Prevention of Malaria
CHAPTER ONE
Study objectives
- To determine knowledge and practices on malaria prevention at households
- To implement an intervention on the integrated approach to malaria prevention in the community
- To evaluate the impact and experiences of using integrated malaria prevention in the community
- To assess community perceptions, utilisation and barriers to integrated malaria prevention in the community.
CHAPTER TWO
LITERATURE REVIEW
Malaria parasites and vectors
Malaria is caused by protozoa of the genus Plasmodium found in the blood of mammals, birds and reptiles. Although there are over 120 species of Plasmodium, the ones which infect humans are P. falciparum, P. vivax, P. malariae, P. ovale and to a lesser extent P. knowlesi (Beanland, 2006). P. falciparum is found worldwide and predominates in Africa where it causes more than 1 million deaths every year (CDC, 2012a). P. vivax, mainly found in Asia, Latin America and some parts of Africa, is considered the most prevalent human malaria parasite because of its high densities in Asia (Feng et al., 2015). P. ovale, which is morphologically similar to p. vivax, is mainly found in West Africa, and is more prevalent than p. vivax in Africa (Kang & Young, 2013). P. malariae is found worldwide and is the only species known to cause fevers that recur at three-day intervals, the other malarial parasites doing so at two-day intervals (CDC, 2012a). P. knowlesi is mainly found in South East Asia and accounts for over 70% of malaria cases in that region (McCutchan et al., 2008).
The life cycle of malaria parasites requires a definitive host (Anopheles mosquito) where sexual reproduction occurs, and an intermediate host (mammals such as humans) in which asexual reproduction takes place. Malaria parasites are transmitted by mosquitoes, and in humans exclusively by female Anopheles. Although there are more than 60 species of Anopheles mosquitoes that transmit malaria globally, it is rare to find more than four species in a particular region (Malaria Consortium, 2007). In sub-Saharan Africa, the species of mosquitoes mainly responsible for transmitting malaria are A. gambiae and A. funestus (Coetzee et al., 2000; Sinka et al., 2012). Although some Anopheles mosquito species such as A. stephensi are zoophilic (feed on animals) (Omrai et al., 2010), A. gambiae and A. funestus are predominantly anthropophilic (feed on humans) making them the most efficient malaria vectors globally (CDC, 2012b).
Global malaria burden
Although malaria occurs in all the six regions of the World Health Organization (WHO), the greatest burden is in the African region, with East Africa having over 10 confirmed malaria cases per 1,000 population (Figure 2.2). Malaria causes more death than any other disease in subSaharan African, with children under five years of age most affected (López et al., 2014). There are 47 countries that constitute WHO African region, with the most affected by malaria being: Nigeria, Democratic Republic of the Congo, Ghana, Mozambique, Burkina Faso, Ghana, Mali, Guinea, Niger, Malawi, Côte d’Ivoire, Cameroon, Ethiopia, Kenya, United Republic of Tanzania, Benin, Togo and Sierra Leone. The other WHO regions are South-East Asia (11 countries), Eastern Mediterranean (21 countries), Western Pacific (27 countries), European (53 countries) and the Americas (35 countries) (WHO, 2015a). Although WHO African region is estimated to account for 82% of malaria cases, WHO South-East Asia region accounts for 15%, and WHO Eastern Mediterranean region 5% (WHO, 2014).
CHAPTER THREE
METHODOLOGY
Research Design
Research design refers to the method or the techniques used in collecting data, as well as presenting and analyzing the data. It is an outline or a scheme that serves as a useful guide to the researcher in his effort to generate data for the study.
Depending on the nature of the problem in view, different types of research methods are available, these methods include historical research, descriptive research, developmental research, case study analysis and experimental research.
It is important to point out that this research made use of historical research and descriptive research. Historical research tends to interpret past trends of event and fact. Historical research is concerned with being able to understand and explain the present and predict the future through an evaluation of available records of past event (Austin and Ogwo, 1990).
CHAPTER FOUR
STUDY RESULTS AND DISCUSSION
Knowledge on malaria transmission and prevention
The majority of participants (89.6%; 337/376) were aware of malaria being transmitted through mosquito bites. However, other transmission routes of the disease given were cold / changing weather (11.7%; 44/376), drinking unboiled water (10.1%; 39/376), and eating maize (6.9%; 26/376). Over half of the participants (56.1%; 211/376) had heard or seen messages about malaria in the previous twelve months. The main source of malaria information was radio (70.6%; 149/211) while others were health facilities (9.5%; 20/211), community leaders (5.2%; 11/211), and television (4.3%; 9/211).
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
Besides mosquito nets, knowledge and practices on other malaria prevention methods was low in study. Use of IRS, another core malaria prevention strategy, was also low in the baseline. Therefore, there is still need to increase coverage and utilisation of IRS and ITNs as the current major malaria prevention methods in Ghana. Popularity of mosquito nets was due to their being the most promoted malaria prevention method in Ghana, with less emphasis on other practices in the integrated approach. There is potential to improve practices on malaria prevention in endemic communities by targeting other methods beyond ITNs, such as installing screening in windows and ventilators. Therefore, the integrated approach to malaria prevention, which advocates the use of several methods in a holistic manner, should be further explored to improve practices on malaria prevention in Ghana.
Recommendations
- Stakeholders involved in malaria control especially the Ministry of Health should intensify efforts of promoting other prevention methods in addition of ITNs and IRS. Behaviour change communication campaigns targeting multiple methods are recommended to improve knowledge and practices on malaria prevention.
Projects to promote the use of integrated malaria prevention should be scaled up by researchers and other partners such as non-governmental organisations so as to benefit other areas since the intervention implemented in this research had positive outcomes to households and the community.
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