Causes, Effects, and Preventive Measures Against Malaria Parasite Among Children Under 5 Years
Chapter One
RESEARCH OBJECTIVES
- Determine mothers’ knowledge regarding malaria in children under five years
- Investigate mothers’ demographic and socio-cultural factors which may influence their knowledge, attitudes and practices regarding malaria in children under five years old.
- Describe the utilization of preventive measures against malaria parasite in children under five years old.
CHAPTER TWO
LITERATURE REVIEW
THE DISEASE MALARIA
Introduction
In this section the researcher discussed malaria as an infectious disease including causes, historical background and classifications.
Causes of malaria
Malaria is a disease caused by protozoa of the genus Plasmodium. It is transmitted to humans by the bite of female Anopheles mosquitoes. Transmission through transfusion of parasite infected blood and the transplacental route have also been reported. The disease is also known as aque, intermittent fever, marsh fever, and the fever (Beale & Block 2011:242; MoH 2007:13, Medecins Sans Frontieres (MSF) 2010:131). Most malaria infections are caused by five Plasmodium species namely P. vivax, P. ovale, P.malariae, and P. knowles which usually cause uncomplicated malaria. However, the fifth species, namely P. Falciparum, is responsible for malaria that can become severe malaria.
Classification of malaria
Malaria is classified into uncomplicated malaria and severe malaria.
Uncomplicated malaria
Uncomplicated malaria is characterised by fever in the presence of peripheral parasitaemia. Other symptoms include chills, profuse sweating, muscle and joint pains, abdominal pains, diarrhoea, nausea, vomiting, irritability and loss of appetite. These can occur as a single symptom or in combination with more symptoms (MoH 2007:13).
Severe malaria
Severe malaria is a life-threatening form of malaria and is defined as the detection of P. falciparum in the peripheral blood in addition to the clinical and laboratory features. According to MoH (2007:13-14) the clinical and laboratory features include the following:
- Prostration: inability or difficulty to sit upright, stand or walk without support in a child normally able to do so, or inability to drink in children too young to sit
- Alteration in the level of conscious ranging from drowsiness to deep coma
- Cerebral malaria: unrousable coma not related to any other cause in a patient with falciparum malaria
- Respiratory distress
- Multiple generalised convulsions
- Circulatory collapse like shock due to septicaemia
- Pulmonary oedema,
- Jaundice and haemoglobinuria
- Acute renal failure
- Severe anaemia (Hb <5g/dl or Hct <15%)
- Hypoglycaemia (blood glucose level <2.2mmol/l)
- Hyperparasitaemia (parasitaemia >200 000/µl in high transmission area, or 100 000/µl in low transmission area).
EPIDEMIOLOGY OF MALARIA
Epidemiology of malaria in the world
Globally, malaria accounts much higher morbidities and mortalities than that caused by tuberculosis (TB), HIV/AIDS and enteric fevers combined together. Presently malaria claims over half million deaths per year. WHO (2013:1) estimated that 3.4 billion people were at risk of malaria in 2012. It was estimated that there were 207 million cases and 627 000 deaths globally in that year.
About half of the world’s population is vulnerable to malaria. Over 85% of malaria cases occur in Africa, 10% in south-east Asia, 4% in Eastern Mediterranean, and 1% in the Americans. Approximately 85% of annual malaria deaths annually occur in under-five children (Jombo et al 2011:10; Mesa 2012:93; WHO 2011:1-3; WHO 2013:1).
Epidemiology of malaria in Sub-Saharan Africa
Sub-Saharan Africa is the most affected region where over 85% of all malaria deaths in the world today occur. This is because P. falciparum, the most dangerous of the five human malaria parasites, is responsible for the majority of infections and P. falciparum. is found in this region. Other contributing factors include limited access to effective treatment, increasing parasite resistance to affordable and recommended medicine as well as delayed care-seeking. Malaria is responsible for 20% of under-five deaths due to all diseases in Africa (Peter, Manuel & Anil 2011:35; WHO 2011:1; WHO 2013:1).
CHAPTER THREE
RESEARCH DESIGN AND METHODOLOGY
THE RESEARCH DESIGN
A research design is a blue print developed to tackle a research problem. It is the ‘architecture’ or structure that is used by the researcher to answer the research questions and achieve research objectives (Burns & Grove 2011:253; Joubert 2007:77; Polit & Beck 2010:74). It helps in maximising control over factors that could interfere with the validity of the study findings. In this study, a non-experimental quantitative descriptive research design is used. Quantitative research design is a study design which involves precise measurements and quantification (Polit & Beck 2010:68; Schmidt & Brown 2012:144). This design entails reductionism, logical deductive reasoning, a reasonable control by the researcher, use of a structured data collection instrument, statistical analysis of data, and in some cases generalisation of the study findings (Polit & Beck 2010:16-17). In this study reductionism was achieved by dividing the study theme into different parts and studied them separately. Data collection and analysis involved the use of a structured data collection instrument (pre-tested structured questionnaire) and statistical analysis methods. The development of a research instrument (questionnaire) was based on a thoughtfully conducted literature review by the researcher. Logical deductive reasoning was done by generating conclusions from questionnaires filled in by a sample of mothers of under-five children who suffered from malaria attacks and made appropriate generalisations.
RESEARCH METHODS
According to Polit and Beck (2010:16), research method is the method employed by the researchers to structure their study to answer the research questions and achieve the study objectives. In this study the researcher used a survey as a research method. A survey is a descriptive or correlational research or simply a non-experimental study in which data collection is done by use of questionnaires or personal interviews like face to face (Bowling 2009:214; Burns & Grove 2011:264). The main advantage of a survey is that a phenomenon is studied in its natural environment (no manipulation). However, there are disadvantages which include difficulties to establish cause-effect relationship (Bowling 2009:217).
The following paragraphs outline the, population and sample, sampling criteria, the data collection, validity and reliability of the measuring instrument, data analysis, ethical considerations, and scope and limitations of the study.
POPULATION AND SAMPLE
The population of a study includes all the individuals who meet the sampling requirements or criteria (Burns & Grove 2011:290; Polit & Beck 2010:306). The population of this research composed of all mothers of children suffering from malaria in Jigawa state.
The target population is defined as subjects with similar attributes to that of the research subjects to whom the researcher may generalise his findings (Joubert 2007:94; Schmidt & Brown 2012:248). In this study the target population consisted of all mothers of under- five children with confirmed malaria and admitted to the paediatric ward, Jigawa State Hospital in 2013-2014.
CHAPTER FOUR
DATA ANALYSIS AND DESCRIPTION OF RESEARCH FINDINGS
THE RESPONDENTS’ ECONOMIC-DEMOGRAPHIC CHARACTERISTICS
Respondents’ age (Question 1.1)
Question 1.1 of the questionnaire enquired about the age category of the participants. The respondents’ ages were grouped into five class intervals namely: 19 years and below, 20-29, 30-39, 40-49, and 50 years and above. The researcher wanted to determine if mothers’ knowledge regarding malaria were influenced by age and if there was an age category that was more knowledgeable than the rest.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
RECOMMENDATIONS
Recommendations for public health practice
Improve mothers’ malaria knowledge
It seems as if public health care professionals should constantly work on improving malaria knowledge of mothers with small children. Radio enjoys a good listenership in all corners of Nigeria and should be used to reach mothers of children under-five years old with malaria messages.
Mobile-phones are widely used even in rural areas of Nigeria. This is another electronic device that can be utilised to improve mothers’ malaria knowledge and practices in children under-five years old.
Free primary education that was introduced in Nigeria since the dawn of multiparty democracy in1994 can be used to achieve universal access to malaria knowledge and good practices. Malaria as a disease should be covered in detail in the primary school curricula.
The health facilities and health workers have a crucial role to play in improving mothers’ malaria knowledge. They should aim at bringing the malaria knowledge to the communities in order to break the chain of malaria. Health care workers should introduce and strengthen malaria educational programmes at the health facilities. This will enable mothers understand malaria and promote early and appropriate health seeking behaviour.
Reduce poverty among women in the country
In order to win the fight against malaria there is need to reduce poverty among Nigerian women and the whole population in general. There is a relationship between poverty and mothers’ treatment seeking behaviour regarding malaria in children under- five years old. Poor mothers delay in seeking treatment when a child has signs and symptoms of malaria. In addition, mothers with low economic status do not comply with recommended preventive measures of malaria such as the use of ITNs and prompt treatment because of affordability.
In terms of treatment and prevention of malaria, mothers employ a wide array of modern and traditional remedies and measures. Mothers with a sound knowledge of the causes and symptoms of malaria continue to use traditional treatments and only a few under- five children sleep under ITNs. Mothers in wealthier social strata frequently use ITNs and health facilities compared to poor mothers who use other protective measures that are perceived to be cheap.
Although state health facilities offer health services for free in Nigeria, they are not accessible to the poor because well equipped health facilities are situated in urban and semi-urban areas. Cost of transport is the main factor which prevents the poorest of the poor from accessing and utilising them. Health providers should look towards community-based services that take ITNs and ACT to mothers in the communities to effectively scale up regular use aimed at protecting children under-five years old from malaria. Reducing or subsidising the costs of ITNs could also promote the use of this preventive measure.
Furthermore, malaria messages are in the newspapers, radios and television which are not always affordable to the poor who live in rural areas which do not even have electricity.
Research regarding technology
The malaria control programme and Jigawa state health management team should make an initiative to use new technology and evidence-based information to reduce malaria morbidity and mortality in children under-five years old. Main emphasis should be on strengthening human and pharmaceutical resources for malaria management in all health facilities in the Jigawa state and the country in general and therefore research should be aimed at this.
Nigeria national malaria management is based upon proper laboratory diagnosis and treatment of malaria episodes. Currently, ACT is available only in health facilities and it is given to patients with confirmed malaria. It is important to find ways to make ACT and RDT kits available in the shops. Mothers who live in hard to reach areas should be able to buy this recommended anti-malarial drug and malaria test kits. It is possible to teach mothers how to test under-five children for malaria parasites at home and use ACT to treat them. Emphasis should be made to give ACT only to children with confirmed malaria to avoid resistance.
CONCLUSION
This chapter presented a summary of study findings and the influence of mothers’ demographic-socioeconomic factors on their knowledge, attitudes and practices regarding malaria in children under-five years old as well as the limitations and recommendations.
This survey revealed that mothers of children under-five years old in the Jigawa state had inadequate information about malaria. There were also wrong attitudes and practices regarding malaria in under-five year old children that could contribute to malaria-attributable deaths in this age group. Most mothers were poor, uneducated and experienced a number of problems to access health care services when a child showed signs and symptoms of malaria.
Malaria related morbidity and mortality in children under-five years old in the Jigawa state could be prevented by doing the following:
- The poverty and illiteracy levels among women in the state should be reduced to improve malaria treatment-seeking
- Education of mothers should include prevention and control of
- Improve health care delivery system by providing health facilities with enough material and human resources to effectively combat
This study revealed that there is still some work to be done in Nigeria regarding mothers’ knowledge, attitudes and practices regarding malaria in children under-five years old. The recommendations made in this final chapter may help with this.
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