FACTORS CONTRIBUTING TO HIGH OCCURANCES OF MALARIA IN CHILDREN

UNDER FIVE YEARS AT BUKULULA HEALTH CENTRE IV IN

KALUNGU DISTRICT.

BY:

ARINAITWE MORRIS

NSIN: JUL18/U020/DCN/004

JUNE, 2022
FACTORS CONTRIBUTING TO HIGH OCCURANCES OF MALARIA IN CHILDREN

UNDER FIVE YEARS AT BUKULULA HEALTH CENTRE IV IN

KALUNGU DISTRICT.

BY:

ARINAITWE MORRIS

NSIN: JUL18/U020/DCN/004

A RESEARCH REPORT SUBMITTED TO UGANDA NURSES AND MIDWIVES

EXAMINATION BOARD FOR A STUDY IN PARTIALFULFILLEMENT

OF THE REQUIREMENTS FOR THE AWARD OF

A DIPLOMA IN COMPREHENSIVE

NURSING

JUNE, 2022
 ABSTRACT
Introduction: The study was carried out in Bukulula health centre IV

The facility attends to care takers of children under five years. Therefore it was thought to be a good

source of data for factors contributing to high under five malaria cases.

Main Objective: The aim of the study was to assess the factors contributing to high malaria cases in

children under the age of five years.

Method: The study was cross-sectional I nature and employed quantitative methods of data collection

and analysis. It took place n April 2022

Result: Fifty two mothers were interviewed and there as a significant relationships between

environmental factors, individual factors and knowledge of others with the prevalence of malaria in

children under the age of five years. It was found out that environmental conditions and geographic

factors contribute to 70% malaria. The individual factors and mothers knowledge on prevention is still

low thus their practices contribute to 69% of the area’s malaria especially under the age of five years.

Recommendation: More funds should be allocated to the primary prevention such as imparting parents

with knowledge on prevention and provision of mosquito nets, repellants, presumptive, intermittent

treatment and prophylaxis of malaria.

Conclusion:People’s practices still contribute to the highest malaria cases in children under five years

and this is due to their knowledge in addition to environmental and geographical factors.
 COPY RIGHT

Copy right©2021 by ARINAITWE MORRIS

 DECLARATION

I ARINAITWE MORRIS do hereby declare that this proposal is mine and based on my knowledge

and experience except where literature has been cited and duly acknowledged as a student of Masaka

School of Comprehensive Nursing. It has never been presented anywhere for any academic award.

Signature…………………………………….….…Date………………….……………………………

ARINAITWE MORRIS

(Researcher)

i
 AUTHORIZATION FORM

This research has been approved by the research committee of Masaka School of Comprehensive

Nursing. I hereby endorsed by the research supervisor and the Principal Tutor of Masaka School Of

Comprehensive nursing to be forwarded to Uganda Nurses and midwives examination board.

Signature…………………………………….….…Date………………….……………………………

ARINAITWE MORRIS

(Researcher))

Signature…………………………………….….…Date………………….……………………………

MISS LUDIGO SUZAN

(SUPERVISOR)

Signature…………………………………….….…Date………………….……………………………

Ms. NAWUSINDO KEKULINA

(PRINCIPAL)

i
i
 DEDICATION
I dedicate this piece of work to the Almighty God and to the community of Kalungu district especially

those that attend Bukulula health center iv for their co operation during this study in preparation for

report.

i
i
i
 ACKNOWLEDGEMENT
The success in producing this work is attributed to such a number of people, to whom I wish to

acknowledge my thanks. The completion of this piece of work has been such a task that would not have

been a success when handled solely.

First of all I thank the Almighty, who gave me abundant health, strength, and courage to be able to do

this work.

My sincere gratitude goes to my supervisor Sr Ludigo Suzan whose commitment, patience and

guidance, gave form to this piece of work.

By the same token, I wish to thank the lectures and all staff in Masaka school of Comprehensive nursing

and the administration for their contribution in various ways to make ethics and the comprehensive

nursing course a success.

Finally special thanks goes to my family, parents, brothers, uncles, aunties,sisters,and friends for their

tolerance ,patience, encouragement and sacrifice throughout my struggle for this academic achievement.

They have never lost hope in me.

TABLE OF CONTENTS
i
v
ABSTRACT...................................................................................................................................................３

COPY RIGHT...............................................................................................................................................４

DECLARATION..............................................................................................................................................i

AUTHORIZATION FORM..........................................................................................................................ii

DEDICATION...............................................................................................................................................iii

ACKNOWLEDGEMENT.............................................................................................................................iv

TABLE OF CONTENTS................................................................................................................................v

LIST OF FIGURES.....................................................................................................................................viii

LIST OF TABLES.........................................................................................................................................ix

LIST OF ABBREVIATIONS.........................................................................................................................x

OPERATIONAL DEFINITIONS................................................................................................................xi

CHAPTER ONE: INTRODUCTION.........................................................................................................１

1.0 Introduction......................................................................................................................................１

1.1 Background.....................................................................................................................................１

1.2 Problem statement...........................................................................................................................２

1.3 Purpose of the study........................................................................................................................３

1.4 Specific objectives............................................................................................................................３

1.5 Research Questions..........................................................................................................................３

1.6 Justification for the study................................................................................................................３

CHAPTOR TWO: LITERATURE REVIEW............................................................................................５

v
 2.1 Introduction......................................................................................................................................５

2.2 Environmental factors contributing to high under five malaria cases at Bukulula HCIV in

Kalungu district.....................................................................................................................................５

2.3 Individual factors contributing to high cases of under-five malaria...........................................６

2.4 The knowledge of mothers on malaria prevention among children under five years...............７

CHAPTER THREE: METHODOLOGY...................................................................................................９

3.1 Introduction......................................................................................................................................９

3.2 Study design and rationale..............................................................................................................９

3.3 Study setting and rational...............................................................................................................９

3.4 Study Population..........................................................................................................................１０

3.5 Inclusion criteria and rationale..................................................................................................１０

3.6 Definition of variables.................................................................................................................１１

3.7 Research instruments..................................................................................................................１１

3.8 Quality control.............................................................................................................................１１

3.9 Ethical Consideration..................................................................................................................１２

3.10 Limitations to the study.............................................................................................................１２

3.11 Dissemination of results.............................................................................................................１３

CHAPTER FOUR.....................................................................................................................................１４

DATA ANALYSIS AND INTERPRETATION OF THE FINDINGS.................................................１４

4.1 Introduction..................................................................................................................................１４
v
i
 4.2 Demographic characteristics......................................................................................................１４

4.3 individual factors contributing to high under fiver malaria cases at Bukulula health centre

iv..........................................................................................................................................................１６

CHAPTER FIVE:.....................................................................................................................................２５

DISCUSSION ON FINDINGS, CONCLUSION AND RECOMMENDATION................................２５

5.1 Introduction..................................................................................................................................２５

5.2 Discussion of results.....................................................................................................................２５

5.3 Conclusion....................................................................................................................................２７

5.4 Recommendations........................................................................................................................２７

REFERANCES..........................................................................................................................................２８

APPENDIX I: CONSET FOAM..............................................................................................................３０

APPENDIX II: QUESTIONIARE...........................................................................................................３１

APPENDIX III: LETTER OF INTRODUCTION................................................................................３６

APPENDIX VI :........................................................................................................................................３７

MAP OF UGANDA SHOWING LOCATION OF KALUNGU DISTRICT......................................３７

APPENDIX V: A MAP SHOWING THE STUDY AREA....................................................................３８

LIST OF FIGURES
Figure 1 : Shows where respondents take their children when they are sick.............................１７

Figure 2 : Showing affordability of treatment costs to the respondents.......................................１９

v
i
i
Figure 3 : Shows the number of children of the respondents that use insecticide treated

mosquito nets..............................................................................................................................２３

Figure 4 :Shows respondent`s knowledge and practice on prevention of malaria.....................２４

LIST OF TABLES
Table 1 : Shows the demographic information of the respondents...............................................１４

Table 2 : Shows whether the respondent’s children suffer from childhood illnesses .................１６

Table 3 : Shows whether respondent knows some signs and symptoms of malaria. ..........１７
v
i
i
 Table 4 ; Shows the number of times the respondent`s children have been admitted if taken to

the health facility........................................................................................................................１８

Table 5 : Shows the preventive measures and nutritional status of respondents........................２０

Table 6 : Shows the landscape and the type of vegetation that covers the respondent’s home.

.....................................................................................................................................................２１

Table 7 : Shows the physical features surrounding the respondent’s home................................２１

Table 8 : Shows temperature, frequencies of rainfall experienced by the respondents .............２２

Table 9 : Shows respondents who understand what malaria is;...................................................２２

Table 10 : Shows mothers who understand what spreads ...........................................................２３

LIST OF ABBREVIATIONS
DHMTs: District Health Management Teams

HIV: Human Immune Deficiency Virus.

MAPD: Malaria Action Program for District

i
x
MOH: Ministry Of Health

NMCD: National Malaria Control Division

NMCP National Malaria Control Program

UNICEF: United Nations Children’s Funds.

USAID’s: United States of America for Integrated Development

WHO: World Health Organization.

WMR: World Malaria Report

OPERATIONAL DEFINITIONS

Health Centre: This is a location where health Care is provided. Like health center IV, III and II.

Malaria: Malaria is an acute fibril illness caused by infection with plasmodium parasites transmitted

one person to another by an infected female anopheles mosquito.

x
Children: For the purpose of this study children refer to the young ones below five years of age.

(under five)

Practice: Refers to carrying out or performing a particular activity, method, or custom habitually or

regularly for example an activity leading to high spread or prevention of malaria.

Beliefs: An acceptance that something exists or is true, especially one without proof.

Prevalence: Is the total number of individuals in a population who have a health a condition or a

disease at a specific period of time expressed as a percentage of the population.

Prophylaxis: Treatment given or action taken to prevent a disease.

Tropics: Region of the earth surrounding the equator.

A vector: Is a living organism that spreads disease through carrying germs.

A disease: Is a disorder of structure or function in a human being especially one that produces specific

symptoms or that affects a specific location and is not simply a direct result of physical injury.

High cases of malaria: It refers to a greater number of people presenting with malaria as compared to

the number of people presenting with other medical, gynecological and surgical conditions at a health

facility.

Mortality: Is the rate of death of children under five years of age

x
i
 CHAPTER ONE: INTRODUCTION

1.0 Introduction

This chapter introduces the topic under study; it includes the back ground, problem statement,

justification, objectives and research questions.

1.1 Background

Malaria is an acute fibril illness caused by infection with plasmodium parasites transmitted from one

person to another by an infected female anopheles mosquito.

It is protozoa disease transmitted by a female anopheles mosquito bite from an infected person to a

normal one. It is caused by a genus plasmodium and there are five species of plasmodium and they

include, plasmodium; vivax, malariae, ovale, falciparum and kwesi .p. falciparum and p.vivax are the

greatest threat. P falciparum is the deadliest and most prevalent parasite on the continent of Africa and p

vixax is the most dominant malaria parasite in most countries outside the sub-Saharan Africa. (WHO,

2020) In 2020, there was an estimated 241 million cases of Malaria world wide

The estimated number of malaria deaths stood at 627000 in 2020. The WHO African countries a

disproportionately high share of the global burden .in 2020, the Region was home to 95% of maria cases

and 96% of malaria deaths. Children under 5 accounted for an estimated 80% of all malaria deaths in the

region (WHO, Prevalence of malaria, 2021)

Globally, the malaria decreased by an average of 0.80% per year from 1990 to 2019. How ever, it

increased from 3195.32 per 100000 in 2015 to 324702 per 100000in 2019. The incidence rate of

children under five was higher than other age groups. Evidences by travelers to sub Saharan Africa and

other endemic areas still show higher prevalence of Malaria in these countries than other areas.

(Oxiford, 2021)

In east Africa the statistics show that in every 2 minutes a new case of under-five death (409000) due to

malaria is registered contributing to 67% of the total deaths (274000)of Malaria in East Africa.

1
Indicating that 750 under five children die every day. As per the study carried out by UNICEF IN 2019

(UNICEF, 2019)

Kenya still stand with the highest prevalence of malaria in East Africa and this is attributed to the land

scape especially the rift valley water bodies and the high vegetation coverage. Following a study carried

out in Siaya county western Kenya from 2006 to 2013 was 36.5%. (medicine, 2018).

Uganda has the third highest Global burden of malaria cases(5%) and the 8 thhighestlevel of deaths (3%)

(1) it is also the highest proportion of malaria cases in east africa23.7%.

There is a stable malaria transmission in 95% of the country .between 2006 and 2019 the estimated

number of Malaria cases decreased 7.2%from 383 to 263 per 1000000 of the population at risk while

deaths fell 9.5% from 0.34 to 0.34 to 0.31 per 100 of the population at risk of over same period.

A progress in children is promising. Data from 2018 malaria indicator survey (MIS) revealed that 4% of

children aged 6 to 59 months were severely anaemic due to malaria in 2016. But this has gradually

decreased every year. (ray, 2018).

1.2 Problem statement.

At Bukulula Health Centre iv on average, the facility receives 1670 patients on monthly basis and of

these 669 patients present with malaria. It was also found out that 401 of the people presenting with

Malaria are children under the age of five years which total mounts to 24.01% of the total population of

cases registered at the facility. This high rate if not combated, will lead to several complications of

malaria such as anaemia, jaundice malnutrition, retarded growths and thus impacting a high cost of

treatment to both the parents and the government at large or else result in high pediatric mortality and

morbidity rate. In Greater Masaka, USAID’s Malaria Action Program for Districts(MAPD) is working

with the National Malaria Control Division(NMCD) and District Health Management Teams (DHMTs)

to improve the health status of Ugandans by reducing child hood and maternal morbidity and mortality

due to Malaria have successfully reduced and managed it. (USAIS, 2018) However at Bukulula health

Centre iv the number of both outpatient and admissions due to malaria especially of under five are still

2
high at 85% of laboratory confirmed malaria cases in 2019 as compared tom 69%2017/18 (JRM,

2019)thus a necessity to research the factors leading to these high cases so that more strategies can be

put in place to prevent and control malaria at this facility.

1.3 Purpose of the study

To determine the main factors contributing to high malaria cases in children under five years. At

Bukulula health Centre IV in Kalungu district.

1.4 Specific objectives

1. To determine the Environmental factors contributing to high under five malaria cases at Bukulula

HCIV in Kalungu district.

2. To determine the individual factors contributing to increased under five malaria cases at Bukulula

HCIV in Kalungu district.

3. To assess the knowledge of mothers attending Bukulula HCIV on malaria prevention among

children under five years.

1.5 Research Questions

1. What are the Environmental factors contributing to high under five malaria cases at Bukulula HCIV

in Kalungu district?

2. What are the individual factors contributing to high under five malaria cases at Bukulula HCIV in

Kalungu district?

3. What knowledge do mothers attending Bukulula HCIV have on malaria prevention among children

under five years.?

1.6 Justification for the study

Malaria is a major concern at Bukulula health centre IV and in greater Masaka as a whole. Uganda

being in the tropics with water bodies like lake kyoga and Victoria, valleys and swamps in addition to a
3
plenty of forest and high vegetation cover that fever the reproduction and growth of mosquitoes, it is at a

risk of malaria infestation thus the 3 rd position in the African countries and 1 st in east African countries.

(Simon P kigozi, 2020)

The estimated number of malaria deaths stood at 627000 in 2020. The WHO African countries are

disproportionately high share of the global burden in 2020, the Region was home to 95% of malaria

cases and 96% of malaria deaths. Children under 5 accounted for an estimated 80% of all malaria deaths

in the region (WHO, Prevalence of malaria, 2021)

With various studies carried out and efforts put in place Uganda still stands at that and registers under

five death hence more researches and campaigns are still required to meet that gap and eradicated

malaria in all areas all over Uganda. Thus the results from this research will help generate the factors

contributing to high under five malaria cases which will be used to generate control and preventive

measures of malaria and they will be used by different organs to eradicate malaria.

4
 CHAPTOR TWO: LITERATURE REVIEW

2.1 Introduction

This chapter looks at the available literature related to the factors contributing to high malaria cases in

children under five years as jotted down by different researchers who have done previous studies in line

with the topic of study.

The literature review will be in line with the specific objectives which are:-

1. To determine the Environmental factors contributing to high under five malaria cases at

Bukulula HCIV in Kalungu district.

2. To determine the individual factors contributing to high under five malaria cases at Bukulula

HCIV in Kalungu district.

3. To assess the knowledge of mothers attending Bukulula HCIV on malaria prevention among

children under five years.

2.2 Environmental factors contributing to high under five malaria cases at Bukulula HCIV in

Kalungu district

Climatic Factors

In a study carried out from 2006-2010, it was found out that. The high prevalence of malaria in Sub-

Saharan region especially central Africa is attributed to the environmental conditions such as climate,

temperature, humidity and weather which favour growth and reproduction of mosquitoes hence high

prevalence of malaria as compared to other countries..(Y Zhang, 2012)

Following a study made in Uganda in 2014 the data obtained from the various regions of Uganda were

indicative of the distribution of malaria cases as studied. This showed that 90-95% of Ugandans and

approximately 13% of this population are children.(Roberts, 2016)

5
Geographic factors.

In Papua Indonesia a research was carried in 2016 the results showed that the highland of Papua are

highly infested with malaria with 65-95% of the inhabitants suffering from malaria every year. This was

attributed to the altitude in addition to the low social economic status.(Tempubolon, 12 april 2016)

Malaria is in 70% of Ethiopia with 52% Ethiopians at a risk of infection and transmission is highly

seasonal and varies geographically (Beckman, 2018)

Analysis of the Geographical distribution of severe malaria in children in KILIFI District, Kenya. This

study shows a correspondence of malaria distribution with the various physical features like rift Valley,

mountain among others . (Schellenberg, 2017)

2.3 Individual factors contributing to high cases of under-five malaria

High prices of replant anti malaria's. Personal mosquito repellants, coils, vaporizers, mild repellent

creams and mats represent a $ 1.5billion industry in India and are available across the state of

Meghalaya and one multi-site study in the main land India found that utilization varies widely by house

hold and individual and is associated with higher social economic status and level of education. (Van

Eijk, 2016)

Failure to attend timely and effective treatment of clinical malaria is imperative to disease transmission

and thus also key for malaria prevention and control. The survey by Bhattacharya et al, also evaluated

that they sought treatment at the facility (66.9%) government hospitals and 30% private hospital/doctor,

with only 3% reporting self-medication. (Bhattacharyya.H, 2015). (H, 2015)

In Bangladesh, individuals who are likely to have some knowledge about how malaria is transmitted as

well as prevention and control measures (Ubydul Haque, 2014)

A total o f 302 malaria cases were matched to 604 controls during the surveillance period. Mosquito

densities were similar In the house of both groups. A greater percentage of people in the group (64.6)

6
used insecticide treated bed nets (ITNs) was associated with the level of education. (WaltersM. Essendi,

june 2019)

In this study, the sample in the study was made up of 4939 children. Of those children, 974 tested

positive for malaria prevalence of 19.7%. The social economic factors closely related to the risk of

malaria were electricity, the house hold structure which decreased with increase in economic status and

level of education. (Mattews, 2016)

2.4 The knowledge of mothers on malaria prevention among children under five years.

In study carried out by Luyiga Faridah Mwanje in Mukono district to establish the knowledge, attitudes

and practices on malaria prevention and control in Uganda, there were 18.6% of the respondents with a

high knowledge about malaria. 61% of them had medium knowledge while 20% had low knowledge

which further showed a gap in sensitization so as to combat and prevent malaria.(Mwanje, 2013)

There is significant risk of malaria in most of the areas of Uganda. It is therefore recommended to seek

knowledge and know the prevention of malaria. Prevention can be achieved through variable methods of

creating awareness (DANIELS, 2020)

From the 1990s to the current trendsin2020 the World Health Organization launched an ambitious plan

to control malaria through creating of awareness and other preventive measures all over the world which

has progressively reduced the prevalence of malaria worldwide especially in the tropical regions.(Mahta,

2020)WHO has further raise awareness through World Wide cerebrating of the Malaria day each year

on 25th April to underscore the collective energy and commitment of the global malaria community in

uniting the common goal of the world free of malaria.(WHO, 2020)

In the Ethiopia Journal of health of health development, the community awareness about malaria , its

treatment and mosquito vector in rural highlands of central Ethiopia is highly emphasized.(lita, 2019)

7
From a community based survey involving 77o heads of households was conducted during September

2015- February 2016 in the peasant association and the results showed that 67% of the participants had

no knowledge about prevention methods of mosquito bites.(M Legesse, 2016)

Following a cross section study in four villages of Nigeria Danwarai, Genhuns, Jiga and Kashinzama of

aliero local Government, are in Kebbistate in northan Nigeria.11.8%lacked knowledge on malaria, 9.6%

lacked knowledge on the cause of malaria. Knowledge on prevention was at 90% but those practicing

prevention measures were at 90% but those practicing preventive measures were at 16%thus showing

that there is need for targeted education programs to increase the communities efforts to prevent malaria.

(KLUWER, 2016)

In a study carried out in Douala, Cameroon, to find out the knowledge of people on the prevention, signs

and symptoms of malaria, a cross section survey was used and individual were interviewed . This study

revealed a high level of knowledge on signs and symptoms, mode of transmission and drugs used for

treating malaria among employees(Chritian Mbhou, 22 june 2020)

8
 CHAPTER THREE: METHODOLOGY

3.1 Introduction.

This chapter presents the methods that were used in gathering relevant information pertaining the study

problem and objectives. The chapter describes in details: study design, study setting, study population,

sample size determination, sampling procedure, inclusion criteria, definition of variables, research

instruments, data collection procedures, data management, data analysis, ethical considerations,

limitations of the study and dissemination of results.

3.2 Study design and rationale

This study was cross sectional and descriptive in nature and employed both quantitative and qualitative

methods of data collection. The design was used because it generated information from mothers and

children by use of objective and structured questions which clearly brought out the factors contributing

to high occurrences of malaria in children under the age of five years attending Bukulula HCIV Kalungu

district. And also it fits within the researcher`s limits and resources of the researcher.

3.3 Study setting and rational

The study was carried out in Bukulula HC IV of Bukulula sub county Kalungu district. The facility

serves eight parishes and 98 villages in several services for example ante-nantal care, maternity,

outpatients, dental services, mental and paediatric services such as immunization and management of all

childhood conditions. Kalungu district is located 109km south west of Kampala along Kampala-

Mbarara road. It is bordered by Gomba district in the north, Butambala district in the north East, Mpigi

district in the East, Masaka city in the south and Bukomansimbi district to the west.

Bukulula sub-county is made up of 8 parishes and 98 villages with well established health centre iv at

Bukulula sub-county head quarter.

This study setting was selected because the facility attend to a very big number of the target population

for the study I.e children under the age of five years.

9
3.4 Study Population.

The study targeted the parents who brought children under five years and the children themselves who

attend Bukulula HCIV. These were able to give relevant information on the topic in line with the

objectives of the study.

3.4.1 Sample size determination and rationale

A sample size of 52 respondents was chosen for the study to be representative of the parents who

brought their children to Bukulula health centre iv in Kalungu district. This is according to Krejcie and

Morgan (1970), where a sample size of 52 is adequate representation and also falls within the guidelines

of UNMEB. It is also thought to be cost effective and convenient for the researcher because of the

limited time the researcher has to conduct the study. The chosen population will also be easy to interact

with since they practice a similar line of professionalism as the researcher.

3.4.2 Sampling procedure and rationale

The researcher used a non-probability purposive sampling method to select the respondents for the

study. This involved tracing for only the parents with children, under 5 years attending Bukulula health

centre iv with children presenting with malaria until a sample size of 52 is reached. The method was

used because these provided enough information to easily exploit the objectives of study.

3.5 Inclusion criteria and rationale

The study involved all children under 5 with their parents attending Bukulula health centre iv presenting

with malaria. This is because these make up the biggest number of all children and parents in Bukulula

Kalungu district.

Exclusive criteria

Children above six years attending Bukulula HC IV and parents who bring their children but with other

conditions.

1
0
3.6 Definition of variables

Dependant variable

High occurrences of malaria cases in children under five years at Bukulula HC IV in Kalungu district

Independent variables

1. Environmental factors contributing to high under five malaria cases at Bukulula HCIV in Kalungu

district

2. Individual factors contributing to high under five malaria cases at Bukulula HCIV in Kalungu

district.

3. Knowledge of mothers attending Bukulula HCIV on malaria prevention among children under five

years.

3.7 Research instruments

The research used an interview scheduled to collect information. This was done using a questionnaire

(interview guide) with both open and closed ended questions will be in English and translations will be

made during the interview into Luganda.

3.8 Quality control

In order to ensure that data was collected is reliable and valid, quality control techniques were ensured

through: pre-visiting, pre-testing of the questionnaire and training of a research assistant.

Pre-visiting

Prior to the study, the study area was visited so as to enable the researcher to familiarize with the study

area, to identify the ways how data will be collected easily and to contact the relevant authorities for

necessary consent and active participation.

Pre-testing

1
1
The researcher pre-tested the instruments a week before the actual study in order to ensure validity,

clarity, applicability, reliability and completeness of the tools. The pre-test was done among 10 mothers

at the paediatric ward at Masaka regional referral hospital

3.9 Ethical Consideration

The researcher obtained an introductory letter from Masaka School of comprehensive nursing to

introduce him to the health centre administration where the study was carried out. He sought permission

from the administration to carry out the study in the area.

A written consent was sought from all respondents before enrolment into study. For all collected data,

confidentiality was maintained by not using participant identifiers such as their signatures and full

names. The researcher and respondents introduced themselves, respect was accorded to the respondents

and the information gotten remained confidential, and respondents were thanked at the end of the

session for their participation. All respondents had right to withdraw from the study for any

circumstances they may encountered.

3.10 Limitations to the study

The researcher encountered the following were the challenges during the study process.

1. Financial constraints during the process of carrying out research. This was solved by seeking

financial help from the researcher’s parents and funds economized by following the stipulated

budget.

2. Gaining trust from the parents and children to easily share their experiences maybe hard. This

was solved through obtained consent from them.

3. Limited time to interact with the parents and children since these normally comes late and they

have less time at the facility. This was solved by the researcher going early to the facility and

explaining the relevancy of the study to the participants.

1
2
3.11 Dissemination of results

The results have been disseminated to the following:

Uganda Nurses and Midwives Examinations Board for the partial fulfilment of the award of the diploma

in Nursing.

Masaka School of Comprehensive Nursing library for reference.

Supervisor to serve as a sample proposal for future researchers

Bukulula health centre IV.

Researcher as evidence of personal effort and contribution

1
3
 CHAPTER FOUR.

DATA ANALYSIS AND INTERPRETATION OF THE FINDINGS

4.1 Introduction
This is the chapter for analysis of data and interpretation of results and findings of the study carried out

to determine the factors contributing to high occurrence of malaria in children under five years

attending Bukulula health center iv in kalumgu district

4.2 Demographic characteristics

Table 1: Shows the demographic information of the respondents.

1
4
 N=52

VARIABLE FREQUENCY(F) PERCENTAGE (%)

What is your gender?

Male 10 19.23

Female 42 87.77

How old are you?

a) 15-32 years 19 36.54

b) 33-45 years 21 40.38

c) Above 45years 12 23.08

What is your marital status?

a) Married 35 67.31

b) Widowed 10 10.23

c) Divorced 7 13.46

What is your level of education

a) Primary 16 30.77

b) Tertiary 5 9.62

c) Secondary 25 48.08

d) None 1 1.92

How many children do you have?

a) 1 22 42.31

b) b) 2-5 22 42.31

c) 5 and above 8 15.39

What is your occupation?

a) Peasant 20 38.46

b) b) Business 18 34.62

c) c) Civil servant 7 13.46

d) d) None 1pastor 1.92

(Specify…………………………… 6house wives 11.54

1
5
Basing on the table above;

Most of the respondents 42(87.77%) were females, while 10(19.23%) were males. The majority were in

the age bracket of 35-45 years 21(40.38%) and 19(36.54%) in the age bracket of 15-32 years while the

minority were 12(23.08%) were above 45years. The majority of the respondents were married,

35(67.31%), 10(10.23%) were widows and 7(13.46%) were divorced. 25(48.08%) ended in secondary

level, 16(30.77%) ended in primary level, 5(9.62%) studied up to tertiary level and 1(1.92%) of the

respondents did not study at all. Equal proportions of respondents had one child and in arrange of 2-

5children. 22(42.31%) each and only 8(15.39%) respondents had more than 5 children each. Only one

respondent was a pastor and the rest were peasants, business owners and civil servants in the

percentages of 38.46%, 34.62 and 13.46% respectively.

4.3 individual factors contributing to high under fiver malaria cases at Bukulula health centre iv

Table 2: Shows whether the respondent’s children suffer from childhood illnesses

N=52

Variable Response Frequency Percentage

(F) (%)

1. Do your children usually suffer from yes 42 80.76

childhood illnesses?

no 10 19.24

total 52 100

Has your child been diagnosed with yes 38 90.47

malaria before?

no 4 9.53

Total 42 100

1
6
Majority of respondents children 90.47% have suffered childhood illnesses and still have been

diagnosed with malaria. Before

Table 3: Shows whether respondent knows some signs and symptoms of malaria.

N=52

variable Response Frequency (F) Percentage (%)

1. How do you tell that your know the signs of malaria 48 92.31

child s suffering from

Don’t know the sins of 4 7.69
malaria before laboratory
malaria
diagnosis?

Total 52 100

From the table above, Majority of the respondents 48(92.31%) know the signs of malaria and only four

of the respondents don’t know the signs of malaria at all.

N=52

Number of respondents.
35

30

25

20 Number of respondents.

15 30

10

5 9
6
4
2
0
Health facility Church Shrine stay home others

Figure 1: Shows where respondents take their children when they are sick.
1
7
From figure 1 above, Averagely 30(58%) of the respondents said they take their children to the health

facility in case of sickness and only few 2(4%) said they opt for other options of where to take their

children when they fall sick.

Table 4; Shows the number of times the respondent`s children have been admitted if taken to the

health facility

N=5
2

variable Response Frequency (F) Percentage (%)

B) If to the health Above 5 4 13.33%

facility, how often has

your child been 3-5 10 33.33%

admitted 1-2 16 53.33%

Total 30 100

From the table above, averagely 16(53.3%) of the respondents said their children have been admitted

once or twice while only 4(13.3%) said their children are admitted for more than five times.

1
8
 N=52

Number of respondents

Expensive
Affordable
Cheap
Unaffordable

Figure 2: Showing affordability of treatment costs to the respondents.

To majority of them (30) the costs are expensive, (10) of them costs are affordable, to 7 are un

affordable and to the minority (5) they are cheap.

1
9
Table 5: Shows the preventive measures and nutritional status of respondents.

N=52

variable Frequency (F) Percentage (%)

Number of meals eaten a day 5 9.61

10 19.23

15 28.84

22 42.31

Common foods eaten 8 15.38

32 61.54

2 3.84

10 19.23

Use of malaria prophylaxis when 10 19.23

travelling to high risk areas

The majority of respondents eat more than three meals a day, while the minority eat one meal a day.

Many of them 42 (80.76%) do not eat a balanced diet while only 10 (19.23%) eat a balanced diet.

And only 10 (19.23%) respondents use malaria prophylaxis while 42 (80.76%) don’t.

Environmental factors contributing to high occurrences of malaria in children under five years at

Bukulula Health centre IV.

2
0
Table 6: Shows the landscape and the type of vegetation that covers the respondent’s home.

N=52

Variable Response Frequency(f) Percentage (%)

Landscape Flat 10 19.23

Hilly 20 38.46

Valley 22 42.31

Vegetation cover Forest 8 15.38

Bush 32 61.5

Shrub 8 15.38

Non 4 7.69

From the table above the majority of the respondents live near bushes and in valleys while minority live

in flat areas without vegetation.

Table 7: Shows the physical features surrounding the respondent’s home.

N=52

Variable Response Frequency(f) Percentage (%)

Physical feature Water 30 57.69

body(lakes,swamps,rivers)

Hills 10 19.23

Planes 12 23.07

Total 52 100

From the table above, averagely 30(57.69%) of the respondents stay in water bodies and a few stay

away from the water bodies.

2
1
Table 8: Shows temperature, frequencies of rainfall experienced by the respondents

N=52

Variable Response Frequency Percentage(%)

temperature hot 20 38.46

cold 22 42.31

Warm 10 19.23

Rainfall Frequently 28 53.84

Rarely 2 3.84

Only in rain

Seasons 22 42.31

The study revealed that most of the respondents experience hot temperatures (20) and cold temperatures

(22) and a few experience warm temperatures (10).It is also evidenced that it rains frequently in most of

the respondent’s home (50) and in only two of the respondent’s homes.

4.4: This section shows the knowledge of the respondents on malaria prevention.

Table 9: Shows respondents who understand what malaria is;

N=52

Variable Response Frequency (f) Percentage (%)

What is malaria Can define 38 73.07

Can’t define 14 26.92

Total 52 100

Form table 9 above, most 38(73.07%) of the respondent could define malaria and only 14(26.92%)

could not.

Table 10 : Shows mothers who understand what spreads

2
2
 N=52

Variable Response Frequency (f) Percentage (%)

What spreads malaria Housefly 1 1.92

Giger bed bug 10 19.23

Mosquito 36 69.23

Total 47

From table above it is evidenced that 36 of the respondents know the correct vector for malaria. 11 don’t

know the correct vector and 5 don’t know at all and can’t even guess the vector that spreads malaria.

N=52

Respondent`s children

sleep under treated mosquito

nets
Do not sleep under treated
mosquito nets

Figure 3: Shows the number of children of the respondents that use insecticide treated mosquito

nets.

From figure 3, it is observed that majority of the respondent`s children 35(67.31%) do not sleep under

insecticide treated mosquito nets while the minority 17(32.69%) do.

N=52

2
3
 45
40
35
30
25
20
15
10
5
0
nt ng es as
na ni m are
re
g ve ho k
p ee ei
r ri s
n th th gh
he n hi
tw si nd to
en or o u
g
do ar nh
tm nd er lli
ea at ve
tr sa w ra
ve o w nt t yes
pti i nd gna he
n
m ta
su ew es i sw no
re os v ax
p cl ha l
ar
ia
p hy I don’t know
al p ro
k em ri a
ta la a
v em
gi

Figure 4 :Shows respondent`s knowledge and practice on prevention of malaria.

CHAPTER FIVE:

DISCUSSION ON FINDINGS, CONCLUSION AND RECOMMENDATION

5.1 Introduction
The findings of the factors contributing to high occurrences of malaria in children under five years at

Bukulula health centre IV in Kalungu district.

2
4
5.2 Discussion of results
Age, gender, marital status, education levels of respondents, their occupation and number of children.

Majority of the respondents in table one were in the age bracket of 15 to 32 years. This could be due to

the fact that, that is the most reproductive age group and hence they participate more in the care of their

sick children. And the least number of care takers above 45 years because most of these mothers are in

menopause hence few have young children under five years. Majority of the respondents 35 were

married because it is married people commonly with children below 5 years, least number of 7 are

divorced simply because majority of them are no longer with their husbands thus may not have children

below 5 years. The results show that majority of the respondents had reached in secondary level and

only 5 had reached tertiary level thus maybe their children often suffer from malaria as they had less

knowledge on the preventive measures. The results also revealed that the majority of the respondents

were peasants and business men because Bukulula is a trading centre and also agriculture is the main

economic activity.

Individual factors contributing to high under five malaria cases at Bukulula health centre IV in

Kalungu district.

Majority of the respondent’s children have suffered childhood illnesses and they have been diagnosed

with malaria perhaps because children’s immunity is low and thus are prone to childhood illnesses. And

they have been diagnosed with malaria because Kalungu district is a high risk areas for malaria.

majority of the respondents know the signs of malaria because of the government efforts put in place to

ensure sensitization abut malaria through USAID’S malaria action program for districts, national control

divisions (NMCD), District health management teams (DH, MTS) health centres and village health

teams ((VHTS) and thus whenever their children fall sick the majority take them to the heath facilities.

Still majority of the client’s children are admitted when they got malaria due to delayed management of

the disease as a result of transport costs and network attributed to far distances from homes to health

facilities and insufficiency of drugs in hospitals that discourage them. Majority of the respondents find

2
5
the treatment costs for malaria so expensive and maybe this should be attributed to their low social

economic status which can also be contributed to their nutrition statuses showed in table 5.

Environmental factors

The results from respondents revealed that to the majority their home are surrounded by thick vegetation

cover, receive plenty of rainfall, some areas are swampy others surrounded by swamps which favour the

breeding of mosquitoes and thus exposing them to a high risk of malaria which is in line with the study

that was carried out by Y zhang in 2012 showing that the prevalence of malaria is related to the climatic

conditions in the sub-Saharan Africa.

(Y zhang 2012)

Mothers’ knowledge on malaria prevention.

Basing on the results, a few of the respondent’s have some knowledge about malaria that is 38 can

define, 36 know the vector however with the preventive measures, majority don’t know and even the

few who know do not put them into practice that is 35 sleep in mosquito nets, 10 close windows and

doors in the evening a few use repellents 2 take malaria prophylaxis 11 drain stagnant water. This could

be attributed to the less knowledge or unawareness hence necessitating more sensitization others are just

reluctant thus need to do routine home visiting for implementation while others lack the relevant

materials to use like repellents, mosquito nets among other thus a need for the Government, NGO’s and

other relevant sectors to intervene and provide them with materials to use.

Therefore the factors above clearly show the evidence of the resultant high cases of malaria at Bukulula

health centre iv and more so in children under five years.

5.3 Conclusion
Malaria in children under five years is at high levels of prevalence due to a number of factors far

reaching beyond the individual factors, environmental conditions, geographic locations and physical

features as well as insufficiency of enough knowledge to prevent it since its preventable. It is associated

2
6
with a lot of effects which range from high expenditures to both the individual and the government and

other \sectors in addition to contributing to high motility rates in infants.

5.4 Recommendations
More efforts should be put in mass sensitisation and creating general awareness to the locals on the

causes of malaria and how best to prevent it.

Health services should be extended to the far reaching areas which do not easily access the available

health centres through outreaches. The transport networks in villages should be improved and transport

means like ambulances should be provided to the people to also cater for the children under five years.

More health workers are needed to reduce the long queues in hospitals and health centres which also

discourage mothers from taking their children for treatment In addition more anti malarials should be

availed at the health facilities.

5.4 Implication to the nursing practice

There is more need fir the nurses to health educate mothers on malaria prevention measures.

Nurses should also do home visiting to ensure the implementation of the implementation of the

preventive measures taught ti the mothers.

Other habits aimed at improving children’s immunity should be encouraged to enable their bodies fight

against invading illnesses like malaria and those include nutrition status, personal hygiene, sanitation,

immunization among others should be taught to the patients but the nurses. Nurses use the core people

in identifying the patients requirements in as far as malaria is concerned and therefore should advocate

for their considerations during planning and implementation of government programs and also lobe

from other sectors like NGO’s.

REFERANCES

Chritian Mbhou, N. ( 22 june 2020). mode of transimission, treatment and prevention awareness. mode

of transimission, treatment and prevention awareness .

2
7
DANIELS. (2020, JUNE). NHS. Retrieved jan 20 , 2021, from NHS: htto/www.nhs.al

KLUWER, W. (2016, jun 30). Medknow publication. Retrieved Dec 10, 2021, from www.ncbi.nih.gov:

http//www.ncbi.nih.gov

lita, s. m. (2019). community awareness about malaria. malaria awereness .

M Legesse, w. D. (2016). malaria survey. dol 10.43/ejhd.v23i144836 , 32-36.

Mahta, M. (2020). medscape. In pediatric malaria (p. 223). Russel w steele.

Mwanje, L. f. (2013). research on KAP for malaria. In L. f. Mwanje, knowledge attitude and practices

of people on malaria (p. 123). Mukono: daily monitor.

WHO. (2020). malairia day. raising awareness of malaria. wester pacific region: www.wh.int.

Arther Mpimbaza, Richard Walemwa, Robert w snow. "BMC."BMC Infectious diseases, july 13, 2020:
503(202).

Beckman, Troy. MALAIRA. USAID, 2018.

H, Battacharyya. "Knowledge beleifs and practices regarding malaria uban sett6ing of east khasi hills."

In Med Sci public health, by Battacharyya H, 4/1045. Meghalaya, Meghalaya: dio 10.5455/ijmsph,

2015.

health, ministry of. dhis hris. october 2021. www.health.go.ug.

JRM. Malaria to zero. masaka, Bukulula, october 2, 2019.

Mattews, danielle Robrts Glenda. "Risk factors of malaria in children under five years."malaria journal,

2016.

medicine, National liberty of. trends in Malaria. siaya: national centre for biomedical information,

2018.

2
8
Oxiford. "navigation."travel medicine, 2021: vol 28.

ray, manta. "knowledge sharing for severe Malaria." fe 8, 2018.

Roberts, Danielle. "malaria Journal."Environmental factors contributing to under five malaria, 2016.

Schellenberg, J A. analysis of Geographical distribution of Malaria. kilifi: et alint J epidemiol, 2017.

Simon P kigozi, ruth n kigozi, rachel Pullan. "septal temporal patterns of malaria."BMC Public health,

2020: 23.

Tempubolon, Welung Hanandita Gindo. "Geography and social distibution ofd malaria."International

Journal of ealth Geographics, 12 april 2016: 16.

Ubydul Haque, Masahiro, Hashizume. "biomedicentral."malaria, 2014: 156.

UNICEF. "Malaria."unicef malaria data, 2019.

USAIS. usaid``s malatria program for districts. kampala: www.malariaconsortium/publications, 2018.

Van Eijk, Rumathampuran L, Sutton PL, Peddy N chouby S. "the use mosquito repellants with

declining malaria transmision in ."parasite vectors, 2016: 481.

WaltersM. Essendi, anne M Vardo Zalik. "malaria."epidemiological risk factors for malaria infection in

the highands of westwern Kenya, june 2019: 211.

WHO. Malaria. WHO, 2020.

WHO. "Prevalence of malaria."world malaria, 2021: 36.

Y Zhang, qy Liu, RS Laun. "spacial temporal analysis of malaria and environment."BMC Public Health,

2012: 923.

APPENDIX I: CONSET FOAM

Introduction.

2
9
Good morning/ afternoon Sir/madam. My name is ARINAITWE MORRIS from Masaka School of

Comprehensive Nursing. I am here to conduct a study on factors contributing to high occurrences of

malaria in children under five years at Bukulula health centre iv in Kalungu district.

Procedure

You will be expected to respond to questions on bio data, social and demographic data as well as

providing information in relation to your child's illness and factors contributing to the present illness .

The study is beneficial to you since the information that will be generated will be disseminated to the

relevant authorities and will be during planning for effective control and prevention of malaria. All the

information you provide will be kept strictly confidential. The tools will be securely stored under lock

and key with the ward in charge. Your participation in this study is entirely voluntary. I therefore kindly

request you to participate in this study by responding to the questions in the questionnaire following the

protocols as described to you.

Statement of consent.

I have read or been informed about this research and had the opportunity to ask questions and my

questions have been answered to my satisfaction. I hereby voluntarily consent to participate in the study

and understand that I have the right to withdraw at any point.

Signature/ thumb print………………………… Date …………………………

APPENDIX II: QUESTIONIARE

SECTION A: RESPONDENT’S SOCIO-DEMOGRAPHIC DATA

1) What is your gender?

3
0
 a) Male b) Female

2) How old are you?

a) 15-32 years b) 33-45 years c) Above 45years

3) What is your marital status?

a) Married b) Widowed c) Divorced

4) What is your level of education

a) Primary c) Secondary

b) Tertiary d) None

5) How many children do you have?

a) 1 b) 2-5 c) 5 and above

6) What is your occupation?

a) Peasant b) Business c) Civil servant d) None

(specify………………………………………………………………..

SECTION: B

INDIVIDUAL FACTORS CONTRIBUTING TO INCREASED UNDER FIVE MALARIA

2. Do your children usually suffer from childhood illnesses?

3
1
a) Yes b) No

If yes?…………………………………………………………………………

Has your child been diagnosed with malaria before?

a) Yes b) No

3. How do you tell that your child s suffering from malaria before laboratory diagnosis?

….……………………………………………………………………………….

4. A) Where do you take your children when they fall sick?

a) Health facility

b) Church or mosque

c) Shrine

d) Stay at home

e) Others(specify)………………………………………………………………………..

C) If to the health facility, how often has your child been admitted

a) Above 5

b) 3-5

c) 1-2

D) How do you find the cots of hospital charges?

a) Affordable

b) Cheap

c) Expensive
3
2
d) Un affordable

5. A) How many meals do you eat a day?

….…………………………………………………………………………………………………..

B) Mention the foods that you normally eat at home?

….……………………………………………………………………………………………………

6. Do you take malarial prophylaxis when pregnant or going to travel

….………………………………………………………………………………………………..

SECTION C

ENVIRONMENTAL FACTORS

1. What is the land scape at you home

a) Flat b) Hilly c) Valley

2. What type of vegetation surrounds your home?

a) Forest c) Shrub

b) Bushes d) Non

3. Is there any big water body near your home?

a) Yes b) No

4. How often does it rain at your home?

a) Frequently c) Rarely

b) Only in rain seasons

3
3
5. Which temperatures do you always experience?

a) Hot b) Cold c) warm

6. Which other physical features are surrounding your home?

a) Hills c) Planes e) Rivers

b) Swamps d) Lakes

MOTHERS KNOWLEDGE ON MALARIA PREVENTION

1. What is malaria?

a) Can define b) Cant define

2. Which vector spreads malaria?

a) Mosquito b) House fly c) Giger bed bug

3. Do your children sleep under a treated mosquito net?

a) Yes b) No

4. Have you ever taken intermittent malaria presumptive treatment when pregnant

a) Yes b) No c) I dint know

5. Do you always close windows and doors in the evening at your home?

a) Yes b) No

6. Is there any stagnant water around your home?

a) Yes b) No

7. Do you give malaria prophylaxes to your children when travelling to forested areas?
3
4
a) Yes b) No

END

THANKS FOR YOUR PARTICIPATION

3
5
APPENDIX III: LETTER OF INTRODUCTION

3
6
 APPENDIX VI :

MAP OF UGANDA SHOWING LOCATION OF KALUNGU DISTRICT

3
7
APPENDIX V: A MAP SHOWING THE STUDY AREA

3
8