CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Malaria has always been the subject of research for medical practitioners from time immemorial. Pregnant women, children, and immune compromised people have the most noteworthy morbidity and mortality, and Africa bears the heaviest weight of malaria infection. WHO (1991) reported that pregnant women and the unborn children are vulnerable to malaria, which is a major cause of perinatal mortality, low birth weight and maternal anaemia. Malaria in pregnancy is a significant health problem in Nigeria and it thus requires systematic studies. Previous literatures have recorded different case of malaria predominance among pregnant women. These comprise 21% among the pregnant women for South West Nigeria, 72% of 250 women likewise recorded request of high rate of anaemia, clinical malaria and placental burden among 300 women were investigated in Ghana (Adefioye, et al, 2007).
In these areas, the principal impact of malaria infection is associated with malaria related anaemia in the mother and with the presence of the parasites in the placenta. The resultant weakness of fetal nourishment adding to low birth weight is a main source of poor newborn child survival and development. In the areas of Africa with stable malaria transmission, P. falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal deaths each year, 8% to 14% of all low birth weight babies and 73,000 to 200,000 of all infant deaths each year (Shulman, 1999). In Nigeria, there is a roughly 25-30% of mortality in children under five and 300,000 deaths every year because of malaria sickness (Odaibo, 2005). Antenatal clinic visits is a significant for delivery of the prevention package for pregnant women. Studies have shown that 40% of pregnant African women present for the first time to antenatal clinics in the second trimester of their pregnancy. The ITNs, some portion of the aprevention package delivered during the first antenatal clinic visit would give extra security to the mother during the rest of the trimesters of pregnancy and into the post-partum period, just as protection for the infant through in any event the first year of life (WHO, 2003b).
Pregnancy exacerbates malaria through a nonspecific hormone-dependent depression of the immune system. The defensive antiplasmodial action is stifled at pregnancy, which has clinical results with significant general wellbeing suggestions on pregnant women. Malaria infection leads to increased morbidity and mortality and the delivery of premature infants with low birth weights due to intrauterine growth retardation (IUGR) that may have been as a result of placental parasitisation. Malaria infection is significant in Africa where its fatality as a result of virulent Plasmodium falciparium is a far greater problem than in most parts of the world. Pregnant women should be adequately informed on how to recognise the symptoms of malaria in their body especially during pregnancy, which is a critical period for women. Studies in West Africa have shown that the persistent failure of some intervention methods in health care delivery has been attributed to complete reliance on only clinical and laboratory diagnosis methods.
Protection of pregnant women living in malaria prone nations has been exceptionally compelling to numerous malaria control programmes because of this group’s higher susceptibility and reduced immunity. Nigeria, accounts for one fourth of all malaria cases in the 45 endemic countries in Africa (WHO, 2003), and 11% of maternal deaths in the country are attributed to malaria. Decidedly, malaria control measures have gotten a more noteworthy consideration in the most recent decade as expanded financing has brought about the scaling up of malaria control programmes. Use of insecticide-treated nets (ITNs) is one of the key components of malaria prevention and control as recommended by the World Health Organization (2003). The nets lessen human contact with mosquitoes, subsequently prompting a noteworthy decrease in the incidence of malaria, related morbidity, and mortality; just as in the unfriendly impacts during pregnancy in regions of extreme malaria transmission.
Another significant intervention for controlling malaria and its effects during pregnancy is the administration of intermittent preventive treatment (IPT). This comprises of a full therapeutic course of antimalarial medication given to pregnant women at routine prenatal visits, whether or not they are infected with malaria or not. Discontinuous preventive treatment diminishes frequencies of maternal malaria scenes, maternal and foetal anaemia, placental parasitaemia, low birth weight and neonatal mortality. Accordingly, the WHO suggests IPT with sulfadoxine-pyrimethamine in regions with moderate to high malaria transmission in Africa.
This study was therefore conducted to examine the clinical status of malaria, i.e., the prevalence and health factors affecting prevalence among selected pregnant women in Lagos, Nigeria. It also identified some socio-cultural factors like knowledge, attitudes and practices, which are essential factors that can be included in the education of pregnant women for effective control programmes.
1.2 Statement of the Problem
Of the estimated 50 million pregnancies that happen every year worldwide, roughly 25 million is thought to happen in developing nations. The pregnant women and their children are believed to be the mostly attackable to malaria. Whereas several initiatives have been implemented over the years to control malaria in pregnancy, none of these has succeeded in its entirety. Without any intervention, malaria would cause 10, 000 of these women and 200, 000 of their infants death as a result of malaria infection and severe malarial anaemia. Developing countries (or rather tropical countries) are thought to bear the global brunt of malaria in pregnancies in addition to the unfinished business of HIV/AIDS and other communicable disease like Tuberculosis.
Malaria in Nigeria and the rest of African countries is recognized as the leading public health problem. Lagos State implemented anti malaria control programme which is called National Malaria Elimination Programme (NMEP) with the goal of significantly reducing the burden of disease consequent upon malaria. In spite of the successes chalked in the implementation, there is still a lot to be achieved by way of reduction in the incidence of malaria. Apart from the uptake of Intermittent Preventive Treatment (IPT) by the pregnant women, there is also a default in the doses of those who take drugs otherwise not prescribed by any medical practitioners which is very dangerous to their health. A significant proportion of the expectant mothers take IPT only once, twice or sometimes the thrice which is the recommended dosage regimen of IPTp.
Malaria is endemic in Nigeria and in Lagos State. It is both a cause and consequence of underdevelopment and remains one of the leading causes of morbidity and mortality in the State. Hospital surveys show that it represents over 60% of outpatient visits and similarly answerable for 30% and 11% mortality in children under five and pregnant women respectively. It is on this note that this study sets to investigate the prevalence of malaria among pregnant women and its health implication among selected patients in Ikeja General Hospital, Lagos State, Nigeria.
1.3 Objectives of the Study
The aim of this study was to determine the prevalence of malaria among pregnant women and its health implication among selected patients in Ikeja General Hospital, Lagos State, Nigeria. The specific objectives include:
- To examine the prevalence of malaria infection among selected patients in Ikeja General Hospital, Lagos State Nigeria.
- To investigate the knowledge and attitude of caregivers to malaria diagnosis in Ikeja metropolis
- To find out the awareness programme on malaria infection made available by the Lagos State Ministry of Health to control malaria among pregnant women
1.4 Research Questions
The following research questions will be provided answers to:
- What is the prevalence of malaria infection among selected patients in Ikeja General Hospital, Lagos State Nigeria?
- What is the knowledge and attitude of caregivers to malaria diagnosis in Ikeja metropolis?
- Is there any awareness programme on malaria infection made available by the Lagos State Ministry of Health to control malaria among pregnant women?
1.5 Research Hypotheses
The following statements will be the research hypotheses:
i) There is a significant relationship between the knowledge and attitude of caregivers and malaria diagnosis
ii) There is no significant relationship between awareness programme on malaria infection made available by the Lagos State Ministry of Health and control of malaria among pregnant women
1.6 Significance of the Study
The result of this study will serve as good base or guide for future reference and it will also encourage further research on the importance of staying healthy and being free from malaria infection that may lead to untimely death. Furthermore, this study will provide relevant information on the reasons for the spread of this malaria parasite and its effects in the body. Also, this study would be of immense importance towards containing this deadly parasite and its management in Nigeria.
1.7 Scope of the Study
This study is on the prevalence of malaria among pregnant women and its health implication: case study of Select patients in Ikeja General Hospital, Lagos, Nigeria. Therefore, one hundred respondents shall be selected within the space of three weeks as it is sometime not possible to get the required samples of one hundred within a day or a week.
1.8 Limitations of the study
Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
Attitudes of Respondents: The researcher encountered the major challenge from the respondents on their typical reluctant attitude to fill the questionnaire or grant interview. In some cases, some respondents expect to be paid for the use of their time and knowledge; if otherwise, they were very reluctant in giving the required information. Some caregivers on their part hoard information in keeping with the oath of secrecy. In spite of repeated assurance of confidentiality most of them fear the loss of their job and some were too busy to grant interview correctly.
Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.9 Definition of Terms
The following terms were used in the process of carrying out this study. They included:
Caregiver: is a paid or unpaid and without formal training member of a person's social network who helps them with activities of daily living. Carerer is most commonly used to address impairments related to old age, disability, a disease, or a mental disorder.
Infection: is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce.
Malaria: A disease caused by a plasmodium parasite, transmitted by the bite of infected mosquitoes. The severity of malaria varies based on the species of plasmodium. Symptoms are chills, fever and sweating, usually occurring a few weeks after being bitten. People travelling to areas where malaria is common typically take protective drugs before, during and after their trip. Treatment includes antimalaria drugs.
Parasite: an organism that lives in or on an organism of another species (its host) and benefits by deriving nutrients at the other's expense.
