Inhibitors to Control of Malaria among Resident of Eleme Local Government Area of

Rivers State.
CHAPTER ONE: INTRODUCTION

1.1 Background of the Study

1.2 Statement of the Problem

1.3 Aim of the Study

1.4 Objectives of the Study

1.5 Significance or Justification of the Study

CHAPTER TWO: LITERATURE REVIEW

2.1 Literature Review

2.1

CHAPTER THREE: MATERIAL AND METHODS

3.1 Materials

3.2 Sources of Sample

CHAPTER FOUR: RESULTS

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 Discussion

5.2 Conclusion

5.3 Recommendation

5.4 References
 CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria is unique among diseases because its roots lie so deep within human communities
(Heggenhougen et al. 2003). Malaria beliefs and practices are often related to culture, and
can influence the effectiveness of control strategies;(Adera TD. 2003) thus, local
knowledge and practice related to malaria is important for the implementation of culturally
appropriate, sustainable, and effective interventions (Vijayakumar et al. 2009).

Globally, an estimated half of world populations are at risk of malaria. Malaria is endemic
in Africa with an estimated 80% of cases and 90% of deaths of the global burden occurring
there, especially amongst children and pregnant women. Together, the Democratic
Republic of the Congo and Nigeria account for over 40% of the estimated total of malaria
deaths globally (WHO 2012). Malaria is a major public health problem in Nigeria with an
estimated 100 million malaria cases and over 300,000 deaths per year. It accounts for 60%
of outpatient visits, 30% of hospitalizations among children under 5 years of age, and 11%
maternal mortality (Nigeria Malaria Fact Sheet 2011).

Twelve years after the first Abuja declaration, Nigeria failed to halve the malaria burden in
2010. In the next 2 years leading up to the Millennium Development Goals’ (MDG)
deadline, Nigeria is still recording high prevalence (98.4%) of malaria (Ako-Nai et al.
2012), hence it is doubtful if Nigeria could halt by 2015 and begin to reverse the incidence
of malaria. The failure to consider community’s knowledge, attitude, and practice (KAP)
about malaria has contributed to the inability of programs to achieve sustainable control
(Tyagi et. al 2005). People’s behavior may increase malaria risk, but to change such
behavior is not easy. Indeed, there are many reasons why particular behaviors exist and
they often are tied to considerable benefits in areas quite distinct from health. Thus, it is
not usually the case that “these people don’t know any better”, but rather that their native
logic and rationality make sense within the realities and limitations of their local
circumstances (Heggenhougen et al. 2003).
Families are the primary context within which most health problems and illnesses occur
and have a powerful influence on health. Most health belief and behavior are developed
and maintained within the family (Campbell et al. 2002). Community perceptions, beliefs,
and attitudes about malaria causation, symptom identification, treatment of malaria, and
prevention influence efforts to address malaria and are often overlooked in control efforts
(Deressa et al. 2003) and it vary from community to community and among individual
households (Rodriguez et al. 2003).Considering these issues it can be an important step
towards developing strategies aimed at controlling the malaria (Munguti 1998).
Understanding who already knows about malaria and malaria prevention, who has adopted
malaria prevention and mosquito avoidance practices, and who is at risk of malaria
infection is a necessary precursor to identifying and targeting vulnerable populations and
ensuring successful implementation and sustainability of malaria control efforts (Adongo
et al. 2005).
There is paucity of data on KAP studies on malaria in northwestern Nigeria. Studies on
KAP (Rodriguez et al. 2003; Mazigo et al. 2010) have demonstrated that, direct interaction
with community plays an important role in circumventing malaria spread. Healthcare
provider like family physician can focus both on traditional physician-patient model and
complement it with population-based medicine for primary prevention of malaria as
domiciliary care and primary prevention are defining characteristics of family medicine.
So, in order to create a synergy between primary care physician and community efforts and
governmental/nongovernmental organized malaria control interventions in north Nigeria in
particular, there is an urgent need to determine the people’s knowledge, attitude, and
practice of malaria and its control.

1.2 Objective of the Study:

Families’ perceptions, beliefs, and attitudes about malaria causation, symptom

identification, treatment of malaria, and prevention are often overlooked in malaria control
efforts. This study was conducted to understand these issues, which can be an important
step towards developing strategies, aimed at controlling malaria.

1.3 Aim of the Study:

The aim of this study was to assess the relationship between the knowledge of ITN, use of
traditional medicine, education, and family income among resident of Eleme Local
Government Area of Rivers State.

This study is aimed at looking at the malaria preventive practices among resident of Eleme
Local Government Area of Rivers State.

1.4 Problem Statement:

Malaria remains a public health threat in Nigeria and within residents of Eleme Local
Government Area of Rivers State, despite the availability of effective preventive measures
such as the use of ITNs and IPTp. The problem is that previous research indicated that
despite availability of ITNs, their use is low. The factors associated with the low use are
not fully understood yet. However, residents of Eleme Local Government Area of Rivers
State have little or no access to ITNs but do not use them. Previous research seems to
indicate that the knowledge of ITN, use of traditional herbal medicine, family income, and
education may be linked to the low use of ITN. However, these findings were inconclusive.
The previous studies available did not demonstrate an association between use of ITNs and
the knowledge of ITN, use of traditional herbal medicine, family income, and education
among people of this residents. This is what this study assessed. Furthermore, based on the
literature, there seemed to be significant gap between the ITN ownership and its use by
pregnant women. A higher proportion of pregnant women in predominantly rural Nigeria
owned ITNs as a result of successful penetration of the massive community level
distribution campaigns in rural regions; yet, the use of the ITNs among them was low
(Ankomah et al., 2012). Hence, there remains an important gap in the current literature
regarding whether pregnant women’s knowledge of ITN, family income, use of traditional
medicine, and level of education influences their use of ITN in rural Nigeria. Therefore,
this study assessed if these factors play a significant role in ITN use.

1.5 Introduction:

Malaria occurs in tropical and subtropical areas of the world (Arbeitskreis Blut, 2009). It is
the leading cause of illnesses and deaths in most of the countries affected by it
(Arbeitskreis Blut, 2009). Malaria is one of the most devastating infectious diseases, killing
more than I million people every year (Schantz-Dunn & Nour, 2009). Malaria is defined as
the “disease of poverty caused by poverty” (Schantz-Dunn & Nour, 2009). The malaria
disease can be prevented. However, it can be a fatal disease if not treated (Mali, Steel,
Slutsker & Arguin, 2009). Malaria is transmitted by the female Anopheles mosquito biting
parasites that infects people and in turn transmits it to other humans within the community
(Mali et al., 2009). After biting the human host, the parasites multiply in the blood stream
and the blood stage parasites are responsible for the clinical manifestation of malaria
(Center for Disease Control and Prevention [CDC], 2015a). After 8 to 30 days of malaria
infection, the disease begins with flu-like symptoms that include fever, headache, muscular
aches and weakness, vomiting, diarrhea, chills, and sweats (Bartoloni & Zammarchi,
2012). When death occurs, it may be due to brain damage (cerebral malaria) or damage to
vital organs (Bartoloni & Zammarchi, 2012). Malaria prevention methods include but are
not limited to, using insecticide treated bed nets (ITNs), indoor residual spraying with
insecticides, and treatment with intermittent preventive treatment in pregnancy (IPTp;
Steketee & Campbell, 2010). According to the CDC, in 2016, an estimated 216 Million
cases of malaria occurred 2 worldwide and about 445,000 people died (CDC, 2018). Most
of the deaths were young children of sub-Saharan Africa (CDC, 2018). The most
vulnerable to malaria infection are women and young children. In fact, pregnant women
are 3 times more likely to suffer severely from malaria compared to nonpregnant women
(Schantz-Dunn & Nour, 2009). Pregnant women usually have more severe malaria
symptoms and outcomes, with higher rates of miscarriage, anemia, intrauterine demise,
premature delivery, low-birth-weight neonates, and neonatal death (Schantz-Dunn & Nour,
2009). Infected pregnant women have about 50% mortality rate in malaria endemic areas
with the highest rate of infection occurring during the second trimester (Schantz-Dunn &
Nour, 2009). This high burden of disease supports the need for malaria prevention and
treatment efforts as part of antenatal care in endemic areas, (Schantz-Dunn & Nour, 2009).
Some adults who live in malaria endemic areas have developed some acquired immunity to
malaria infection due to immunoglobulin production from prior childhood malaria
infections (Schantz-Dunn & Nour, 2009). However, for pregnant women, the malaria
immunity diminishes during pregnancy, hence making them more vulnerable to malaria
infection (Schantz-Dunn & Nour, 2009). Malaria is a public health issue in more than 100
countries, with more than half of the world’s population at risk (Kaiser Family Foundation,
2013). Sub-Saharan Africa and parts of Asia and Latin America are the hardest hit regions
for significant malaria epidemics (Kaiser Family Foundation, 2013; WHO, 2013). Malaria
affects about 3.3 billion people or half of the world’s population, and in 2010, Africa had
about 216 million malaria cases and about 655,000 deaths (Otsemobor et al., 2013).
 CHAPTER TWO

LITERATURE REVIEW:

2.1: Literature Review:

Malaria is a protozoan infection in humans caused by the parasite Plasmodium. It is a life-

threatening vector borne infection and children under 5 years and pregnant women are the
most vulnerable group in endemic areas. Malaria is essentially a disease of the tropics and
subtropics particularly the sub-Saharan African region although it can be found in
temperate areas due to migration from the tropics. Over 90% of the world’s malaria occurs
in sub-Saharan Africa and about 500 million cases are recorded annually; a child under the
age of 5 years is said to die from malaria in every 2 minutes (Erhun et al., 2005; Paul et al.,
2019) [1] [2]. Malaria has continued to be one of the leading causes of morbidity and
mortality in children despite effective preventive and treatment modalities and more than
20% of world’s population are affected by malaria (WHO 2000) [3]. The morbidity and
mortality from malaria are still unacceptably high in the developing countries, especially
among the vulnerable group, despite all control efforts. Malaria remains a public health
problem facing developing countries and Nigeria being the most populous African country
bears a very high percentage of this burden. Nigeria accounts for 25% of global malaria
burden (WHO 2012) [4] and being the eighth most populous country in the world, the
burden of malaria in Nigeria is conversely a world burden especially with the level of
migration of Nigerians particularly to the western world. The UK Health Protection
Agency (HPA 2011) [5] states that about 1614 malaria cases were reported in the UK
yearly between 2005 and 2010, and 22% of these cases in 2010 were from Nigeria.
Estimate shows that over 50% of Nigerians suffer at least about of malaria every year
(WHO 2000) [3]. And malaria accounts for 20% and 25% of under-five mortality and
childhood mortality respectively and this constitutes a huge economic burden (Erhun et al.,
2005; Ekong et al., 2013; Babalola et al., 2013) [1] [6] [7]. Malaria is holo-endemic in
Nigeria with transmission all the year round. Nigeria has two main seasons in the year, the
dry season which is from October to about March and the rainy season which is from April
to September with peak of the rains between May and July when malaria transmission is
very intense. Rainfall pattern in Nigeria varies with the South having more rains than the
North. Annual rainfall decreases northward; rainfall ranges from about 2000 millimeters in
the coastal zone (averaging more than 3550 millimeters in the Niger Delta) to 500 - 750
millimeters in the north. The far south is defined by its tropical rainforest climate, where
annual rainfall is 60 to 80 inches (1524 to 2032 mm) a year. The Niger Delta is located on
the Atlantic coast of Southern Nigeria encompassing an area of 20,000 km2 and it is the
world’s third largest wetland (Okonkwo et al., 2015) [8]. The mangrove swamp forest
vegetation encourages all-year-round transmission of malaria in this area. The knowledge
of the preventive measures of malaria is an important preceding factor for the acceptance
and use of malaria preventive practices (Winch et al., 1994) [9]. Surveys of residents of the
Atlantic coast revealed a lack of knowledge and many misconceptions about the
transmission and treatment of malaria, which could adversely affect malaria preventive
practices and treatment (WHO 2000; Afolabi 1996) [3] [10]. Prevention of malaria is
currently based on two complementary methods: chemoprophylaxis especially in pregnant
women and protection against mosquito bites. While several malaria vaccines are under
development, none is available yet. Measures aimed at protection against mosquito bites
include use of personal protection measures against mosquito bites and vector control
measures. These include use of insecticide treated bed nets (ITNs) especially long-lasting
insecticidal nets (LLINs), indoor residual spraying (IRS), use of protective nets in
windows, doors, ventilators, and eaves to prevent access of mosquitoes, larviciding, and
clearing vegetation and containers around houses where mosquitoes harbour and breed
(Walker et al., 2007; CDC 2008; Nganga et al., 2008) [11] [12] [13]. Assessing malaria
preventive practices in the high rainfall region of the Eleme Local Government of Rivers
State will ascertain the local malaria situation and help to develop appropriate control
measures to advice policy makers and the residents in the subregion with appropriate
knowledge of the health problem (Erhun et al., 2005) [1].
Of infectious diseases that occur mostly in the tropical and subtropical areas of the world,
malaria is the world’s leading killer (DeGaborik, 2006). It is the leading cause of illnesses
and deaths in most of the countries affected by it (Mali et al., 2007). Maternal illness and
low birth weight result from Plasmodium falciparum mosquito infection, which occurs
predominantly in Africa (WHO, 2013). The infection is usually asymptomatic; however,
the parasites may be present in the placenta, which can contribute to maternal anaemia and
placental parasitaemia (WHO, 2013). According to the WHO (2013), maternal anaemia
and placental parasitaemia can lead to low birth weight, contribute to infant mortality, and
increase the risk of severe malaria, causing spontaneous abortion, stillbirth, and
prematurity (WHO, 2013). Malaria poses a major public health issue in Nigeria, which
accounts for more malaria-related deaths than any other country in the world (U.S.
Embassy in Nigeria [USEN], 2011, p. 1). Pregnant women and children under the age of 5
years old are the most vulnerable groups due to low or no immunity. Approximately 97 %
of the Nigerian population is at risk, and malaria cases are estimated at 100 million with
over 300,000 deaths annually in Nigeria (USEN, 2011, p. 1). Malaria also contributes to
about 11% of maternal mortality and a prevalence of about 28% (South East region) and
about 50% (South West, North Central, and North West regions) in children under age 6 to
59 months (USEN, 2011, p. 1). There are measures that are used to prevent and treat
malaria. Preventive measures include, but are not limited to, the promotion of ITNs
(USEN, 2011). Among other malaria preventive 21 measures, ITN provides simple and
effective means of malaria prevention (Akaba et al., 2013). Ownership of ITNs among
pregnant women is high in predominantly rural Nigeria residents of Eleme as a case study;
however, the use of these ITNs is low there (Ankomah et al., 2012). The reasons for the
low use of ITNs among pregnant women are not understood. Previous literature has
indicated that the knowledge of ITN, use of traditional herbal medicines, family income,
and education have been linked to the low uptake of ITN; however, these findings are
inconclusive (Tongo, Orimadegun & Adeyinka, 2011; Ankomah et al., 2012; Marchie &
Akerele (2012); Onabanjo & Nwokocha (2012); Akaba et al., 2012).

Focusing on the social and physical environments is important in understanding

health and disease patterns. There are characteristics of the social and physical
environment that shape human experience and personal behaviors (Abdulkarim, 2012).
Social, political and economic systems shape behaviours of individuals and populations,
which have an effect on access to resources necessary to maintain good health
(Abdulkarim, 2012). Recognizing the social and environmental conditions helps identify
determinants that might be responsive to interventions within the community that may lead
to improved health outcomes (Abdulkarim, 2012).