that were organized among the respondent groups in the health
centre unit.

Results were submitted on four tables (1-4), each table bearing information on a
particular objective on the study. The results were submitted in frequency (f)
modulation and the equivalent percentages (%), and the figures discussed according to
content.

The results showed that:

 Table 4.1 shows the lack of knowledge among women over childbearing. Age
(≤5 years) only 5 women were found to have (4-5 years) knowledge over
childbearing. And this could be reference to (table 4.2) wherein, the most infected
women are on ages (15-25) years those with (0<1 years) knowledge over
childbearing.

25
 Secondly, table 4.3 shows other parameters in the present study, e.g. fever or
history of fever, hemoglobin level g/dl, test method and mean weight kg (SD).
At the health facility of Kakoya, half of the children have respiratory or
gastrointestinal infected problem. Every fourth child in the health facility had
malaria of which is the main reason for visiting the health centre.

 Lastly, the other table (4.4) indicates factors on the prevalence of malaria spread.
Parameters like MUAC, radio, use of bed net, intake of all preceding 2 weeks and
mothers education, are said to influence the rapid infection spread of malaria.

5.1 Conclusion

In this community and facility based survey on the prevalence of malaria, four in
every child under five years of age had malaria due to either lack of education of the
mother, low bed net effectiveness, in access to radio health awareness programs,
negative perception over the spread of malaria. Among the age adjusted risk factors
for a malaria infection was a decreasing MUAC. This is due to the fact that we
targeted children ≤5 and women 15-45 years old in the general population who were
mostly asymptomatic

5.2 Recommendation

Improved nutrition, identification and elimination of causes of low bed net

effectiveness, and reinforced health education are promising and tangible measures to
further reduce malaria in this area of Kakoya. In parallel, community-based
surveillance of malaria should be included to monitor the progress of malaria control.

26
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Appendix 1

Paramedical

school of community health science

N’jala University

Bo Campus, Kowoma.

QUESTIONNAIRE FOR PREGNANT WOMEN, LACTATING MOTHERS AND

CARE GIVERS AT THE KAKOYA PHU BAFODIA CHIEFDOM KOINADUGU
DISTRICT, NORTHERN REGION OF SIERRA LEONE.

PREAMBLE:

My name is John Mansaray I am a final year student at the N’jala University,

Kowoma, Bo Campus pursuing a Bachelors degree in Paramedical Study in the
department of school of community health sciences. The questionnaire is to
Investigate The Prevalence of Malaria Among Under Five Children in Kakoya
Community Bafodia Chiefdom, Koinadugu District.

Your answers to the questions will go a long way to help reduce the spread of malaria
in your communities.

INSTRUCTION: Fill in the blank spaces provided after each set of questions.

SECTION ONE

Date …………………… Occupation………………….. Sex: male female

Pregnant women Lactating mother Caregiver

Participants’ Age : 15-25 years 26-35 year 36-45 years

SECTION TWO

To assess the level of knowledge among women over children

Have you ever faced with the issue of childbearing? Yes No

At what age do you experienced or practice childbearing?……………

How many years the child was during your childbearing ?……………

Has your child faced with any health complications? Yes v No

31
Did you report to the PHU?

What was the result behind the report? Makaria: Infected Uninfected

On the Prevalence of malaria among under five children

Child’s Age: 0-2 yrs 3-4 yrs 4-5 yrs Mean Weight (kg/SD)

Fever/ history of fever mean haemoglobin level

Test method………………………………………………….

Factors responsible for malaria spread

Mothers’ education: JSS primary None do you have a radio to listen to

health advice? Yes No do you sleep under bed net? Yes No

did your child take all precedings? Yes No MUAC

What government should do to address the spread of malaria? Design policies to help

reduce the spread of malaria? week strong very strong

Thank you very much!!!

32