CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Pregnant women are more likely than non- pregnant women to become infected with malaria and to have severe infection. The effects of malaria during pregnancy include spontaneous abortion, preterm delivery, low birth weight, stillbirth, congenital infection, and maternal death. Malaria is caused by the four species of the protozoa of the genus Plasmodium, which is transmitted by the bite of the female Anopheles mosquito, congenitally, or through exposure to infected blood products. It is a completely preventable disease; however, about 3.4 billion people are at risk of the disease globally with 1.2 billion people at high risk (World Health Organization 2013). In 2012, malaria was responsible for the death of approximately 482,000 under-five children even though an estimated 136 million Long Lasting Insecticide Treated Nets (LLITNs) were distributed to endemic countries which Nigeria is one and Yala local Government of Cross River State inclusive the same year ( WHO, 2013). Thus, malaria is still a major public health concern particularly in sub-Saharan Africa and other parts of the developing world, (Pluesset al.2010). In Nigeria, malaria is responsible for around 60 percent of the out-patient visits to health facilities 11 percent of maternal deaths (National Population Commission, 2008; Noland et al., 2014). Similarly, about 70 percent of pregnant women suffer from malaria which contributes to maternal anemia, low birth weight, still births, abortions and other pregnancy-related complications (Federal Ministry of Health Abuja, 2005). The financial loss due to malaria is estimated to be about 132 billion Naira($797 million) annually in form of treatment costs, prevention costs and loss of man-hours (Noland et al., 2014; World Health Organization, 2012).

Malaria, a debilitating febrile and life threatening illness, is caused by a parasite called Plasmodium. Its route of transmission still remains as bites from infected female anopheles mosquitoes. Environmental factors, behavioral patterns of vectors and human populations combine to provide favorable conditions for malaria transmission (Boutin et al., 2015). Proven effective options to reduce morbidity and mortality include early diagnosis, combined with prompt effective therapy and malaria prevention through reduction of human-vector contact, especially with the use of long lasting insecticidal nets (WHO 2007). Perceptions about malaria illness, particularly households’ perceived susceptibility and beliefs about the seriousness of the disease, are important preceding factors for decision-making concerning preventive and curative actions (Rakhshani et al., 2013). The understanding of the possible causes, modes of transmission, and individual preference and decision-making about the adoption of preventive and control measures vary from country to country, community to community and among individual households (Adongo, Kirkwood & Kendall 2015). There have been a considerable number of reports about knowledge, attitudes, and practices relating to malaria and its control from different parts of Africa. These reports concluded that misconceptions concerning malaria still exist and that practices for the control of malaria have been unsatisfactory ( Federal Ministry of Health 2010).

Achieving sustainable control of the disease depend on extensive public health promotional programs which focus on current and proven methods of malaria prevention and management. While much is known about vector biology and behavior and the malaria parasites, the importance of human behavior in malaria transmission has not been critically evaluated. Studies focusing on the current practices of malaria prevention and treatment options in the population are sparse. Thus, it is expedient to evaluate current knowledge of malaria prevention practices and management options as well as the uptake of the management options. According to Minja et al (2011) state that most high-burden countries (Including Nigeria), long lasting insecticidal nets coverage is still below agreed targets. This may be related to the perception of its use among the community members. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of LLINs and other preventive measures for malaria control by the community members (Minja et al., 2011). Therefore, this study assessed the knowledge of malaria prevention among pregnant with emphasis on knowledge of long lasting insecticidal nets use and other preventive measures among pregnant women in Yala Local Government Area of Cross River State.

Knowledge is look upon as information and understanding a person has about a subject or which all people have (Collins English Dictionaries).

Meanwhile, a pregnant woman is that woman who have lost her menses and is tested pregnant positive. She is that woman who is nursing a baby internally and is sharing her food with the unborn.

STATEMENT OF THE PROBLEM

Malaria prevention methods are diverse. Their availability sometimes does not guarantee effective usage and the use of each method in isolation may not provide the necessary results for the fight against malaria. Pregnant women are relatively more vulnerable and so it is recommended that they should be protected against malaria. Proper protection will require malaria prevention methods in combination. This study seeks to find out what methods pregnant women use and how many of them use these method and above all, the knowledge of malaria prevention among pregnant women. The morbidity and mortality from malaria are still unacceptably high in the developing countries, especially among the vulnerable groups like pregnant women, despite all control efforts. The knowledge about the preventive measures of malaria is an important preceding factor for the acceptance and use of malaria preventive measures like Long Lasting Insecticide Treated Nets (LLITN) by community members. Question on the knowledge of the prevention of malaria among pregnant women now arises due to the fact that majority of pregnant women that comes to the clinic are tested malaria positive and also cases of malnourishment, anemia, abortion etc were reported due to malaria infection. It is based on this premises that the researcher decided to carry out this research work.

Therefore, this study assessed the knowledge of malaria prevention among pregnant women in Yala Local Government Area of Cross River State.

PURPOSE OF THE STUDY

The purpose of this study is to find out the knowledge of prevention of malaria among pregnant women in Yala Local Government Area of Cross River State, specifically it would seek to:

1.    Find out the malaria preventive measures use by pregnant women in Yala Local Government.

2.    Find out the level of compliance in the use of the preventive measures.

3.    Find out the knowledge of pregnant women on the prevention of malaria in Yala Local Government of Cross River State.

­SIGNIFICANCE OF THE STUDY

The outcome of this study will be of great benefits to the individual:

In every aspect of life, be it positive or negative, it is the individual person that benefit before the other. This is so because he or she comes in contact with the action /activity before others. It therefore means that if the pregnant woman have the knowledge on the prevention of malaria, she in the first place not be affected by malaria parasite and in such case, the unborn baby will not be aborted, the husband and other members of the family will not lost either of the two (The fetus and the mother) to the cold hands of death.

Community: The community as thecloset to the individual is the next beneficiary in as far as the pregnant woman have the knowledge on the prevention of malaria. The community will not spend their financial resource on the health of the individual, health problems like abortion, mal-nutrition, lost of weight etc due to malaria infection of an individual.

 State and the Country: This simply refers to the Government. They takes most of the health burden of her citizens. If the pregnant women have the knowledge on the prevention of malaria, the problem of either national or international government thinking on how to prevent malaria in the country will be minimized.

Health sector: This is the body charge with the responsibility of caring for the health of the citizens.The knowledge of pregnant women in the prevention of malaria, help to reduce the workload of the health sector. Take for instance, most of the health campaign like distribution of net, sharing of surfadoxine peremethidine (sp) to pregnant women by Presidential Malaria Initiative (PMI) and Global Fund (GF) also will be  reduce and so money and time spent on this area can be used  for other purposes. This  health sectors ranging from the primary health care up to the specialist hospital as well as the stake holders and policy makers. This is so because no one individual is free from the scourge of malaria infection. The study on completion if put to use will afford the opportunityto develop ways to preventive strategies in place with compliance to bring about a malaria free community.

The findings of this study will benefit the health sector most especially the primary health care who majorly at the preventive level. In this case, the primary health care department will come to know the reason for prevalence of malaria in our locality and the possible way out. On the part of the stake holders and policy makers, it will enable them make relevant policy that will help to bring down the rate of malaria infection in the state. More so, in the part of the community health workers from Junior Community Health Workers up to the Community Health Officer, the findings of this study will help them to properly health educate the community members on the part they are lacking.

Finally, on the part of the community the findings will make the community member become actively involved in the campaign for the prevention of malaria and possibly take ownership of the programmed.

RESEARCH QUESTIONS

For the purpose of this study, the following research questions were formulated to guide the study.

1.      What are the prevention measures use by pregnant women in Yala Local Government Area?

2.      What are the level of compliance in the use of preventive measuresby pregnant women in Yala Local Area of Cross River State?

3.      What are the knowledge of pregnant women on the prevention of malaria in Yala Local Government Area?

SCOPE OF THE STUDY

This study is limited to knowledge of prevention of malaria among pregnant women in Yala Local Government Area of Cross River State. Also, the collection of data is limited to pregnant women in some selected health facilities In Yala Local Government Area.

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