Prevention And Control Of Malaria Among Pregnant Mothers Attending Hospitals And Clinics In Ahiazu Mbaise

Project and Seminar Material for Nursing (Science)

Prevention And Control Of Malaria Among Pregnant Mothers Attending Hospitals And Clinics In Ahiazu Mbaise

Abstract

Malaria in pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality. Malaria accounts for about 11% of all maternal deaths in Nigeria, and indirectly contributes to additional 11% of maternal deaths mainly by being a leading cause of anaemia in pregnancy.Prevention tools such as use of insecticide-treated nets (ITNs) and intermittent preventive treatment in pregnancy (IPTp) with Sulphadoxine-pyrimethamine (SP) has been shown to be effective in preventing malaria in pregnancy. This study was carried out to assess the use of malaria preventive measures by pregnant women. It was a descriptive cross-sectional study involving pregnant women at two ante-natal clinics.

A total of 330 pregnant women were recruited for this study by systematic random sampling. Data was collected using well structured close-ended questionnaires used to elicit information on socio-demographic characteristics, knowledge of malaria disease, ownership of insecticide treated nets (ITN), and ITN use in pregnancy, as well as the knowledge and uptake of intermittent preventive treatment in pregnancy (IPTp) and barriers to the use of these malaria preventive measures in pregnancy.

At the end of the study, it was observed that Majority 94.5 % of the women were aware of the mode of malaria transmission. A very high knowledge of malaria preventive measures like insecticide treated nets (ITNs) and the intermittent preventive therapy in pregnancy (IPTp) was also observed in this study. A total of 65.5% of the respondents possess insecticide treated nets (ITNs). About 83.6% of the respondents use insecticide treated nets (ITNs) , while 63.7% of the respondents have received intermittent preventive therapy in pregnancy (IPTp).There was no significant association between parity and use of ITNs and parity and uptake of intermittent preventive treatment in pregnancy (IPTp)

The use of these preventive measures use was still found to be poor.Non-availability, cost, erroneous belief and late booking for antennal care were also found to be affecting the use of these malaria preventive measures in pregnancy.

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 Significance of the Study
  • 1.6 Scope of the Study
  • 1.7 Limitation of the Study
  • 1.8 Definition of Terms
  • 1.9 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

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 an infections disease caused by a parasite, plasmodium which infects red blood cells. Historical records suggest that malaria has infected human since the beginning of mankind. The name “malaria” (Meaning bad air in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to malaria in 20th century. Laveran; in 1880 was the first to identify parasites in human blood. In 1889, Ross discovered that mosquitoes transmit malaria.

Malaria in pregnancy is a serious public health issue which affects the mother, the fetus and the neonate. Malaria infection is caused by five different species of malaria parasite which include; Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowles (Quartey, 2016). These parasites are mainly transmitted through the bite of an infected female anopheles mosquito. Women are more susceptible to malaria infection with its deleterious effects during pregnancy, with Plasmodium falciparum been the most common species for malaria infection during pregnancy in sub-Sahara Africa accounting for 99% death globally (WHO, 2017). An estimate shows that 125 million pregnancies were at risk of malaria infection annually with 32 million pregnancies in malaria-endemic sub-Sahara Africa (Moya-Alvarez, Abellana, & Cot, 2014). In 2016, there was an estimated 216 million cases of malaria, a 5 million increase over the 2015 figures. Sub-Saharan Africa carries the heaviest burden of malaria with 91% recorded death (WHO, 2017).

Adverse effects of malaria infection include maternal anemia, low birth weight (LBW), stillbirth, especially in areas of high levels of immunity where pregnant women present asymptomatic infection (Moya-Alvarez et al., 2014). In Ghana, the major cause of malaria morbidity is Plasmodium falciparum where malaria transmissions are stable year-round with seasonal variations within the ecological zones in the country. In areas of low malaria transmission where acquired immunity is low, pregnant women are prone to episodes of severe malaria infection leading to negative health outcomes. It is estimated that 5-12% of all low birth weight (LBW) are due to malaria in pregnancy (Menendez, 2006). Malaria continues to be one of the preventable causes of LBW in dense transmission areas of sub-Sahara Africa (Eijk et al., 2012). In Ghana, 10.1 million people were infected with malaria in 2015 and the country recorded 2,133 malaria-associated deaths in 2015 (NMCP, 2015). In 2017, Ghana recorded 33.4% of OPD confirmed malaria in pregnancy cases (Ghana Health Service, 2018). Malaria constitutes 31.1% of causes of outpatient morbidity in 2016 in Ghana. The case fatality rate of malaria in the Greater Accra Region stood at 0.26 for all ages in 2016 (NMCP, 2017).

In order to protect the pregnant woman and her fetus from the devastating consequences of malaria infection during pregnancy, a number of available preventive measures have been outlined by WHO. These intervention programs in Ghana include vector control, chemoprophylaxis and case management (WHO, 2017). Vector control will help reduce and prevent malaria infection. Additionally, chemoprophylaxis drugs can be used to prevent malaria infection among pregnant women living in dense transmission areas where malaria is endemic (WHO, 2017). WHO recommends intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-sp) with each antenatal care (ANC) visit after the first trimester which can prevent maternal death and anemia and other negative effects of malaria (WHO, 2017). Pregnant women attending ANC clinics begins IPTp-sp at sixteen weeks through a monthly interval under Direct Observed Therapy (DOT) at a Focus ANC Clinic (Dapaa, 2017).

An indoor residual spray is another important preventive measure to rapidly reduce the incidence of malaria in endemic areas of Ghana. Indoor residual spray (IRS) involves the spraying of indoor walls and ceilings where malaria-carrying mosquitoes hide after biting individuals and households. Indoor residual spray (IRS) is effective for 3-6 months, relying on the insecticide formulation (WHO, 2017). It is estimated that in 2015, 106 million people were protected by IRS (WHO, 2017).

Achievement for the malaria preventive measures affecting pregnant women since the introduction of the Roll Back Malaria Partnership (RBM) has remained elusive for most sub-Saharan Africa. A report in 2015 for 20 countries with information on IPTp-sp and ITN together with case management have the lowest coverage among ANC participants (Hill et al., 2013). Ghana has adopted a management plan to reduce the burden of malaria in 2020 by 75%. This goal calls for greater involvement of all stakeholders and requires multi-disciplinary research if the goal of total eradication of malaria is to be attained in 2030 (Awine, 2017).

1.2 Statement of the Problem

Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world and Nigeria in Particular. The burden of malaria infection during pregnancy is caused mainly by Plasmodium falciparum, the most common malaria species in Africa (WHO, 2010). 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, 2007). Malaria during pregnancy compounds or provokes anaemia, which, when severe, increases the risk of maternal death (estimated at around 10,000 deaths annually), low birth weight (linked to around 100,000 annual infant deaths in Africa), pre-term delivery, congenital infection and reproductive loss of overwhelming morbidity and mortality (Fakeye, 2009). There have been a considerable number of reports about poor knowledge, attitudes, and practices among pregnant women relating to malaria and its control from different parts of Africa. The disease remains the world’s most important tropical health challenge. Access to medical care is limited in many malaria-endemic areas and where medical services exist, they commonly lack facilities for laboratory diagnosis, and treatment option. Thus this research work is made to find out the rate at which malaria affect pregnant women and their unborn children.

1.3 Objectives of the Study

The broad objective of this study is to examine the prevention and control of malaria among pregnant mothers attending hospitals and clinics in Ahiazu Mbaise. Specifically the study seeks:

  1. To examine the rate at which malaria is prevalent among pregnant mothers attending hospitals and clinics in ahiazu mbaise.
  2. To find out the rate at which malaria affect pregnant mothers attending hospitals and clinics in ahiazu mbaise.
  3. To ascertain the symptoms of malaria present in pregnant mothers attending hospitals and clinics in ahiazu mbaise.
  4. 4. To ascertain the intensity of malaria effect on pregnant mothers attending hospitals and clinics in ahiazu mbaise.
  5. 5. To determine the complication associated with malaria in Pregnant Women.

1.4 Research Question

  1. What is the rate at which malaria is prevalent among pregnant mothers attending hospitals and clinics in ahiazu mbaise?
  2. What is the rate at which malaria affect pregnant mothers attending hospitals and clinics in ahiazu mbaise?
  3. What are the symptoms of malaria present in pregnant mothers attending hospitals and clinics in ahiazu mbaise?
  4. What is the intensity level of malaria effect on pregnant mothers attending hospitals and clinics in ahiazu mbaise?
  5. What are the complication associated with malaria in pregnant mothers attending hospitals and clinics in ahiazu mbaise?

1.5 Significance of the Study

The findings from this study would be useful to the following; pregnant women, ministries of health, parastatals, health sectors, policy makers Health practitioners would benefit from this study; as it would help them in caring adequately and planning well for pregnant women attending antenatal clinic when treating them for malaria. This study would be of great importance to ministries of health by informing them on the importance of this study is to address the issue concerning the attitude towards the use of traditional herbal medicine for the treatment of malaria among pregnant women attending antenatal care and to organize enlightenment programmes aimed at enhancing the attitudes of pregnant women towards frequent antenatal clinics. This study will help policy makers to formulate relevant policies on malaria prevention while making informed decisions on the steps to follow in increasing antenatal care attendance levels among pregnant women attending Teaching Hospital in Imo State This study would be useful to government and parastatals by educating them on the need to provide concerted health education intervention to improve the attitude and knowledge of pregnant women regarding poor health seeking behavior and adequate strategies for malaria prevention especially with the use of insecticide, treated Net, adequate funding, etc. necessary for controlling and reducing incidence of malaria in the general public.

1.6 Scope of the Study

The broad objective of this study is to examine the prevention and control of malaria among pregnant mothers attending hospitals and clinics in Ahiazu Mbaise. The study will also ascertain the symptoms of malaria present in pregnant women admitted to specialist hospitals. It will ascertain the intensity of malaria effect on pregnant women and their unborn children admitted to Specialist Hospitals.It will determine the complication associated with malaria in Pregnant Women.

1.7 Limitation of the Study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint was the scanty literature on the subject owing to the nature of the discourse thus the researcher incurred more financial expenses and much time was required 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. Additionally, the researcher will simultaneously engage in this study with other academic work. More so, the choice of the sample size was limited as few respondent of Pregnant Women were selected to answer the research instrument hence cannot be generalize to other hospitals. However, despite the constraint encountered during the research, all factors were downplayed in other to give the best and make the research successful.

1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.

The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.

Chapter Five

Summary, Conclusion and Recommendation

5.1 Summary of the Study

The study interviewed 270 pregnant women who attended the antenatal clinic during the study period. The overall prevalence was 11.1% among the respondents. This prevalence of malaria infection was lower and consistent with other studies found in sub-Saharan Africa where malaria is endemic and having high intense malaria infections and transmissions (Balami et al., 2018). A lower prevalence of malaria of 5% was reported in similar research conducted in Madina, Accra Ghana (Stephens et al., 2014). Another study found 10.9% in Luanda, Angola,(Cisse et al., 2014). However, other studies have shown the higher burden of malaria infection. In Nigeria, a higher prevalence of malaria was found among pregnant women 48.1%. In Gabon, the burden of malaria was 34.4% (Balami et al., 2018). The prevalence of malaria infection in this study could be attributed to the use of RDT which has low sensitivity compared to a polymerase chain reaction (PCR). One of the most widely used methods of malaria diagnosis is microscopy, which has the advantage of determining parasite density and species. Another factor that led to the low prevalence was the fact that 78.2% of the respondents have enough information about malaria infection and its prevention. A review of the prevalence of malaria infection during pregnancy in West Africa was 35.1% (95% CI: 28.2-41.9) done with microscopy which may be lower when PCR was used (Takem & Alessandro, 2013). However, recent trends have shown that pregnant women who suffer malaria infection are decreasing in sub-Sahara Africa. Another plausible factor for the lower prevalence in this study could be explained by an association between education at the SHS/Vocational level and malaria infection. The odds of malaria infection was lower with higher education and this was statistically significant.

Educational level with respect to SHS/ Vocational had a statistical association with malaria infection in this study. Overall, participants who attained a higher level of education had lower odds of malaria infection compared to those with no education. This may be as a result that pregnant women who were educated may easily comprehend malaria information and thereby able to adopt and implement preventive methods of malaria control. This finding is also consistent with other studies in Uganda, Cameroun, and Nigeria, where it was found that knowledge and educational level were significantly associated with malaria infection. Participants who had a college education were 2.3 times more likely to be knowledgeable than those who had no education (Goshu & Yitayew, 2019). Another study found an association between educational level and IPT-sp utilization. Educated pregnant women were more likely to understand the effects of malaria in pregnancy and were more likely to receive the maximum doses of IPT-sp (Ibrahim1 et al., 2017). However, another study conducted in Lagos Nigeria revealed that educational level did not have a significant association with infection. This may be due to massive health campaigns on a regular basis on both print, TV and radio (Chimere et al.,2013). A similar study found no association between educational level and malaria infection at Ridge Hospital, Accra Ghana, where pregnant women received health information on malaria during the antenatal visit. This has bridged the gap between educated pregnant women and women with no education as regards malaria prevention (Kiptoo, 2016).

In our current study, there was no significant association between gravidity and malaria infection under the adjusted model. However, women with multigravidae have lower chance of having malaria of 8.40% compared to primigravidae 19.48%. This is as a result of acquisition of immunity to malaria infection. In Burkina Faso, a study conducted revealed that primigravidae have increased risk of malaria infection compared to multigravidae. Similar findings were found in India which revealed a four times more increased risk of infection among pregnant women with their first and second pregnancies compared to those with their third pregnancies or more (OR=4.23; 95% CI: 2.15-8.42), (Balami et al., 2018). Other studies have confirmed this trend, where multigravidae women were less likely to have malaria infection compared to primigravidae (Clerk et al., 2009). Most studies have not adjusted parity for other covariates such as age for the simple fact that pregnancy is related to a reduction in immunity. In Mali, the number of pregnancies was statistically significant with the prevalence of malaria only in the unadjusted model. This finding is consistent with this study (Cisse et al., 2014).

A study done to determine ITN used during pregnancy and birth prematurity in Kenya, pregnant women who used ITN delivered 25% fewer premature babies than those who did not use ITN (Hile et al., 2013). Similarly, a study done at Korle-Bu Teaching hospital revealed low usage of ITN among pregnant women as low as 6.3% (Wilson et al., 2011) This may be partly due to the cost of ITN and lack of access (Wilson et al., 2011). Other barriers may include poor ventilation, size of ITN and husbands lack of encouragement and acceptability.

To reduce and prevent a malaria infection, the World health organization (WHO) recommends the use of three doses of IPT-sp. Findings in this study showed low coverage of IPT-sp among study participants. The study recorded 50.74% IPT-sp coverage which is even higher compared to the national average of 39% as reported by the Ghana Demographic and Health Survey in 2014 (Ibrahim1 et al., 2017). The utilization of IPT-sp in this study was lower than the 80% recommended by WHO and this is consistent with other studies in sub-Saharan Africa (Ao et al., 2017). There was no statistical association between IPT-sp and infection in this study. The finding in this study is analogous with other studies in sub-Saharan Africa. The study showed that 89.1% of participants who received IPT-sp were negative for malaria infection. Another study in Ghana has shown that IPT-sp had a statistically significant association with malaria infection where 15% of IPT-sp users were positive for malaria infection. This figure is much higher than the current study of 10.95%. The low coverage of IPT-sp is consistent with other studies in Ghana, and the reason may be related to late enrollment at ANC, and inadequate prenatal services in the communities. Since IPT-sp could reduce malaria infection, focused antenatal care services must be scaled up.

5.2 Conclusion

Overall, the study found that the prevalence of malaria infection was low with 11.1%. This low prevalence could be attributed to the lack of association. It could also be due to the scaling-up of malaria interventions that has seen the level of knowledge, the use of ITN and IPT-sp increase tremendously in Ghana. These effective interventions have had a positive impact on malaria infection among pregnant women given that women had repeated contact with ANC until delivery.

5.3 Recommendation

This study underscored the need to scale up health promotion among pregnant women. It is therefore recommended that healthcare providers especially midwives should encourage women in their fertility age to seek early ANC service when they are pregnant. The district health directorate should continue to implement the World Health Organization (WHO) recommendations for malaria control.

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