Malaria In Pregnancy Among The Pregnant Women Attending Antenatal Care

Project and Seminar Material for Nursing (Science)

Abstract

A study was conducted to assess malaria in pregnancy among the pregnant women attending antenatal care in Ozubulu. Also, the knowledge and attitude of caregivers to malaria diagnosis were determined. A total of 243 pregnant women were sampled for malaria parasites infection using thick and thin film smears and 393 caregivers were sampled for knowledge and attitude in malaria diagnosis. The result showed a prevalence of 53.9% (131/243). It was found that women in their first pregnancy had the highest prevalence of 65.8% (48/73). Highest prevalence of 71.6% (58/81) was also recorded among women in their first trimester. Pregnant women aged 21 -25 years had highest infection rate of 68.8% (33/48). The result also showed that all the caregivers interviewed knew about self-diagnosis of malaria. 57% (224/393) of the caregivers knew about microscopy, while only 2.5% (10/393) knew about Rapid Diagnostic Tests. 40.2% (158/393) of the caregivers rated laboratory diagnosis as not important, 47.8% (188/393) as barely important and 12% (47/393) as very important. 38.7% (152/393) of the caregivers suggested use of community health workers in enlightenment program on malaria diagnosis. Following the high prevalence of malaria infection in pregnancy, more efforts are needed in the control of malaria in pregnancy. The people need public enlightenment in the importance of malaria diagnosis.

Table of Content

Preliminary Page(s)

Title Page
Declaration
Approval
Dedication
Acknowledgement
Abstract
Table of Content

Chapter One

1.0 Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Research Objectives
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Operational Definitions
1.8 Organization of Study

Chapter Two

2.0 Literature Review

2.1 Trends in Prevalence of Malaria in Pregnancy
2.2 Epidemiological Factors of Malaria
2.3 Effects of Maternal Malaria on Infants
2.4 Immune Response to Malaria During Pregnancy
2.5 Antenatal Care Services in Nigeria and Malaria in Pregnancy
2.7 Challenges to Diagnosis of Malaria
2.8 Knowledge About Symptoms of Malaria
2.9 Attitude Towards Malaria

Chapter Three

3.0 Methodology

3.1 Study Area
3.2 Sample Population
3.3 Sample Size
3.4 Research Design
3.5 Data Analysis

Chapter Four

4.0 Results and Discussion

4.1 Results
4.2 Discussion

Chapter Five

5.0 Conclusion and Recommendations

5.1 Conclusion
5.2 Recommendations
References
Appendix

Chapter One

1.0 Introduction

1.1 Background of the Study

Malaria is a life-threatening parasitic disease transmitted by female Anopheles mosquitoes. More than 40% of the world population lives in malarious areas (WHO, 2010). It is estimated that the number of cases of malaria rose from 233 million in 2000 to 244 million in 2005 but decreased to 225 million in2009(WHO, 2010). The number of deaths due to malaria is estimated to havedecreased from 985 000 in 2000 to 781 000 in 2009 (WHO, 2010). Malaria is the most highly prevalent tropical disease with high morbidity and mortality, and with high economic and social impact (WHO, 2010). Over 90% of all deaths caused by malaria occur in sub – Saharan Africa and about 85% of deaths glob ally were in children under 5 years of age (WHO, 2010). In addition, pregnant women are at immense risk of malaria due to natural immune depression in pregnancy (Fievet et al., 2007). About 25% of all estimated malaria cases in the World Health Organisation African Region occur in Nigeria (WHO, 2010).

Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world (WHO, 2010). The burden of malaria infection during pregnancy is caused mainly by Plasmodium falciparum, the most common malaria species in Africa (WHO, 2010). Each year at least 3 million pregnancies occur among women in malarious areas of Africa, most of who reside in areas of relatively stable malaria transmission (Brabin, 2000). The symptoms and complications of malaria during pregnancy differ with the intensity of malaria transmission and thus with the level of immunity the pregnant woman has acquired (Perlmann a nd Troye-Blomberg (2000). Pregnant women and the unborn children are particularly vulnerable to malaria, which is a major cause of prenatal mortality, low birth weight, and maternal anaemia (Greenwood et al ., 2007).

Beyond the impact of malaria on children and pregnant women, it affects the general population. 100% of the total population of Nigeria is at risk of malaria and at least 50% of the total population suffers from at least one episode of malaria each year (WHO, 2010). About 51% of malaria cases a nd deaths in Nigeria occur in rural villages away from effective diagnostic or treatment facilities (WHO, 2010). Malaria cases and deaths have been increasing in the country, mainly due to injudicious use of antimalarial drugs, delayed health seeking, and reliance on the clinical judgment without laboratory confirmation in most of the peripheral health facilities (Vanderetal.,2005). Despite evidence of the cost- effectiveness of improving treatment access and compliance (Goodman et al., 1999), most victims of malaria still die because of a lack of health care close to their homes or because their condition is not diagnosed by health workers (WHO, 2000; Armstrong-Schellenberg et al., 1994). Early diagnosis and prompt effective treatment of malaria illness has been a cornerstone of malaria control (Vander et al., 2005). Diagnosis based on symptoms alone has inherent difficulties (Van der et al ., 2005), although volunteer health workers in rural areas have practised it with some success (Pagnoni, 1997; Okanurak and Ruebush, 1996 ). The reduction of morbidity and the interruption of parasite transmission by means of community-based antimalarial treatment require an accurate, rapi d and practical method of diagnosis. The delivery of treatment in r ural areas in Nigeria is complicated by the centralized nature of microscopy services (Alaba and Alaba, 2008). Over the past few years, developments in rapid field diagnostic techniques based on the demonstration of parasite antigens have opened new possibilities for improved rural malaria diagnosis that is independent of centralized diagnostic services (Bojang, 1999 ; Singh et al ., 1997).

1.2 Statement of the Problem

There have been a considerable number of reports about knowledge, attitudes, and practices relating to malaria and its control from different parts of Africa. These reports concluded that misconceptions concerning malaria still exist and that practices for the control of malaria have been unsatisfactory (Deressaet al., 2008). However, epidemiological patterns of malaria are widely different from one place to another (Himeiden et al., 2005). Specific data of a place collected can help in the making of a design of improved programme for strategic malaria control for a particular location. There are available effective low -cost strategies for the treatment of malaria, but any attempt to control a disease such as malaria in an area or locality should first of all be preceded by an extensive evaluation of the magnitude of the prevailing situation; a complete description of the health problems of the community comprising an account not only of the prevalence, but also of the community’s view of its own problem s and its use of existing health services. Ascertaining the factors that influence community and provider acceptance of and adherence to the new treatment regime will be vital to improving the effectiveness of this intervention and reducing the risk of development of drug resistance, and thus reduction in prevalence, towards elimination and subsequent eradication. Part of the rationale for investigating malaria prevalence in pregnancy is to compare present with past situations especially with current efforts at controlling malaria during pregnancy.

1.3 Research Objectives

The main objective of this study is to assess malaria in pregnancy among the pregnant women attending antenatal carein Ozubulu, Anambra State, Southeast Nigeria. The specific objectives;

To determine the prevalence of malaria infection among pregnant women attending antenatal clinics in Ozubulu, Anambra State, Southeast Nigeria.
To determine the knowledge and attitude of caregivers to malaria diagnosis in the rural community.

1.4 Research Questions

What is the prevalence of malaria infection among pregnant women attending antenatal clinics in Ozubulu, Anambra State, Southeast Nigeria?
What is the knowledge and attitude of caregivers to malaria diagnosis in the rural community?

1.5 Research Hypothesis

HO1: Malaria infection is not prevalent among pregnant women attending antenatal clinics in Ozubulu, Anambra State, Southeast Nigeria

1.6 Significance of the Study

This study examines the factors that promote or inhibit the practice of healthy behaviours and standard prevention of malaria, especially among pregnant women. Findings from the study will be used by the Health authorities, community stakeholders, and the hospital management, in planning and developing adequate measures for control and prevention of malaria to improve individual health, public health and curb the spread of the disease. This study will be of most significance to the residents and stakeholders of Ozubulucommunity, as well health care givers as it provides prevention strategies that will result from the study findings.

Also, this research work will contribute to the existing body of literature and knowledge on the subject of standard precautions among health care givers and professionals. This study would also serve as a means of reference source for future researchers as well as educate the public on the results of the findings as well as recommendations made that will be of benefit to the health system and public health of the community and individuals.

1.7 Operational Definitions

Malaria:

Is a mosquito-borne infectious disease affecting humans and other animals caused by single-celled microorganisms belonging to the Plasmodium group. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death.

Pregnancy:

Occurs when a sperm fertilizes an egg after it’s released from the ovary during ovulation.

1.8 Organization of Study

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.

Chapter Five

5.0 Conclusion and Recommendations

5.1 Conclusion

This study recorded high prevalence of malaria parasitaemia among pregnant women attending antenatal clinic in Ozubulu. The high prevalence of malaria parasites once more brings to fore the endemicity of malaria in Anambra State, which is in the savannah belt of south-eastern Nigeria, thus a good environment for mosquito breeding, especially in the rainy season. Though this study was conducted in the dry season, poor environmental sanitation favoured the breeding of mosquitoes in the study community.

Regular environmental sanitation to dislodge mosquitoes from their breeding places will go a long way to reduce prevalence of malaria in villages commonly seen in the tropics. Early antenatal booking for effective monitoring and prompt treatment of malaria in pregnancy will contribute significantly in reducing maternal morbidity and mortality, and its prenatal mortality, and it is of necessity that routine intermittent preventive treatment of malaria is recommended for pregnant women in this area. Several studies have shown that protection against malaria contributes to the prevention of malariain pregnancy, thus highlighting the importance and efficacy of chemoprophylaxis and use of other methods of malaria control like insecticide impregnated nets.

Practice of presumptive treatment is of considerable concern for both the health of individuals and the increased risk it poses to the development of parasite resistance to the first-line treatment against malaria (WHO, 2010). Malaria RDTs have been recommended to improve diagnostic efficiency . These RDTs have opened new possibilities for improved rural malaria diagnosis that is independent of centralized diagnostic services (Bojang, 1999 ; Singh et al ., 1997). But considering the poor knowledge of community members to RDTs and poor attitude to laboratory importance, it is of great necessity that intensive health education should be implemented to inform communities about the new treatment regime, as well as effective refresher training of healthcare workers, with follow -on activities such as job aides and supportive supervision on the use of RDTs.

5.2 Recommendations

Therefore, it is necessary to enlighten them on importance of intermittent preventive treatment of malaria and use of insecticide treated nets in pregnancy. Educating them on the importance will augment the acceptance of and adherence to these new preventive measures, which are crucial to improving the effectiveness of malaria preventive control, by limiting placental malaria and its adverse effects on foetal outcomes; and improving child survival and development, thus reducing the burden of malaria in endemic areas.

In addition, supply lines should be streamlined for RDTs to ensure consistent stocks in the healthcare centres. Considering the high level of poverty in Nigeria, government should create an avenue of subsidy in health services, both in diagnosis and treatment of malaria. These recommendations will be integral to the success and sustainability of intensified malaria control, subsequently leading to elimination of malaria in Nigeria.

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