Gollis university

Department of health science

Faculty of health officer
Prevalence of Malaria and Prevention Awareness among Patients Attending Adult Outpatient
Department(OPD) at Hargeisa Group Hospital, Somaliland, 2023
By

HANA OSMAN IBRAHIM

Health Officer student

August, 2023
 Gollis university

Department of health science

Faculty of health officer
Prevalence of Malaria and Prevention Awareness among Patients Attending Adult Outpatient
Department(OPD) at Hargeisa Group Hospital, Somaliland, 2023
By
HANA OSMAN IBRAHIM
Health Officer student

August, 2023

ADVISOR:
Dr TASHOME
1. Introduction
1.1 Global Malaria Burden
Malaria is a serious and sometimes a fatal disease caused by a parasite that commonly infects a
certain type of mosquito which feeds on humans. People who get malaria are typically, very sick
with high fevers, shaking, chills, and flu-like illness. Because malaria causes so much illness and
death, the disease is agreat drain on many national economies. Since many countries with
malaria are already among the poorer nations, the disease maintains a vicious cycle of disease
and poverty.Usually people get malaria by being bitten by an infective female Anopheles
mosquito.Only Anopheles mosquitoes can transmit malaria and they must have been infected
through a previous blood meal taken from an infected person.(DegifieBereka, September,
2017)According to the latest World Health Organization (WHO) estimates, Globally, the World
Health Organization estimates released in December 2015, there were 212 million cases of
malaria in 2015 and 429,000 deaths. Between 2010 and 2015, malaria incidence among
populations at risk fell by 21% globally, during the same period, malaria mortality rates among
population at risk decreased by 29%. An estimated 6.8 million malaria deaths have been averted
globally since 2001.(WHO, 2015).The WHO African Region continues to carry a
disproportionately high share of the global malaria burden. In 2015, the region home to 90% of
malaria cases and 92% of malaria deaths. Some 13 countries… mainly in sub-Saharan Africa…
account for 76% of malaria cases and 75% deaths globally. In areas with high transmission of
malaria, children under five are particularly susceptible to infection, illness and death, more than
two thirds (70%) of all malaria deaths occur in this age group between 2010 and 2015,the under-
five malaria death rate fell by 29% globally.(WHO, 2015).Despite decades of control measures
and intensive interventions, malaria continues to cause extensive morbidity and mortality
throughout the widespread regions where it is endemic There are six species that commonly
cause malaria infections in humans: Plasmodium falciparum, P. vivax, P. ovale (two sympatric
species), P. malariae, and P. knowlesi; and recently P. cynomolgi has been implicated.The vast
majority of research has been directed towards P. falciparum, which is the primary contributor to
disease burden throughout sub- Saharan Africa. (Sama, W., Dietz, K., and Smith, 2016).Sub-
Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the
region was home to 90% of malaria cases and 92% of malaria deaths. Children under five years
of age are particularly vulnerable, accounting for an estimated 70% of all malaria deaths.
Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving
treatment. New findings presented in the report show that, in 2015, approximately half (51%) of
children with a fever seeking care at a public health facility in 22 African countries received a
diagnostic test for malaria, compared to 29% in 2010.(ORGANIZATION, 2015).
1.1 Statement of the Problem
Malaria epidemics remain a major public health problem for the world population. Mainly
developing African countries especially those sub-Saharan are seriously affected by this
disease.According to WHO report, in 1997 out of 52.2 million total deaths of the world, 17.3
million were due to parasitic diseases. Malaria imposes a great deal of financial burden on the
countries’ economy and on the societies by reducing productivity. Malaria remains an acute
public health problem, particularly in sub-Saharan Africa. According to the report, there were
212 million new cases of malaria and 429 000 deaths worldwide in 2015. There are still
substantial gaps in the coverage of core malaria control tools. In 2015, an estimated 43% of the
population in sub-Saharan Africa was not protected by treated nets or indoor spraying with
insecticides, the primary methods of malaria vector control. In many countries, health systems
are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large
proportion (36%) of children with a fever were not taken to a health facility for care in 23
African countries. (WHO, 2015).

Malaria, which is one of the most ancient infectious diseases, is present in 101 countries. It is a
major health problem in 90 countries where an estimated 40 % of the total world population
currently lives in areas with malaria. (WHO, 1997-1998).A variety of factors cause the
increasing rate of malaria epidemics including complacence and policy changes that led to reduce
funding for malaria control programs in the 1970s and 1980s. The emergence of drug resistance,
human population growth and movement, land-use change, and deteriorating public health
infrastructure are some of the important factors for the increasing rate of malaria epidemics.
(Ashenafi Woldemichael Woime, June 2008).In 2017, there were an estimated 219 million cases
of malaria in 87 countries. The estimated number of malaria deaths stood at 435 000 in 2017.
The WHO African Region carries a disproportionately high share of the global malaria burden.
In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths. Total funding
for malaria control and elimination reached an estimated US$ 3.1 billion in 2017. Contributions
from governments of endemic countries amounted to US$ 900 million, representing 28% of total
funding. (WHO, world malaria report, 2017)According to the latest World malaria report,
released in November 2018, there were 219 million cases of malaria in 2017, up from 217
million cases in 2016. The estimated number of malaria deaths stood at 435 000 in 2017, a
similar number to the previous year. The WHO African Region continues to carry a
disproportionately high share of the global malaria burden. In 2017, the region was home to 92%
of malaria cases and 93% of malaria deaths. In 2017, 5 countries accounted for nearly half of all
malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (11%),
Mozambique (5%), India (4%) and Uganda (4%). Children under 5 years of age are the most
vulnerable group affected by malaria; in 2017, they accounted for 61% (266 000) of all malaria
deaths worldwide.(World malaria report, 2016- 2017-2018).
Malaria is caused by a parasite, transmitted from one person to another through the biting of
certain species of mosquitos in parasite-endemic regions. Those at greatest risk of severe
forms of the disease, and death, are children under the age of 5 years, and pregnant
women.
An estimated 125 million pregnancies per year are at risk of malaria around the world.1 For
both mother and child malaria is potentially life-threatening. Common risk factors are
maternal anaemia, premature labour and poor birth outcomes such as low birth weight,
which are associated with a negative impact on early childhood development.2 WHO
reported3
that in 2018 around 11 million pregnancies were exposed to malaria, resulting in
high levels of maternal anaemia (see figure below from WHO World Malaria Report 2019)
the delivery of around 872,000 children with low birthweight.

1 Dellicour S et al. “Quantifying the Number of Pregnancies at Risk of Malaria in 2007: A Demographic Study”.
PLos Med; 7(1): e1000221 (2010).
2 Schantz-Dunn J & Nour NM. “Malaria and Pregnancy: a global health perspective”. Rev Obstet Gynecol;
2(3):186–192 (2009).
3 WHO World Malaria report 2019. https://www.who.int/publications-detail/world-malaria-report-2

1..SIGNIFICANCE
This study can also issue of awareness. It can also be valuable to the association working in healthcare professional
specifically public health workers, and public health programs. This study can also provide information to those
working in the area of infectious disease proficient
 Objectives
General objective
To Asses prevalence of malaria and prevention Awareness Among adult out patients

1.3.1. Specific objectives

The specific objectives of the study were:

1. To Estimate the Prevalence, of Malaria Among adult out Patients Attending In

hargeisaa hospital
2. To asses prevention Awareness of malaria Among Adult patients
3. To assess the value of preventive to treated and curative interventions in reducing
malaria morbidity in an area of intense perennial malaria transmissions.
4. To define the demographic of respondents in term of gender, education, marital
status,socio-economic conditions.

Conceptual Frame Work

The following is a conceptual framework of the possible factors that influence of malaria
. the socio-economic activities
life style and domestic activities.
Occupations of the people such as farming, fishing, animal
rearing, stone quarrying, have an impact of transmission.
The life style of the people such as sleeping outside, watching
television
or visiting the video centers, cinema

center,haveanimpact of
transmission.
5. Climatic condition may influence mosquito
breeding.
6. They are normally detached from the
main house have an impact of transmission of malaria.
 Chapter two
Literature review

2.0 Overview malaria

most important public health problems worldwide it as leading cause morbidity and mortality in
many developing countries young children and pregnant woman as most affected. As 2004 107
countries or territories malaria transmission it estimated that the worldwide approximately
3.2billion people at risk of malaria infection transmission and about 350-500 million clinical
disease episodes occur annually around 59%of the world (Ahmed, Comparison among different
diagnostic, 2007)malaria transmission widely distributed and occurs in countries of Africa Asia
central and south America the middle east and Oceania however significant geographical
variation in morbidity and mortality exist between countries and regions where malaria
transmission exist as estimated 200,000 new born deaths occur each year as a result of malaria
infection during pregnancy (Ahmed, Dr. Mejbah Uddin, 2007)
The world health organization estimated that were 216 million malaria infection and 655,000
deaths from malaria in 2010 with in vast majority of these occurring in the African region
(Cunnington, 2012) in 217 estimated us 3.1 billion was invested in malaria control and
elimination efforts globally by governments of malaria endemic countries and international
partners an amount slighter higher then report in 2016 Region, followed by the WHO regions of
South-East Asia (US$ 300 million), the Americas 200 million and the Eastern Mediterranean and
the Western Pacific 100 million In 2017 1.4 billion was invested in low-income countries 1.2
billion (Organization, 2018)Africa ha the greatest burden of malaria cases and deaths the world
wide an estimated 60% of all cases and over 80%of malaria deaths occur in sub Saharan Africa.
In sub Saharan Africa malaria is responsible for 1in 5 of all childhood deaths the most malaria
infections in sub-Saharan Africa are caused by p falciparum 93of which principal vectors are
anopheles are estimated one million of people in Africa die from malaria each year and most of
these are children under 5 years in India about 70%of the infections are reported to caused by p
vivax 25%-305%by falciparum 48%-8%by mixed infections and 1%by p malaria India reported
3 million fewer cases in the same period, a 24% decrease compared with 2016 (Shraddha
Gondaliya1, 2015.) Ethiopia is greatly affected by climate change which malaria has profound
consequence on transmission on cycles of vector-born infection disease the prevalence ofmalaria
estimated to 1.3 billion (asart, 2017)
2.1 Malaria situation in Africa
Annually there are 149–274 million cases and 537,000–907,000 deaths from malaria, with the
majority of the cases occurring in sub-Saharan Africa Hackett noted that “Like chess, it malaria
is played with a few pieces, but is capable of an infinite variety of situations.” In the early 1900s
malaria was widespread. Getting et al. Estimated 58% of the landmass had endemic malaria or a
risk of malaria epidemics in the 1900s. In 2007 the percentage had decreased to 30%. It should
be noted that for Africa these numbers are very uncertain. the standard deviation over the mean
Plasmodium falciparum rate for children between 0 and 15 years in 2007 the same data used by
Getting et al In large parts of Africa the standard deviation has the same magnitude as the mean.
Getting et al. refer to a study by Lysenko that described malaria in the 1900s. The Getting study
included both Pl. falciparum and Pl. vivax; therefore, the decrease is probably not as pronounced
as they describe. Getting et al. also argue that the relationship between climate and malaria has
broken (Lunde, 2003)

2.1.1 Prevalence of malaria

Risk of malaria infection is directly related to the prevalence of infected Anopheles mosquito
populations. Over half of the world’s population (3.3 billion people) is at some level of risk of
becoming infected because they live in areas where malaria is endemic either seasonally or year-
round. (who, report, 2012) (who, Malaria Disease Report, 209)
The prevalence of malaria among under five children in Damotdisric was 38/419(9.1) children
plasmodium falciparum plasmodium vivax and missed infection estimate that infection rates
increased by 40 percent between 1970 and 1997 in sub-Saharan Africa. To cope with this
dangerous resurgence, public health workers carefully select prevention methods best suited to a
particular environment or area. In addition to medicines and insecticides, they are making there
are five known species of Plasmodium that are capable of infecting humans, viz. P. falciparum,
P. vivax, P. ovale, P. malaria and P. knowlesi. The latter cause’s malaria in macaques, Global
prevalence is concentrated around the equator in tropical and subtropical regions because of
ample rainfall, warm temperatures and stagnant waters that provide ideal habitats for Anopheles
mosquito larvae. Malaria is considered by the WHO to be endemic in 106 countries worldwide,
with 10 countries in the eliminating phase but is also capable of infecting humans (van
Hellemondet al., 2009). Of these species, P. falciparumandP. Vivax are the most virulent and
were responsible for an estimated 660 000 deaths in 2011. P. ovale and P. malaria cause
generally less life threatening illnesses. Combined, these parasites had contributed to over 200
million reported cases of malaria in 2011 (who, report, 2012)

2.1.1 Knowledge about malaria

General knowledge about malaria General awareness of malaria is high in most parts of Uganda.
A baseline survey in five districts from all regions of the country (Net Mark, 2001) indicated
99% level of awareness. Similarly, Commercial Market Strategies (CMS) study (Okello, 2001)
carried out in Mukono, Jinja and Arua indicates 99% level of awareness. A study by Kilian
(2002) on malaria related knowledge and behaviors in three districts in western Uganda also
indicate significant improvement in general knowledge about malaria. The Home Based
Management of
 Malaria/Fever (HBM) baseline (2001) and follow up survey (2003) and PSI (2003) tracking
survey also indicate similar levels of awareness about malaria
Malaria have indicated that some community members still have misconceptions about causes of
malaria. Kalisa (1997), in a study in Hoima district reported that community members’
misconceptions about the cause of malaria included; Bedbugs, poor nutrition, maize and
mangoes. A study done in Iguana (Namusobya et al, 1998) observed that other perceived causes
of malaria were: drinking dirty water, raw fruits, poor sanitation, cold environment,
splenomegally, worms, and Tsetse fly. More or less the same responses were observed in Mpigi
district in a study by Luanniale and Rajais (1996). These misconceptions certainly have
implications for community’s malaria preventive behaviors and practices. A study done by
Njama, D et ‘al (2003) in Kampala city also indicated that 90% of the caregivers knew that
mosquitoes cause malaria although they equally indicated other perceived causes such as
drinking un boiled water (36%) and respiratory illnesses (14%). (Waiswa, KNOWLEDGE
ATTITUDES AND PRACTICES ABOUT, 2004)

Objectives
General objective
To Asses prevalence of malaria and prevention Awareness Among adult out patients

Specific objectives
The specific objectives of the study were:

5. To Estimate the Prevalence, of Malaria Among adult out Patients Attending In

hargeisaa hospital
6. To asses prevention Awareness of malaria Among Adult patients
7. To assess the value of preventive to treated and curative interventions in reducing
malaria morbidity in an area of intense perennial malaria transmissions.
8. To define the demographic of respondents in term of gender, education, marital
status,socio-economic conditions.