THE PREVALENCE OF MALARIA AMONG PREGNANT WOMEN AND ITS HEALTH IMPLICATION (CASE STUDY OF SELECT PATIENTS IN IKEJA GENERAL HOSPITAL)


THE PREVALENCE OF MALARIA AMONG PREGNANT WOMEN AND ITS HEALTH IMPLICATION (CASE STUDY OF SELECT PATIENTS IN IKEJA GENERAL HOSPITAL)  

ABSTRACT

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.

Contents

ABSTRACT 2

CHAPTER ONE 2

INTRODUCTION 2

1.1 Background to the Study 2

1.2 Statement of the Problem 5

1.3 Objectives of the Study 6

1.4 Research Questions 6

1.5 Research Hypotheses 7

1.6 Significance of the Study 7

1.7 Scope of the Study 8

1.8 Limitations of the study 8

1.9 Definition of Terms 8

CHAPTER TWO 9

LITERATURE REVIEW 9

2.1 Trends in Prevalence of Malaria in Pregnancy 9

2.2 Epidemiological Factors of Malaria 12

2.3 Effects of Maternal Malaria on Infants 15

2.4 Immune Response to Malaria during Pregnancy 17

2.5 Antenatal Care Services in Nigeria and Malaria in Pregnancy 19

2.6 Confirmatory Diagnosis of Malaria 22

2.6.1 Microscopic Tests 22

2.6.2 Rapid Diagnostic Tests (RDTs) 24

2.7 Challenges to Diagnosis of Malaria 27

2.8 Knowledge about Symptoms of Malaria 30

2.9 Attitude towards Malaria 31

2.10 Gender Roles and Treatment Seeking Behaviour 32

2.11 Knowledge and Attitude towards Diagnosis 33

CHAPTER THREE 35

RESEARCH METHODOLOGY 35

3.1 Introduction 35

3.2 Research Design 36

3.3 Population of Study 36

3.4 Sample and Sampling Techniques 36

3.5 Sources of Data Collection 37

3.6 Research Instrument 37

3.7 Procedure for Administration of Research Instrument 37

3.7.1 Validity of the Instrument 38

3.7.2 Reliability of the Instrument 38

CHAPTER FOUR 38

DATA ANALYSIS AND INTERPRETATION 38

4.1 INTRODUCTION 38

DATA ANALYSIS 38

TABLES BASED ON RESEARCH QUESTIONS 40

4.3 Analysis of the Respondents’ Views on Research Question 40

4.4 Testing Hypotheses 45

4.5 Discussion of findings 48

CHAPTER FIVE 49

SUMMARY, CONCLUSION AND RECOMMENDATIONS 49

5.1 Preamble 49

5.2 Summary 50

5.3 Conclusion 50

5.4 Recommendations 50

REFERENCES 51

QUESTIONNAIRE 56

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 andwith 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 malariatransmission, P. falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal deathseach year, 8% to 14% of all low birth weight babies and 75,000 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 thesecond 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 falcipariumis 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 foetalanaemia, 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 objectivesinclude:

i. To examine the prevalence of malaria infection among selected patients in Ikeja General Hospital, Lagos State Nigeria.

ii. To investigate the knowledge and attitude of caregivers to malaria diagnosis in Ikeja metropolis

iii. To find out the awareness programme on malaria infection made available by the Lagos State Ministry of Healthto control malaria among pregnant women

1.4 Research Questions

The following research questions will be provided answers to:

i. What is the prevalence of malaria infection among selected patients in Ikeja General Hospital, Lagos State Nigeria?

ii. What is the knowledge and attitude of caregivers to malaria diagnosis in Ikeja metropolis?

iii. 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.

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THE PREVALENCE OF MALARIA AMONG PREGNANT WOMEN AND ITS HEALTH IMPLICATION (CASE STUDY OF SELECT PATIENTS IN IKEJA GENERAL HOSPITAL)



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