Prevalence Of Malaria Among Pregnant Women Attending Antenatal Care

Project and Seminar Material for Nursing (Science)

Prevalence Of Malaria Among Pregnant Women Attending Antenatal Care (Charles)

Abstract

This study was carried out to examine the prevalence of malaria among pregnant women attending antenatal care using selected pregnant women in PHC in Owerri city as a case study.The study was carried out tofind out the prevalence of malaria among pregnant women, assess the prevalence of malaria according to the occupation of pregnant women attending antenatal care, assess the prevalence of malaria according to the educational background of pregnant women attending antenatal care and assess the factors contributing the prevalence of malaria among pregnant women attending antenatal care. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of all the pregnant women in the selected PHC in Owerri city.In determining the sample size, the researcher conveniently selected 41 respondents and 35 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables and mean scores. While the hypotheses were tested using chi-square statistical tool.The result of the findings reveals that the prevalence of malaria among pregnant women is high.The study also revealed that the factors contributing the prevalence of malaria among pregnant women attending antenatal care includes: being illiterate, first trimester, primigravidae, living far from health centers, not sleeping under long lasting insecticide treated nets and living near irrigation areas were factors that increased the prevalence of malaria.Therefore, it is recommended that early antenatal bookingfor effective monitoring and prompt treatment of malaria in pregnancy should be encourage. And it is of necessity that routine intermittent preventive treatment of malaria is recommended for pregnant women. To mention but a few.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

Malaria is a mosquito-borne disease affecting human and other animals caused by parasitic single – called microorganism belonging to the plasmodium group (WHO, 2014). Malaria causes symptoms thattypically include fever, malaise, vomiting, and headache. In severe cases it cause jaundice, seizures, coma or death (Caraballo, 2014). Symptoms usually begin ten to fifteen days after being bitten by infected mosquito.

If not properly treated, people may have recurrences of the disease month later (WHO, 2014) in those who have infected, re-infection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria (Caraballo, 2014).

The disease is most commonly transmitted by an infected by an infected female anopheles mosquito. The mosquito bite introduces the parasites from the mosquito saliva in to a person blood. The parasite travel to liver where they mature and produce. Five species of plasmodium can infect and be spread by humans. Most deaths are caused by P. falciparum because P. vivax, P. ovale, and P. malariae generally cause a milder form of malaria. The species P. knowlesi rarely causes disease in humans. Malaria is typically diagnose by the microscopic examination of blood using blood films, or with antigen –based rapid diagnosis tests. Methods that use the polymerase chain reaction to detect the parasites DNA have been developed, but are not widely used in areas where malaria is common due to their cost and complexity (Nadjim,2012). Therefore the distribution of malaria in Africa may be classified broadly into four epidemiological areas the hypo, meso, halo and hyper-endemic areas. The epidemiological location is made by several factors including the ecosystem, climate, and state of the environment, human behavior, vectors and parasite bionomics (WHO,2005). Malaria is ubiquitous in the tropical regions of the world. It is found in central America, the Island Hispaniola in the Caribbean, the Amazon region of south America, throughout most of sub Saharan Africa, part of the Arabian peninsula, the near east, and in parts of the South Pacific. Many of these same regions also share heavy HIV/AIDS and TB burdens (NMIS, 2010).Malaria is endemic throughout most of the tropics, approximately 3.4 million people worldwidewho are exposed annually,1.2 billion are at high risk. The world health organization (WHO) state that more than 207millions developed symptomatic malaria in 2012. An estimated 655000 persons died of malaria in 2010 out of which eighty six percent of the victims were children under 5 years of age and about 91% of malaria related death occurred in the WHO African region and approximately 300-500 million cases a year. Nigeria, the Democratic of Congo, Burkina Faso, Mozambique, Cote d’Ivore and Mali –account for 60%or 390,000,of malaria death globally (WHO, 2010).

Malaria is transmitted through out Nigeria. Five ecological zones define the intensity and seasonality of transmission and the mosquito vector species: mangrove swamps; rain forest; guinea-savannah; Sudan savannah; and Sahel –savannah. The duration of the transmission sea son decreases from year round transmission in the south to three months or less in the north. Malaria accounts for 60%of outpatient visit and 30% of hospitalizations among children under five years of age. It is also responsible for estimated 300,000 deaths in children under five years of age each year and contributes to an estimated 11% of maternal mortality (WHO 2010).

Malaria poses a significant public health challenge with a high global burden. However, large regional disparities exist in the burden of malaria (WHO, 2015). SubSaharan Africa alone accounted for 90% of the malaria cases and 92% of malaria death worldwide (WHO 2016). The number of malaria cases declined by 42% while the malaria death rate declined by 66% in the African region. Nigeria and republic of Congo are two major countries contributing to the high malaria burden, as 36% of the malaria cases worldwide occurred in these two countries (WHO, 2016) poverty and geography play significant roles in the prevalence of malaria in the countries.

The mosquito species found in Africa have a long lifespan and prefer to bite human; a significant factor for the high prevalence of malaria in Africa furthermore, climatic conditions like rainfall, temperature and humidity affect the survival of mosquitoes, thus increasing the transmission rates of malaria (Yan, G. 2002) Malaria infection during pregnancy poses substantial risk to the mother, her fetus, and the neonate. The prevalence of parasitemia appears greatest in the second trimester, and susceptibility of clinical malaria may persist into the early postpartum period. Due to the endemicity and high transmission rate of malaria in Nigeria, pregnant women have acquired immunity being resident in stable malaria area and are susceptible to subclinical infections, which may result in adverse effects to both mother and child. It significantly contributes to anaemia in pregnancy; increases the occurrence of low birth weight; is associated with pre-term deliveries, still births and prenatal mortality. It has been established that pregnancy quadruples a woman’s risk of malaria illness and doubles her risk of death (WHO, 2016). Preventing severe anaemia caused by malaria will lead to fewer pregnant women requiring blood transfusion thereby reducing the risk of transfusion-related infection especially HIV and hepatitis B. The adequate control of malaria in pregnancy should lead to better outcome of pregnancy, improve survival of mothers and reduces prenatal mortality.

This large burden has led to the development and setting of several strategies and target aimed at malaria control, and where possible its elimination. The global strategy for malaria, 2016 to 2030 targets at 90% reduction in the incidence and mortality rates of malaria, as well as an elimination of malaria in 35 of its endemic countries by 2030 one of SDG target indicators it to end the epidemics of AIDS, tuberculosis, malaria and other neglected tropical disease by 2030 ( WHO ,2016). Nigeria is currently a malariaendemic country with its entire population (186 million) at risk of contracting malaria (WHO. 2015), and a whopping 76% of this population at high risk. In 2015, Nigeria contributes about 29% of malaria cases and 26% of the malaria deaths worldwide (WHO, 2016). These larges figures imply that Nigeria success in tacking malaria control will play a large part in the actualization of the global goals. Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions through the world (NMSP, 2013).Thirty million African women in malaria endemic area become pregnant and are at risk of infection with Plasmodium falciparum (NMSP 2013) (FMOH 2005). An estimated ten thousand of these women and two hundred of their infant die as a result of malaria infections during pregnancy and severe malarial anaemia contribute to more than half of these deaths (RNM, 2008). Malaria infection in pregnancy is major risk for maternal and child health (WHO 2015) it increase the risk of miscarriage, stillbirth and low birth weight about 200000 neonatal death occur annually (WHO 2015).

Malaria in pregnancy account to 5 to 12% of all low-weight birth (Steketee et al, 1996). In low risk zones, episodes of severe malaria significantly associated with still births, spontaneous abortion, premature delivery and maternal death (WHO 2007). Intermittent preventive treatment in pregnancy (IPTP) is one of the key interventions recommended by WHO to bolster the prevention of asymptomatic infections among pregnant women living in moderate to high risk region (WHO, 2007). In 2012, thirty six sub-Saharan African countries had endorsed intermittent preventive therapy in pregnancy (IPTP)as part of antenatal care but coverage of IPTP has remained a challenge, with few women receiving adequate IPTP doses each of four recommended antenatal care visit.
Among the African countries which provided this information, sixty for percent of pregnant women attending antenatal care had received at least one dose intermittent preventive treatment during pregnancy in 2012 .Only 23% of them had received three doses (WHO, 2003).Malaria in pregnancy (MiP) contributes to maternal and neonatal mortality .

1.2 Statement of the Problem

Malaria infection during pregnancy causes an enormous risk to the mother, fetus, and neonates [12]. Indeed although malaria during pregnancy might be asymptomatic due to a high level of acquired immunity in mothers residing in high transmission areas, it is still associated with an increased risk of maternal anemia, spontaneous abortion, stillbirth, prematurity, and low birth weight (Steketee 2001, BJ B.1983).

Moreover, severe maternal anemia increases the mother’s risk of death. Malaria-related anemia is estimated to cause as many as 10,000 maternal deaths each year in Africa [WHO. 2004].

Different risk factors for malaria among pregnant women were identified by previous studies. These include educational status (Fana SA, Bunza MD, Anka SA, 2015), age [äckle MJ(2013)], ANC visit, gestational age [Mario J Jäckle 2013], parity gravidity, and ITN utilization [Nega D, 2015]. Hence this study seeks to examine the prevalence of malaria among pregnant women attending antenatal care.

1.3 Objectives of the Study

The major of this study is to critically assess the prevalence of malaria among pregnant women attending antenatal care. By extension, this study will specifically;

Find out the prevalence of malaria among pregnant women.
Assess the prevalence of malaria according to the occupation of pregnant women attending antenatal care.
Assess the prevalence of malaria according to the educational background of pregnant women attending antenatal care.
Assess the factors contributing the prevalence of malaria among pregnant women attending antenatal care.

1.4 Research Question

The study will be guided by the following questions;

What is the prevalence of malaria among pregnant women?
What is the prevalence of malaria according to the occupation of pregnant women attending antenatal care?
What is the prevalence of malaria according to the educational background of pregnant women attending antenatal care?
What are the factors contributing the prevalence of malaria among pregnant women attending antenatal care?

Being illiterate, first trimester, primigravidae, living far from health centers, not sleeping under long lasting insecticide treated nets and living near irrigation areas were factors that increased the prevalence of malaria

1.5 Research Hypotheses

Ho: Malaria is not common among pregnant women attending antenatal care.
Ha: Malaria is common among pregnant women attending antenatal care.

1.6 Significance of the Study

This study will be helpful especially to pregnant woman as it would be an addition to the issue of malaria and its effects on pregnant women. Furthermore, the health counselor may acquire sufficient factual information’s in establishing meaningful information with pregnant women clients and the community in order to reduce malaria among pregnant women. This study will be useful to academic reseachers who will be conducting a research on this similar topic.

1.7 Scope of the Study

This study is to critically assess the prevalence of malaria among pregnant women attending antenatal care.The study specifically seeks to find out the prevalence of malaria among pregnant women, assess the prevalence of malaria according to the occupation of pregnant women attending antenatal care, assess the prevalence of malaria according to the educational background of pregnant women attending antenatal care and assess the factors contributing the prevalence of malaria among pregnant women attending antenatal care.

1.8. Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.9 Definition of Terms

Malaria:

Malaria is caused by infection with a microscopic parasite and is transmitted to humans by the bite of certain sorts of mosquito called anophelines.

Antenatal Care:

Antenatal care is the care you get from health professionals during your pregnancy. It’s sometimes called pregnancy care or maternity care.

1.10 Organization of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the prevalence of malaria among pregnant women attending antenatal care using selected pregnant women in PHC in Owerri city as a case study. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was to examine the prevalence of malaria among pregnant women attending antenatal care using selected pregnant women in PHC in Owerri city as a case study.The study was specifically carried out to find out the prevalence of malaria among pregnant women, assess the prevalence of malaria according to the occupation of pregnant women attending antenatal care, assess the prevalence of malaria according to the educational background of pregnant women attending antenatal care and assess the factors contributing the prevalence of malaria among pregnant women attending antenatal care.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 35 responses were validated from the enrolled participants where all respondent wereall the pregnant women in the selected PHC in Owerri city.

5.3 Conclusions

Based on the findings of this study, the researcher concluded that;

The prevalence of malaria among pregnant women is high.
The prevalence of malaria according to the occupation of pregnant women attending antenatal care is high.
The prevalence of malaria according to the educational background of pregnant women attending antenatal care is high.
The factors contributing the prevalence of malaria among pregnant women attending antenatal care includes: being illiterate, first trimester, primigravidae, living far from health centers, not sleeping under long lasting insecticide treated nets and living near irrigation areas were factors that increased the prevalence of malaria.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

Early antenatal bookingfor effective monitoring and prompt treatment of malaria in pregnancy should be encourage. And it is of necessity that routine intermittent preventive treatment of malaria is recommended for pregnant women.
Government should formulate policies regarding to regular environmental sanitation to dislodge mosquitoes from their breeding places, this will go a long way to reduce prevalence of malaria in pregnant women especialu those living in the tropics.
Maternal and child health services should be given utmost support at every level for the prevention and control of malaria in pregnant women.