CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Nigeria is the 14th largest country in Africa. It has 923,768 square kilometres of total land area. Nigeria is 7th largest country in the world in terms of population and largest in Africa. Nigeria lies in sub-Saharan Africa. The population of Nigeria is approximately 177.1 million. Nigeria is lower middle income country according to the World Bank, 2016. Malaria is a social and medical problem receiving multidisciplinary and multidimensional solution (WHO, 2003) and has been a major public health problem in sub-Saharan Africa. According to Ogbu et al. (2015) prevalence of malaria parasitaemia was 38.8% in a study conducted among asymptomatic women at booking visit in a tertiary hospital, North central Nigeria. All ages are susceptible but children under 5 years and pregnant women are particularly at risk of severe and complicated malaria. Malaria has remained a major public health problem in Nigeria and it is responsible for 30% childhood and 11% maternal mortality despite the availability of effective interventions. A study showed that 87% of women had undergone at least one episode of malaria during the current pregnancy with 89.0% of them attributing it to bites from infected mosquitoes, while 75% consider malaria an important health risk during pregnancy (Enato et al., 2007a). In Northern part of Nigeria pregnant women and their unborn children have been reported to be vulnerable to malaria which kills children every 30 seconds (Davidson, 2000; Bawa et al., 2014). The disease burden is especially high among these groups as a result of immature and weakened immunity. Malaria prevention and control program focus on these biologically vulnerable groups particularly those living in poor and hard to reach communities. These communities often have limited access to primary health care as well as to simple and effective preventive tools such as Insecticide Treated Nets (ITNs). In addition, they are less likely to have access to information regarding the disease and how to avoid it (WHO, 2003; Enato et al., 2007a). Malaria in pregnancy is a common and serious public health problem in Nigeria as large proportion of the asymptomatic pregnant women had malaria parasitaemia with its attendant anaemia (Ogbu et al., 2015). Malarial infestation during pregnancy affects more primigravidae and teenage mothers than those of higher gravidity and older age group. Malaria increases susceptibility to other infections and retard growth and development in children. It is associated with considerable economic burden including direct loss to government productive work or education (Oladepo et al., 2010; Bawa, 2014). Malaria during pregnancy has been associated with increased incidence of anaemia, spontaneous abortions, preterm labour, fetal distress, congenital infections, fetal death inutero, still births and intrauterine growth restriction (Mutabingwa, 2003). Despite the evidence that the use of ITNs decreases malaria related mortality and morbidity, its use is still low as reported by the 2013 Demographic Health survey where only 30% of pregnant women in households with ITN slept under Ione the night preceding the interview (NPC & ICF Macro, 2014). Encouragement of consistent and appropriate use of bed-nets has been reported to be a challenge (Cruz et al., 2006). Up to 400,000 infant deaths due to low birth weight could be averted each year if IPT were routinely available to every woman during pregnancy (USAID Health, 2007). According to a study carried out in Southern Nigeria, the prevalence of Titiloye et al. 93 malaria in pregnancy was 30% and despite the common occurrence of malaria during pregnancy, there was a limited knowledge and use of recommended anti-malarial intervention by women attending antenatal clinics (Enato et al., 2007b). Many pregnant women who due to poverty and/or lack of education do not go for antenatal care and have no access to preventive malaria care may hence present when the disease is severe. This may lead to abortion, stillbirth, premature delivery, low birth weight babies and/or high mortality for pregnant women. Malaria infection is estimated to cause 400,000 cases of severe maternal anaemia and from 75,000-200,000 infant deaths annually in sub-Saharan Africa (Centre for Disease Control and Prevention, 2007). According to Abasiatai et al. (2008) in order to prevent the deleterious effects of malaria during pregnancy, intermittent preventive treatment (IPT) of asymptomatic pregnant women, use of insecticide treated bed nets (ITNs) and prompt and effective case management of malaria have been recommended by the World Health Organisation (WHO) as a three pronged approach to the prevention and control of malaria during pregnancy in areas of stable transmission (WHO, 2004).
1.2 STATEMENT OF PROBLEM
Achieving sustainable control of the disease depend on extensive public health promotional programs which focus on current and proven methods of malaria prevention and management. While much is known about vector biology and behaviour and the malaria parasites, the importance of human behaviour in malaria transmission has not been critically evaluated. Studies focusing on the current practices of malaria prevention and treatment options in the population are sparse. Thus, it is expedient to evaluate current knowledge of malaria prevention practices and management options as well as the uptake of the management options. In most high-burden countries (including Nigeria), ITN coverage is still below agreed targets (Minja & Obrist, 2005). This may be related to the perception of its use among the community members. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of ITN for malaria control by the community members (Minja et al., 2001). Furthermore, given that malaria infection during pregnancy could negatively affect both the mother and the unborn child, it is essential to investigate factors that influence pregnant women’s malaria prevention and control practices. Pregnant women residing in slum areas may be at more risk of malaria infection than their upscale counterparts because of the prevalence of mosquito breeding spots in these communities. This is of particular concern because more than one billion people or about 14% of the total global population live in slum areas. In Nigeria for instance, urban inequalities have increased, with large populations living in informal settlements, which are commonly referred to as slums and characterized by limited access to water and sanitation infrastructure. Despite the fact that the general structure and appearance of slum neighbourhoods suggest unfavourable health effects, not many studies have examined the health of pregnant women and children residing in these areas.
1.3AIMS OF THE STUDY
The major purpose of this study is to examine the menace of malaria among children and pregnant women in Nigeria. Other general objectives of the study are:
1. To examine the factors that influence malaria prevention and control practices among pregnant women and children in Nigeria.
2. To examine the knowledge of malaria prevention among caregivers of children and pregnant women in a rural community.
3. To examine the impact of malaria among children and pregnant women in Nigeria.
4. To examine the problems related to malaria in children and pregnant women.
5. To examine the relationship between malaria and general wellbeing of children and pregnant women.
6. To suggest malaria preventive measures and control among citizens of Nigeria.
1.4 RESEARCH QUESTIONS
1. What are the factors that influence malaria prevention and control practices among pregnant women and children in Nigeria?
2. To what extent is the knowledge of malaria prevention among caregivers of children and pregnant women in a rural community?
3. What are the impact of malaria among children and pregnant women in Nigeria?
4. What are the problems related to malaria in children and pregnant women?
5. What is the relationship between malaria and general wellbeing of children and pregnant women?
6. What are the suggested malaria preventive measures and control among citizens of Nigeria?
1.5 RESEARCH HYPOTHESES
H01: There is a significant impact of malaria among children and pregnant women in Nigeria.
H02: There is a significant relationship between malaria and general wellbeing of children and pregnant women.
1.6 SIGNIFICANCE OF THE STUDY
The study is of great significance to investigating the harmful effects caused by malaria among children and pregnant women in Nigeria. The information ascertained from the study will guide public as regards to save lives of children and pregnant women through the prevalence of malaria in pregnancy and children in Nigeria. The study will expose the predisposing factors and control measures of malaria attack and the awareness will be very important to the pregnant women in antenatal clinic and the public in general. The study shall therefore serve as a reference for further research.
1.7SCOPE OF THE STUDY
The study is based on the menace of malaria among children and pregnant women in Nigeria (A case of children and pregnant women of Ukwa east, Abia state)
1.8 LIMITATION OF 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).
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.
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