Prevalence And Associated Factor Of Malaria In Children Under The Age Of Two Years

Project and Seminar Material for Nursing (Science)

Prevalence And Associated Factor Of Malaria In Children Under The Age Of Two Years


Abstract


Background: Enhanced malaria control has resulted in its reduction in some areas of Sub Saharan Africa including Nigeria. However, asymptomatic hosts serve as a reservoir for the malaria parasite for communities. The objective of this study was to determine the prevalence of malaria parasites and risk factors associated with malaria infection among children Under-two years admitted on paediatric ward of Kawo General Hospital.

Methods: This community-based cross sectional study was conducted from 1st-March-2022 to 1st- May 2022 among children under two years admitted on paediatric ward. Interviews with parents or guardians were conducted to collect data on malaria associated risk factors.

Results: A total of 138 children were included in the study. Children who were not sleeping under insecticide treated nets were 15 times more likely to be infected with malaria parasites compared to those who were sleeping under nets

Conclusion: It is important to understand the determinants of malaria so that effective monitoring and evaluation of malaria can be carried out. This study showed the importance of socioeconomic status as well as education in the fight against malaria.

The asymptomatic infections in the community forms a reservoir for transmission in the area. Young age of the child and not sleeping under mosquito net were associated with malaria parasite infection. It is important to ensure that resources are channeled in order to optimize prevention strategies that are put in place. Once the population is empowered, then preventive strategies for malaria elimination can then be implemented successfully and if the population is educated, then it is able to understand better the strategies in place and implement them successfully.

The government must be economically sound in order to effectively implement the malaria control strategies so resources must be in place to implement malaria control strategies as well as sustaining them.

Keywords: Malaria, Children, Prevalence, Risk factors, Kawo General Hospital


Table of Content


Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2: Statement of the Problem.
  • 1.3 Purpose of the Study
  • 1.4 Study Objectives
  • 1.5 Research Question.
  • 1.6 Test of Hypothesis
  • 1.7 Scope of The Study
  • 1.8 Justification
  • 1.9 Definition of Terms
  • 1.10 Limitation of the Study
  • 1.11Conceptual Frame Work.
  • 1.12 Organization of the Study

Chapter Two:

Literature Review

  • 2.1 Conceptual Review
  • 2.2 Theoretical Review
  • 2.3 Summary of Reviewed Literature

Chapter Three:

Methodology

  • 3.1 Design of the study
  • 3.2 Population of the study
  • 3.4 Instrument for data collection
  • 3.5 Validation of Instrument
  • 3.6 Reliability of the instrument
  • 3.7 Experimental Procedure
  • 3.8 Control of Extraneous Variables
  • 3.9 Method of data collection
  • 3.10 Method of Data Analysis
  • 3.11 Ethical Considerations

Chapter Four:

Data Analysis and Result

  • 4.1 Introduction
  • 4.2 Demographics Characteristics of the Respondents
  • 4.3 Hypotheses

Chapter Five:

Conclusion and Recommendation

  • 5.1 Introduction
  • 5.2 social-economic and human factors
  • 5.3 Environmental determinants
  • 5.4: Insecticide Treated Mosquito Nets
  • 5.5 Recommendations
  • 5.6 Conclusions
  • REFERENCES
  • APPENDIX

List of Abbreviation


  • ACTs: Artemisinin Based Combination Therapy
  • DALYs: Disability Adjusted Life Years
  • HIV/AIDS: Human immunodeficiency virus infection / acquired immunodeficiency syndrome
  • IPTP: Intermittent preventive therapy in pregnancy
  • IRS: Indoor-residual spraying
  • ITNS: Insecticide-treated mosquito nets
  • LLITNs: Long Lasting Insecticide Treated Nets
  • MOHSW: Ministry of Health and Social Welfare
  • MOP: Malaria Operational Plan
  • MSAT: Mass screening and treatment
  • NIMR: National Institute of Medical Research
  • NMCP: National Malaria Control Program
  • NMTSP: National Malaria Medium Term Strategic Plan
  • RBM: Roll Back Malaria RDTs Rapid Diagnostic Tests
  • U2CC: Under-two catch-up campaign
  • UNDP: United Nations Development Programme
  • UNICEF: United Nations Children Education Fund
  • WHO: World Health Organization

Chapter One


Introduction

1.1 Background of the Study

Malaria is a febrile parasitic infection transmitted by an infected female anopheles mosquito. It is a major cause of illness and death in children. Malaria has remained a major threat to public health and economic growth in Africa. It threatens 2.4 billion people, or about 40% of the world’s population living in the world’s poorest countries, and more than one million deaths are attributable to the disease annually (WHO, 2000). According to WHO/UNICEF (2005), the disease is a major public health problem in Africa with over 200 million clinical episodes.

This preventable disease has reached epidemic proportions in many regions of the world and continues to spread unchecked (W.H.O., 1998). African children under two years are most at risk of malaria.

In semi-arid and highland regions of Africa, malaria is epidemic and causes deaths annually (Worall et al, 2004). Malaria presents a major socio-economic challenge to African countries, considering that it is the most affected region. This challenge cannot go unnoticed given that good health is not only a basic human need, but also a fundamental human right and a prerequisite for economic growth (UN, 2003).

Malaria is caused by a parasite that is transmitted from one person to another through the bite of the Anopheles mosquito (a female infected Anopheles mosquito). The major vectors of human malaria are Anopheles gambiae, Anopheles funestus, Anopheles arabiensis and Anopheles melas.

A. arabiensis is most dominant in the savannah areas and cities. A. gambiae are found in highly dense forest areas, A. funestus has an uneven distribution while A, melas is a salt water species (Federal Ministry of Health, 1990).
When the mosquito bites an infected person, it ingests microscopic malaria parasites found in the person’s blood. The malaria parasite must grow in the mosquito for a week or more before the infection is passed to another person. Thereafter, if the mosquito bites another person, the parasites pass from the mosquito’s mouth to the person’s blood. They feed on the blood cells, multiply inside the liver thereby destroying the red blood cells. This causes a cut off in blood circulation, which could lead to premature death, (WHO, 2000). Symptoms of malaria include fever, shivering, pains in the joint, vomiting, anemia, hemoglobinuria, retinal damage, and convulsions. The classic symptom of malaria is cyclical occurrence of sudden coldness followed by rigor then fever and sweating lasting four to six hours. This occurs every two days in plasmodium vivax (P. vivax) and plasmodium Ovale (P. ovale) infections, while every three days for plasmodium malariae (P. malariae) (Nyika, 2009). Rarely transmission can be through accidents, such as transfusion, inoculation of infected blood from one person to another, or transfer through the placenta from an infected mother to her unborn child.

Malaria can be prevented by the use of mosquito coils and repellants, spraying the insides of houses (where most Anopheles species feed and rest) with insecticides (indoor residual spraying, IRS) and by sleeping under bed nets that have been treated with long-lasting insecticides (longlasting insecticide nets, LLINs). Mass screening and treatment (MSAT) with effective antimalarial drugs can also reduce malaria transmission (Griffin et al., 2010).
However, the levels of malaria risk and transmission intensity exhibit significant spatial and temporal variability related to variations in amount of rainfall, temperature, altitude, topography, and human settlement pattern (Abeku et al, 2003). Once adult mosquitoes have emerged, the ambient temperature, humidity, and rains will determine their chances of survival. Warmer ambient temperatures shorten the duration of the extrinsic cycle, thus increasing the chances of transmission (Jackson, 2010).

The Ministry of Health (MOH, 2009) records show that between 3-3.5 million cases of malaria are reported each year, over 900,000 of which are children under two years. Malaria is said to account for 61% of Under-two hospital admissions and 8% of admissions of pregnant women. In those children who survive, malaria drains vital nutrients from them impairing their physical and intellectual development (W.H.O. 199)


1.2 Statement of the Problem.

Malaria continues to be an economic burden and a great threat globally and almost impossible to eradicate for the past six decades. Malaria is by far the leading cause of death in Kawo General Hospital. The disease is responsible for 25% of deaths of children below 5 years.

Nigeria is a malaria endemic country in which malaria control measures such as the use of insecticide treated bed nets (ITNs), indoor residual spraying of insecticide (IRS), and Intermittent Preventive Treatment (IPTp) for children have been implemented. Despite of all these efforts yet the overall prevalence of malaria infection remains high among the Under-two children.

This verifies that there could be several reasons for this situation including the deficiencies in the Health system that leads to lack of access to malaria control interventions and low effectiveness of these interventions than expected. Thus it is very essential that operational research is conducted to identify the gaps. Therefore this work involves a community approach first to confirm the prevalence of malaria in Under-twos, coverage of ITNs, IRS as well assessing of malaria prevalence among the Under-two children, determining the coverage of ITN use among community members, as well as assessing the factors (socio-economic, physical, environmental, demographic factors) associated with malaria prevalence in Kawo General Hospital under two year old admissions.


1.3 Purpose of the Study

To specify the factors contributing to the prevalence of malaria in children under two (2) years in Kawo General Hospital.


1.4 Study Objectives

  1. To establish the effects of variation in climatic condition on prevalence of malaria
  2. To describe the prevalence of malaria parasite infections among children under two years
  3. To determine the socio-economic factors associated with the prevalence of malaria among under- twos admitted in Kawo General Hospital.
  4. To determine the coverage of ITN use among the community members

1.5 Research Question.

The study sought to answer the following research questions:

  1. What are the effects of variation in climatic conditions on prevalence of malaria?
  2. What is the prevalence of malaria parasite infections among children under two years in Kawo General Hospital admissions?
  3. What socio-economic factors are associated with the prevalence of malaria among under- twos.
  4. What is the coverage and use of ITN among the community members?

1.6 Test of Hypothesis

  • H0 there is no significant relationship between using ITN and Malaria prevalence in under twos
  • H1 there is significant relationship between using ITN and Malaria prevalence in under twos

1.7 Scope of the Study

The study is aimed at determining the factors contributing to the prevalence of malaria in under twos. The relationship between socioeconomic and environmental factors and their influence on the prevalence of malaria in under two year olds. This study is estimated to take about 8 weeks starting from 1st-March-2022 to 1stMay-2022.


1.8 Justification

Despite the availability of the malaria control measures and intervention, the morbidity and mortality in Under-twos is still unacceptably high. (MoH, 2010). This study is then designed to investigate the changing epidemiological data of malaria. The collected data will provide the understanding on the factors that influence the high prevalence of malaria parasite among the under two year‘s children admitted in Kawo General Hospital.

The information that will be collected will be an essential component in the effectiveness of Malaria control and elimination interventions that are currently being scaled up hence it will be used to realign the effectiveness of Malaria control measures so as to effectively reduce malaria burden and achieve elimination.


1.9 Definition of Terms

Stable Malaria Transmission:

Areas with a stable transmission have a persistent transmission and hence prevalence of infection.

Unstable Malaria Transmission:

In areas with an unstable malaria transmission the prevalence of infection varies highly over time and space.

Holo-Endemic:

Endemic at a high level in a population, affecting most of the children and so affecting the adults in the same population less often Hyper- endemic – an area exhibiting a high and continued incidence—used chiefly of human diseases.

Endemicity:

The quality or state of being endemic.

Epidermic:

Affecting or tending to affect an atypically large number of Individuals within a population, community, or region at the same time. A malaria epidemic is defined as an abrupt increase in Malaria transmission that exceeds by far the inter-seasonal variation normally experienced in a given area and often associated with increased morbidity and mortality.

Haemoglobinuria:

Presence of haemoglobin in urine.


1.10 Limitation of the Study

The study was confronted with logistics and geographical factors.


1.11 Conceptual Frame Work.

The conceptual framework represents a relationship between factors that influence the prevalence of malaria among the under twos admitted in Kawo General Hospital.


1.12 Organization of the Study

The study is organized into five chapters.

  • Chapter one covers; background to the study, statement of the problem, general objective of the study, specific objectives of the study, research hypotheses, significance of the study, limitation of the study, delimitations of the study, operational definition of terms and organization of the study.
  • Chapter two covers review of related literature.
  • Chapter Three covers research methodology which includes: introduction, research design, target population, sampling techniques and sample size, data collection instruments, validity and reliability of research instruments, data collecting procedures, data analysis techniques and ethical considerations.
  • Chapter four covers research results of the study.
  • Chapter five covers discussions and interpretations

Chapter Five


Conclusion and Recommendation

5.1 Introduction

This chapter discusses the findings of the research study on factors affecting the malaria prevalence in children under two years in KIU-TH in the year 2018. The purpose of the research was to analyze social-economic, the demographic as known as human factors, behavioral as well as the environmental factors of malaria prevalence in children under two years. The findings are going to be categorised according to the behavioral determinants, environmental determinants. The recommendations from this study will be discussed as well as the conclusions that were obtained from this study.


5.2 Social-Economic and Human Factors

This study showed that malaria has got important behavioral related drivers in the disease. A higher malaria prevalence is associated with a number of factors that lead to lowered malaria transmission, like increased literacy levels, higher access to malaria health awareness campaigns and health education, as well as being able to afford disease prevention methods and treatment (Imbahale et al., 2010, Ademowo et al., 1995, Tarimo et al., 2000).. The findings from chapter 4 are consistent with literature review as far as malaria prevalence under two is concerned. Both studies show that failure to use ITNS was an important determinant in malaria prevalence and morbidity in KIU-TH in children under 5 in the year 2018. Social-economic, type of place of residence and weather where significant factors in malaria prevalence. These factors and malaria prevalence are strongly correlated. So this finding confirms what other studies have shown. A number of studies that have been carried out have also confirmed that malaria is poverty related (Sachs and Malaney, 2002, Gallup and Sachs, 2001, Teklehaimanot and Paola Mejia, 2008, Malaney et al., 2004). The type of place of residence whether its urban area or rural area as well as region could be linked to the altitude, where some studies (Drakeley et al., 2005a, Hay et al., 2004, Lindsay and Martens, 1998) found an effect on malaria prevalence depending on the altitude. This study also showed that those dwelling in rural areas had a higher risk of contracting malaria as compared to those living in urban areas. This could also be linked to the fact that those living in rural areas are generally of a low economic status compared to their counterparts living in urban areas in one report on malaria and poverty it was shown that poverty results in people living in conditions that promote mosquito breeding (Teklehaimanot and Paola Mejia, 2008). Generally the population of Bushenyi is mainly rural (Luka, 2010) and this also explain the problem of malaria in Bushenyi as it is more common in rural populations as this study showed. Factors contribute to increased transmission in poorer areas with slum conditions. This study showed in that those who dwelt in slum-like conditions were at a higher risk of contracting malaria as compared to those whose dwellings were not classified as slum. Use of insecticide treated bed nets was also an important factor in malaria control with households that had more children sleeping under ITNs having less cases of malaria in the household. This finding is corroborated by other studies (Maxwell et al., 2002, Deressa et al., 2007, Mmbando et al., 2011) that also found that the use of ITNs is important in malaria control. This again links to socialeconomic those households with a higher income are the households that are able to provide ITNs for their children.


5.3 Environmental Determinants

Temperature and rainfall influence malaria endemicity. Altitude is a known factor in influencing temperature and rainfall (Cibulskis et al., 2011, Reiter, 2001). The environmental factors that were analyzed in this study were seasons, rain or wet as well as dry as these environmental factors have been shown to be important drivers of malaria prevalence (Alegana et al., 2013, Weiss et al., 2014, Alegana et al., 2014). TSI, rain and precipitation were generated from longterm annual average temperature, vegetation and precipitation and represent estimates of a year (Noor et al., 2013). These environmental factors that were used in this study were not statistically significant.


5.4: Insecticide Treated Mosquito Nets

5.4.1 Utilization of ITNs Household Members and Under two children

In this study the utilization of ITNS for respondents has shown that majority of them (83percent) were using bed nets when they went to sleep, while only a few (17percent) who were not using bed nets in regular bases during their sleep. This means that there was regular utilization of bed nets in the area of the study although there was minor proportion that were not using especially during the hot season. Also the study found the utilization of ITNS for the children of Under-two years was highly marked of (99 percent) and only one percent (1%) did not use ITNs on the previous night of the study. The higher ITNS utilization have been achieved due to the fact that most of household members were able to access freely ITNS distribution to the community through health facilities and by using community leaders and highly knowledge on ITNs utilization and attitude which leads to the community to change of behaviour. It means that most of the under two children were protected with malaria infection by using ITNs strategy. From these results Bushenyi district has been able to reach the proposed target goal of ITNs utilization set by Roll Back Malaria by reaching more than 75 percent by 2015 and required to sustain this condition and other malaria control measures including IRS, early diagnosis and proper treatment. The mother and caretaker have understood the importance of using ITNs for their children to prevent transmission of malaria.

Low rate of use was primarily due to lack of sufficient nets to cover all household members and what they had were very old and torn out. This also experienced by(Gobena, Berhane, & Worku, 2016) on their study at Kersa, Eastern Ethiopia where it found that among the reasons of low utilization of bed nets include hot weather, social factors, perceived low mosquito density, technical factors such as hanging of ITNs and its adequate availability were the major reasons to non-use of mosquitoes nets owners

High utilization of ITNS could be contributed with ministry of health Malaria Elimination Program for conducting pushing system of distribution of bed nets to the community by using mosquito net distribution team and all health facilities which providing health services in the catchment area of the community. Also, higher health education and promotion on ITNS use which was provided by the program has contributed on raising awareness, acceptability and utilization the bed nets which were distributed to the community.

5.4.2 Knowledge of Respondents on the Use of ITNs

Despite level of education of the respondents, the majority have good knowledge of the use of LLINs in their homes. The respondents were knowledgeable of the importance of using treated bed nets, the time of using it, types of nets and source of information pertaining to LLINs utilization. They mentioned that LLINs strongly prevent them from mosquito’s bites which can lead to malaria illness, most of the respondents explained their concern on proper LLINs utilization make them live free with malaria without gets recurrent sickness or gets disturbance with mosquitoes when they sleep during night.

This was consistent with the study conducted by Rutagwera, (2014) to the women in a household, found that there was significant difference of ITNS utilization between those who had knowledge on the use of ITNS as means for protection against malaria and those who had no knowledge. It was shown that most of those women who know that ITNS protect against malaria they are more likely to sleep under bed nets with their children of under two years compared to those who not know they are less on utilization.

5.4.3 Attitude of Respondents on the Use of ITNs

In this study majority of respondents have positive attitude on the use of LLINs as they believe that ITNS have the ability to kill mosquitoes when they are correct utilized as directed, also it prevents them from mosquito bites and malaria transmission, while some of them explained that by using ITNs make them sleep comfortable in the night.
Despite of ITNs for prevention against malaria, it also kills other nuisance insects in the household. Similar findings were observed by Terefe, Samuel, & Fiseha, (2013), in the study conducted in Nairobi hospital showed that more than half of pregnant women had positive attitude toward ITNs utilization for prevention against severity of malaria for pregnant mothers as well as under two children

This study contradicts with the one done in Tanzania where the attitude of respondents showed that there was a negative attitude of the study respondents towards the use of ITNs. The study participants perceived that young children were the most susceptible to the insecticide poisoning they believe that ITNs were most powerful to kill mosquitoes within six months continuously, even ticks cannot survive if they land on it, so they are feared that if their children touch it they will die too, they also believe that its poison could even harm the unborn baby if pregnant mothers inhales it during asleep (Nnko et al., 2012).

Other study from Ghana also found a negative attitude on the perception of ITNs where parents considered using bed nets was difficult because sleeping under them can be hot and uncomfortable or they believed that bed nets resemble as a burial shroud. In a study conducted at Southern Ethiopia by Dagne, and Deressa, (2016), found that ineffective ITNs utilization for under two years children was affected by the unavailability of bedrooms in some of family members, inadequate number of ITNs according to household members and less perception of ITNs a preventive measure for malaria control. It was found that about 13.2 percent of the household were supplied with free ITNs but did not own these bed nets at the time the survey and about 42 percent of the children of under two years were not sleeping under ITNs during previous night of the study and it was found that many of community members do not understand the importance of ITNs utilization.


5.5 Recommendations

The following recommendations arise from the findings of this study. These are:

ITNs are also an important tool in malaria control and must be made available to the population in need. Funding must be made available in order to provide the required ITNs and programs must prioritise their availability and need to have in place a budget to adequately supply ITNs to the population There must be programs to empower the communities so that they improve their Social-economic and this in turn helps to reduce prevalence of malaria It is important that care-givers especially mothers have access to information on malaria and how to identify signs and symptoms so that suspicious cases can be quickly identified and appropriate action is taken in order for the children to get the treatment that they need


5.6 Conclusions

It is important to understand the determinants of malaria so that effective monitoring and evaluation of malaria can be carried out. This study showed the importance of socioeconomic status as well as education in the fight against malaria. In order for malaria to be eliminated in the population it is important for the government to empower the population economically and also ensure that health education is a part of the efforts that are put in place to fight malaria. This will assist in the fight to eliminate malaria. It is important to ensure that resources are channeled in order to optimize prevention strategies that are put in place. Once the population is empowered, then preventative strategies for malaria elimination can then be implemented successfully and if the population is educated, then it is able to understand better the strategies in place and implement them successfully. The government must be economically sound in order to effectively implement the malaria control strategies so resources must be in place to implement malaria control strategies as well as sustaining them. The other important determinates also are linked to socio-economic status, therefore reduction of poverty will go a long way in the fight to eliminate malaria. More work needs to be done on the identification of hotspots and identifying the determinants in specific populations. This will help in ensuring that the interventions are not generic but specific for a given population.


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