AN EVALUATIVE STUDY OF THE INFLUENCE OF MALARIA ON CHILDREN AND PREGNANT WOMEN IN NIGERIA

Abstract

Background

Adequate knowledge of malaria prevention and control can help in reducing the growing burden of malaria among vulnerable groups, particularly pregnant women and children aged under 5 years living in malaria endemic settings. Similar studies have been conducted but with less focus on these vulnerable groups. This study assessed knowledge of malaria prevention and control among the pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, Oyo State, South West Nigeria.

Methods

In this cross sectional study, data on socio-demographic, clinical and knowledge on malaria prevention was collected using interviewer administered questionnaires from consenting study participants attending Adeoyo maternity hospital between May and November 2016. Data was described using percentages and compared across the two maternal groups in the study population. Knowledge scoring from collected data was computed using the variables on causes, symptoms and prevention of malaria and thereafter dichotomised. Multivariate analyses were used to assess the interactive effect of socio demographic and clinical characteristics with malaria knowledge. Level of statistical significance was set at p < 0.05.

Results

Of the 1373 women in the study, 59.6% (818) were pregnant women while 40.4% (555) were mothers of children aged under 5 years. The respondents mean age was 29 years ± 5.2. A considerable proportion of both the pregnant women (n = 494, 60.4%) and the non-pregnant mothers of children aged under 5 years (n = 254, 45.8%) did not have correct knowledge on malaria prevention measures based on our assessment threshold (p < 0.001). Having a tertiary level education was associated with better knowledge on malaria (4.20 ± 1.18, F = 16.80, p < 0.001). Multivariate analyses showed that marital status, educational attainment, gravidity, and HIV status were significantly associated with knowledge of malaria prevention and control.

Conclusion

The findings indicate that socio-demographic factors such as marital and educational status greatly influence knowledge on malaria prevention and control measures. Key health stakeholders and authorities need to implement strategies and direct resources to improve the knowledge of mothers on malaria prevention and control. This would stem the tides of malaria related deaths among pregnant women and children aged under 5 years.

Background

Malaria is a major public health problem in ninety-one countries world-wide with sub-Sahara Africa bearing 80% of the disease burden. Malaria remains endemic in Nigeria where the parasitic disease disproportionately affects children aged under 5 years and pregnant women compared to the rest of the population groups. In pregnancy, malaria increases the risk of maternal anaemia, spontaneous abortions, stillbirths, premature deliveries, intra-uterine growth retardation and low birth weight babies, and these are all important causes of infant mortality. Also, more than 70% of all malaria deaths occur in children aged under 5 years. The scope of malaria control is changing worldwide with more emphasis on community and individual participation. Health education can improve participation in malaria control, when such education is designed to address gaps in the knowledge, attitudes and practice of individuals in the communities. Nigeria has implemented three national malaria strategic plans (NMSP) till date, and is presently implementing a fourth NMSP (2014–2020). This fourth NMSP aims to achieve pre-elimination status and reduce malaria-related deaths to zero by 2020.

Evidence from malaria knowledge, attitudes, and practices (KAP) studies reported that misconceptions on malaria transmission and risk factors still exist with adverse impact on malaria control programmes. Findings from a study conducted by Singh et al. in rural areas of Northern Nigeria revealed that although knowledge about malaria prevention measures was high (90%), it was poorly reflected in their practices (16%). Another study by Adebayo et al.  assessed the knowledge of malaria prevention among mothers of children aged under 5 years and pregnant women in a rural community in Southwest Nigeria. This latter study also found poor knowledge and utilization of malaria prevention measures among majority of the caregivers in the rural study area. Considering the vulnerability of both children aged under 5 years and pregnant women to malaria, this study aimed to determine the knowledge of malaria prevention and management among pregnant women and non-pregnant mothers of children aged under 5 years seeking health care at one of the main secondary maternity hospitals in Ibadan, Nigeria. Only few studies have assessed knowledge on malaria prevention among mothers in hospital-based setting. This study sought to fill this gap and provide new insights on the depth of knowledge gaps. The findings will help to improve implementation of integrated malaria control strategies. It will also be essential in establishing epidemiological and behavioural baseline indicators to evaluate and improve progress by malaria control programmes.

Methods

Ethics statement

Prior to data collection, ethical approval was obtained from the Oyo state ministry of health ethics committee (IRB AD13/479/1035) in Nigeria and from the biomedical research ethics committee (BREC- BE199/16) of the University of KwaZulu-Natal, South Africa. Study participants voluntarily signed written informed consent forms without any incentives. They consented because they believed their responses would contribute to increased effective control of malaria. The participants were also assured of confidentiality. The data collection tool was translated to both Yoruba, which is the dominant local language, and English language.